Healthcare In The Real World: Or How We've Politicized The Personal

Lately, it seems like there has been a lot of talk about healthcare in the US. No one on either side of the political debate seems particularly pleased with the new healthcare bill, and many seem unhappy with the state of healthcare as it is. I often hear people complaining that private healthcare is available to anyone who is hard working, a tax payer, and who wants it and publicly assisted healthcare is there for the poor. Since it’s already so widely available, they seem to reason, then why should we change the system?

They’re right, to a point. Yes, private healthcare is available to nearly anyone who wants it, at least on the surface, and yes there are already public assistance programs for the poor, but this is a pretty incomplete view of the American healthcare system, which avoids addressing the fact that many Americans fall somewhere between having ability to pay for their own healthcare and being poor enough to qualify for public assistance.

I am one of those Americans.

I have worked, mostly full time, for the past 16 years. During those 16 years, I had exactly one year of working for a company which provided reasonable health insurance to its employees. Most of my jobs have involved waiting tables, and most of them have been for corporations, as opposed to mom and pop restaurants. I think this is important to note, because the corporate jobs which did provide any healthcare at all, provided bare bones, emergency only coverage to employees who worked a minimum of 40 hours a week. However, the one independently owned company I worked for offered the best insurance they could afford to their employees. Many of my friends have had exactly the same experience, with major corporations offering piss poor or no benefits to employees while smaller companies seem to offer livable policies. This experience flies in the face of those naysayers who bemoan the fact that it would be unfair to “force” small businesses to provide health insurance. You see, most small businesses seem to operate under the belief that their employees are human beings and, as such, deserve to be treated fairly. If a business is already providing good coverage for their employees, the healthcare bill as I understand it will not affect them at all.

However, this is not about the healthcare bill and what it will or won’t do. This is about what it is like to be one of the many people who cannot afford to insure themselves, but are not eligible to receive publicly assisted healthcare.

For me, it is pretty horrendous.

As a 31 year old student with little to no income during the school year, I certainly cannot afford to purchase private insurance for myself and, even if I could, half of the things which concern a thirty year old woman would not even be covered. These include, but are not limited to: birth control, maternity, some forms of cancer screening (including breast and cervical), yearly gynecological exams, and STI screenings. However, as an uninsured woman, I can access these things though my local Planned Parenthood where I can pay on a scale that relates to my current income level.

This may sound like a pretty good deal, but a trip to Planned Parenthood is not a very pleasant experience. For me, an annual checkup must be arranged months in advance, I must answer hours worth of questions about my sexual history, medical history and current income every single time I walk through the door, and I often spend hours in their waiting room only to be led to an exam room, told to undress and left sitting, in nothing but a paper robe and knee socks, for up to an hour while I wait for the clinician on duty to come into the room. I never see the same clinician twice and, as a result of that, a routine pelvic exam can take over hour as each new caregiver must ask the same questions each time. Furthermore, using Planned Parenthood as a resource for birth control means that I have very little personal choice in terms of which type I receive. One clinician may determine that I need a combination pill one year, while another (as was my most recent experience) may aggressive push me toward having an IUD inserted to the point of refusing to continue my previous pill. If I take issue with the method they are prescribing, I am often told that as a non insured patient I should be grateful for what I can get and take it or leave it. Don’t get me wrong here, I am grateful for the resource, but it is still very frustrating to feel as though my opinion regarding my body does not matter as much as it would if I were insured. Although trips to their clinics are not often pleasant or comfortable as an overtaxed system must provide care for thousands of men and women each day, I am at least able to access some healthcare through them.

Even with access to sexual healthcare through Planned Parenthood, not having insurance still leaves me in a precarious position in terms of general sickness and health issues. In my position, being sick rarely means a trip to the doctor, unless there is something seriously wrong. This means that I will often hold off on seeking care until I am nearly disabled by whatever sickness I have and, even then, will not seek help unless I am pretty certain that the illness requires antibiotics. Instead, most illnesses involve a lot of googling, a lot of self medication and a lot of hoping that I am not further damaging myself. The only time I will immediately seek medical care is when I am certain that I’ve got a urinary tract infection, as those absolutely cannot be effectively treated by any home remedy and can progress into sepsis or kidney infections.

In those rare situations where I must seek medical attention, I am often at a loss for what to do. You see, most primary care doctors won’t keep a self paying patient because there is too much risk of unpaid services. Without a primary care doctor, I am often given two options. I can spend an entire day and a month’s salary at the emergency room, or I can utilize an urgent care center.

Whenever the option exists, I use the urgent care center to avoid taking up the time of emergency room staff and incurring the ridiculous cost of being seen in a hospital. Again, I am grateful that such places exist, but using one is not a comfortable experience at all. As with Planned Parenthood, I must redo a full patient history every time I am seen. This means, again, spending hours in a waiting room and constantly having to repeat that I am self paying. Often just those very words are enough to cause the staff’s attitudes to change ever so slightly. Depending on the staff member, I have received everything from lectures on the importance of health insurance to pitying glances in the waiting room and downright degradation in the exam room. Because these centers are often staffed by students who perform all initial consultations, I have been lectured on eating disorders, been told that the student examining me is “certain” that I am sexually promiscuous based on my tattoos, been warmed that my seasonal congestion is a sign of AIDS and been prescribed medication that I am deathly allergic to, despite having clearly marked the allergy on my intake forms. All of these snafus could have easily been avoided if being a self paying patient wasn’t seen as akin to being uneducated or unemployed.

Furthermore, they could all be avoided if I had the ability to have one primary care doctor who I see repeatedly. Having a consistent doctor would mean the world to me as it would mean that I did not have to jump through hoops, be embarrassed, degraded or talked down to, whenever I am in the already frightening position of being sick. It would also mean that I would have access to preventative care and advice beyond the realm of WebMD.

Unfortunately, given our current system, this will not be possible until I am employed by a company which provides decent care, or the system is massively reformed to address the stranglehold which drug manufacturers and insurance companies have on the system. As one doctor recently explained to me, the current system has doctors answering to insurers and drug companies exploiting this fact by offering samples under the table in order to convince doctors to prescribe their drugs. This means that a doctor with a private practice must justify every service he or she performs to the patient’s insurance company before he or she justifies it to the patient. It also means that it is not in a doctor’s best interest to make services affordable to self paying patients as it takes money out of the pockets of the very insurance companies which pay most of their salaries. Often, giving away those free samples from drug reps is the only way for a doctor to circumvent this. In other words, most doctors have their hands tied in terms of being able to provide service as they see fit and this leaves many patients with less autonomy than they should have.

I know the healthcare debate is shrill and fully loaded for every American, but I also think that we have become so lost in the sound and the fury or it all that we may have forgotten who really is affected by the way our current system operates. This is not to say that I am looking for a handout, or, as one Planned Parenthood receptionist recently inferred, crying “poor” in order to exploit the system. On the contrary, I am looking for a reform which will remove the power over our well being from the hands of the insurance and drug companies and return to its rightful place in the hands of each American citizen and their respective caregivers. I only hope that whatever happens in 2014 makes that more possible than it is at this point.

-Shannon

Enjoy the First installment of Pillow Talk with Shannon and the Dead Guy!

This Week, we discuss the blogosphere's reaction to a 5 year old dressed as Daphne from Scooby Do
....enjoy!

Remember That Time We All Blew Up Over a Kid's Costume and Got It All Wrong?

For many children, and some adults, Halloween is a time of fantasy and freedom. It’s the one night of the year when anyone can decide to be anything, even if that means pushing beyond the limits of reality. We frequently see children dressed as witches, fairies, serial killers, action heroes, ninjas and pirates, not to mention a whole host of inanimate objects. One of the things that has seemed so magical about Halloween to me is that it is the one night out of the year when the whole country seems to live by “kid rules”. What I mean by “kid rules” is simply this: when you are a child, you are free to be imaginative and open without the burden of an adult understanding of the world. A 6 year old who dresses up as Superman or a princess in the course of imaginative play may have an awareness of the fact that they are not likely to develop the ability to fly or to kiss a frog and get a prince, but they are also not concerned about such things. They are simply enjoying the act of imagining. On Halloween, I’ve always felt that we all get that freedom, regardless of how old we are. I think that, if we polled many adults and asked them if they agreed with this assessment, they would say yes.

Why then, is the world so up in arms over this kid? For those of you who are unaware or don’t feel like looking at the link, a mom in Lee’s Summit, MO has written in her blog about her 5 year old son’s decision to dress as Daphne from Scooby Doo this Halloween, and the reaction to his costume from some of the other mothers at his preschool. According to the mom, whose name is Sarah, some of the other mothers were pretty disdainful toward her for allowing her son to dress like a female character. One even seemed to indicate that Sarah should have forbidden the costume in order to make sure that her son understood that he is not a girl. In short, these moms were acting like total dicks, but may be not in the way we think they were.

Many people have reacted to Sarah’s blog with a hearty “who cares if your son is gay?”

Others have reacted with the standard “OMG! You’re crazy. He’s going to now catch the gay!”

And now, we have on our hands the standard issue “Is it ok to be gay” debate, which leads to the even more annoying, ‘is it ok to encourage your kid to be gay” debate.

Neither of these debates are new, and neither of them are wrong, per say. However, neither of them should even apply here. While I think it is always a good idea to discuss issues of tolerance for those with different sexual orientations from our own and for those with different senses of identity from our own, I think it’s total bullshit that we are discussing this boy’s sexuality based on his Halloween costume. Furthermore, I think that, by doing this, we are ignoring several larger issues and actually continuing to damage the way our society approaches the gay and transgendered communities.

I know it may seem odd to say that people speaking out on behalf of a little boy’s seemingly homosexual tendencies is damaging to the gay and transgendered communities, but bear with me here. First of all, a five year old child’s desire to be a female cartoon character does not indicate that he will always and forever want to dress like a fem. Think about all the things that you played at as a child. If you can tell me honestly that you’ve grown up to be all these things, then I will grant you a pass on this one. You’re probably too busy being a firefighter/superhero/frog/teacher/astronaut to worry about the internet anyway. Since most of you are not in that category though, allow me to let you all in on a little secret: imaginative play does not always indicate anything other than imagination.

Now that we’ve gotten that out of the way, let’s focus on the bigger issue here. Not all transgendered people are gay. Many individuals who are transgendered are straight. This may seem like a bit of a statement of the obvious, but the fact that a little boy’s costume has caused so many people to come forward to discuss his potential homosexuality indicates that we are in drastic need of a whole lot more understanding here. So, let’s disregard the fact that his costume choice does not necessarily dictate that he is or will be transsexual or transgendered, and talk about the fact that gender identity and sexuality are not the same thing and when we view them as the same, we are damaging everyone by giving in to the same kind of limited and limiting thinking which has relegated both communities to the fringes of society for a very long time.

You see, the thing is that gender issues are not about sex. They are about identity. Identity, as anyone but the most vapid among us can demonstrate, is an extremely complex thing and sexuality is only one small part of that. When we view cross dressing as an indication of someone’s sexual preference, we are limiting that person and refusing to gain a real understanding of who they are. Likewise, when we view someone’s sexuality as the sole factor in their identity, we are limiting them without understanding them. Even if the intention behind it is to be helpful or supportive, which is certainly the case with most of the commenters on Sarah’s blog, the message is still a little bit wonky. What we are saying when we do this is that gay and transgendered people are different enough from what is normal to be placed into a flat two dimensional category which is relegated to the side and that one defining aspect is good enough for them.

It’s bad enough that we allow gender norms to dictate what is considered normal in our most superficial pursuits, but when we allow them to define an extremely diverse group of people as “others”, we are allowing them to dictate entire personalities. I wonder how any straight person who does not break gender norms in any way would feel if they were solely defined by one small factor of their personal identity. Let’s say, for instance, that Joe Blow is a straight male who likes to wear t-shirts. It would be wholly ridiculous if we looked at Joe over there and said “The fact that Joe wears T-shirts is the most important thing about him and dictates a variety of unrelated facts, therefore, when considering Joe, we need only consider his T-shirt.” Why then, do we do this to people who break gender norms? Are they suddenly not as complex and interesting as the rest of us? Or is it because somewhere, deep inside ourselves, we are terrified that we are not complex enough so we limit others as a defense? I suspect it is the latter, and that this mentality is exactly what is leading an entire country full of adults to go batshit insane over a 5 year old’s Halloween costume.

-Shannon

Those Disgusting Gay Pride Parades: A Response To Paladino

Admit it, you’re kinda intrigued but also put off by gay pride parades. Maybe ‘put off’ is too strong a term for you. Perhaps you’re, say, perplexed by them? Yes, perplexed – how’s that?

And, frankly, who wouldn’t be perplexed?

Gangs of overweight bull dykes cruising along on their blustering hogs? Rail-thin twinks dithering about wearing nothing but glitter and body paint? Big muscley dudes grinding each other to the drilling beat of unhappy-sounding techno music? And drag queens?! Drag queens everywhere! Ten-foot drag queens. 300-pound drag queens. Drag queens in leather, pleather, feathers, sequins, furs, nylons, raw meat, you name it.

It’s all so weird. Disgusting even.

And that’s the point.

Sort of.

My reaction to my first gay parade was probably not too dissimilar to most people’s. Who are these freakshows and why are they behaving so unseemly, so trashy, so utterly untoward? Just when I thought I had seen the “worst” of it, a whole new level of inappropriateness revealed itself in the flesh (and, my, were there lots of it). Needless to say the whole thing made me feel uncomfortable, confused, dirty. But, above all, it made me feel afraid.

Looking back the fear was innocent enough; some would say naïve even. I was coming to terms with my own sexuality then (still am); and witnessing those “extreme” representations of sexual expression only complicated the whole process. You see, like many others, I could only handle a little bit at a time in what I presumed to be the linear process of coming out. The reality, of course, is that nothing in life is truly linear, especially human sexuality. But linearity is, seemingly at least, safe and somewhat controllable. Even the notion of a ‘process’ can be very comforting.

This comfort, however, comes at a price – a price most gay people recognize early on, not only in spite of but also because of the torment, discrimination and hatefulness they’ve endured. It’s not unlike enlightenment attained through suffering.

And therein lies the paradox of gay pride parades.

Like any other procession (derived, of course, from the word ‘process’), there’s a natural beginning, middle and an end to a gay pride parade – in terms of both time and sequence. But that’s pretty much where the linearity desists. For the parade itself is meant to celebrate the OPPOSITE of linearity. What’s the opposite of linearity?, you may inquire. Well, it can be anything you want it to be – revolution (derived, of course, from the word ‘revolve’), centrality, randomness, chaos, nothingness, otherworldliness, whatever.

You see, those freakshows – with their props and their dancing and their nakedness – are merely acting as embodiments of the idea that nothing meaningful in life is so straightforward or predictable or right. Additionally, and equally importantly, instead of fearing complexity, randomness and unknowingness, the freakshows are in fact humbly, if not joyfully, acknowledging them.

In other words, they’re embracing their perplexity.

(often quite creatively)

When I write that I’m still coming to terms with my sexuality, I really mean it. I believe that, as humans, we are fated or wired to undertake the complexities of our sexuality no more or less so than any other core aspect of our being. Our essence, after all, isn’t something we are granted but rather something we continuously strive toward – openly, respectfully and non-linearly.

So the next time you come across a gay pride parade, whether on the streets or on TV, instead of gawking or judging, take a look at your own openness and humbleness, and be also proud – proud of your own perplexity. It’s what links you to everybody else, including those freakshows; who maybe don’t seem so freakish anymore.

-duardo