14 ms·

> Doughty said the CMS lacked the authority to issue a vaccine mandate that would require more than 2 million unvaccinated healthcare workers to get a coronavir

• aklemm 5y ago
  "some agency"? It's an agency put in place and managed (budget, appointments, etc.) BY ELECTED REPRESENTATIVES. Did you want a direct vote on vaccine mandates? Sometimes it seems people fail to understand what a representative government is.
  • mistermann 5y ago
    "Representative".
• kitd 5y ago
  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. 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.
  • bko 5y ago
    I disagree. It is a political decision to force 2 million Americans to get a vaccine that they don't want under threat of not being allowed to work in their profession. If you disagree with the decision at least you can vote the bastards out. 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
    • avs733 5y ago
      congress could have acted here, they could still act. they didn't. Not doing something is a choice when it occurs in reaction to someone else doing something. 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...
    • wayoutthere 5y ago
      This is absolute horseshit. Government regulation of public health during a pandemic is absolutely its role. We have required a great number of vaccines for the last 100 years. The coronavirus vaccines are some of the most-tested out there. Anti-vaxxing was a fringe position that nobody took seriously before Covid. The only reason this virus is remotely political is because we had a demagogue in the president’s office who likes to force people into contrarian positions because it strokes his ego. So if people want to stay home from work because their politics don’t allow them to do the job, that’s not my problem.
• runako 5y ago
  > that I have never heard of until now CMS is one of the largest government agencies (by budget, >$1T annually).
  • kspacewalk2 5y ago
    Technically, perhaps. But really it's a small government agency whose major task is to disburse oodles of cash to people not employed by it.
    • runako 5y ago
      Either way, ignorance of the existence of CMS is more indicative of a person's general level of ignorance about the US government. If I was just learning about the existence of CMS, I would at least learn a little more about the basics of the existing US government before making proclamations about how it should operate.
      • junon 5y ago
        Person on the internet preaches about something they're entirely unqualified to talk about, news at 11. (To be clear, I agree with you 100%)
    • sieabahlpark 5y ago
      You truly have no idea, do you.
• Anechoic 5y ago
  and whose head is appointed by one person 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_call_vote_cfm.cfm?congress=117&session=1&vote=00201 https://www.senate.gov/legislative/LIS/roll_call_lists/roll_...
  • runako 5y ago
    Not to mention, this is exactly how representative government works. It's not controversial that we do not have a direct vote on Secretary of Defense, a position that arguably has more human impact as the head of CMS.
    • sieabahlpark 5y ago
      Why are you moving the goal posts? No one said the population should directly vote on it. They said the representatives (who the people voted for) should be deciding through the legislature, not through a single appointed person.
      • runako 5y ago
        > it is a Senate confirmed position - she was approved with a vote of 55-44 (with five R votes). The elected representatives chose to delegate this power to the person they approved as the head of CMS. What principle would be involved in requiring Congress to execute its powers in a different manner (i.e. by not delegating), simply because one does not like the outcome in this case? Who would decide which powers Congress could delegate and which it had to exercise directly? Has someone already drafted the Amendment to the Constitution which would limit the powers of Congress in this way? There's no reason in principle for Congress to directly make this decision about requirements placed on CMS contractors and not other aspects of vendor relations handled by CMS. (The narrow issue here is whether CMS can require its contractors to enforce vaccine mandates.)
        • jaywalk 5y ago
• invokestatic 5y ago
  I think it’s actually reasonable for an agency (CMS) to decide eligibility criteria for receiving federal Medicare and Medicaid dollars. This was authority granted to the agency by Congress. Requiring employees to be vaccinated as a condition to accepting Medicare seems pretty reasonable to me. Just as I would hope hospitals need to meet basic care standards to be eligible as well. 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.
  • bko 5y ago
    > Requiring employees to be vaccinated as a condition to accepting Medicare seems pretty reasonable to me. 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.
    • invokestatic 5y ago
      It's interesting you bring up both commerce clause and abortion as I'm currently taking a constitutional law class covering both issues. The commerce clause did wildly expand through the 20th century, but I just want to point out that US v Lopez substantially cut back Congress' Commerce power. It laid out clear restrictions to what and when Congress has the power to regulate interstate commerce. Further cases like NFIB v Sebelius (Obamacare) also cut down on commerce power. 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.
• hammock 5y ago
  >Too often we look at the end results (e.g. will this increase vaccination rates) 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.
  • peter422 5y ago
    Vaccinated people have far, far fewer cases of severe covid and far fewer deaths. What else do you want them to look at?
    • hammock 5y ago
      Is that true for all ages?
      • ufo 5y ago
        It is.
        • hammock 5y ago
          Do you mind sharing the data that supports that?
          • ufo 5y ago
            The studies that got the vaccines approved in the first place had to show that they were effecitive for all adults. I'm sure that with some digging it should be possible to find the data split by age group. More recently, we've also gotten data for many vaccines showing that they're also effective for children and adolescents. Lastly, another important group is the elderly. Some studies suggest that they respond more poorly to the vaccine and that the protection may last a shorter time. In response, many countries have prioritized the elderly for receiving booster shots (3rd dose).
• dahfizz 5y ago
  > Too often we look at the end results (e.g. will this increase vaccination rates) rather than the means of getting there. 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.
  • verall 5y ago
    Because the chance of a net neutrality bill making it through the Senate is roughly equivalent to guessing Satoshi's wallet. We can barely pass debt ceiling increases to avoid national default. 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.
    • AnimalMuppet 5y ago
      OK, but then the answer is to fix Congress, not to bypass it.
      • kelnos 5y ago
        And what if it is fundamentally unfixable? Do we just allow everything to grind to a halt and pretend that everything is working as designed as the country crumbles beneath us? I guess that's easier to do when it's the working class and not most HN-type folks who would get hit the hardest by that plan. Congress has been delegating rule-making authority to the executive branch since before all of us were born. You may not like that, or you may think some amount of delegation is appropriate, but we've passed that point. But this is the reality here, and the functioning of our federal government pretty much has this baked in at this point, for better or worse.
        • AnimalMuppet 5y ago
• petesergeant 5y ago
  > 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 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.
  • temporaryi3 5y ago
    I'M in the UK and I absolutely do not trust the civil service at all.
  • wrycoder 5y ago
    Except in the US, the civil service is politicized and its employees are 95% in favor of one party, as shown by their political donations history.
    • dragonwriter 5y ago
      > Except in the US, the civil service is politicized and its employees are 95% in favor of one party, as shown by their political donations history. 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 https://www.opensecrets.org/industries/indus.php?ind=W03
      • wrycoder 5y ago
• mattzito 5y ago
  Except that the role of the CMS, as established by congress, is to set the guidelines of care and standards of participation for providers who opt to accept Medicare and Medicaid patients. 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
  • bko 5y ago
    > 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?
    • deleted 5y ago
      [deleted]
    • loudtieblahblah 5y ago
      i'm pretty sure the average person on Hacker News would be ok with the Social Security administration banning gas powered leaf blowers. This place has become as intellectually low-brow as Twitter and Reddit.
      • bwb 5y ago
        Gas powered leaf blowers would have to be banned under the law before a government agency can then afford said law. Bit different...
    • 5y ago
• AuthorizedCust 5y ago
  > Could you imagine a news report about how the much touted vaccine efficacy of 95% didn't really pan out? 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!
  • mikem170 5y ago
    Or did they just not run the trials long enough to detect the efficacy dropping?
  • orang2tang 5y ago
    Anyone who took a biology class and paid attention could have told you that an efficacy-killing variant was an inevitability. Hell, even tinfoil hat Alex Jones said the same thing, and was for that specific instance, vindicated entirely. The top virologists didn't just "not take this into account", they willfully withheld this truth of how viruses operate in order to push a flakey, quickly-deteriorating product into people's arms. 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
    • wavefunction 5y ago
      The 95% efficacy claim was the result of a scientific study of the efficacy of the vaccine against COVID infection. It was definitely not a lie unless you are an insane person with an outrageous definition of what a "lie" is.
    • deleted 5y ago
      [deleted]
    • peter422 5y ago
      If virologists weren't talking about it, how did you learn about it? Do you know enough about virology (or immunology as this would be) that I should listen to you over them? 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).
• mherdeg 5y ago
  > Could you imagine a news report about how the much touted vaccine efficacy of 95% didn't really pan out? It's true. 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-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-do-the-numbers-really-mean-11629999129 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.
• 0fuchs 5y ago
  To often we see procedure propriety as government interference in free society Which is it? Maybe social utilitarianism is all there is? Maybe the rest is just being left alone. Formal demands by churches their flock act as social missionaries and stewards to save others souls being LARPed in a secular world. Why do I have to care about inside these machines and not just the machines (organic or synthetic)? There are separate needs due to physics that we cannot let our imaginations of unfettered freedom disabuse us of. That will lead to mistrust; if moral relativism is fine for anti-vaxxers, why not open hostility? My biology cannot control itself in all situations. We don’t let a chainsaw wielding psycho live in his own world. That’s based on real world observation of the outcomes. How is viral transmission that can be measured physically, even though it requires some specific tools, be considered any less violent towards others than a chainsaw wielding knob? Our evidence comes from the same observable space as our evidence a chainsaw wielding knob is unsafe. Philosophical wankery does not change the physical truth.
• jancsika 5y ago
  > Everything is a crisis and someone can solve it if they're just given the right permissions. 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")
• ryandrake 5y ago
  > 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. 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. 1: https://supreme.justia.com/cases/federal/us/197/11/ https://supreme.justia.com/cases/federal/us/197/11/
• Dumblydorr 5y ago
  Sidenote, if you haven't heard of CMS, that speaks more to your lack of experience in this area than the org's obscurity. I'm not saying everyone should know it, but your paranthetical downplaying of the org shows you're not deep in healthcare knowledge. Should it mean anything to us as readers that you personally never heard of a key agency?
• foogazi 5y ago
  > that I have never heard of until now and whose head is appointed by one person. 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
• wycy 5y ago
  > 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] This is not true at all. Media has been talking openly about "waning immunity" and "declining effectiveness" all along.
• smohare 5y ago
  In what universe should such important public health decisions be made by elected officials largely ignorant of basic science, whom also represent also represent some of the most uneducated and misinformed people alive? There’s a reason, for example, why we don’t let the market or public opinion dictate the efficiency or safety of drugs.
  • encryptluks2 5y ago
    And when some department of unelected officials test radioactive oatmeal on children or infects people with syphilis, we somehow ignore these issues and pretend like that it would never happen to us.
• _ea1k 5y ago
  I agree with your facts, but I think its a little disingenuous to only highlight that one aspect of the context. It wasn't that many months before that when a lot of people were willing to accept 50+% VE and delighted if it could approach 70%. I remember that too, and I think its needed context.
• quickthrowman 5y ago
  > 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. 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…