Beware the Common Enemy

What do Stalin, Saddam Hossein, and the Taliban all have in common? Each one, at one point in our history, was an ally of the US. It was not that these people were at one time fundamentally different in character than what we now know them to be, but it was that we shared a common enemy; with Stalin, it was Hitler; with Hossein it was Iran, and with the Taliban in Afghanistan, it was Russia. In the latter two cases, there was much more to it than just the common enemy. There were also issues of corporate greed, and the desire to control oil that was the underpinnings of the US economy that was dependent on the auto and housing industry. As Franklin Roosevelt said about a mid-20th century Nicaraguan ruthless dictator, "Somoza may be a son-of-a-bitch, but he's our son-of-a-bitch". (Note: there is some question about whether Roosevelt said this, but there is no doubt that he was a strong supporter of this corrupt, greed-driven dictator because he was against communism)

What does all this have to do with current events? Beyond international policy practices that still continue, this phenomenon of "my enemy's enemy is my friend" has reared its head in the healthcare debate as well. The "enemy", in this case, is Obama. For some, it is his policies, including a proposal for a single-payer option in healthcare. There is certainly room for debate here, as there are legitimate concerns about funding a program like this. (I personally have two concerns about the healthcare issue: the first is that we expect too much from healthcare, and the second is that government is an institution that is way too slow and bureaucratic to really get anything done, but I welcome the discussion).

For the fiscal conservatives who have legitimate concerns about either the financing of a program or merely have concerns about the role that government might play in healthcare (keeping in mind that Medicare, Medicaid, and the VA are already in place), having your issues heard is currently being drowned out by other "anti-Obama" allies who have more insidious motivations. Among the allies include a colllusion of: corporate greed folks, the Republican leadership that is looking for any opening to regain some power, a right-leaning media looking for viewership, and blatant racists who simply cannot believe that a black man is President. Here's how, to me, it seems to be playing out: The more corporate folks (Dick Armey, healthcare corporations, Fox News) whip people into an emotional frenzy that then comes out in the form of fear of communism, fascism, government killing old people, loss of gun rights. The racism gets thinly veiled by comments about the country being taken over by Muslims. The success of this movement is dependent on keeping people's fears heightened, and calling these fear "patriotism".

For the benefit of all of us, it would be great if we could all take a deep breath, relax, listen, and re-engage the frontal lobes. If we could open up dialog with real exploratory questions, and seek common solutions, we would all benefit. But for those who really have concerns about any government expansion in the role of healthcare, it is important to pull apart from those who are dependent on polarizing effect of "my enemy's enemy is my friend" approach. The blatant racists, partisans looking merely for power, and corporate greed folks are exploiting you for their personal agenda and care little for your real concerns. In fact, they don't want you to think. They just want you to be angry.

Pigs at the Trough

I just got back from a presentation at the DC Department of Health's AIDS Administration. Let me start by saying that all the people in the room were caring people who have their hearts in the right place, so this is not about them as individuals. This is, however, an absolute slamming of "AIDS, Inc." - an institution that has completely taken over and has no intention of going away.

Here's why: The presenters gave a lot of data about the sexual behavior of "msm" (men who have sex with men). What the data showed is that msm still make up the highest number of people contracting HIV and that sex and drugs impact behavior. There were lots of slides with numbers, statistics and terms - including one item that showed that 64% of respondents knew the HIV-status of their last sexual partner. The problem with this last issue - which I raised - was whether this information was reliable. The presenters said that it was a good thing that these people think it is, but I would actually say that it may not be good - it could be reinforcing the false sense of security that you could just tell if someone has HIV based on their word and how they look.

There were many other issues I had with the presentation (including the usual - what does any of this tell us that changes what we know? how does this help get people to get tested? How does this change the stigma? etc.). The fact is that this study only reinforces the stigma of HIV as a gay man's disease. But the real kicker is this: these presenters referred to this study as their "baby", that it's only three years old, and that they will be replicating it to two other high risk groups over the next 6 years (3 years each group), and then repeat as they fine-tune their data collection. Meanwhile, there were giggles and chuckles as they talked about the limitations of their work, how they defined msm, and how good they all feel about the data.

ARE YOU KIDDING ME?! We are talking about lives here. Where is the talk about stopping the spread of HIV NOW! Where is the concern that this is not a gay disease, a black disease, a women's disease, but a public health issue?

I did raise the question, with passion. It was heard, and I think registered. I also wonder, however, where is the community outrage?! These people are talking about multi-year studies that tell us what we already know (really, it seemed like what they were studying was a new methodology of epidemiological data collection rather than collection of useful data).

There was some talk about the high levels of support from among people ages 18-34 to make HIV-testing routine in doctor's offices. Two things about this (I mentioned both of these): this is the age group least likely to have a routine around medical care so it's less of a reality, and this is a group that is most amenable to testing, so let's get the tests to them. I made this impassioned plea: the community is ready to take action, to self-administer and make HIV-testing more portable. We either need people like these epidemiologists to help us make the case statistically, or to get out of the way so we can do it.

What is clear, based on all the meetings and conversations now at the highest levels of HIV-administration at both municipal/state (here in DC, sort of the same thing) and federal levels, is this: all people mean well and want well, but the bureaucrats are limited in their power, and the epidemiologists are calling the shots. Unfortunately the shots they are calling are for more studies. We know enough. We need the psychologists, social scientists, sociologists, theologians and artists to now step up and create more options. And, most importantly, the community voice and passion must be raised. This is the only way that change will really happen in any timely matter.