[bko]

> to what types of medical orders are allowed to be given to patients

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?

[DSMan195276]

The problem I see with this kind of argument is that whether a health care provider provides abortion services has very little (nothing) to do with the care given to a medicaid or medicare patients. Where-as them being vaccinated for COVID does have a very clear impact on medicaid/medicare patients, especially since medicare patients are more likely to be in a high risk group (IE: old).

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.

[bko]

> The problem I see with this kind of argument is that whether a health care provider provides abortion services has very little (nothing) to do with the care given to a medicaid or medicare patients.

There's no mechanism to enforce this reasoning. It's whether the agency has the power to do it or not. For instance it could be argued that natural immunity is far superior to vaccines, so excluding healthcare workers with natural immunity from working is not about protecting patients.

> It seems to me like you just don't think medicare or medicaid should be a thing to begin with.

???

[DSMan195276]

> There's no mechanism to enforce this reasoning. It's whether the agency has the power to do it or not. For instance it could be argued that natural immunity is far superior to vaccines, so excluding healthcare workers with natural immunity from working is not about protecting patients.

I'm not sure what you're getting at, Congress gave the agency the power to set guidelines for requirements for caring for medicaid/medicare patients, that's what they do. If a guideline would not actually impact medicaid/medicare patients, then they can't do it and it would rightfully get struck down in court when it is challenged for not falling within their powers. That's quite literally the same mechanism currently being used to challenge their power to require vaccines.

Your point about natural immunity seems reasonable, it doesn't mean requiring vaccines for those without natural immunity wouldn't still make sense though so I don't think it really fits your point. Claiming that the particular way they went about this requirement is bad is different from saying they can't require a vaccine at all. I think your point makes some sense, but it could still be paired with a vaccine requirement making it effectively the same thing.

> ???

I thought what I said was pretty self explanatory. If Medicare and Medicaid are going to be worth it then we have to have some standard level of care that we're paying for - we shouldn't be paying tons of money just for medicare/medicaid patients to receive bad care. Why should my tax dollars to go a healthcare provider who doesn't want to get the vaccine when that money can go to one who will? The medicare/medicaid patients that we're paying for will get better treatment from those healthcare providers who require vaccination, and if better care is not the goal than what is?

[bko]

>> It seems to me like you just don't think medicare or medicaid should be a thing to begin with.

Please don't ascribe beliefs or intentions to me that I didn't explicitly state.

> Why should my tax dollars to go a healthcare provider who doesn't want to get the vaccine when that money can go to one who will?

Medicare and Medicaid should be fee for treatment. Why shouldn't I be allowed to choose what provider I want to visit for the same treatment? They can have different covid policies, much like schools do. I don't think it should be a federal issue.

> The medicare/medicaid patients that we're paying for will get better treatment from those healthcare providers who require vaccination, and if better care is not the goal than what is?

You're mistaking treatment for safety protocols. A health care provider can have a certain doctor to nurse ratio or a million other things and they may not all be "optimal" as defined by the powers that be. We should allow people to choose what health care provider is right for them based on their constraints and not restrict options.

[kelnos]

> We should allow people to choose what health care provider is right for them based on their constraints and not restrict options.

Disagree. If I'm footing the bill for that care (as a taxpayer) I expect to have a say in what constitutes minimum quality of care.

And allowing unvaccinated healthcare workers to treat patients is reckless, and falls well below that minimum quality bar.

(I would also accept healthcare workers with natural immunity, assuming we can establish some sort of testable minimum antibody level that confers a similar level of protection as a vaccine.)

[DSMan195276]

> Why shouldn't I be allowed to choose what provider I want to visit for the same treatment? They can have different covid policies, much like schools do. I don't think it should be a federal issue.

You can, by paying for it yourself :P

> You're mistaking treatment for safety protocols. A health care provider can have a certain doctor to nurse ratio or a million other things and they may not all be "optimal" as defined by the powers that be. We should allow people to choose what health care provider is right for them based on their constraints and not restrict options.

I see what you're saying but I think it's an odd distinction, treatment outcomes and safety protocols are clearly linked, why should tax dollars go to treatment provided with substandard safety protocols when the same can be spent for better treatment elsewhere? Functionally it would just end up costing us and the program more over time and lead to worse outcomes. The other issue here is that most patients aren't even going to know enough about the various things you listed to make an informed opinion about them.

[nickgros]

> There's no mechanism to enforce this reasoning.

The mechanism would be the judicial system, and in the case of restricting abortion services, the regulation would probably be subject to strict scrutiny.

https://en.wikipedia.org/wiki/Strict_scrutiny

[Beldin]

> For instance it could be argued that natural immunity is far superior to vaccines

Lots of things could be argued; some things shouldn't be argued without evidence.

During a pandemic, statements that will be interpreted as suggesting that catching the disease beats vaccination fall squarely in that category.

[lukeschlather]

"it could be argued" is not a substitute for the judgement of the regulatory body. The regulatory body hears arguments and makes a determination, I'm pretty sure that's the mechanism. (And it sounds like the court has decided to overrule it on shaky grounds.)

[SkyPuncher]

The person you're replying to has a slightly incorrect statement. At least to my knowledge.

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.

[mattzito]

It might be a difference without a distinction, but technically the provider is participating, non-participating, or opt-out. In the first two cases, the provider has to meet those standards, and while I'm sure that there might be deltas between how medicare/medicaid patients and non- are covered (e.g. minimum post-procedure length of stays), all of the requirements around the provider apply to everyone at the provider. That is, you can't have one hospital administrator with a degree for the medicaid people and one without for not - the hospital administrators, full stop, have to have the appropriate degrees and certifications.

[beerandt]

No- they say play by our rules for everyone or the majority of your revenue disappears.

[JumpCrisscross]

> 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 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.

[claytongulick]

You should probably read the Jacobson decision more carefully [1], since you believe that it grants the government the right to mandate vaccines.

The decision is much more narrow that you've been led to believe.

It specifically addresses state police powers, not federal powers.

It also doesn't mandate vaccination, it allows a small fine to be paid instead.

Also, according to a well known attorney I consulted (who has argued several cases before the Supreme Court) the Jacobson decision has been overturned countless times and is considered an awful ruling, the Healthcare equivalent of Dred Scott.

[1] https://en.m.wikipedia.org/wiki/Jacobson_v._Massachusetts

[JumpCrisscross]

> since you believe that it grants the government the right to mandate vaccines

Specifically avoided saying that. Stated simply, my point is there is positive precedent to the precursors to vaccine mandates, and reasonable ambiguity to the question per se. There is clear negative precedent for abortion. As such, comparing them is misleading. (Better analogy may be found in gun rights.)

[kelnos]

I'm not ok with it, but would be forced to accept that it is within the authority granted to the agency to make that call.

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?

[mattzito]

No, of course not, but that's not what I was referring to - I was referring to, are doctors allowed to leave standing orders for patients? Can they give them over the phone? What kind of procedures can nurses and NPs order? Those sorts of things.

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.

[adrr]

Banning health care providers from abortion would be unconstitutional. It would be the same as a president banning health care providers from serving muslims. Women have a constitutional right to get an abortion. People don't have a constitutional right to not vaccinate. Government can and has jailed and/or fined people for not getting a vaccine. These SCOTUS approved mandates helped rid America of smallpox.

[willcipriano]

Ehh constructional right is a bit strong.

The supreme court ruled that the 14th amendment[0], has somewhere hidden within it a right to privacy. This right to privacy appearently applies exclusively to abortion, as warrentless wiretapping of every US citizen has been determined not to be a constitutional violation.

I find it funny that they can find a right to privacy in the 14th, but give the thumbs up to civil asset forfeiture that directly contradicts the text and is a obvious violation. They seem to make things up as they go along depending on what is politically expedient.

[0]https://constitution.congress.gov/constitution/amendment-14/

[bbatha]

The right to privacy is in the 4th amendment, the 14th amendment is used to "incorporate" constitutional rights to the states. Prior to the 14th amendment the rights in the constitution only prevent abridgement of rights by the federal government but states were free to take them away.

[cies]

> Banning health care providers from abortion would be unconstitutional.

Forcing care workers to take a medicine against their will is constitutional you say?

All medical procedures should be voluntary, or we go back to the times of lobotomy and forced sterilizations of minorities (and that's not as many decades back as you may think).

> Government can and has jailed and/or fined people for not getting a vaccine.

This means being unvaxed is a something only the rich can afford. Pay fines, and have a good lawyer.

[Isthatablackgsd]

> Forcing care workers to take a medicine against their will is constitutional you say?

They are not forced to take the medicine. They are given an choice to take the vaccine or find another job. If they refused to take the vaccine, that is their choice, period. They cannot claimed they are being forced because they are given an choice in the first place. They are given a free will with their decision. Thousands of Thousands people screeching for being forced when they are given a choice. Society don’t have to conform to those people who want to endanger their people and their livelihood.

[refurb]

This is an incredibly weak argument and the courts have already ruled similar issues.

The government can’t violate your right to free speech. They also can’t “ask” a private company to censor you as it effectively the same thing.

Telling someone “its your choice but if you don’t do it you’ll lose your livelihood” is not a choice at all.

[cmh89]

Choices have consequences. I have the choice to stop wearing clothes to my job and the consequence of that choice is that my job would fire me.

The ability of the government to establish vaccination requirements is long established. It's only becoming a hot topic now because anti-science folks have been programmed to fear a safe and effective vaccine.

[exodust]

> I have the choice to stop wearing clothes to my job

The difference is you flipped the switch and decided to turn up to work without clothes. You decided to radically change your behavior and actions in the workplace. This will obviously have consequences due to your unsightly naked body offending co-workers.

When someone doesn't flip any switch, but continues to work exactly as they did before, they have not done anything you can label a "choice with harsh consequences".

Unvaccinated people are not suddenly shedding and dangerous, in the way a naked person is shedding pubic hairs everywhere.

[refurb]

It's clearly not an established process since Biden's mandates is being struck down.

[kelnos]

You're aware that we've had vaccine mandates for decades, right? Were you also upset about requiring kids get (for example) MMR vaccines before allowing them to attend public school? If so, then congratulations: some diseases we'd thought we'd eradicated have been coming back because of anti-vax nutjobs.

You are not an island. You live in a society, a community of people that requires individuals to give up some personal liberties for the good of the whole. Those who don't like that should go move to an isolated island where their harm to others can be limited.

[adrr]

Greater good of society out weighs people's individual rights. These are basic constitutional tenets. Why you can't yell fire in a crowded theater even though you have the right to free speech. Why the SCOTUS has ruled vaccine mandates are constitutional.

[coredog64]

Schenk was overturned because it was a bad decision. In general, “fire in a crowded theater” is my heuristic for “this person doesn’t know what they’re talking about”.

This is the top Google result for “fire in a crowded theater”: https://www.theatlantic.com/national/archive/2012/11/its-tim...

[adrr]

Use the more modern version it and yell “I have a bomb”.

[beerandt]

You got the premise wrong, not the phrasing.

With firecodes what they are today, a bomb is a more comparable danger to what a fire was 100 yrs ago, anyway.

[refurb]

You actually can yell fire in a crowded theatre and no, the the US doesn’t automatically weigh the “greater good” over individual rights.

[tastyfreeze]

Society is a cultural framework and does not in any way supercede individual rights. There is no greater good. The SCOTUS has ruled that states have the authority to mandate vaccination not the federal government. The federal government is extremely limitited in its authority by the Constitution.

[claytongulick]

"Greater good" has been the justification for the worst atrocities committed in history.

Be careful about so willingly giving up your right to self-ownership.

You may not ever get it back.

[adrr]

Greater good is what it makes it possible to have individual rights. Imagine if you had an absolute right to free speech. You could write or speak anything without legal recourse. Trademark law and copyright law wouldn’t work. Fraud wouldn’t be prosecutable.

Apply that to other rights like the right to bear arms. If government couldn’t set standards and people could procure any weapon, how does society function? How does air travel even exist with people owning anti aircraft missiles.

That’s why our founders made our constitution a living document with courts interpreting the constitution and balancing individual rights with our collective rights.

[claytongulick]

I see the "living document" argument made a lot, and I don't think it means what some people think it means.

The founders were purposefully vague in several areas of the constitution because they absolutely did want circumstances to determine interpretation, however they were not vague at all about delegated and reserved powers. These things are not "living" in a sense of judicial review.

By "living" document, it was intended that the constitution could be modified by an amendment process. There was never a provision for judicial review.

In fact, then entire concept of judicial review arose from Marbury vs Madison [1] where the court claimed this power.

The purpose of the U.S. Constitution, and one of the things that makes it unique in history, is to limit the powers of the government. The founders believed that individual rights were innate (granted by God), not granted by government and certainly not granted by the federal government.

All powers other than those specifically Delegated to the federal government are reserved for the States - the 10th Amendment makes this clear.

It is not the role of the federal government to decide on "greater good" mandates, those powers are very specifically reserved for the states, who are constrained on what they may do by the Constitution and its amendments.

We, as a country, have allowed the federal government to overstep this in many areas. The DEA, for example, only exists because of a very bad interpretation of the Interstate Commerce Clause, which arose from a bad Supreme Court decision (Wikard vs Filburn)[2] about whether or not you were allowed to grow your own wheat.

[1] https://en.wikipedia.org/wiki/Marbury_v._Madison

[2] https://en.wikipedia.org/wiki/Wickard_v._Filburn

[odessacubbage]

you can indeed yell fire in a crowded theater.

[Chris2048]

Then just ban men from having them as well.

> Women have a constitutional right to get an abortion.

Do they? Where is that written?

EDIT: the vague "life, liberty, or property" clause as interpreted by Roe vs Wade. This is such a blank-cheque it may as well not be in the constitution as in hands all power to the interpretation of the courts.

[adrr]

" the vague "life, liberty, or property" clause as interpreted by Roe vs Wade. This is such a blank-cheque it may as well not be in the constitution as in hands all power to the interpretation of the courts."

If you read federalist papers or any of the writings of founders on the constitution. The constitution is a living document that is decided by the courts. It is really hard to have a fruitful debate without people having even basic knowledge on this subject.

[refurb]

No, it’s not a living document open to the whims of interpretation or flavor of the month.

That’s how you end up with Russia taking over Odessa due to “national security” reasons.

If it’s a living document it’s not worth the paper it’s written on.

[Chris2048]

I didn't say the courts couldn't interpret the constitution, but "living document" doesn't need to imply vague - RvW carved out a limited clarification without supplying a general rule of what is and isn't covered. The courts shouldn't have the power to totally skewer the constitution, ad-hoc.

> having even basic knowledge on this subject

That's your opinion. People debate in echo chambers all the time, if that's what you'd prefer.

[adrr]

https://en.wikipedia.org/wiki/Roe_v._Wade