(Follow me on Twitter @mjhopkins81! If you like what I have to say, here, please share this article)
There must have been a point in my life when I enjoyed going out to large parties. I seem to remember a point back when I first attempted college at WVU when I just couldn't wait to get to this or that party and get wasted and dance to loud music; when I could go out to clubs and get wasted and dance, and actually enjoy myself in the process. Though I remember at one time having these longings, I can't seem to recall at what point those desires morphed into revulsion - when "I'll see you when you get here!" became, "You go on ahead. I think I'm going to stay in, tonight."
While some people will largely point to me being in my thirties as the obvious reasoning behind my lack of any desire to be social, the real cause is much more complex, and my age isn't really a factor. I can name at least twenty people right off hand who defy the culturally imposed "age limit" on having "fun." The gay male community, in particular, is rife with them (often a little much so, for my tastes). The overabundance of the Over-Forty gay male demographic at events like Folsom Street Fair and Dore Alley often leaves me feeling as if I'm missing something. Everyone around me appears to be having fun, and all I keep thinking is, "Goddamn, it's fucking hot/cold/rainy! Fuck, these boots are fucking killing my feet! If one more sweaty asshole slimes his way past my unsuspecting back, I'm going to take his truncheon and beat him unconscious!"
At this point, I have to assume that it's something internal about me that just fails to get what the big deal is with all these events. I was never a proponent of the "party" scene (as it relates to events) - events like Muscle Beach, White Party, Black Party, and basically any event that boasts about having an ostensibly famous DJ never really piqued by interest. For a while, I remember enjoying dancing in clubs, but after taking a few serious dance classes, I now just feel both self-conscious and awkward because I can hear every mean instructor (because, really...they're the only good ones who actually get results) screaming at me to be mindful of my form and carriage.
Mostly, it's that I don't enjoy the music, and I usually don't enjoy the company. That isn't to say that these DJs aren't good at what they do; it's that I hate dance music, particularly dance remixes of good songs that had no need to ever be turned into an "anthem." Because I move around so frequently and being poor tends to necessitate living on the far-flung outskirts of any major metropolitan area, few of my close friends are ever near enough to me to make going out together on a regular basis feasible. When the rare opportunity arises when we are able to make plans, I have a tendency to dread the coming outing as the date nears, greeting it with all the enthusiasm of a penile swabbing with a sandpaper Q-Tip.
If I really don't want to go out, I'll inadvertently find a way to make sure I'm unable to go. I'll pick up a shift at the restaurant without "remembering" our plans; I won't make enough money to afford gas or drinks to go out; I'll catch a cold. It's all unintentional, I think, but I can't guarantee that I don't subconsciously put myself into these positions in order to avoid being social.
More often than not, I prefer to be the entertainer. I never mind big social gatherings when they're being hosted by me, both because I kind of enjoy the attention, and because it gives me a chance to bring together people who would likely never meet one another because I tend to pick up friends from almost every walk of life and from every social group. As my mentor once told me, I will likely never really "belong" to any kind of community, so much as I will make my own.
Maybe this is why I'm never threatened by change. When the WeHo gay boys panic about the encroaching lesbian takeover (despite the fact that the one lesbian bar closed and the nearest lesbian community center/Safe Space is so far outside West Hollywood city center that they can spit into Beverly Hills and Westwood), I don't feel like anything is wrong with that. When the leather queens complain about women coming into their leather bars and "ruining the masculine atmosphere," I think them antediluvian and on the verge of extinction.
Because of my tendency to cobble together people from various backgrounds and create my own version of "family," I am comfortable in almost every situation. I am not shy, nor am I uncomfortable with my gender identity or sexuality (they are different aspects). I'm more than happy to strip completely naked in front of pretty much anyone, save for children, whereas many men feel overly exposed and vulnerable, unable to "relax" around women enough to be comfortable with nudity in mixed company.
While this may sound as if I am a very sociable person, fully able to integrate myself into the types of environments I so loathe, the reality is far different. My friends will post photos of themselves at these massive events and parties, and there's a part of me that thinks to myself, "What the fuck? Why wasn't I invited???"
And then, after I think about it, I come to the realization that I wouldn't have had a good time, anyway. If it's too loud to make conversation with the person next to you without screaming or sign language, I'd rather be anywhere else than there. It isn't that I don't want to support my friends who are go-go dancers or drag queens, it's that being in those places makes me miserable, one the one hand, and more likely to commit homicide, on the other hand.
So, while my friends enjoy themselves at Dore Alley and Pride festivals, I will be doing what I love best - sitting in my bed with my laptop on my lap, my iPad to my right, a controller in my hand, and something on the television, engaging in my own form of social engagement, all in the purring company of my wonderful gremlin, Goblin.
Sunday, July 21, 2013
Tuesday, July 9, 2013
All of My Worst Fears - Confirmed
(A quick reminder - you can now follow me on Twitter @mjhopkins81; if you like what I have to say, here, please share this article)
For the past three days, I've been at the ADAP Advocacy Association (aaa+) Sixth Annual ADAP Conference. The purpose of this conference is to update attendees on the current state and future of the Ryan White Act and the AIDS Drugs Assistance Program (ADAP), providing vital information about current funding levels, proposed legislative changes, and what advocates can do to ensure that people living with HIV/AIDS receive the care and treatment they both need and deserve.
I should first note that I am not an optimist. No one who knows me would accuse me of being one, which puts me in the often awkward position of being perceived as being overtly negative. Either I'm hypercritical of circumstances, or I don't "offer any solutions," this perception is often tendered by people who are either unable or unwilling to look beyond their pie-in-the-sky, eternally frustrating (to me) optimism, and confront the very real issues at play that can literally make or break even the best laid plans.
In my May post, Stuck in the Gay Pride Rut, I discussed Jonah Lehrer's January 2012 piece in the New Yorker, Groupthink - The Brainstorming Myth, in which he addressed the problems inherent to the long-celebrated approach to meetings and planning sessions. Brainstorming is a business approach lauded for its strict adherence to positivity. Within the session, no one can deride or question anyone else's idea, because that may frighten less confident people from putting their ideas forth by creating a so-called "negative" environment.
To recap the article, Lehrer discusses research showing that, while brainstorming can often provide a handful of unique ideas, having someone in the room who questions, criticizes, and uses logic to discard ideas that will be largely unfeasible often results not only in more ideas, but in better ideas. The ideas that come from what brainstorming advocates would consider a "negative" or "adversarial" environment often end up producing better, more quantifiable results than those wherein everyone's ideas, regardless of how stupid or untenable, are considered valid.
What it all boils down to is the basic fact that not every idea is a good idea; not everyone can be a star; not everyone is able to put forth a good idea. Sorry if that offends some people, but suck it up and deal in reality, not in fantasy.
Furthermore, research indicates that having someone willing to point out problems with ideas often helps to alleviate those issues by forcing others (who are willing to set aside their "You're so negative!" bullshit attitudes) to address them head on, rather than continuing forward with no sort of contingency plan or solution when those problems manifest themselves.
These things having been established, most of the conference, for me, was spent in often abject horror as all of my worst fears about the Affordable Care Act (ACA) were confirmed by presenters who were experts in their respective fields within the healthcare arena. Every objection I've long expressed to the legislation, all of which have been pooh-poohed by the eternal optimists who insist "Well, this is the best we could do," were validated. While I certainly enjoy the opportunity to say, "See! I told you so!" I take no pleasure in being right; rather, I am in no way comforted by my accurate assessments of the ACA, and am honestly not hopeful for the future of healthcare in America.
From the beginning of this long, drawn out saga, I have been disappointed in the legislation that was cobbled together with seemingly little forethought as to the ramifications it may have in the future. What started out as a promising venture eventually turned
Take, for example, the mandated insurance purchase on behalf of individuals:
The prevailing thought behind this mandate was that, by forcing everyone into the insurance pool, insurance giants would be incentivized to offer drastically lower rates so that everyone could afford coverage. That sounds like a great idea, but unfortunately for the brainstormers in the room, no one thought to put a Federally mandated premium cap provision (for basic coverage) in place that would control costs.
Anyone who has paid attention to the numbers for the last 35 years will point out that, while inflation and the cost of living have risen exponentially, while average annual incomes (for single-earner households) has remained largely stagnant. Inflation increased from 1978 to 2013 by 265.48%.
By 2012, households were spending an average of just under $50k/year for annual living expenses. That's simply ridiculous - it is almost the cost of a single-family home in 1978...total.
So, what is coming down the pipe for individuals looking to purchase health insurance once open enrollment starts in October 2013? A whole lot of shit.
Insurance companies who choose to raise their rates are going to be subject to review by the Federal government, which, again, sounds great. Unfortunately for the consumer, that Federal review doesn't mean a goddamned thing, primarily because they have no power whatsoever to penalize companies who are charging their customers an arm and a leg for the most basic coverage.
"But," say the Free Market enthusiasts, "Bringing those exorbitant rates to the attention of the consumer will have a deleterious affect on the insurance companies' reputations, and they will be all but forced to compete for business with each other by lowering prices."
And to that, I respond, "Bullshit."
Insurance companies across the country have enjoyed a largely negative reputation earned for bilking customers and helping to drive up costs for operations that normally cost 1/10 of the price, and despite those negative reputations have yet to reduce their rates, still offer less and less coverage for more and more money, and the consumer is the one getting screwed in the end. What incentive do they have to lower costs when they have an entire country of people who are being forced to purchase their product?
The answer is, "None." Basically, it's everyone into the insurance pool, but the insurance companies control the water level.
Furthermore, there are no national standards of coverage set consumers, which means that what one company offers as "basic coverage" is what one company offers as "basic coverage." The consumer can shop around all they want to find the coverage they desire for the cost they can afford, but what the U.S. needs, as well as healthcare recipients, is a system where they can find the coverage they need for the cost they desire.
There is also no mandate for national implementation. The reason why every company and provider in the nation are basically stalled is that no one seems to know what's going on with the ACA. The requirements are unclear, the implementation is unfeasible, and each state is left to their own devices to figure out the rules that both fit their own statewide regulations while simultaneously fulfilling the requirements set at the Federal level.
This problem has basically paralyzed business owners and states because they literally just have no idea what to do.
In speaking with a Republican friend of mine (who conveniently enjoys military healthcare coverage), he argued that he shouldn't have to pay a tax to cover the chain smokers and fat asses who can't take care of themselves. What he doesn't realize is that, thanks to our current approach to healthcare (which really should be called "sick care"), he's already paying the cost of those people 25 times over. Were we to simply toss out our current model and switch over to a tax-funded Universal/Single-Payer option - the same kind of healthcare every major industrialized nation in the world current enjoys and manages to afford at a fraction of the cost - the amount he paid in taxes would be far less than what he currently pays for substandard (by comparison) care.
What this boils down to is one of my early points - when we needed a dictatorial approach to crafting healthcare reform, we got a democratic approach which almost always results in a terrible end result. They brainstormed and got a handful of great ideas (i.e. - ending discrimination based on gender and pre-existing conditions), but along with that came hundreds of really awful ideas.
Forgive me for coming across as "negative," but the stark reality is that we have not one, but several problems on our hands, and no one yet seems able to even begin to formulate an answer. At this point, all we can do is take an honest look at what we have and identify the problems before they come to fruition.
For the past three days, I've been at the ADAP Advocacy Association (aaa+) Sixth Annual ADAP Conference. The purpose of this conference is to update attendees on the current state and future of the Ryan White Act and the AIDS Drugs Assistance Program (ADAP), providing vital information about current funding levels, proposed legislative changes, and what advocates can do to ensure that people living with HIV/AIDS receive the care and treatment they both need and deserve.
I should first note that I am not an optimist. No one who knows me would accuse me of being one, which puts me in the often awkward position of being perceived as being overtly negative. Either I'm hypercritical of circumstances, or I don't "offer any solutions," this perception is often tendered by people who are either unable or unwilling to look beyond their pie-in-the-sky, eternally frustrating (to me) optimism, and confront the very real issues at play that can literally make or break even the best laid plans.
In my May post, Stuck in the Gay Pride Rut, I discussed Jonah Lehrer's January 2012 piece in the New Yorker, Groupthink - The Brainstorming Myth, in which he addressed the problems inherent to the long-celebrated approach to meetings and planning sessions. Brainstorming is a business approach lauded for its strict adherence to positivity. Within the session, no one can deride or question anyone else's idea, because that may frighten less confident people from putting their ideas forth by creating a so-called "negative" environment.
To recap the article, Lehrer discusses research showing that, while brainstorming can often provide a handful of unique ideas, having someone in the room who questions, criticizes, and uses logic to discard ideas that will be largely unfeasible often results not only in more ideas, but in better ideas. The ideas that come from what brainstorming advocates would consider a "negative" or "adversarial" environment often end up producing better, more quantifiable results than those wherein everyone's ideas, regardless of how stupid or untenable, are considered valid.
What it all boils down to is the basic fact that not every idea is a good idea; not everyone can be a star; not everyone is able to put forth a good idea. Sorry if that offends some people, but suck it up and deal in reality, not in fantasy.
Furthermore, research indicates that having someone willing to point out problems with ideas often helps to alleviate those issues by forcing others (who are willing to set aside their "You're so negative!" bullshit attitudes) to address them head on, rather than continuing forward with no sort of contingency plan or solution when those problems manifest themselves.
These things having been established, most of the conference, for me, was spent in often abject horror as all of my worst fears about the Affordable Care Act (ACA) were confirmed by presenters who were experts in their respective fields within the healthcare arena. Every objection I've long expressed to the legislation, all of which have been pooh-poohed by the eternal optimists who insist "Well, this is the best we could do," were validated. While I certainly enjoy the opportunity to say, "See! I told you so!" I take no pleasure in being right; rather, I am in no way comforted by my accurate assessments of the ACA, and am honestly not hopeful for the future of healthcare in America.
From the beginning of this long, drawn out saga, I have been disappointed in the legislation that was cobbled together with seemingly little forethought as to the ramifications it may have in the future. What started out as a promising venture eventually turned
Take, for example, the mandated insurance purchase on behalf of individuals:
The prevailing thought behind this mandate was that, by forcing everyone into the insurance pool, insurance giants would be incentivized to offer drastically lower rates so that everyone could afford coverage. That sounds like a great idea, but unfortunately for the brainstormers in the room, no one thought to put a Federally mandated premium cap provision (for basic coverage) in place that would control costs.
Anyone who has paid attention to the numbers for the last 35 years will point out that, while inflation and the cost of living have risen exponentially, while average annual incomes (for single-earner households) has remained largely stagnant. Inflation increased from 1978 to 2013 by 265.48%.
By 2012, households were spending an average of just under $50k/year for annual living expenses. That's simply ridiculous - it is almost the cost of a single-family home in 1978...total.
So, what is coming down the pipe for individuals looking to purchase health insurance once open enrollment starts in October 2013? A whole lot of shit.
Insurance companies who choose to raise their rates are going to be subject to review by the Federal government, which, again, sounds great. Unfortunately for the consumer, that Federal review doesn't mean a goddamned thing, primarily because they have no power whatsoever to penalize companies who are charging their customers an arm and a leg for the most basic coverage.
"But," say the Free Market enthusiasts, "Bringing those exorbitant rates to the attention of the consumer will have a deleterious affect on the insurance companies' reputations, and they will be all but forced to compete for business with each other by lowering prices."
And to that, I respond, "Bullshit."
Insurance companies across the country have enjoyed a largely negative reputation earned for bilking customers and helping to drive up costs for operations that normally cost 1/10 of the price, and despite those negative reputations have yet to reduce their rates, still offer less and less coverage for more and more money, and the consumer is the one getting screwed in the end. What incentive do they have to lower costs when they have an entire country of people who are being forced to purchase their product?
The answer is, "None." Basically, it's everyone into the insurance pool, but the insurance companies control the water level.
Furthermore, there are no national standards of coverage set consumers, which means that what one company offers as "basic coverage" is what one company offers as "basic coverage." The consumer can shop around all they want to find the coverage they desire for the cost they can afford, but what the U.S. needs, as well as healthcare recipients, is a system where they can find the coverage they need for the cost they desire.
There is also no mandate for national implementation. The reason why every company and provider in the nation are basically stalled is that no one seems to know what's going on with the ACA. The requirements are unclear, the implementation is unfeasible, and each state is left to their own devices to figure out the rules that both fit their own statewide regulations while simultaneously fulfilling the requirements set at the Federal level.
This problem has basically paralyzed business owners and states because they literally just have no idea what to do.
In speaking with a Republican friend of mine (who conveniently enjoys military healthcare coverage), he argued that he shouldn't have to pay a tax to cover the chain smokers and fat asses who can't take care of themselves. What he doesn't realize is that, thanks to our current approach to healthcare (which really should be called "sick care"), he's already paying the cost of those people 25 times over. Were we to simply toss out our current model and switch over to a tax-funded Universal/Single-Payer option - the same kind of healthcare every major industrialized nation in the world current enjoys and manages to afford at a fraction of the cost - the amount he paid in taxes would be far less than what he currently pays for substandard (by comparison) care.
What this boils down to is one of my early points - when we needed a dictatorial approach to crafting healthcare reform, we got a democratic approach which almost always results in a terrible end result. They brainstormed and got a handful of great ideas (i.e. - ending discrimination based on gender and pre-existing conditions), but along with that came hundreds of really awful ideas.
Forgive me for coming across as "negative," but the stark reality is that we have not one, but several problems on our hands, and no one yet seems able to even begin to formulate an answer. At this point, all we can do is take an honest look at what we have and identify the problems before they come to fruition.
The Future of HIV Care
(A quick reminder - you can now follow me on Twitter @mjhopkins81; if you like what I have to say, here, please share this article)
At this point, there is little impetus in the House to end the sequester in the 2014FY budget; the Senate, however, paints a much rosier picture, as their budget proposal ends sequestration. Realistically, however, neither bill is likely to make it through both houses as the ideological divide is so deep that there is little room for negotiation.
At this point, there is little impetus in the House to end the sequester in the 2014FY budget; the Senate, however, paints a much rosier picture, as their budget proposal ends sequestration. Realistically, however, neither bill is likely to make it through both houses as the ideological divide is so deep that there is little room for negotiation.
What does this mean for the over 50% of people living with HIV/AIDS (PLWHA) and their access to comprehensive medical care and treatment?
The answers to this most basic question are a mixed bag of mainly neutral to negative outcomes, from my perspective. As someone who is directly affected by this question, and has experienced care and treatment in four vastly different states with wildly different approaches, I must admit that I have a vested interest in moving away from the way we currently address these issues.
To better explain how we currently address the issues of low-income HIV (and the greater Medicaid/Medicare model, overall), allow me to take a few moments to bring you up to date:
Under the current model, each state and territory is basically left to their own devices when it comes to providing care for their low-income citizens. At first glance, this seems like a good way to address the myriad regional disparities in terms of each state's individual needs, allowing the state to best determine the approach that best works for them. This, however, has largely proven to be untrue for those in need of the greatest assistance.
The great divide occurs between those who work in healthcare and those who work in policy and politics. By every metric of health, the states who present the greatest concern are almost exclusively in the South. The elected representatives and executives of those states are, unfortunately, those most opposed to providing those services.
The Southern states have the highest rates of literally every disease, from heart disease, renal disease, obesity, every single STD/STI, and every single type of cancer, and yet, they are the least likely to have access to testing, care, and treatment for various reasons - sheer geography (literally not being able to get to it), mistrust if medical authorities, cultural stigma against identifying as someone with a disease...trying to address these issues requires many more resources and actions than what these states are either willing or able to deliver, and they are in no way interested in asking the Federal government to step in, nor would that be welcome by those states' residents.
So, what does that mean?
Honestly, I don't know.
Beyond the basic fear of what will happen to Ryan White/AIDS Drugs Assistance Program (ADAP) program after the Affordable Care Act (ACA) goes into effect, there is an even more terrifying fear of what might happen if we attempt to get Ryan White reauthorized after it expires in September 2013 in the current political climate.
While the AIDS Healthcare Foundation (AHF) has a vested interest in reauthorizing it immediately in order to address the crisis well into development in the South, most HIV/AIDS advocates are more wary of the high probably that, given the current influence of austerity drunk Republicans (Teatards) and their tinfoil hat(e)-wearing constituents in Congress, whatever attempts to reopen the bill to adjust the formula so that more funds could be reallocated would result in a partial or wholesale gutting of what we currently have.
Right now, the reality of the situation from my perspective is that, despite all of the hopeful optimism and worry management being done by those "in the know," there is very little good news for those low income PLWHA who fall through the cracks.
That having been said, I think anyone who reads what I write understands that I am particularly realistic/pessimistic when it comes to the direction our country and specifically our healthcare system are heading. The levels of confusion, dismay, and lack of information all combine to create a precarious path for advocates and educators to attempt to traverse.
I don't have the answers to several of these problems that will please everyone, or even anyone. When it comes to developing new ideas, Democracy has proven to be successful; when it comes to implementing ideas effectively, a dictatorship is infinitely better.
Right now, we're living in what I believe to be the waning days of theRoman American Republic - as monied interests have taken a terrifying amount of control over our politicians and political process, we are often faced, as voters, neither with choices between Good vs. Evil, nor even between the lesser of two evils; rather, we find ourselves forced to choose between candidates and constituents who are increasingly uninterested in maintaining any sort of control over our system of government and our election process.
We have entered into a frightening era when one candidate can win their primary by averring to "not being a Union guy" (thereby being a corporate shill), while another can win their primary by promising more than can ever be conceivably delivered, while really being...yet another corporate shill.
At this time, there is only one Senator in Congress who has gone out of her way to ensure that she represents actual people (Elizabeth Warren, D-MA); as for Congress, Alan Grayson (D-FL) is one of a handful of Congressmen who will actively (though not always effectively) step into a fray with the intention not of honoring his enemies, but in order to set them aflame and put them out with a bag filled with their own words.
Ultimately, we have no idea who are our allies and enemies - the old battle lines no longer apply, primarily because we are no longer playing a chessboard, but in a minefield. We cannot rely upon the vast majority of our currently elected representatives for support or opposition, because they are often so preoccupied with ensuring their own reelection that they are incapable of achieving any real positive goal.
And so...here we are. We are stuck in an unfortunate holding pattern on the ground, while those in the sky are circling the airport on quickly exhausted fuel supplies, and those most in need of service are stuck in the terminal waiting for an open seat on an overcrowded plane.
Beyond the basic fear of what will happen to Ryan White/AIDS Drugs Assistance Program (ADAP) program after the Affordable Care Act (ACA) goes into effect, there is an even more terrifying fear of what might happen if we attempt to get Ryan White reauthorized after it expires in September 2013 in the current political climate.
While the AIDS Healthcare Foundation (AHF) has a vested interest in reauthorizing it immediately in order to address the crisis well into development in the South, most HIV/AIDS advocates are more wary of the high probably that, given the current influence of austerity drunk Republicans (Teatards) and their tinfoil hat(e)-wearing constituents in Congress, whatever attempts to reopen the bill to adjust the formula so that more funds could be reallocated would result in a partial or wholesale gutting of what we currently have.
Right now, the reality of the situation from my perspective is that, despite all of the hopeful optimism and worry management being done by those "in the know," there is very little good news for those low income PLWHA who fall through the cracks.
That having been said, I think anyone who reads what I write understands that I am particularly realistic/pessimistic when it comes to the direction our country and specifically our healthcare system are heading. The levels of confusion, dismay, and lack of information all combine to create a precarious path for advocates and educators to attempt to traverse.
I don't have the answers to several of these problems that will please everyone, or even anyone. When it comes to developing new ideas, Democracy has proven to be successful; when it comes to implementing ideas effectively, a dictatorship is infinitely better.
Right now, we're living in what I believe to be the waning days of the
We have entered into a frightening era when one candidate can win their primary by averring to "not being a Union guy" (thereby being a corporate shill), while another can win their primary by promising more than can ever be conceivably delivered, while really being...yet another corporate shill.
At this time, there is only one Senator in Congress who has gone out of her way to ensure that she represents actual people (Elizabeth Warren, D-MA); as for Congress, Alan Grayson (D-FL) is one of a handful of Congressmen who will actively (though not always effectively) step into a fray with the intention not of honoring his enemies, but in order to set them aflame and put them out with a bag filled with their own words.
Ultimately, we have no idea who are our allies and enemies - the old battle lines no longer apply, primarily because we are no longer playing a chessboard, but in a minefield. We cannot rely upon the vast majority of our currently elected representatives for support or opposition, because they are often so preoccupied with ensuring their own reelection that they are incapable of achieving any real positive goal.
And so...here we are. We are stuck in an unfortunate holding pattern on the ground, while those in the sky are circling the airport on quickly exhausted fuel supplies, and those most in need of service are stuck in the terminal waiting for an open seat on an overcrowded plane.
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