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PaperclipPerfector  10mo ago (text post)   37260 thread views

Culture War Roundup for the week of February 3, 2025

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Reuters: Health clinics grapple with US funding squeeze

It seems funding hasn't been fully restored and a lot of affected clinics don't have sufficient cash reserves:

Three community health centers near Richmond, Virginia, were forced to shut down after federal funds used to pay staff salaries remained inaccessible since last week, said Virginia Community Healthcare Association spokesperson Joe Stevens.

As of Friday, another nine centers across Virginia also could not access federal funds but continued to see patients by tapping into reserve funds.

"They will need money in the next week," said Stevens. "We don't know why some centers can access funds and some cannot."

In Virginia, community health centers provide medical, dental, behavioral health, pharmaceutical and substance use services for approximately 400,000 patients. For much of the state's rural areas, the centers are the only option for primary care, said Stevens.

One center that was still unable to access federal funds is in southwestern Virginia, where the next closest option for medical care is more than an hour's drive, he said. Most providers were able to access Medicaid and grant monies once the spending freeze was rescinded. However, some say they are still cut off from payments used for essential care, including medical, dental, prescription drugs and behavioral health.

And, of course, problems with transgender-serving clinics and federal grants for STI prevention and treatment:

Late last week, some healthcare centers that provide HIV prevention services and care for transgender patients received notices that grants issued by the U.S. Centers for Disease Control and Prevention would be terminated. The letters cited the Trump administration's orders on diversity and gender identity, according to three recipients of the notices.

A spokesperson for the U.S. Centers for Disease Control and Prevention referred questions about the grants to the Department of Health and Human Services.

St. John's Well Child and Family Center, a network of public health centers in South and Central Los Angeles, cannot access $746,000 remaining from a $1.6 million grant used to provide prevention, testing and treatment for about 500 transgender people at risk of HIV, sexually transmitted infections, tuberculosis and hepatitis C.

"We have made a decision not to cut back any programs because of any threats from the federal government," said St. John's President Jim Mangia.

St. John's has joined a lawsuit filed by California's attorney general contesting the funding cuts. Mangia says he will seek private funding to make up the loss.

The LGBT Life Center in Norfolk, Virginia, received a letter stating $6.3 million of the organization’s funding, or 48% of its annual budget, would be terminated, said spokesperson Corey Mohr. The center provides medication and monitoring to 400 patients with HIV.

I'm curious what the LGBT Life Center's grant was for, given that St. John's had 25% more patients. Maybe it was specific to HIV-positive patients and treatment is genuinely more expensive than prevention? But I had thought PrEP, PEP, and ART were the same medication at different doses, and that progression of HIV to AIDS is very uncommon, so that wouldn't make much sense.

St. John's Well Child and Family Center, a network of public health centers in South and Central Los Angeles, cannot access $746,000 remaining from a $1.6 million grant used to provide prevention, testing and treatment for about 500 transgender people at risk of HIV, sexually transmitted infections, tuberculosis and hepatitis C.

When I was younger, I had developed pretty libertine attitudes about human sexuality and I still mostly have the same gut feelings, but every now and then, I bump into things that make me think the conservatives have a point. This is roughly $3K per person for STI testing and treatment. Why? Why do these people insist on doing such consistently risky behavior that they need constant STI surveillance? Even being somewhat promiscuous doesn't result in constant infections, the behavior here really just has to be completely outside the range of anything that most people would consider normal. As you note, the other Life Center apparently spends about five times that much per capita, clocking in over $15K per person.

Making everyone else pay for egregiously bad behavior is just galling.

This stuff never stays confined to one community forever. In addition, the US medical system guarantees anyone access to healthcare (if they don’t pay for it, the state and/or all insurance users do), so you’ll be paying for much more expensive AIDS treatment in the long haul. If reducing promiscuity is the goal, cutting funding for PrEP seems like a poor place to start; gay men were highly promiscuous even at the height of the AIDS pandemic (that is in fact how it happened) and I doubt they will become less so today, when the disease is more easily treated and no longer a death sentence.

On the other hand, consequences removed also remove any incentive to stop doing stupid things. Maybe cutting funds to treat active disease is a bad idea, but I do think that much more of the burden for these kinds of lifestyle diseases (not just promiscuous sexual activity, but obesity, drug use, smoking, and high risk trill seeking) that add burdens to the public, and often not nearly as much for the person who brought the problems on themselves. If they were to see others like themselves forced to pay for treatment after a lifetime of risky behavior catches up to them, they’d likely take at least some warning. It’s much like what’s happened in the student loan crisis— more and more kids are choosing options other than college because they see how much trouble their older siblings and parents got themselves in by going to college without a solid plan. If we’d actually managed to forgive the loans, that would not happen. And I think the same might well work to a degree for lifestyle choices that cause disease or injury— if you had to spend yourself into poverty undoing the damage of I.e. obesity, then a lot of people would look at people having to do that because they couldn’t put down their forks and decide to download a weight-loss app and control their eating and exercise plan. If they see their future as “I’ll just get free ozempic at taxpayer expense when it gets bad enough,” tge lack of negative consequences give them no reason to avoid the problem or take positive steps to fix it.

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