Comment by Shivetya | Hacker News Reader

Comment by Shivetya | Hacker News Reader

Parent Full thread

Actually if the Independent Payment Advisory Board fails to develop a proposal should costs exceed certain thresholds then the Secretary of Health and Human services must submit a proposal themselves which they must implement.

Since all appointees to this committee must be agreed upon by the Executive Branch as well as both minority and majority leaders from each party (hence 12 from Congress with the Presidents approval/recommendation) and 3 from the President, yes the Executive branch could very well determine what health options are available too you.

The real issues before us now are.

1) why can the Secretary of Health and Human Services even refuse to divulge enrollment numbers? 2) why is the same not keeping the President fully aware or made aware of the problems the site faced before launch and after (conspiracy advocated claim the President knew) 3) By regulating what must be covered and not covered they are deciding what you can have and have not. Remember, there are a lot of gray areas in the law which the Secretary has shown more than enough interest in creating actual rules.

Of course, the nice part is that since they do have analytics (as terribly implemented as it appears to have been), we can force enrollment number disclosure by filing a FOIA request for the web analytics data.

Which, incidentally, I did today before this story broke.

You can still by supplemental insurance, so they aren't regulating what you can have, they are regulating the minimum floor.

Obamacare is not a "minimum floor" it is a full suite of mandated coverage for every politically connected medical sector.

Yes, its a minimum floor. And there are many plans that offer more than the ACA minimum.

You may not like where the minimum is set, but that doesn't make it anything but a minimum floor.

> they aren't regulating what you can have, they are regulating the minimum floor.

This is utter nonsense on its face. If I have (or want) something under the minimum floor, they have regulated that away from me. They have regulated what I can have.

They also regulated away spoiled beef in stores, non smoke detectors equipped bedrooms and poisoned tap water. You can't have it. Minimum floor.

Indeed. I'm simply asking that we call a spade a spade.

Some municipalities mandate the addition of sodium fluoride in their public water systems. Sodium fluoride is a poison, so it's not necessarily accurate to claim they have 'regulated away' poisoned tap water.

No one drinking publicly fluoridated tap water in the US is coming even close to a toxic dose. You might as well call all caffeinated beverages toxic given the toxic dose of caffeine is 1/30th that of sodium fluoride.

The difference is that said municipalities mandate that this toxic substance be added to people's water. With soda, people have more direct awareness and choice. With communal water, many people remain trusting and assuming. Meanwhile, there is no hard, double-blind science backing any clear benefits of fluoridation; yet the negatives keep growing. The EPA lowers their "recommended maximum" continually throughout the years, as pressure for sanity builds. Sane countries banned fluoridation long ago. Furthermore, the more it infects the food chain, the more "a little bit" adds up. It doesn't magically stay contained in tap water alone. Sure, it won't matter to most people, even not on principle alone. It will matter to some people, though, in compounding their chronic health problems. And that matters to me.

Then there is ethics.

Ethics and choice matter. Even if there were startling net benefits to this very toxic substance, using or ingesting it should be exclusively on an individual basis: personal choice, OTC, or per a physician. Advocating for needlessly and forcefully "medicating" (read: it's not medicine) other people through their communal water supply is, in no uncertain terms, blatantly unethical. It seems to stem from either psychopathy, greed, or sheer ignorance. It's on the same order as an industry and some physicians promoting nicotine cigarettes for health, once upon a time, and other such barbarities of an era.

Most things that are considered to be medicine are pretty toxic. It's the dose that makes them into medicine.

Some of this is because to be a medicine, a substance sort of needs to have a noticeable effect on our biology.

I appreciate your comment. You caught my conventional language and prodded me. I should be more careful. Toxicity is a factor of everything in medical science involving substances. ...in life rather. Medicine of all various forms is vast, highly varying per person, often contradictory over time in understanding, and constantly evolving. Conventionally, I consider medicine to be [something that is beneficial down to the personal level].

I'll rephrase. It isn't good medicine.

Fluoride treatments and water fluoridation are medicines like mercury treatment was once medicine. Explicit forms of "medication" must be relegated solely to an individual's active consent when consent is possible. That means a conscious choice to partake in the "medicine," on or in one's body, without medicating other people in the treatment. That's basic ethics. The benefit:negative ratio would have to be astronomically high to justify any less standard where medicine is concerned.

Medicine is very personal. Speaking for myself, when an extremely toxic substance to humans, no matter the dose, is intentionally added to something as important as water and thus a food chain, it has already lost the ethical equation. Massively "medicating" passive "patients" through the water supply is just sad. Worse still, ingesting fluoride hasn't been justified on any beneficial, medical level -- and quite the opposite with negatives. Thus, it's hard for me to associate the term "medicine" with it. I completely concede to that point though.

Wow, I didn't know fluoride conspiracy theorists still existed. Thanks.

That's a snide dismissive. I encourage you to not be condescending to others for making statements against your preconceived notions. You may support ingesting fluoride for yourself, for whatever reason. I'd also encourage you to research it with a more skeptical and intellectual spirit, if only for the sake of your health.

How you treat others and yourself is up to you, of course. Beyond your personal choices, you'll then have a titanic task of providing basis for your support of fluoride as a medicine to the point where you justify medicating the rest of your community through its water supply.

The difference is that said municipalities mandate that this toxic substance be added to people's water.

That horribly toxic chemical chlorine is added to water too. It is significantly more toxic than sodium fluoride. It also happens to be responsible for the greatest improvement in public health in the 20th century.

Sane countries banned fluoridation long ago.

Most countries who don't fluorinate water didn't ban it. They simply never implemented it or stopped implementing it because it is quite expensive and technically difficult to do well. Instead many simply add fluoride to their table salt (like France, Germany, Switzerland) or heavily pushed topical fluoride applications. The countries that have neither (like say Japan), tend to have significantly worse dental health than the US.

Meanwhile, there is no hard, double-blind science backing any clear benefits of fluoridation

You must be kidding. We have long-term longitudinal studies that clearly show the benefits and safety. Every decade, someone puts out a review paper[1] of the studies and comes to the same conclusion, fluoridation at low levels is good. We have scientific consensus that it is beneficial.

1. http://www.nature.com/ebd/journal/v9/n2/full/6400578a.html

Chlorine has a clear justifiable use and is easy to remove. Hence, filtration is very popular and recommended to remove chlorine and other contaminants. Water treatment serves to bring a base level of safety. That which does not kill one quickly is not equivalent to that with which one should be satisfied.

Fluoridation, alternatively, is not easy to remove. Fortunately, I can afford distillation and reverse osmosis. Many other people can't. I'm not sure why you're so eager to medicate the water supply when more studies, decade after decade, present more negatives. Positive fluoride studies are notorious for conflating correlation with causation, especially in light of the more direct causation of cultural advances in education for merely brushing teeth as well as access to dental care. There is a lack of evidence showing significant variance in dental caries between fluoridated and non-fluoridated municipalities. That should alarm you. Fluoride accumulates. For whatever reason, you don't seem interested in its negatives.

Again...

Even if there are light or even startling benefits, it does not make valid the ethics of mass medication. You may feel strongly about wanting everyone to have fluoride. I suggest voicing your pro-fluoridation stance in a more positive way rather than advocating it be done through a water supply where it's very hard to remove, and compounds. Maybe advocate for "free fluoride tablets" and fluoride-filled toothpaste if you must. Don't include others in your treatment.

You aren't being forced at gunpoint by the IRS to drink tap water. You are free to buy whatever water you want. You are being forced to buy insurance. A very big difference.

you're not forced to buy insurance. There is a new tax and you're just given a chance to avoid it by buying some specific product. For example i avoid some taxes by paying mortgage. Nobody forces me to have a mortgage or medical insurance. Either of it just reduces taxes and provides some benefits to me as perceived to me.

They both use force. Putting heavily toxic, hard-to-remove substances into tap water -- as additives rather than as "necessary" treatments -- is, I would hope, an action considered aggressive and highly unethical to many people. Consider the degree to which people are now dependent on municipal water and the degree to which water is crucial to sustain life. I would call poisoning a water supply a form of force. It's physical and economic taxation, mostly hurting poor people (who can't afford proper filtration). And it's to the detriment of an entire food chain.

Under the new health insurance law, the penalty for not buying health insurance is a fine. I forget the yearly amount: $500-1000 (depending)? Yes, that's a form of force. The amount of the fine and who it impacts is the amount of force. It's economic taxation. It also further opens up a slippery slope in the ability for such forms of force to be used increasingly in other aspects of government and society. That's another topic.

Both propositions are easily argued as forms of force. They could easily be argued as unjustified compared to other systems and methods. However, for now, I'd argue that contaminating water is a larger form of force.

Spoiled beef is quite a different thing from requiring a 60 year old man to buy maternity coverage.

You mean spreading the cost of maternity coverage across all policyholders. Perhaps you're not aware of how insurance works, spreading risk and all that jazz.

Have healthcare system where costs are externalized? People complain. Have healthcare system where costs are internalized and properly accounted for? People complain.

1) You don't get to tell me what I "mean". 2) I'm quite aware of how insurance works. Please do share with us the probability of a 60 year old man becoming pregnant, then explain why that "risk" needs to be "spread".

I wonder what the probability of a 60 year old man getting his lovely partner pregnant might be? That looks like a reason for spreading risk to me.

Given that the law also requires the lovely partner to have her own coverage, I think your "reason" is dubious at best.

Also note that the law requires 60 year old women to buy maternity coverage. Is their lovely partner going to make them pregnant?

Given that the Guinness record for the oldest natural conception is 59, I think not (there are a few cases of older women giving birth, but those all involved in vitro fertilization or the like).

What other astoundingly unlikely events do you guys think people should be required to insure against? Meteor impact? Virgin birth? All the molecules of air rushing to one side of the room and suffocating you?

well, i truly doubt that the law mandates for male coverage to include maternity or female coverage - prostate cancer. The law just mandates the same insurance price for males and females.

It is pretty much the same as me paying [through taxes] for the FDA beef inspectors even though i don't eat beef. Just a socialization of the cost of basic government services (healthcare is among them, it is just Republicans are slower as usual to recognize the facts of reality, and thus "socialization" of the cost happens inside an insurance pool instead of society-wide as it would be in the case of single-payer )

"well, i truly doubt that the law mandates for male coverage to include maternity or female coverage - prostate cancer."

You're wrong. The law says what the policy has to cover. Whether the policy holder is male or female doesn't enter into it.

"It is pretty much the same as me paying [through taxes] for the FDA beef inspectors"

Really? Since when is the FDA (actually, USDA in this case) a private, for-profit operation?

>Really? Since when is the FDA (actually, USDA in this case) a private, for-profit operation?

i already addressed that - the Republicans forced for it to be done through private for-profit operations instead of a government agency like FDA/USDA/etc...

Reply on news.ycombinator.com