#unaffordable insurance

[willinglyghoulified]

"This is why I'm about to quit my job."

-a Neurodivergent's Shpeil; a story and takeaway under cut

What is happening in my head: Why is he just standing there in the middle of the isle? Does he not know that he's in the way? I have to get to the next shelf, but I don't want to ask him to move, I've already asked like six times, and he's bumped into me twice. I just have to get past him somehow, then I'll be able to get the last few items I need and finish up this 712-piece order.

What actually happens: I said excuse me again, and he didn't hear me because he was talking to someone about which is better: pizza rolls or "chickie nuggies."

What happens in my head next: OH MY GOD HE IS SUCH A NUISANCE I ABSOLUTELY HATE HIM DOESN'T HE KNOW THAT HE'S A BURDEN IN THE WORKPLACE AND PEOPLE HATE IT WHEN HE SINGS PASSIONATELY TO EVERY FUCKING SONG THAT PLAYS ON THE SPEAKERS AND HE'S SLOW AND SHOWS NO REGARD FOR THE PEOPLE AROUND HIM AND WHY THE FUCK DOES HE STAND THERE SPREAD-EAGLE WHERE NO ONE CAN GET PAST HIM AND FOR FUCK'S SAKE I HATE HIS NAME TOO SOMEONE SHOULD HAVE NAMED HIM CHAD: LORD OF THE SHITHEADS BECAUSE GODDAMN AND OUR FLOOR LEAD IS JUST GOING TO TELL ME TO PICK UP HIS SLACK AND TAKE HIS CART AND FINISH IT BECAUSE HE'S TOO SLOW.

What actually happens next: I said excuse me yet again, and he heard me this time. I asked him if I could go around him, my heart beating out of my chest. He said sure, and I whipped my cart -- which is as long as a fucking countertop and about two hundred pounds at this point -- past him at high speed which probably isn't the safest choice.

The rest of the day: I stay pissed off all day, hating everyone around me, not speaking to anyone, and they all are looking at me like "goddamn I don't want to get in that bitch's way, she looks extremely unpleasant." My manager checks on me, asks me if I'm okay, and I can't explain anything to where he'll understand, so I fake a smile and say "yeah why? I'm fine. Don't worry about it, I'm just tired. Thanks for checking on me." I take out my frustration on my husband when he asks me if I want something to eat on the way home and I tell him I literally can't think straight and just want to go home and not to ask me anything again that requires making a decision or other long thought processes. My husband's in a shit mood now because he got his head bitten off by an overstimulated wife that just wants to wrap herself in a blanket and disappear from the world.

The takeaway: I don't know how many neurodivergents struggle with this particular symptom, but I'm extremely irritable around people. I want to be left alone. Being too close to too many people I don't like or hardly know causes me physical discomfort. I'm in literal mental anguish when I have to engage in conversation that I don't care for. I'm exhausted to think of meaningful responses when people talk to me. I even have a hard time responding to emails, texts, or chats, and I have a heart attack when I get a phone call. My mom has to make my doctor's appointments for me just so I don't have to get on the phone. And yet I stay working where I work because I'm terrified that I won't find anything else that pays me this much or suits my needs. I'm not disabled, and it would be extremely difficult to get disability in the US for stuff like this. So I continue to work in places I don't like, I continue to suffer around people I don't want to be around, and I continue to feel like there's something horribly wrong with me that no one else seems to have a problem with. It's just me. In my mind, I'm just messed up. I'm unlikable. I'm overlooked. I don't matter. And if I fail at this job like I've failed at all the others, I'm worthless, too. And I can't afford to fail again.

[vanity-complex]

.

[moderndaypandora]

jenny moves to london* and gets to find out how fucking expensive it is, even with the insurance from her butcher shop blowing up. she lands a job as a bartender in a pub because she does have customer service experience, and her willingness to intimidate belligerent drunks with a meat cleaver makes up for her generally abrasive personality.

"i thought americans are supposed to be smiley?" you thought wrong, motherfuckers, now order or leave.

she gets away with it because the pub owner seems to find her funny and said he has a soft spot for socially inept goths, they remind him of his boyfriend. pub owner's only his side gig, anyway. he's a professor or something at a local university. he's nice enough to drink with sometimes, and he's the most average guy she's ever met, outside of his name. what the fuck kind of nickname is hob, anyway? whatever. all that matters to jenny is he has zero contact with the paranormal at all, he's not interested in her romantically, and she can pay for her life in london**.

*with what visa? doesn't matter. that's a problem for show writers to actually solve or conveniently ignore in season 2. for the sake of excusing it in my own brain, she qualifies for a uk ancestry visa due to a single grandparent coming from the uk (gi bride in wwii?) and birthing one of her parents in a commonwealth country (canada) before the entire family emigrated to port townsend. **mostly. crystal's parents are unknowingly funding a 2-bedroom flat in north london only a 10 minute bus ride from the finsbury park station on the picadilly line. jenny would love to pretend she's too proud to let an infant pay her rent, but she doesn't lie to herself and london is almost unaffordable.

[allthecanadianpolitics]

A new study has revealed the worst place in Canada to buy a home, and it might surprise you. MetroVancouverHomeSource.com looked at each province's average house price and median annual income to determine its rankings. While British Columbia's housing market makes headlines over and over again for its unaffordability, it's actually Ontario that took the not-so-coveted prize with a score of 20.97 out of 100. "The average house price in the province is a staggering $931,870, while the median annual income is $41,690. Ontario also has high living costs, with high childcare, food, and household maintenance costs. However, the province has the lowest healthcare costs of all ten provinces," the report found. Apparently, BC placed a bit better for the chance of buying a home due to having "the lowest mortgage insurance premiums on average."  But the average cost of a home in 2023 is higher than in Ontario — a jump compared to 2022 and remains more than double what it would cost in Alberta.

Continue Reading.

Tagging: @politicsofcanada

[irradiatedpiratebooty]

Yall I hate making personal posts like this. Genuinely. I try to keep my personal real life away from social media. But christ I'm struggling here.

I have really severe ADHD. I cannot work or function or do anything without my medication. I physically can't. But right now my medication is completely unaffordable for me.

I've been applying everywhere I can, but I live in a college town so the competition really fucks me over. I mean, which would they rather pick, a competent college student, or an adhd/autistic dropout who never learned how to mask properly?

And recently, I got dropped off my insurance plan. And thanks to me being unable to work decent jobs, I haven't earned enough to file enough taxes to qualify for affordable Healthcare. The only Healthcare I legally qualify for is a Healthcare that's $300 a month when I'm living off pocket change.

I really hate to ask, I do, especially since right now I'm without my medications so I can't get many things done, if at all, but if anyone is willing to help me out, I'm doing $5 doodle commissions. I'll work down the queue as best I can, it'll be slow but I'll do my best.

Link to my Ko-fi for assistance is below. I appreciate the help. Currently I can get a one month prescription of my medications for $45. So I'll be able to get it relatively soon but I need to save up so I can afford it each month.

If you're not able to assist that way, any advice on how to afford medications (I already use GoodRX) or any suggestions on jobs, would be greatly appreciated too.

[furryprovocateur]

i love how any time we complain about housing pricing being too high or health insurance being unaffordable it's all like "you arent personal responsibilitying hard enough" but then when an article comes out like The Millennials Are Killing the Napkin Industry the comments are full of people being like "do these kids even know how to have fun? we used to have napkin parties all the time" and "well there goes the fucking weekend. 20 year olds just ruined this saturday's napkin party"

[tallulah477]

𝓘 𝓢𝕖𝕖 𝓨𝕖𝕝𝕝𝕠𝕨

Colors of Pandora Day 3: Yellow

Pairing: None (Reader Centric - Although, I do picture a WLW relationship towards the end)

Warnings: Mentions of the death of a parent, Slight grief/morning/loss, Other than that the rest is happy fluff

Word Count: 1.5K

Despite the multitude of otherworldly colors that Pandora has to offer, the moment you step on the alien moon - all you see is yellow.

The sun shines brightly in the sky, warm rays gleaming over the wide expanse of dense forest as far as the eye can see. And even though you’re first seeing this while on base - the disgusting man-made structures of steel and the whirling of machines can’t dissuade you from the excitement you feel now.

Yellow is the color of your hope.

Earth is dying, along with everything you’ve ever cared about with it. Your research has always kept you busy and the friends you had in your youth found lives of their own. It’s hard enough to keep up with relationships while struggling through adulthood, and you were always so busy anyway that most of those who were willing to reach out eventually gave up on trying. Your momma was the only friend you ever really needed anyway. Someone loyal who loved you unconditionally and who you knew would always be there for you.

The research on Pandora has found incredible breakthroughs for the medical industry. Tiny yellow glass vials that could fix everything. New serums for cancer cures and even an elixir to stop human aging - the opportunity to be healthy and live forever with those you love.

But they’re expensive. Unaffordable for someone like you, and your momma’s insurance is a huge joke.

She’s not on Earth anymore, so you don’t want to be either.

But it’s in moments of despair that you need hope. She wouldn’t want you to wallow in your grief, stricken by the pain you feel at her absence and terrified at the thought of actually being completely and utterly alone. Yellow can be cruel - fearful and cowardly, anxious beyond measure.

You refuse to think about it like that. Yellow was her favorite color. Her with her pretty yellow dresses and excessive sunflower decorations that always made the tiny and cramped apartment you both could barely afford feel more like a home than any other space. You wanted to take it all with you as you packed for the interstellar trip, but the most important thing you could bring yourself to actually pack was the small, frilly yellow flower clip she always had pinned in her hair.

It sat safely clipped on your tank top strap as you lowered yourself in for your cryosleep, letting it be the symbol you intend it to be. When you close your eyes, you believe you can feel your momma’s loving and protective hold wrapping around you - and you think you can even see the faintest hint of a soft yellow aura behind your closed eyelids.

Your momma always thought the color yellow was beautiful - radiating of love and joyfulness, a necessity in an otherwise dull and dying world. She saw the beauty in it, and now so do you.

You don’t approve of what the RDA is doing. Their destruction and carelessness for the place the Na’vi and the wildlife call home is deplorable at best. The same cycle of Earth repeating here.

It’s the negative of yellow again. A darker yellow, a more irritating shade maybe - one that begs caution when dealing with the devious and heartless people that surround you now, but still the same color you hold dear to your heart.

But they’ve offered you a chance for a new life. A new body built for the rougher terrain and the freedom to use it to further your research. It’s for them, you know that. But you feel like it's for you more.

Yellow is the color of your happiness as you walk through the Pandoran forest. Your new body moves effortlessly through the foliage, confident steps that take you across the mossy surfaces that your human feet would probably slip on if you even tried to cross. The sun in the sky is bright - too brilliant a yellow to even look up at for too long. But its rays feel amazing on your body, skin soaking up the heat as you stretch out like a cat along the soft ground of the found meadow.

The water along the meadow’s edge is blue, clean and inviting in a way the water on Earth could never be anymore. But when you hover over it and gaze into the reflection staring back at you, you see yellow. You’ve never liked your eyes before, never thought they were anything special. But they look so striking now, like twin pools of swirling honey.

You’ve always thought that happiness was dependent on the external. Good environment, good circumstances. Happiness is yellow in the same way that joy is yellow. Similar in shade and even closer in their meaning, but still so different in the end.

If happiness is yellow, bright and vibrant and soul-changing as it washes over you, enveloping you in its warm embrace and soaking into your skin, then joy is yellow too - soft and playful, almost child-like as it wells in your heart, growing and growing until it’s uncontainable and it shoots out from your being and into the world for all to see. An internal feeling that only you can manifest - a color only you can create and share with the world.

When you meet her, you know she’s going to bring you both.

She’s stealthy, a true predator, especially considering you’re not and you most definitely shouldn’t be out without protection. The gun slung across your back is useful in theory, and you’ve been trained on how to fire it acceptably, but you’re not sure if the time ever actually came time to use it if you actually could. You think it would be okay - to die at the hands of an alien animal or one of the natives. Pandora has already given you more than you could have ever hoped for after your mother passed and you think that if things ended right now, it would have all been worth it.

She could have ended it. Who knows how long she was watching you - up in the trees or hidden in the tall foliage, an arrow dipped in neurotoxins meant to kill you in less than one minute flat if the arrow itself doesn’t do the job first pointed straight at your heart.

But she didn’t.

Yellow is the color of your curiosity. The question of ‘why’ is a repeating mantra in your head because when she finally does reveal herself to you, it's like she already knows you. She’s not afraid, even smiles at your wide eyed stare - her own eyes like sparkling suns.

It’s the color of her own curiosity too.

“I watched you,” she says. “I learned. Now you watch too.”

You watch as she extends her arm out towards a nearby bush, fingers just brushing against the leaves before something explodes out of it. A gecko-like creature bursts from its hiding spot, jumping up and unfurling into a circular glowing fan as it flies up in the air. A startled laugh slips from you in amazement as a few others pop out as well, circling up overhead in a display that almost looks magical. The glow coming from the creatures is tinted yellow, and while your eyes are on them, her eyes are on you.

You see yellow in the ways she treats you. For the first time in a long time, you have a friend. A friend who cares about you, who wants to be around you. Someone who’s not your momma, but who gives off the same energetic vibe as she did.

She shows you her world and how to see it not just through your own eyes in a constant state of wonder, but through hers. Yellow is the color of your new found appreciation for the place you now call home. She guides you through it, introducing you to all that Pandora has to offer and teaching you all you can do to give back to it in return. You see yellow in the energy around you - yellow in the animals and in the dirt.

In her.

When in this body, the little yellow flower clip usually sits pinned to the waistband of your pants or tucked safely in your hair on your sleeping human form back at the lab. You want it with you always, but you can’t bear the thought of losing it somewhere out in the alien environment where you might never be able to find it again.

It’s a big thing, to not have it on your human body right now. It’s not with your Avatar body either. Or rather, not on it.

Instead, it’s clipped beautifully at the end of her songcord. It’s bigger than the rest of the beads and jewels she’s used to weave it, but it makes your heart sing to see it kept there so proudly. You know she’ll keep it safe for you.

When she catches you looking at it again, her smile is blinding. And when she steps closer to wrap her arms around you, holding you close - all you feel is yellow.

**Special thanks to @xylianasblog for the prompt!

[donnieisaprettyboy]

just so you guys know how fucked up US healthcare is

I’ve been off my antidepressants for months because it was about $150 to get a 3 month refill. anti anxiety was the same. $300 for meds I need; I’m a full time student with a part time job. $300 is an entire paycheck for me. This $300 is AFTER insurance.

So what do you do if you can’t afford meds in America? Three options, honestly:

1. You don’t get your meds

2. Don’t use insurance and have the pharmacist use GoodRX

3. See if your meds are available through mark cuban‘s online pharmacy.

For my non-Americans out there, let me explain what GoodRX is

Plenty of medical providers keep GoodRX cards at the reception desk. How does it work? Hell if I know. But if you tell the pharmacist “don’t use my insurance, use my GoodRX card instead,” they do it. and 9 times out of 10 it’s cheaper. and literally all you have to do is show them a piece of cardboard. no signup, no paying to join, nothing. it’s essentially just a reusable coupon you can use instead of insurance.

For me, tho, GoodRX only brought my meds down to being about $200 total. Still unaffordable.

Again, for my non-Americans, you may be wondering what the hell the mark cuban online pharmacy is.

Billionaire Mark Cuban created an online pharmacy that provides some very common medications for a MUCH lower price than literally anywhere else in the US.

It’s a little bit of a pain to get started, but when you do it gets mailed to your door. They take insurance, but currently they don’t take mine.

Want to know how much my meds (which, btw, went from 2 medications to 3, one of which increased dosage) cost on mark cuban’s website?

For a 60 day supply, after tax, and after paying $15 for expedited shipping, it was about $35.

Thirty. Five. Dollars.

Why the FUCK were my meds EVER over $300 when I can get them shipped to me for LESS THAN $40.

(just to break down the costs a bit more, that’s (including cost for shipping) ~$0.15 per pill online (one of my meds is twice daily) vs ~$0.90 per pill from my pharmacy with insurance, and it wasn’t even all my meds. )

[eros-sinclair]

OK I HAVE A CONCEPT!

okokokok so

bear with me i know this is going to be stupid as FUCK but just b e a r w i t h m e

Archangels and Demon lords are forced to play D&D together.

And the Nephalem is the DM running the whole thing, and its set in a semi modern world where their characters have to deal with shit like "they just got in a fight and now cant go to the hospital because they dont have insurance" and shit like that.

They are all forced to work together as a team to fight against a corrupt politician or something, but they are also dealing with weird modern problems like learning how to send an email or hotwire a fucking car.

here are some quotes from the initial conversation

"Ok Belial, roll Deception" "HA i have such a high modifier i couldnt possi-" "What did you get?" "… nat 1"

"You can't buy that, Diablo. You don't have any coin." "How do I get coin?" "Get a job, mate." "Like what?" "Idk, barista?"

"how do I send this message?" "you can try email, letters.." "what is email I want to do that one" "alright you spy a computer next to you" "I shove the message into the artifact" "you…. what?"

"I run up in front and block the attack" "Did… you just save me, Asmodan?" "Shut up, Tyreal"

"Tyrael you are our only healer and healthcare is unaffordable. if you die we are all fucked." "glad to see you care… kind of"

some other things:

Diablo's character would 100% die first and he would be mega salt about it, he always plays a Teifling (bc he wants to keep the horns)

Tyrael would play a Cleric, who the party relies on for healing bc none of their characters have Insurance to pay for hospital visits.

At the beginning of the campaign the DM has angels and demons on opposite sides of the table but by the end they are all mixed up and sitting together. He knows he did a good job when they beat a hard encounter and they all cheer and some of them even hug or highfive.

they're having a lot of fun but would never admit it outside of sessions.

And I did of course draw this.

in this senario half the party is fighting a mutant rat while the other is trying to figure out how to hotwire a car so they can run it over.

[blackwoolncrown]

Yeah I put this in the tags but it bears focus-

I’m no professional on the matter so I can only wager a guess but a huge amount of the population of the US is in a Slow Death situation.

We don’t have accessable health insurance, a pandemic is raging. Hospital costs are completely unaffordable if you do get sick. Jobs are hardly hiring and none of them are paying wages that can compete with the ever-rising cost of living, not to mention the astronomical and impossible rent prices (the fact that a majority of us cannot afford to buy a home but homes are being bought by bank bots notwithstanding).

Literally, for example, one of the things that drove me out was that there was nowhere I could move. ‘Downsizing’ just isn’t a thing. All the prices are high regardless of how reasonable it is for the size and in the meantime most work fields just cannot provide a living wage....

Much less the ability to save money...which is what ppl would need in case any unfortunate event came along (in a pandemic).

Meanwhile what’s actually happening is like global water levels- a creeping rise in costs and lack of support meaning every day everything is costing more and you’re making less and draining your savings and your energy trying to keep up but no help is in sight bc it’s year 3- almost 4- of this.

I don’t mean to be a downer but that’s literally what’s happening in the US rn. t’s a slow bleed, frog-in-hot-water situation. It’s bad. Everyone I know back home is shacking up w each other just to afford rent and food and these ppl are making good money. It doesn’t matter.

Despite working 3-4 businesses non stop basically all day every day I couldn’t afford to stay and couldn’t afford to leave either without crowdfunding- but I made the bid to go bc I literally could not see a livable future there and literally every mmonth it got more expensive. Literally my body could not produce enough money to keep up and afford just staying alive in the US.

It’s suffocation.

Capitalism is beyond late stage. It feels darker than that rn, at least in the US.

[thequeenofsastiel]

If you have healthcare through the Affordable Care Act(ACA), AKA Obamacare, appreciate it now because Republicans are going to repeal it the second they get into power. You think healthcare is unaffordable now? Just wait. And I promise, even if they replace it with something else, it'll probably be just as if not more expensive than the ACA, and will likely cover fewer things. I'll be astonished if the part about covering pre-existing conditions is in their version(meaning that insurance companies aren't allowed to refuse to pay for care for illnesses that you already have when you start getting insured by them). And again, that's assuming they bother to replace it with anything at all, something that is by no means guaranteed.

Like I said, it's about to get bad.

[meret118]

The price of new cars has grown so much that they’re practically unaffordable for middle-class consumers now, and these rising costs hit low-income people even harder. It’s particularly difficult because for many, a car is often an essential means of keeping a good job.

So they’re stuck with a kind of Catch-22: They can’t live with the rising costs of car ownership, but they can’t live without them, either. And their rates are already likely to be higher if they have poor credit or live in a high-crime neighborhood. “The people least able to afford it are paying the highest amount,” said the industry insider.

[millenniallust4death]

The staggering cost of life-saving drugs is a topic that I am invested in. I'm going to gift the New York Times article to remove the paywall. A drug Martin was on is mentioned in the article for its sharp increase in price. You don't have a lot of options when you have an aggressive blood cancer so you hemorrhage money to pay. One reason I fundraise for Myeloma Canada is their lobby work to add drugs to formulary lists - you want your drug on the list or insurance companies refuse to pay. Finally, you should care about proposed changes to patent laws in your country because drug companies are really working hard to extend the life of patents beyond 20 years. Extended patents mean no affordable generics.

Unfortunately, I know that all of my mutuals are going to be affected by the unaffordable cost of prescription medications sooner than they think. I don't care where you live. Yes, even in Canada. You should vote like your life depends on it.

[religion-is-a-mental-illness]

By Jennifer Block

Published: Nov 7, 2023

In August, a Missouri law went into effect that limits gender treatment for minors to counseling. Such laws, which have passed in 22 states to date, can be particularly cruel. Minors already on puberty-suppressing drugs or cross-sex hormones are being effectively cut off. Trans adults on Medicaid who’ve been taking hormones for years may find their prescriptions are suddenly unaffordable. And often these laws are tied to overt acts of culture war — like a ban on drag shows in Tennessee.

This wave of legislation is unfortunate for another reason. A lot of fair-minded, thoughtful people may question whether hormones and surgery are appropriate for the growing number of young people who are distressed about their biological sex. But given all the campaigns in red states, many progressives are instead biting their tongues and trusting that doctors know what they’re doing.

The problem is that as more kids identify as transgender than ever before, it’s still worth asking whether “gender affirming care” is the right model for them. Despite the certainty advocates project that this is an open-and-shut case, it wasn’t long ago that this “affirming” approach for children was simply an idea — a hypothesis informed by experience, but an idea nonetheless. Yet in less than a decade, it became standard of care and is now practically gospel in the United States, even as other countries are redirecting services toward psychotherapy and social support.

A natural response on the left to bills restricting or even outlawing gender-related medical treatment is “keep your laws off my body.” As a vocal supporter of abortion access, I’m sympathetic. But it’s a mistake to conflate these two causes. Abortion is a thoroughly vetted, one-time procedure, and denying access to it reduces a woman to an incubator. That’s quite different from a relatively new hormonal protocol in children that can lead to major, irreversible, long-term impacts.

The practice of medicine doesn’t have perfect checks and balances, but it does have a history of proving itself wrong (for the latest episode, see: cold medicine). So when a new approach for children and adolescents involves powerful medications and surgeries, people aren’t necessarily misguided (or “anti-trans”) to voice concerns. Yet journalists, parents, researchers, and clinicians who have raised questions about the evidence have been ensnared in a conversation about identity and rights. Now it seems all we can hear are the loudest and most reactionary voices, echoing in statehouse rotundas.

Loaded terms

For as long as gender roles have existed, there have been people whose inner compass, even at an early age, felt unaligned with their bodies. What’s new today is the ability to medically address that mismatch in adolescence, before puberty has fully had its say.

And since about 2016, the number of young people receiving what are called “puberty blockers” — drugs that suppress the signal to the pituitary to release the hormones that transform tweens into sexually mature adults — has grown. An analysis by health technology company Komodo found that the number of kids between the ages of 6 and 17 in the United States who began suppressing puberty to treat gender-related distress rose every year between 2017 and 2021 and leveled off in 2022. Komodo counted more than 6,000 children in that category in that time span, although that number is likely an undercount because it only represents treatments covered by insurance. Massachusetts is among the top five states, generating 6 percent of claims.

At least 14,700 minors with a gender dysphoria diagnosis began taking prescription estrogen or testosterone from 2017 through 2021, according to Komodo’s analysis — especially testosterone, as female-born teens now outnumber males 3 to 1 in many clinics. And a recent study found that gender-related surgeries, such as breast removal, nearly tripled between 2016 and 2019, including among 12- to 18-year-olds.

Meanwhile, European countries, including those that pioneered early intervention for children with gender dysphoria, have generally limited gender-related surgery to adults.

“Puberty blockers,” “hormone therapy,” and “top surgery” fall under the umbrella of “gender-affirming care.” These are loaded terms, fraught with as much activism and obfuscation as “pro-choice” and “pro-life,” yet they were validated by medical sources like the 2018 American Academy of Pediatrics (AAP) statement in support of the “gender affirmative care model.”

This document informs clinicians that “many medical interventions can be offered to youth who identify as transgender and gender diverse,” including drugs that suppress pubertal development, cross-sex hormones, and, “on a case-by-case basis,” surgeries. These kids, even before puberty, “know their gender as clearly and as consistently as their developmentally equivalent [cisgender] peers,” the statement says. An approach of “watchful waiting” to see how a young patient’s identity develops is “outdated” and “does not serve the child because critical support is withheld.”

The statement presented the affirmative approach as settled consensus based on evidence. However this past August the AAP — under pressure by several members — announced that it would commission an independent systematic review of the evidence. That’s typically the first step in developing what the National Academy of Medicine calls “trustworthy guidelines,” so that patients and providers can make decisions informed by a thorough, unbiased evaluation of the available research. But the AAP hadn’t done that before releasing its 2018 statement. The AAP did not respond to requests for comment other than to reaffirm its 2018 statement.

Existing systematic reviews have prompted Sweden, Finland, and England to restrict treatments for minors, because the evidence that they are likely to result in more benefit than harm is of low quality. But unlike US states that have taken legislative action, these countries are allowing hormonal treatment in select cases, and they are ensuring that researchers follow the recipients over time so the evidence base gets stronger.

The case for watchful waiting

Not only do red-state gender laws tend to lack the humanity and room for inquiry seen in Europe, I think they also distract progressives from fully absorbing what the people they’re marching with are actually chanting. The argument for early treatment is not just a medical one — it is a metaphysical one. It holds that gender identity is something that exists deep inside a person’s psyche and that this diagnosis, essentially, will be revealed to the clinician, even by young children. That is a radical interpretation of patient-centered care.

When I spoke with the AAP statement’s lead author, Jason Rafferty, a child and adolescent psychiatrist in Providence, he reiterated that this model of care is fundamentally about “affirming and validating the child’s sense of identity from day one through to the end.” Its main principle is that when a patient says, “‘I’m X,’ we operate under the assumption that what they’re telling us is their truth, that the child’s sense of reality and feeling of who they are is the navigational beacon to sort of orient treatment around.”

Joshua Safer, director of the Mt. Sinai Center for Transgender Medicine and Surgery and a coauthor of the Endocrine Society’s practice guideline — another influential document — told me, “I know that kids who are talking that way when they are 9 years old are overwhelmingly consistent in their thought processes,” and thus, giving such patients puberty blockers “would save them from surgery” down the road.

But when I spoke to the Dutch clinician and researcher Thomas Steensma — who joined the team that pioneered the early treatment model that migrated to the United States — he distanced himself and his colleagues’ practice from the current American iteration. In brief, he said, “That’s not our approach.”

In the Dutch clinics, he said, young patients undergo a “long, focused” process of assessment, and even social transition is not a given. “It’s not necessarily true that a child who feels gender dysphoria or incongruence will grow up with [those feelings],” he explained. “Our approach is to make developmentally informed decisions with the child, with the family,” and through counseling to explore what might help. “Identity is not the strongest force in providing medical treatment” because it becomes more fixed during puberty. “It’s common sense,” he said, that the brain matures with the body, and that one gains greater capacity to “reflect on your body and about your identity.”

In 2016 — while the AAP statement was being drafted and reviewed — Steensma coauthored a review of 10 studies of gender-incongruent and dysphoric youth. Among 317 kids, 85 percent resolved their identity distress “around or after” puberty. The review also found that most dysphoric kids turned out to be same-sex attracted, lending credence to the concern that enthusiastically affirming kids may mean “transing away the gay.” The article made clear that “there is currently no general consensus about the best approach to dealing with the (uncertain) future development of children with gender dysphoria,” even social transition. In its 2015 guidelines, the American Psychological Association also said there was no consensus.

Steensma’s article explains that, in the model of “watchful waiting” — what the AAP derided in its 2018 statement — children are neither discouraged from nonconforming behaviors nor counseled to accept their natal sex (denounced by critics as “reparative” or “conversion” therapy, historically the term used to describe the widely condemned practice of trying to “convert” same-sex attracted adults). Rather, families are encouraged to allow their child to explore their feelings and given counseling “to bear the uncertainty of the child’s psychosexual outcome.” There’s an effort to “find a balance between an accepting and supportive attitude toward gender dysphoria while at the same time protecting the child against any negative reactions and remaining realistic about the chance that [dysphoric] feelings may desist in the future,” wrote the authors.

This is different from what has become the dominant approach in the United States, in which children’s sense of identity is supposed to be accepted as true and real by care providers and medically treated accordingly. Not affirming, by this interpretation, is tantamount to conversion therapy. But in the approach Steensma describes, children are in an unpredictable process of self discovery, and thus care providers must follow closely and exercise caution in treating. “We do think puberty suppression can be a good intervention for adolescents struggling with gender incongruence,” Steensma told me. But “you have to be very careful.” “We say, don’t make certain decisions where you close developmental pathways. Watch and see what happens with the identity.”

These competing approaches — one proactive, one restrained — could have been treated with equivalence by the AAP and other entities as they continued to evaluate the evidence. Instead, tens of thousands of pediatric providers, including the therapists charged with assessing prospective patients, were essentially told to trust their young patients in determining whether to recommend potentially life-altering treatment.

A risk-benefit calculation

In the mid-2000s, Boston Children’s Hospital became a satellite for the Dutch early treatment approach. Pediatric endocrinologist Norman Spack, now retired, told me what motivated him to pitch this to his higher-ups was years of witnessing young adult trans patients struggling. Even with hormones and surgery they couldn’t easily pass as their felt gender, they had little support from family or society to express themselves, and many were fighting addiction, homelessness, and suicidality. Spack wanted to pilot a strategy of early detection, because it was at puberty when “they started to fall apart,” he told me recently. The idea was to catch these patients before “their bodies escaped from that neutral space of pre-puberty.”

Seeing the suffering of a population is often the impetus for a preventive treatment. Obstetricians began using electronic fetal monitors in the 1970s in the hopes of preventing cerebral palsy and stillbirths. Physicians began screening men for prostate antigen in the hopes of catching and curing deadly cancers. These were solid rationales, but what happened was an epidemic of overdiagnosis and overtreatment. Strapping laboring patients to beeping machines initially succeeded in tripling the rate of Cesarean surgeries without any concomitant improvement in infant outcomes (and added harm to their mothers). PSA testing increased the rate of prostate surgeries without an overall survival benefit — and a not insignificant amount of resulting urinary and sexual dysfunction.

Spack told me that the evidence for early intervention was “the many, many years of nontreatment for transgender youth waiting until they were adults to do anything medically for them” and seeing where that led.

But what if he was only seeing a sliver of the population — the minority who continued to feel distress and seek treatment, rather than the bigger picture that included those who may have felt a mismatch in childhood and then realigned during puberty? Imagine only studying cases of emergency Cesareans and drawing policy conclusions based on those births rather than everyone who gave birth in a particular year. I ran that comparison by Gordon Guyatt, a research methodologist at McMaster University and one of the founders of evidence-based medicine. Earlier intervention is a “reasonable hypothesis,” he said, but if the population you’re observing is “a subpopulation that is unrepresentative and you make inferences about the entire population, you’re in trouble.”

Spack said the suicidality among his trans patients, even kids under 12, “was so strong that I felt we had to do something.” And he saw many kids “flourish” with treatment. Research does suggest that LGBTQ youth are at higher risk for depression and suicide, but the World Professional Association for Transgender Health’s own systematic evidence review makes clear that it can claim no definitive relationship between hormonal treatment and mental health outcomes, especially in adolescents, and that it’s “impossible” to say what impact hormonal treatment has on suicide. Long-awaited research funded by the National Institutes of Health — Spack was one of the original lead investigators — recently published in the New England Journal of Medicine reported some improvements among 315 youth receiving treatment in university-based gender clinics, but there were also two suicides. “Sometimes you have to bite the bullet, and go with more than a hunch” based on “smaller numbers and not being able to answer all the questions at once,” said Spack.

By 2011, the Dutch had published on the outcomes of a cohort of 70, which seemed reassuring, though the findings had limitations and haven’t been replicated elsewhere. Steensma told me he and his colleagues have never thought of their work as “scientific proof” that their model would work everywhere. “We always have said, ‘This is what we can provide from evidence, but you have to do your own studies.’”

In a new analysis of the mental health outcomes of the first 44 recipients of gender-related puberty suppression at the UK’s Tavistock clinic, roughly a third got better, a third got worse, and a third did neither. The National Health Service has ordered the Tavistock clinic to close after a review found the care “inadequate.”

Like the Dutch, the Boston clinic didn’t take kids at their word without psychological assessment. In fact, the staff used tools the Dutch had designed. Laura Edwards-Leeper, the clinic’s original psychologist, told me that extensive, exploratory talk therapy was historically part of the model. But lately she’s been outspoken about her concerns that “more providers do not value the mental health component, largely because they believe if the young person says they’re trans, they’re trans,” she told me.

The dramatic rise in young people presenting for treatment, especially genetically female teens, and the number of clinics that have sprung up with little to no emphasis on assessment, all make Spack “anxious.” “I run into so many people who tell me they have a child or grandchild or niece who’s trans. And I always say, ‘Well, who made that determination and when?’”

The logic of affirmation

I’ve spent the last year reporting on pediatric gender medicine and policy for The BMJ, one of the oldest medical journals. Like other journalists in this space, I’ve been accused of transphobia, hate, bias, and worse. Some of the rhetoric is extremely hostile, but the underlying logic is apparent: If people need medical treatment to exist in their identity, and kids know who they are, then anything that might impede access is an existential threat. Politicians who simultaneously target pride parades and library books and “groomers” only reinforce that terror and turn up the political heat. That’s even more reason for journalists to keep cooler heads and stay true to our duty: to hold authorities to account.

The most important question is one that the Europeans and Americans seem to be answering differently: What if it’s possible that there are kids who identify as trans who indeed know who they are at very early ages — younger versions of the adult patients who haunted Spack — and there are also kids who identify as trans for a finite period of time? And what if there’s no sure way to tell them apart?

Before he stopped returning my calls and emails, Rafferty acknowledged that children are in a “process of discovery” and may understand themselves one way at the onset of puberty and another way five years later, but that uncertainty shouldn’t preclude medical treatment. “It needs to be an ongoing, flexible, dynamic approach that we understand from the beginning may change over time, and so we need to bring in interventions when they seem their most appropriate from our medical perspective,” he told me. “If we’re wrong, then we need to back up and say, ‘What do we need to do differently?’”

And what if a kid has taken hormones that caused permanent hair growth or vocal changes or damaged their sexual function and came to regret these effects? In a recent Zoom meeting — footage of which has been shared on social media — Marci Bowers, a California gender surgeon and president of the World Professional Association for Transgender Health, shared a startling observation: Adult patients who transitioned from male to female couldn’t have orgasms if they had been “blocked” at the earliest signs of puberty and went directly on to estrogen. Bowers told me she was sharing a hypothesis, but that it was “a wake-up call for those who counsel this group of patients.” Safer told me “there’s some discussion about adjusting the timing of some of these treatments” to achieve more optimal function. “If you come to our meetings, that’s what we’re discussing. Nobody is worried about puberty blockers for a year or two.”

Yet data suggest that more than 95 percent of the children who begin puberty blockers continue on to cross-sex hormones. “The most difficult question,” the UK pediatrician Hilary Cass wrote in her interim report of a national review of gender health services, which led to the order to close the Tavistock clinic, “is whether puberty blockers do indeed provide valuable time for children and young people to consider their options, or whether they effectively ‘lock in’ children and young people to a treatment pathway . . . by impeding the usual process of sexual orientation and gender identity development.” In 2020, following a systematic review, the UK’s National Health Service removed language that called the blockers “fully reversible” and replaced it with “little is known about the long-term side effects.”

There is an unknown number of people whose identity shifted and feel they’ve been irreparably harmed by medically transitioning. Corinna Cohn, who was born male, began hormones at 16 and had genital surgery at 19. Now, at age 48, Cohn testifies in support of laws restricting treatments in minors. “The thing that I’m most convinced of right now is that the longer somebody puts off medicalization, the more opportunities they’ll have to really clarify in their mind whether transition is actually good for them,” said Cohn, for whom “transition was a way out of having to deal with puberty. But I’m sort of stuck in a state of arrested development, because I never completed the adjustment to my body as it was becoming an adult body.”

Bowers pointed out that “you can always find someone who is going to regret” and warned me not to “single out transgender care” when one in five people regret their knee surgery, for example. “People have to take some responsibility in making those decisions,” she said.

But how can young people and their families make informed decisions without strong evidence it will make them better? How can children who’ve never experienced sexual intimacy consent to treatment that may limit their ability to have it in the future?

Edwards-Leeper believes some children do benefit from early treatment. “But to the general question of how can a young kid consent to something like this, it is a huge ethical dilemma . . . because honestly, they can’t,” she told me. “The responsibility falls on the parent.”

Rafferty told me patients who live with harms or regrets do not signal a failure of the affirmative care model. If a child or patient doesn’t like the effects of an intervention, or begins to feel different in their identity, then the provider continues to affirm by discontinuing treatment. “They’re not treatment failures if that’s what’s affirming,” he said.

In other words, the logic of affirmation seems to ensure only successful outcomes, circumventing questions of risk and benefit entirely. If parents and providers find this untenable, they are rejecting an argument — not trans people.

[ Via: https://archive.md/guho4 ]

==

There are no grown-ups in charge. Children are self-diagnosing and self-treating.

[dreamlandsystem]

feeling crushed about the cost of covid vaccines.

not everyone can afford to get the updated vaccine. without insurance, the vaccine is extremely unaffordable. the cheapest we could find one in our area was $200. our city doesn’t offer any sort of free or discounted vaccines.

idk it kind of feels like they’re trying to kill off us poor folks at this point. all we can do is mask up and hope that everyone who can afford a vaccine is getting one.

bc unless we magically stumble across $400 so we can get ourselves and our partner system vaccinated, it’s just not going to happen.

[vidreview]

VIDREV: "Marvel's Defenders of The Status Quo" by Pop Culture Detective

[originally posted december 1st 2022]

this is a good video. it makes a lot of really great points about the mcu and i think you should watch it. but i want to nitpick about one thing.

at around 11:10, the channel's titular detective says of the mcu's villains that

"When we take a look through the pantheon of marvel's supervillains and evil masterminds, we immediately notice that nearly all of them strive to destroy or disrupt the status quo in some way. In short, they seek structural change. Now, granted, it's mostly bad, authoritarian change, but…"

i want to zero in on the use of the word "authoritarian" here. the argument of this video is that marvel superheroes exist only as reactionary forces who defend the status quo rather than try to transform the world as it exists, while the villains are the ones who DO want to change things but in such a violent way that their entire argument is conveniently nullified. i agree with this argument and i think the video does a good job justifying it.

but there's a missed opportunity here in this subtle deployment of "bad, authoritarian," what feels to me like a little slipup of ideology.

why is it that the villains seeking to impose a new order are "authoritarian," but the heroes seeking to maintain the current order aren't? "authoritarian" is a slippery word, we like to use it when talking about dictators saying "kill the minorities" or just, generally, to describe when politicians work against the will of the people. except when it's in america for some reason! american politicians aren't authoritarian because they are, erm, "elected." sure they do things against the will of the people, but they can't just get away with it, there's a whole series of checks and balances and democracy and and and

and yet they get away with it anyway. every single time. no one in san francisco wants the cops to have killer robots, but the city council gave them killer robots anyway. is that not authoritarian? oppressed people in cities across the nation begged for police to be defunded if not abolished, and now they're getting more money than ever. is that not authoritarian? rail workers are currently being forced by the government to accept a contract they don't want in order to avert a strike that could grind the US economy to a halt. is that not authoritarian? is that not the textbook definition of a politician enforcing strict obedience to authority?

this postulated nature of mcu villains to want "bad, authoritarian change" feels of a distant piece with liberals who desperately pearlclutch at the simple verbal utterance of the phrase "dictatorship of the proletariat." but dictatorships are bad! that's when the authoritarians dictate their will and the people just have to do it!

unlike in america where we have to work despite being in the midst of a lethal pandemic. unlike in america where housing is unaffordable, health insurance is tied to employment, and public transportation basically doesn't exist. just because there isn't a single guy standing behind a podium explicitly saying "the cost of entry into american society is a car, a mortgage, and a job at lockheed martin" doesn't mean it's not an authoritarian order. just because no one in charge is out and out saying you have no other choice doesn't magically give you other choices. "freedom of choice" is moloch's favorite song because it sounds so sweet. but everyone i know who had to get off medicaid when they were forced economically incentivized to get a job they didn't want says their employer-provided insurance is worse. a friend who had top surgery scheduled has to start the process all over now!

we live in a dictatorship of the bourgeoisie. the ruling class owns the media, owns the means of media production, owns the insurance companies, owns the tech corporations, owns the politicians. our psychosphere is shaped by the messages they allow to spread. isn't it funny how after the george floyd uprisings of 2020 were crushed, mainstream news media all but stopped talking about them and then stopped covering protest at all? isn't it conspicuous that now it seems like all that energy we had has just vanished into thin air? it's almost like the ruling class circled the wagons and refused to acknowledge the widely popular demand for massive systemic change.

but to just cut this down to the final quick, i'm gonna go ahead and suggest that "authoritarian" is a functionally useless term. anyone in a position of power is an "authoritarian" whether they're a federal judge or a postal worker. to pose democracy as the opposite of "authoritarianism" is like saying that rain is the opposite of water. this attitude comes from a deeply entrenched liberal misconception that democracy is what happens when The People choose to make things happen. as opposed to communism, uh, where The People, um

you see what i mean? it's all just uninformed moralizing gobbledygook meant to deliberately obscure the material reality of oppressive systems. there is no conceivable human system which can ever hope to avoid the presence of individuals making choices on behalf of the masses. there will always be people wielding authority, and there will always be malcontents, always be victims, always be the dissatisfied.

this does not negate the simple fact that if we had a dictatorship of the proletariat in america, over a million human beings would be alive today who died of covid in the last two years. and that's to say nothing of the endless swathes of human beings who've been slaughtered on the altar of capitalism through the process of organized abandonment.

we must understand that the status quo is COERCIVELY ENFORCED. the villains of the mcu often come from a working class background, know many who were in the same position, who share common cause with oppressed people. the avengers are rich corporate gods who never even attempt to use their powers proactively to help people. why is it then that the villain's plot is more "authoritarian" than the hero's? this in itself reveals how useless "authoritarian" is as a word, because it dilutes all political conflict to just two guys wielding authority. it treats the entire spectrum of human political reality as if it is a duel between two gentlemen, one of whom is an honorless scoundrel destined to lose for his duplicity. funny how that works!

anyway the video does a good job of explaining why the mcu has no regard for mass movements and its use of "bad, authoritarian change" just happened to jump out at me because i've been reflecting a lot on "authoritarianism" recently and felt like this was a good vehicle for talking about it. anyway go watch that video it's good