Saturday, January 22, 2022

Doctors Are Vassals Of The State

If there is any doubt that doctors do not have autonomy in their workplace, recent court decisions regarding vaccine mandates have proven it. A couple of weeks ago, The Supreme Court ruled that the Biden Administration's vaccine mandate for all employers with more than 100 employees was unconstitutional. Congress never authorized this action and the executive branch doesn't have that authority no matter how the administration contorted the laws. Then last week a US District Court in Texas found that vaccine mandates for federal employees were also unconstitutional, again citing overreach of the administration in their use of federal laws. 

So does anybody in the US need to get the vaccine? Large employers cannot force their employees to take the coronavirus vaccine. Federal employees also cannot be required to accept the vaccine. Small employers have not had any federal mandates for their employees to receive it or get fired. The only federal mandate for vaccines that was accepted by the Supreme Court was for doctors, nurses, and all medical industry who accept Medicare and Medicaid reimbursements. Yup, it's all about the money.

The reason the Centers for Medicare and Medicaid Services was able to force healthcare workers to get jabs despite deep concerns among large groups of the population, including doctors and nurses, is that there is a clause in the Medicare laws that states the government can do whatever it takes to make sure the programs function smoothly. Therefore it gives the Secretary of Health and Human Services broad authority to make sure they run uninterrupted, which in this case means healthcare workers who accept money from CMS do not get sick from Covid and they do not transmit the virus to their patients.

I am not a vaccine skeptic. I got my first shot the first week that it was available at our hospital. I have since been boosted. I just find it frustrating that even though physicians are some of the most highly educated people in the country, we are under the boot of the federal government with little recourse for dissent. 

Besides vaccine mandates, other government rules keep doctors on a very short leash. EMTALA laws tell us who we can and cannot treat (spoiler: we have to treat everybody). HIPAA laws decide what we're allowed say. Through the Joint Commission, they dictate what we can wear, where we can eat, how we dispose of trash, and essentially all functions of a healthcare facility. Doctors are threatened with loss of their livelihoods if they exercise their freedom of speech to talk about their skepticism of the consensus. Our incomes are based on the whims of the federal government where they threaten to cut reimbursements every year. Medicare reductions of 1-2% are considered a win for the healthcare community even though inflation is soaring all around us. 

Do physicians have any constitutional rights left? When physicians first got into bed with the federal government, many were anxious about cozying up with such a large entity. We were assured it would be just a small program, costing only a few billion dollars each year. Besides, shouldn't doctors just suck it up so the elderly and destitute can receive their rights to decent healthcare? Half a century later, as the programs expand their eligibilities and the demographics of the population has changed, Medicare and Medicaid enrollment are now over 100 million people

The medical community essentially cannot function without government money. With so little leverage, is it any wonder the Congress can so easily talk about cutting medical reimbursements each year and face almost no backlash? We are required to follow rules that would have a private employer facing an ACLU lawsuit within five minutes. If we're going to ride the bull, we're going to have to expect to get gored.


  1. I couldn't agree more as a fellow physician! Everything you said is right on. And it doesn't help that I live in California.

  2. New York either...The oppression is high... That's why tens of thousands of people, including medical professionals are leaving states like these

  3. For the solo/ group practices must opt out of CMS to remove governmental control. Easy to say but hard to do because of financial considerations. We are at best indentured servants to CMS and insurance companies. The alternative is a cash based practice.

  4. Recently and happily fully retired after "surrendering" my license in California. 45 years in practice with a clean record. I was fortunate and able to escape what has happened to the practice of medicine.

    The previously-existing Physician-patient relationship is no longer permitted in many settings, a myth of the past. Explore membership in the AAPS, a dues-paying physician organization with no government or drug company or insurance control. Explore direct primary care (DPC) with such practices slowly being successfully established in California.