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PaperclipPerfector  6mo ago (text post)   36458 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 Most providers were able to access Medicaid and grant monies once the spending freeze was rescinded.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.

I am open to the idea that this is actually the best policy given a number of realistic political constraints. This does not move me to find it less galling that I'm stuck paying for people to live degenerate lifestyles. Avoiding HIV is absolutely trivial, but the "community" in question apparently insists on spreading HIV.

I do not like subsidizing homosexuality, or promiscuity more broadly. But how far does this go? I'm pretty happy with a policy of 'you choose not to be monogamous, you're going to get STD's on your own head be it. No public funding for testing, treatment, or prevention. Medical providers aren't obligated to give STD treatment.' To be clear, I wouldn't oppose sodomy laws either.

There are quite a number of conservatives who halfway do it. Letting people die from preventable STD's when they choose not to prevent them by sane and reasonable sexual behavior is beyond the overton window.

Okay, but are we also going to stop subsidizing treatment for smokers with lung cancer, alcoholics with cirrhosis, and fat people with ... everything?

Yes.chad is an argument I'll accept (though not agree with). But if you start finely parsing which people should be let die for their moral failures, then you're just making disgust-based judgments. There is much more of a public health argument to be made for treating STDs. (The health problems of smokers, drunks, and fatties generally do not impact other people directly.)

(That said, yeah, I also find it galling to pay for treatment for people who have preventable catastrophic health bills.)

Weren't smokers a net cost savings as they died younger and quicker before their medical costs really started escalating in old age?

Smokers and drinkers are also taxed heavily on their vice to discourage consumption and reimburse the state. Are the degenerates and sexual devients paying some sort degeneracy tax? I think their 'tax' had been shame and exclusion from 'polite society' but those taxs were repealed.

I'd like to tax sugar and HFCS to dissuade the fatties and recover some revenue for their care.

What really needs to be taxed is clearly "healthy lifestyles" that allow people to reliably live to 80+.

Free cigarettes at 50?

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Presumably the difference would be that the state invests a lot of effort in disincentivising smoking, alcoholism, and obesity. All of those are understood to be important public health issues and the state does what it can to discourage them. There aren't anti-promiscuity campaigns on the same order as anti-smoking campaigns.

One might argue that there are state sexual health campaigns, so safe sex is analogous to moderate drinking, if that counts?

There is much more of a public health argument to be made for treating STDs. (The health problems of smokers, drunks, and fatties generally do not impact other people directly.)

If we wanted to do it only for public health reasons, we could add some sort of punishment high enough that the recipients arent better off, that would eliminate the fairness concerns.

are we also going to stop subsidizing treatment for smokers

The writers of Obamacare were willing to explicitly call out and allow higher insurance premiums for smokers, so to some extent we're already there. I have to solemnly swear I don't use any tobacco products annually at open enrollment, which is easy for me as I never have used. It's politically, but not practically, inconceivable to similarly have to swear I'm not an IV drug user or particularly promiscuous.

On that note I've long wondered whether nicotine pouches are classified as tobacco products.

As I recall they are pretty specific there -- I think something like 5-10 cigars per year was still considered "non-smoker" for life insurance purposes, last I renewed.

Not sure their stance on pouches and vapes nowadays -- but I've heard that the main purpose of the blood/urine test that life insurance providers (sometimes?) do is checking for nicotine so people can't just lie about smoking, so I could imagine some issues there. (do they do tests for health insurance in the US? if not, "non-smoker" is accurate, and there's no tobacco in Zyn, so even "no tobacco products" seems defensible)

Paying for preventable catastrophic health bills because of stupid behavior is one thing. Yes, there's some moral hazard in giving a skydiver the same life insurance rate as everyone else, but insurance companies actually look at the risks and decide it's only worth charging more if you're an instructor or other high jump-count enthusiast. And the risk of base jumping will make your insurer laugh in your widow's face if she tries to collect.

But what's worse is the skydiver asking his life insurance to pay for his parachute and training on the theory that him dying by jumping without a parachute would cost them more money. This is the prep situation.
And what's even worse than that is the government forcing the insurer to pay for this (and raise costs on everyone else) because the national skydiving federation somehow became a powerful lobby that dictates government policy.

The sane solution, like we use for skydivers irl, is making paying for prep out of pocket a condition of obtaining health insurance at a base rate, just like not smoking or buying your own parachute before jumping.
If they don't, their insurance is void and we saddle them with non-dischargeable medical debt in exchange for their treatment (or we charge city gays with 6-7 figure incomes an actuarially fair rate for their coverage)

And if people can't deal with this, the only answer is "right, first we eliminate the influence of the national skydiving federation and fire any bureaucrat who had dealings with them. As well as any agency who gave federal grants to the "Chutes Over Chicago 501c" that seems creepily obsessed with holding skydiver storytimes at local kindergartens

But what's worse is the skydiver asking his life insurance to pay for his parachute and training on the theory that him dying by jumping without a parachute would cost them more money.

Isn't that how kidnapping insurance works?

It's not a matter of life insurance rates, when a motorcyclist riding a crotch rocket smashes into a bridge, the ER docs will stitch him back together. When an associate in inner city crime gets shot in the stomach, the same ER is gonna pull the bullet out and patch him up.

It goes well beyond the world of insurance. And it's long past the point of arguing that we should leave the uninsured victims of motorbike crashes to die on the side of the road.

I don't think you read the post, specifically the end of paragraph 3.

Yes.chad.

Put people on those Christian healthsharing plans that are allowed to just not cover things they think come from unChristian behavior. These exist and have enough people on them to stay in business; clearly it's doable.

Now obviously I have a much stronger objection to paying for prep than I do for dialysis; I just said sodomy should be punishable by law. But, you know, it's pretty reasonable to tell type II diabetics that they have to pay for their own treatment until they can lose weight.

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