> "There is no question that mandating a vaccine to 10.3 million healthcare workers is something that should be done by Congress, not a government agency," wrote Doughty.
That's a good point. You can agree that its within the federal authority to mandate vaccines, but it really should be a decision made and explicitly endorsed by elected representatives rather than some agency (Centers for Medicare & Medicaid Services) that I have never heard of until now and whose head is appointed by one person.
[EDIT]
Too often we look at the end results (e.g. will this increase vaccination rates) rather than the means of getting there. You see it on the left and right. If their guy is in power, they want to expand the scope and reach of their office. Everything is a crisis and someone can solve it if they're just given the right permissions.
And this eventually leads to dishonesty and loss of trust. Even news is reported through a utilitarian lens. Many journalists today think they're doing advocacy rather than reporting. They're not assigned topics but talking points. Someone could be the 'tech bad' guy and his stories are nominally about tech but about how big tech is subverting democracy, bad for the environment, you name it.
Could you imagine a news report about how the much touted vaccine efficacy of 95% didn't really pan out? It's true. Everyone was around 6 months ago and remembered the efficacy levels being thrown around. Now people are being gaslit to thinking they didn't hear what they heard and its about hospitalization. All because being honest could hurt the cause. And yes, vaccine efficacy was 95% and yes it does mean what you think it means [0]
/rant
https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
They set rules for everything from how many hospitals can be owned by a single entity, to what sorts of qualifications are required for hospital administrators, to what types of medical orders are allowed to be given to patients. Their explicit charter is to ensure Medicare and medicaid patients are cared for and their health is looked after. From that lens, requiring a vaccination that reduces the likelihood that one of those patients is infected with a potentially deadly disease (particularly deadly for those on Medicare, given the demo), is eminently reasonable.
And the administrator is confirmed by congress. If this regulation was about almost anything else, this would be a nothingburger
Suppose an anti-abortion president gets elected and he elects someone as head and tells them that health care providers that accept medicare or medicaid cannot provide abortions. Not making it illegal per-se, but just for the providers that accept medicare or medicaid for any of their services.
You okay with this as well?
It seems to me like you just don't think medicare or medicaid should be a thing to begin with. I think it's basic sense that if we're paying for medicare and medicaid we should require the healthcare providers receiving our tax dollars to meet some standard level of care, or else we're just wasting our money. We can argue over what that level of care should be, but I don't think it's all that debatable that requiring things like vaccines could fall into that level of care if not having them is particularly risky for patients.
CMS only controls this for patients covered by Medicaid/Medicare. It can set the tone for the entire industry, but does not solely control the industry. Typically, they create influence by setting/rejecting Medicaid/Medicare reimbursement standards. Since enough patients are covered by CMS, it tends to be easier for hospitals to broadly adopt the policies.
Not comparable. Based on current law, abortion is a Constitutionally-protected right. Based on precedent from the Spanish-flu era, the government has broad public health powers.
All that said, as someone who isn’t a fan of how much power Congress has ceded to the executive through administrative powers (which delegate legislative powers to the executive through rulemaking), I wouldn’t mind seeing those curtailed.
Assuming it is: I think policy measures like that should be subject to medical needs. I think there's a clear medical need to require COVID vaccinations for healthcare workers, but banning abortions doesn't pass that test.
And hell, didn't the Trump administration actually do this, though maybe through different means? Withholding federal funding from providers who offer abortions?
Your example is a covered procedure, some of which is defined by the CMS, but much of it is defined by federal statute that dictates what classes of procedure are covered by medicaid/medicare. To go to your example specifically, federal statute ALREADY limits medicaid abortion coverage to abortions arising from rape, incest, or that put the health of the mother at risk. 16 states go beyond that and cover abortion in more cases, but they pay for that with their own money (which is also allowed statutorily). So in your case, what the new CMS head was declaring is unlawful on its face, as this is something that congress has specifically addressed.
This is from someone who chose freely to get the vaccine. Even at my own peril I support other’s freedom to choose.
And would you be comfortable having a pediatrician who wasn't inoculated for diphtheria knowing that an infection could be fatal for your baby?
Congress does not delegate lawmaking, Congress delegates the execution of its powers to the Executive branch. This is how the country has functioned since the beginning, for it would be impractical for it to work otherwise.
Say more: delegation will happen at some level, by definition. In military matters, every step or shot a soldier takes is a decision that has been delegated through a chain of command from Congress. Since Congress is not ever going to be in a position to execute every decision for every individual over which Congress has power, Congress inevitably will delegate the execution of its powers. It has always been this way, and will be this way as long as we have a republic.
Most of our other problems are a consequence of that.
Congress often delegates their power to other agencies. It’s an important regulatory function that allows agencies to adapt to a changing world even in a gridlocked legislature.
That's just a backdoor for giving more power to the federal branch. Its like 'interstate commerce' where anything that has interstate implications (pretty much everything) can be influenced by the federal government. What if an anti-abortion president elected someone to this board and told them that no health care provider that accepts medicare or medicaid can offer abortions?
I don't see mandating people to get a vaccine that they don't want as non-political bureaucratic action, especially considering its coming from the president's office. It's mandating a medical treatment. Take a step back and ask under what authority and supervision should we require a government to be mandating a medical treatment.
The difference I see with abortion is that the SCOTUS held in Roe v Wade that women have an affirmative right to an abortion under substantive due process of the 14th amendment. If the government coerced healthcare providers to stop providing abortions, this would be a direct infringement on a right protected by the constitution. Conversely, there is no constitutional right to /not/ get a vaccine. Of course, the demographics of the court has changed, so it's very possible the SC will rule that not getting vaccinated is also a constitutional right conferred by substantive due process.
Note that while the position is appointed by POTUS, it is a Senate confirmed position - she was approved with a vote of 55-44 [0] (with five R votes).
[0] https://www.senate.gov/legislative/LIS/roll_call_lists/roll_...
I'm from a country (UK) where parliament has absolute power, but also where the populace largely trusts the civil service. Health decisions, prosecution decisions, and so on are explicitly devolved from the government so that they don't become politicized. To me, that seems better, rather than asking politicians to intercede in what should essentially be decisions for experts to make.
Yes, although UK Govt ministers tend to retain accountability when things go wrong, at least in the eyes of the media.
That's not at all generally true historically, even if you drop the made up specific number and say something like “vast majority", of US civil servants; it is true of some states, localities, or agencies, and reversed for others.
2020 looks like that, but the 2020-2021 election and transition cycle were rather outside of historical norms. [0]
There is some historical imbalance, but then, that people who adhere to the party that consistently demonizes government, government work aside from military and law enforcement, and government workers, aside from military and law enforcement don't tend to choose to work for government as much as people who don't adhere to that party is...somewhat unsurprising.
[0] https://www.opensecrets.org/industries/indus.php?ind=W03
If the CMS does it, it is a public health decision. Doing it in Congress makes it a political decision.
IMO, the better route is that the CMS issues the mandate, but that Congress ratifies it. Ie, they have to provide a clear reason why the public health decision should be overruled.
You're acting like its a trivial procedural matter. These people obviously feel very strongly about it since they're under immense pressure everywhere to get it and they still refuse. Or they may have other reservations, but to dismiss that and just have some nameless faceless un-elected organization intrude in their lives in such a meaningful way is really gross
Whether it is a 'trivial' procedural matter simply isn't affected by people's strongly held beliefs
Strongly held beliefs don't exempt you from seat belt laws, from tax rules, or from any other law unless congress doing the thing congress is designed to do allows for it. It shouldn't.
CMS isn't unelected...it is an arm of the executive branch headed by the, elected, president and run by someone confirmed by the elected senate. It is given the authority to make rules in specific areas by the elected congress.
Your entire thread or argument is predicated on a false assumption...
I'm not a fan of the situation, but you're acting like it's forced sterilization. It's just a vaccine with a very safe profile. For God's sake, all healthcare workers including the cleaning staff have to get flu shots and show their immunizations every year, or they can't work. Even as a college student I had to get a meningitis shot.
Do you mean like "Efficacy of Pfizer/BioNTech Covid vaccine slips to 84% after six months, data show" (https://www.statnews.com/2021/07/28/efficacy-of-pfizer-biont...) or "Covid-19 Vaccine Efficacy: What Do the Numbers Really Mean?" (https://www.wsj.com/articles/covid-19-vaccine-efficacy-what-...)? Or did you have something else in mind?
I thought this was pretty well-discussed as VRBPAC/ACIP began to review the data guiding their third dose/booster recommendations but maybe I've misunderstood.
Strongly agree. Tangentially, I felt this way about net neutrality. It should have been law passed by Congress. Instead, everyone cheered when an unelected executive board passed a net neutrality bill that the public wasn't allowed to read.
And then, everyone had the audacity to be surprised when the FTC undid net neutrality as fast as it did it. There is a reason we have a legislature and not just an executive branch that can do anything it wants.
The net neutrality PR did work though, the FCC was under a lot of pressure . ATT didn't pay all of those marketing firms to fraudulently post thousands of anti-net-neutrality comments for nothing.
This is not true at all. Media has been talking openly about "waning immunity" and "declining effectiveness" all along.
It didn’t pan out because of Delta, a way more infectious variant that became common well after the 95% figure was determined.
And it’s fully accurate to say that despite Delta, the vaccines are effective at preventing severe disease, hospitalization, and death. I think that’s a very good thing!
So that "95%" figure was a lie to begin with, because those who touted it knew exactly what was going to happen. Viruses evade, and any non-sterilizing vaccine will be evaded by a virus. This is how you get delta, this is how you get omicron (which, by the way, was first found in fully vaccinated individuals and likely created through this evolutionary pressure).
Thanks
On what basis? It's proved impossible so far to make a strongly efficacious flu vaccine because of constantly shifting variants. But on the other hand, there are many examples of successful vaccines that have never had an efficacy-killing variant emerge (polio, smallpox, chicken pox). How would anyone who has taken a biology class know a priori whether COVID-19 would be a flu or a polio?
If the vaccines don't work, why do people in the real world die much, much less often from covid once they are vaccinated?
If you are so sure an immune-evading variant will emerge, why hasn’t one? (There is no evidence at all that omicron evades the vaccines).
CMS is one of the largest government agencies (by budget, >$1T annually).
Even that might not be quite the best end result to be looking for (unless you own the jab patents).
Shouldn't we be looking at clinical outcomes of covid patients, or counts of severe covid cases instead?
If we optimized for marriage rate in the world we might end up with a whole lot of unhappy couples and/or broken homes.
Jacobson v. Massachusetts[1] established that it is within the State's power to mandate vaccinations, so shouldn't this be up to individual states? I'm also pro- nationwide mandatory vaccinations, but Congress also doesn't seem to be the right way to do it.
Odd, the fact that you have never heard about the CMS has no bearing on whether it has the authority to issue a vaccine mandate
Are you aware that Federal regulatory agencies are a result of Congress delegating their power, mostly to the executive branch? Congress has already delegated their authority…
There’s a reason, for example, why we don’t let the market or public opinion dictate the efficiency or safety of drugs.
I remember that too, and I think its needed context.
That's a facile statement. I'd have to bait an HN into playing devil's advocate just to get an opposing view.
What are the "Zig and Rust" of protecting democracy in a time of crisis? Or maybe more realistically-- if we want a "Zig and Rust" for making democracy "memory safe," what are the sources to start with? (Note: I'll filter any citations that rely on invisible hands or, "let's start by decentralizing all the thingies")
Just wanted to add this comment from the middle of this discussion.
There is so much irrationality these days that we need to have a solid foundation for our decision making and not based on the whims of the panicked masses.
I have relatives who work in healthcare and refuse to get the vaccine. They're at risk of losing their jobs because regardless of external pressure, the hospital employing them is incentivized to let them go by the patients. They're a hospital focused on physical therapy, which is does as much elective business by volume as prescribed... And very few patients are willing to work with a physical therapist who isn't vaccinated, so they're simply losing business as word-of-mouth gets around that they don't require vaccines and patients sign up for their PT regiments with other hospitals in the region.
By the same token that the government (absent a law from Congress) perhaps can't force organizations to employ vaccinated staff, the government may have no say if an individual employee is fired because an organization requires vaccinated staff of their own accord.
This would be a good time for Congress to show some leadership and lay down some legal guidelines.
Better to wait for the updated booster before forcing more people to take it.
I mean this would be a good time for Congress to show leadership in general. As in, make a decision. Really, any decision that shows some reasoning behind it. Entirely too many people in the service of legislature are more worried about their electability than doing a good job. There's a reason that branch has, on average, a mid-teens approval rating most of the time.
2. Every temporary injunction issued in the litigation surrounding the wall and Muslim ban was conducted with the Democratic version of this same strategy.
This is the game. Sound and fury, signifying nothing. We will learn the law in time.
We require other vaccines.
There is plenty of room for dissent, but it stops being “dissent” when it is simply denying reality.
Ah yes of course, when the common view gets the label of “reality” dissent is no longer “dissent.” /s
If only everyone could see the line in the same place, but well if that were the case I don’t suppose there’d be any dissent at all.
In other words most healthcare workers share the same demographics as those who currently have low uptake on the vaccine.
The lower tiers of nurse only require 2 years, IIRC, and I think those are more like technical programs than typical liberal-arts-informed degrees. Then there's the clerks, the front-desk people (to include the ones at the "front desk" of each floor, department, or section of the hospital, plus the ones at the actual main entrance[s]) the cleaning and housekeeping staff (someone has to go around restocking supplies and such), the entire billing department, the people who come around to bug sick people about their insurance details, the security guards (hospitals have lots of them), and so on.
Or maybe they are aware of drugs that received authorization in the past and that the same companies that are making bank of the vaccines, don't have the best history with being honest and transparent.
https://www.kff.org/other/state-indicator/flu-vaccine-requir...
Not surprised by this ruling at all.
Even without vaccines, that means nearly half of Americans already have natural immunity which is vastly superior to vaccine immunity.
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...
No- that many have had a positive test or other diagnosis confirming covid.
There were plenty of non-hospitalized, non-diagnosed cases before the tests existed. And plenty of people have had it and never saw a reason to get a test to confirm it.
I'd say we're far above that estimated number.
...but even if you full blown covid, there is no exemption from the vaccine requirement - that's one of the main arguments of many health workers.
in her words no one really knows how the lipid nanoparticles actually work, and it is much too soon to be forcing this onto the public, and thats just the delivery mechanism. so you have a novel mRNA vaccine, with a novel delivery mechanism, and very little long term safety data. she does not feel like these have been tested to the same standard as other vaccines, we are at the point where if this is mandated for our children we will probably move somewhere they are not.
To anyone paying attention it's obvious that this is not the case. Everyone should not get vaccinated, some folks can't get the vaccine. And not it's not safe and effective for everyone, some have had a bad reaction.
It would be one thing if the government realized this and placed reasonable exceptions for those who either can't get it or don't need to because they have natural immunity or immunity through monoclonal antibodies. But they don't and they continue to push this one way of getting immunity.
And that's where the distrust forms. More and more it seems that the government doesn't actually give a damn about these edge cases, all they want to do is check the box that says you have been vaccinated.
Things like vaccines also threaten the status of people who use the virus in order to extract money from their audiences, like megachurch preachers and snake oil salesmen. Some people got really wealthy off Ivermectin and HCQ prescriptions during this whole thing.
So that's not the case with all doctors.
Then again, I'm fit, healthy, great diet, low stress, eat well, lots of sunlight. Covid poses less risk to me than driving, my kids it doesn't rise to the level of conscious thought.
Covid's over here.
Their jobs are being threatened too, and are more likely to have large debt from school and to be the primary breadwinner of their family than nurses.
Nurses just have more realistic freedom to say no.
This is an international forum.
If you're not vaccinated or have natural immunity, there's likely zero increased reason for personal concern.
