Celebrating Diversity, Wondering about Equality

Earlier in the day, the Supreme Court had announced its decision paving the way for same gender marriage throughout the US. The energy of the happy-hour crowd was euphoric. Smile, hugs, "happy marriage day" messages. A definite day of significant progress. Among the crowd were men who clearly had lived through much of the long-struggle for gay rights mixed in with the young generation that will largely benefit from the struggle. I wondered how much the latter appreciated the work of the former or, as we see with the HIV/AIDS pandemic, how much of this will simply be taken for granted, just as my generation did not fully appreciate the struggles of the depression of my grandparents. Also among the crowd were some lonely figures, some of whom will no-doubt join the countless other people in the world - gay and straight - who can legally marry in wondering if and perhaps hoping for the "right one" to come along.  And, this being DC, no doubt many of the celebrants are among the rich and powerful - the already well-to-do.

As I left the noisy, celebratory scene and walked out onto the street, it was back to reality. Among this reality scene were many people who continue to live on the fringes of society - people who sleep on the streets, ask for donations, perhaps suffer from the neglect of a society that often seems to place greater value on acquisition of wants instead of helping meet each others' needs.  I don't say this with smugness. I, too partake in this to some extent. I think I do better every year, but I still have a long way to go.

This is why, to me, the ruling the day before basically keeping the Affordable Healthcare Act in tact, was more significant.  This was one of the few rulings in the past few years that addressed the biggest inequity that we continue to ignore - economic inequality (as did the Fair Housing ruling earlier in the week that was a reminder of how institutional our racist/classist policies still are). This was the program that Obama promised when he was running for President, and the one that he spent enormous political capital on when he knew he had it, and he has paid the price for since then in three House election cycles.  Now, the Supreme Court has solidified this, helping to ensure income inequality is less a factor in accessing healthcare.  Given other Supreme Court decisions removing voting rights and anti-discrimination protections that are routinely used against the poorest among us, this was huge.

So, while I absolutely celebrate and understand the significance of the marriage ruling, I cringe to think that the celebrations of this are deluding us from getting the real work done for justice. I cringe to think how many gays and lesbians will indulge in spending sprees on costly weddings and unneeded gifts, sending a message that "we have arrived", when the reality is we have a long way to go.

Missing from the Healthcare debate...

In the spring of 2011, I fell off my bike and broke my arm.  No cast was needed, but I did have x-rays taken 3 times and had 3 office visits to confirm that my arm was broken and was healing.  I would have been fine with just getting the information after the first or second session, since I was not getting any treatment such as a cast.  Instead, my insurance got billed for almost $2000.

In the spring of 2012, I was experiencing some shoulder pain when I worked out, especially doing a few exercises.  I went back to the same arm guy, had x-rays, was told I have tendinitis, and was sent to physical therapy for 12 sessions.  The majority of the sessions consisted of using exercise equipment, doing stretching exercises and putting a heating pad on.  I could have just as easily done these at home or at the gym.  Each of these sessions was billed to my insurance at about $90/pop, and my out-of-pocket expenses were roughly 50%.  This doesn't include the initial assessment.  I am supposed to go back to the arm doc for a follow-up, but I don't want to pay anymore or have my health insurance plan have to pay any more just to be told I'm good.  

Both of these are examples of what I consider to be an aspect of our broken and costly healthcare system that is ignored but is perhaps an area that we could all agree on: while we do need a safety net for covering the basics and the vitals, there is a strong element in the system that over-prescribes and exploits minor ailments in order to "feed the beast."  In this system, we the consumer are often not very informed about things, and blindly do what we are told.  I'm no exception.  I did just what the doctor ordered.  But here's how I would like it to have gone, and perhaps would like to see it go in the future: a frank discussion about the diagnosis, and then a more thorough look at options.  For example, I would have been fine with the initial doctor saying I have tendinitis, and getting a recommendation to meet with a physical therapist to learn about exercises and a bit more about tendinitis.  After that, it's up to me.  I'm in my 50's, am not a lefty (except when I eat).  I can live with tendinitis; I have had shin splints since high school, and have learned to accommodate.  I broke my knee, and have arthritis there, but still do ok.  I can handle this.  It was really not necessary to have the system milk me and my insurance.

This is one of the fundamental problems that I think also needs to be addressed, and I think that universal healthcare is one way to bring it forward.  There are others, but we don't seem to use them.  I did question some orders for blood tests from an MD once, stating I didn't want to pay for them since I wasn't really willing to do the treatment.  Drove him nuts, but I think we need to move to a serious conversation not just about comprehensive healthcare but also informed consumerism.  My priority is to get my HIV treatment.  Beyond that, I'll live with the aches and pains.  If I have something I need a diagnosis and perhaps some recommendations, I'd like that as well.  It's the unnecessary and costly visits that trouble me, but that's what you get when you have people whose livelihood is dependent on people having maladies.  I think that if we are to have a sustainable system, we need to become equal partners with our physicians and insurance companies, not just pegs moved around for financial gain.