Box Turtle Bulletin

Box Turtle BulletinNews, analysis and fact-checking of anti-gay rhetoric
“Now you must raise your children up in a world where that union of man and box turtle is on the same legal footing as man and wife…”
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Posts for December, 2011

Study confirms Maggie Gallagher’s claim

Timothy Kincaid

December 19th, 2011

Maggie Gallagher, the nation’s chief opponent to marriage equality, loves to claim that marriage is good for society because those who are married live healthier lives. And a new study appears to confirm that claim.

From the NY Daily News

A report published in the American Journal of Public Health shows that in states where gay marriage is legal, homosexual men visit doctors less and their health costs go down considerably.

“Our results suggest that removing these barriers improves the health of gay and bisexual men,” Mark Hatzenbuehler, a Robert Wood Johnson Foundation Health & Society Scholar at Columbia University’s Mailman School of Public Health, said in a news release

Of course, Maggie only meant heterosexuals who are married. Alas.

I didn’t really need a study to know that those who are in committed relationships take fewer risks, enjoy greater contentment, and have someone there to nag them about their weight. But it’s nice to have confirmation… Of sorts.

To be honest, I don’t place much faith in this actual study. Comparing one year to another year in one clinic has about as much statistical value as guessing. But I guess it did at least show that enacting equality doesn’t lead to increased health costs – as The Peter absurdly likes to imply.

But Maggie and her NOM buddies just love statistically irrelevant studies and if she were consistent she’d see this as evidence in favor of marriage equality.

So does that mean Maggie will switch sides and support marriage? Nope. Even if this were irrefutable proof that marriage equality would improve the health of ever gay person with no negative consequences for anyone gay or straight, Maggie would still fight to keep inequality in place. Because your health is a far far lower priority than having her church get to dictate what law and culture should allow.

Maggie Gallagher opposes anal sex

Timothy Kincaid

January 28th, 2011

“Defenders of traditional marriage” like to pretend that their objections to marriage equality are based in procreation or what’s best for children or religious freedom or culture or something, anything, other that bias, animus, or a desire to harm gay people. But sometimes their real motivates leak through the front they present to the world.

Take, for example, this portion of an essay by the National Organization for Marriage’s Maggie Gallagher:

Anal sex is painful, unsanitary, unsatisfying for women, and creates unique risks for serious physical diseases (if you doubt me, go read the Wikipedia entry on the subject) because the anus is not designed for sexual intercourse, increasing the risk of torn flesh and the intermingling of bodily fluids — blood, semen, fecal matter — that can spread an astonishing variety of diseases. The female partner is far more at risk than the man in these encounters. This should be a feminist issue.

Now, of course, Maggie is directing this rant to women. So it has nothing, no nothing at all, nope not whatsoever, to do with her views about homosexuality. And as some gay men don’t engage in anal sex and few lesbians as well, well then obviously this say nothing, no nothing at all, about Maggie’s perspectives of gay people in general. Right?

Except that Maggie isn’t just condemning heterosexual anal sex. In fact, that isn’t her target at all.

In the minds of anti-gay activists and others to whom Maggie directs her essays, homosexuality is inextricably linked with anal sex (lesbians exist as an after-thought). When a preacher rants, “it’s not natural,” and you know he’s thinking anal sex. Hear a politician declare, “that’s not how the body was created,” and it’s anal sex he’s discussion. See an erudite talking head with crisply parted hair and wire-frame glasses espousing his views on “complimentarity” and guess what he means? Anal sex.

So when Maggie attacks anal sex with imagery of “torn flesh” and blood and fecal matter and “astonishing variety of diseases,” it really isn’t about young women at all. Sure, she’d rather they engage only in vaginal intercourse with their lawfully married husband, but that isn’t her point. Rather, Maggie sees this as “dirty” and “icky” and, let’s be real, a homosexual practice that godly heterosexuals should have nothing to do with.

Maggie is generally pretty good at hiding her personal contempt for gay people. But sometimes, like this time, it seeps around the edges.

Google to compensate for “Gay Health Insurance Tax”

Timothy Kincaid

July 1st, 2010

The gay health insurance tax is such an odd, unfair, and blatantly discriminatory tax that many heterosexuals have difficulty understanding it – or even believing that it exists. Here’s how it works:

Suppose Joe and Susan are married. Joe has a job with great benefits and Susan works part time as a freelance artist so they take advantage of Joe’s health plan to cover Susan and their two children. The company pays the premiums and everyone is happy.

But if Joe is Janet, the rules change. Janet works at a great company which does not discriminate between gay and straight couples. It recognizes her marriage to Susan and provides health coverage to Susan and their two children just as it would if Janet were Joe.

But now the federal government pops its head in to object. For tax purposes, family benefits are not considered part of your taxable income. Unless you are a same sex family, in which case the federal government says that you are not a family at all. If you are a same-sex couple then you have to pay the Gay Health Insurance Tax.

“Susan is not a relative,” they say. “She’s just some random stranger who is being covered by your health plan. And these kids are her children, not yours.” So, as Susan is not Janet’s spouse according to federal law, they do not treat the health insurance premiums which cover Susan and the kids as family benefits.

“This is income,” they say. Just as any other amount taken from your check and paid to a third party (say a creditor with a lien) is considered part of your income, so too are these insurance premiums paid to cover this other random non-spouse person considered part of your income.

And so they tax Janet. Assuming that Janet is in the 35% tax bracket, her wonderful company may give her coverage for Susan for which they pay premiums of $500 per month, but the IRS gives her a tax bill for $175. So while Joe and Janet may do the same exact work and receive the same exact pay, Joe takes home an extra $2,100 per year.

Now some companies are seeing this as unfair. They support the idea of equal pay for equal work and are stepping in to make up the difference. The latest (and largest) is Google. (NY Times)

On Thursday, Google is going to begin covering a cost that gay and lesbian employees must pay when their partners receive domestic partner health benefits, largely to compensate them for an extra tax that heterosexual married couples do not pay. The increase will be retroactive to the beginning of the year.

This is great news for Google’s gay workforce. But it is also good news for those who work at other companies, especially those with whom Google competes for skilled high tech employees.

But given the competitive nature of the benefits culture in Silicon Valley, where companies often offer extra perks to attract top employees, Google’s decision could lead to policy reviews, experts said.

“It could have a ripple effect, prompting other employers, and particularly employers in the same industry, to take a look at their own benefits package and see whether it would be appropriate to extend those benefits,” said Kathleen Murray, principal in the health and benefits consulting business in San Francisco for Mercer, the consulting firm. “When you have a high-profile company doing anything, that tends to get into the mind of the culture, and it can have a more diffuse effect.”

And as more companies begin to recognize the special gay health insurance tax levied specifically at gay couples, the more the public becomes aware of this bizarre inequality and the easier it becomes to get it changed. A provision which would eliminate the tax was at one point part of the health care reform but did not make it to the final bill.

It seems that some of our representatives believe that gay people should pay higher taxes than heterosexuals. Ironically, they are the ones that you often hear calling for tax cuts… just not for us.

More perspective on the blood donation ban

Timothy Kincaid

April 5th, 2010

From the Kansas City Star

increasingly accurate tests have been developed to detect HIV in donor blood. The first tests that became available spot antibodies that the immune system produces when confronted by HIV. It usually takes two to eight weeks, but sometimes longer, for the body to make enough antibodies for the tests to detect.

A newer test can find HIV itself in the blood. This test shortens the time between infection with the virus and detection to nine to 11 days.

FDA to reconsider blood donation ban

Timothy Kincaid

March 13th, 2010

From the LA Times:

Federal health officials announced Friday that they would reexamine a 27-year-old set of restrictions on blood donations by gay men.

The FDA “has been actively engaged in reexamining the issue of blood donor deferral for men who have had sex with other men, taking into account the current body of scientific information, and we are considering the possibility of pursuing alternative strategies that maintain blood safety,” the agency said in a statement.

The issue will be examined by the Department of Health and Human Services’ blood safety committee in June, according to the statement.

Rethinking the blood donation policies

This commentary is the opinion of the author and does not necessarily reflect that of other authors at Box Turtle Bulletin.

Timothy Kincaid

March 8th, 2010

givebloodIn 1983, the FDA established a policy requiring that blood banks not accept donations from any male who had engaged in sex with any other man at any point since 1977. This was implemented so as to attempt to eliminate blood which was potentially infected with the HIV virus from the pool, and it made sense at that time.

It wasn’t until 1983 that the HIV virus was identified, and a method of testing for the virus wasn’t established for another two years.

In 2006, the AABB, America’s Blood Centers, and American Red Cross jointly asked the FDA to reconsider these rules. They argued that continuing the ban was not justified by scientific advances since the ban was implemented.

AABB, ABC and ARC believe that the current lifetime deferral for men who have had sex with other men is medically and scientifically unwarranted and recommend that deferral criteria be modified and made comparable with criteria for other groups at increased risk for sexual transmission of transfusion-transmitted infections. Presenting blood donors judged to be at risk of exposure via heterosexual routes are deferred for one year while men who have had sex with another man even once since 1977 are permanently deferred.

Current duplicate testing using NAT and serologic methods allow detection of HIV- infected donors between 10 and 21 days after exposure. Beyond this window period, there is no valid scientific reason to differentiate between individuals infected a few months or many years previously. The FDA-sanctioned Uniform Donor History Questionnaire was developed recognizing the importance of stimulating recall of recent events to maximize the identification of donors at risk for incident, that is, recent, infections. From the perspective of eliciting an appropriate risk history for exposure to HIV and other sexually transmitted infections, the critical period is the three weeks immediately preceding donation since false negative NAT and serology reflect these window-period infections, and the length of these window periods provide the scientific basis for the deferral periods imposed for at risk sexual behaviors.

The FDA refused.

They argue that as gay men have a higher concentration of HIV infection than some other demographics, this justifies a blanket ban on all donations by all gay men.

Men who have had sex with men since 1977 have an HIV prevalence (the total number of cases of a disease that are present in a population at a specific point in time) 60 times higher than the general population, 800 times higher than first time blood donors and 8000 times higher than repeat blood donors (American Red Cross). Even taking into account that 75% of HIV infected men who have sex with men already know they are HIV positive and would be unlikely to donate blood, the HIV prevalence in potential donors with history of male sex with males is 200 times higher than first time blood donors and 2000 times higher than repeat blood donors.

This week, Senator John Kerry, along with several other Senators, sent a letter to the FDA requesting that they reconsider their rules.

“Not a single piece of scientific evidence supports the ban,” the Democratic senator said in a statement. “A law that was once considered medically justified is today simply outdated and needs to end, just as last year we ended the travel ban against those with HIV.”

I doubt that this will be effective. If the FDA refuses to listen to those who know the very most about donation, testing, infection, and the blood supply, why would they listen to John Kerry?

But Kerry’s action does allow us as a nation to re-question why the ban is in place. Is it a matter of heath science or a matter of mistrusting (or disliking) gay men?

The FDA argues that any increased risk of tainting the supply is unacceptable. And that allowing gay men to contribute would unquestionably increase that risk.

But is that true? Does the ban effectively increase the safety of our blood supply? Or does it actually do harm?

To answer these questions, I think we need to look closer at the ban and how it functions.

1. The ban is only as effective as it is perceived to be reasonable. Remember, the ban is voluntary; by that, I mean that the only thing which stops donation is a questionnaire and the donor’s decision to answer honestly. If a gay man is determined to donate, he will only be persuaded not to donate if he believes that the criteria of exclusion is based on reason and not on bias.

2. We must assume that only a psychopath would choose to purposefully donate HIV infected blood. And no questionnaire is going to stop a psychopath. Therefore, this purpose of the questions is to eliminate those who are unknowingly infected.

But who donates blood? According to the Red Cross, only 3 out of 100 of Americans donate. And this 3% is not representative of the population as a whole.

Yes, blood donors come from all races, ages, political affiliations, and economic situations. But they have one thing in common, they are motivated by altruism or a belief that it is in the common good that they donate. They donate because it is the “right thing to do”.

And let’s be practical here for a moment. The type of person who donates blood is not generally the type of person who is irresponsible. If you are a ‘give blood’ type of gay man, you are probably also a ‘get tested’ type of gay man.

So the only unaware HIV-positive infected gay men who are likely to be prevented from donating are those who have good reason to believe (falsely) that they are HIV-negative. That’s not a very big demographic.

3. The FDA does not exclude other demographics who are infected at higher rates than the population at large. For example, over half of all new HIV infections detected in 2007 were in African Americans. While many of those infected are also MSM (men who have sex with men, a term used by the infectious disease community), many are heterosexual. Over 60% of women with AIDS are black. (AVERT)

The estimated lifetime risk of becoming infected with HIV is 1 in 16 for black males, and 1 in 30 for black females, a far higher risk than for white males (1 in 104) and white females (1 in 588).

There are many reasons for this (and for godsake let’s allocate more resources to stemming this trend) and I’m not trying to make comparisons or demonize anyone. But it does demonstrate that the FDA’s banning policies seem inconsistent.

The screening does seek to eliminate those women who might have had sex with a MSM or intravenous drug user in the recent past, but it does not issue a blanket ban based on race (nor should it). However, the “ever had sex at any time in your friggin’ life” definition effectively serves as a ban based on orientation.

So while the FDA does not say that the President of the United States is banned from blood donation based on his ethnicity, it does prohibit donation by Rep. Barney Frank.

4. Not all gay men are equally at risk. Homosexual activity does not create HIV. It is a virus, not a consequence of specific sexual acts. Only about 12% of gay men are infected with the HIV virus.

Yet the FDA treats my friends, a couple in their 40’s who met in high school and have been together ever since, the same as it does some gay man who is single and has an active and diverse sex life. Ironically (and amusingly) it considers ex-gays like Alan Chambers to be no less of a risk than the man whose fetish is to be the recipient in unprotected anal sex.

The FDA clumps gay men into a single demographic and assumes that all gay men are at a higher risk than all heterosexuals.

While statistics indicate a rising infection rate among young heterosexual women, their overall rate of HIV infection remains much lower than in men who have sex with other men.

But clumping in this manner is a foolish and rash policy. Contamination is more likely to come from a young single heterosexual woman who relies on the pill than it is from a gay man in a committed relationship who uses condoms regularly.

5. While the ban on gay men donating does not – in my opinion, as discussed in the points above – serve to diminish much risk of contaminating the blood supply with the HIV virus, it is quite effective at something else: labeling all gay people as dirty and diseased.

This universal ban says, in effect, that all gay men are suspect, a cause of concern, human rats carrying contagion. It feeds the myth that gay equals AIDS and lends credence to the anti-gay activists who market in fear and animus.

But is lifting the ban the answer?

I would argue that a full lifting of the ban is not a wise decision. That would increase – at least in some tiny measure – the risk of taint to the blood pool. Rather, I would advise to change the policy in a way that not only increases the blood supply and to reduces stigma but which also could serve an additional medical function.

Obviously the screening questions need to eliminate the risk of undetected recent infections. But such risks should be based on actual behavior based risk, not on stereotyping of communities. This may even serve to reduce the risk of accidental taint from gay men who ignore the current policy as being nothing more than bias.

Science-based periods of either long-term monogamy or sexual abstinence would likely be respected as reasonable and appropriate. Few gay men would argue that every gay man, regardless of sexual history or responsibility, should donate blood.

And revising the rules for donation to match the requests of the Red Cross would certainly be better than the current policy. But I recommend a different approach.

I recommend that all persons who have any risk of HIV transmission – be they gay men, single heterosexuals, or anyone else who could be at risk – be required to take an HIV test as a step in the donation process. Those persons who tested negative and who had no sexual contact for the previous six months (or whatever restrictions are reasonable) could be treated as acceptable donors. The oral swab tests are non-intrusive, give a response in 20 minutes, and are more than 99% accurate.

The current controls over the blood supply do an amazing job at detecting and removing infected blood. But implementing a screening method that is based on measurability rather than voluntary deferral would effectively eliminate unknown carriers, gay or otherwise.

And it would also reach a population of potentially at-risk citizens who might otherwise go undetected.

The single largest contributor to the spread of HIV is unknown infection. Granted, as I discussed above, those gay men who are most likely to donate blood are also among those most likely to be tested regularly. But HIV testing at a blood donation site could provide access and a safe friendly environment for non-gay people who might be a bit intimidated or uncomfortable asking their doctor or going to the testing center in the gay part of town.

HPV vaccine effective in preventing anal cancer

Timothy Kincaid

February 17th, 2010

Anal cancer, a very rare condition, impacts gay men to a greater extent than heterosexuals (about 0.35% of gay men get anal cancer). The most significant contributor is infection with the Human Papillomavirus (HPV), the same virus that contributes to cervical cancer in women, causes genital warts, and is linked to some rare oral cancers in straight men. HPV is very common and most sexually active adults will be infected at some point in their life.

In October, the FDA approved the use of Gardasil, a vaccine, for males ages 9 through 26 for the prevention of genital warts. Now Merck has release testing results showing that the vaccine is significantly effective in the prevention of anal cancer in gay men.

Merck & Co., Inc. announced today that in new Phase III data, GARDASIL® [Human Papillomavirus Quadrivalent (Types 6, 11, 16 and 18) Vaccine, Recombinant] was 77.5 percent (95 percent CI: 39.6, 93.3) efficacious against anal intraepithelial neoplasia (AIN) associated with human papillomavirus (HPV) types 6, 11, 16 and 18 in 16-to-26 year-old men who have sex with men.

In this PPE analysis, GARDASIL prevented 77.5 percent (95 percent CI: 39.6, 93.3) of HPV 6, 11, 16, and 18-related AIN and anal cancer. A total of 29 men were diagnosed with HPV 6, 11, 16 or 18-related AIN during the study, with 24 cases in the placebo group and five in the vaccine group. No cases of HPV 11 or 18-related AIN were observed in the vaccine group. No cases of anal cancer were seen in either the placebo or vaccine group.

Most sexually active adults have been or will be infected with HPV. In most cases, the infection goes away naturally. But Merck also found that the vaccine efficacious in preventing infection in women aged 27 to 45, a demographic that is not yet approved by the FDA. It is easy to surmise that the next step will be to test men in this age group with the eventual goal of marketing to everyone.

Although the odds are low of getting HPV related cancer, it is probably to the advantage of all women and gay men to reduce those odds even further by getting vaccinated, if possible. While this may not be covered by your insurance, the $360 for the three shots may save your life.

Aetna demostrates insurance industry callousness about the medical needs of their “members”

This commentary is a personal rant from the author and may not necessarily reflect the opinion of other authors at Box Turtle Bulletin. Additionally, it is not directly within the realm of what this site normally covers. I wrote it anyway. I make no claim that this is representative of anyone else's story, but it's mine.

Timothy Kincaid

February 2nd, 2010

AetnaIn 2004 Aetna Insurance Company adopted the slogan, “We want you to know.” However, I really, really, truly, very much wish I knew nothing about Aetna.

As I wrote last Friday, Aetna, my HMO insurer, decided as of January 1, 2010 to move a medication that I require off of their preferred list. They do allow one other alternate medication, but I have an allergic reaction to that medication which results in redness and eye irritation and my ophthalmologist will not prescribe it.

In my update last Friday, I told you that it looked like a tier override might be possible. It is now clear that this was a misunderstanding. As I do not reside in New Jersey, such an option is not available.

During this process I discovered something interesting. Aetna has in place procedures to ensure that those who decide the pricing are shielded from all contact with those who suffer the consequences of their decisions. Even the intermediaries who speak with doctors are not allowed to talk to these decision makers, instead having all interaction be by means of forms and email.

Aetna wishes to make certain that those who deny coverage are not swayed by emotional appeal or the circumstances of any individual members. Were they to be made aware of the difficulties that they cause, they might be inclined to prioritize ethical practice ahead of gasp-worthy profits ($1.4 billion in 2008) and exorbitant executive salaries (which increased 625% between 2005 and 2008).

So Aetna wins. By taking my drug off the preference list, they will shift $25 per month from their bottom line to mine. And I have no recourse at all other than, of course, informing you, my Congressman, my Senators, my state legislators and the CA Insurance Commissioner of the practices of this corporation.

Insurance company arrogance is one big reason people are unhappy about health care

This commentary is a personal rant from the author and may not necessarily reflect the opinion of other authors at Box Turtle Bulletin. Additionally, it is not directly within the realm of what this site normally covers. I wrote it anyway. I make no claim that this is representative of anyone else's story, but it's mine.

Timothy Kincaid

January 29th, 2010

Most Americans have health insurance. And most Americans are content with their level of coverage. But “most” is not enough to quell the dissatisfaction that is growing in the nation over the way in which health issues are treated.

But unlike the politicians, I think the underlying discontent lies not in whether there is a single payer or whether catastrophic care is planned for or even in the increased cost of heath care. Rather, I think that the anger and frustration results from a total lack of control over ones own care coupled with the arrogance and condescension with which insurance companies treat the people who pay for their astronomic executive salaries and bonuses.

Allow me to illustrate.

I have pigmentary glaucoma. This is a rare genetic eye condition (discovered mostly in near-sighted male Caucasians in their 30s and 40s) in which bits of pigment flake off the iris and clog the eye’s drains. If untreated, the pressure in the eye builds, destroying the optic nerve and leading to blindness.

This is an easily treated disease. As long as I maintain a regimen of eye drops, I can keep the intraocular pressure in my eyes under control (below 21 mmHg) and avoid nerve damage. And although my eyes had reached pressures of 40 and 38 before detection, I have been very fortunate in that I have had very little loss of vision.

There are three different primary medications from which I can choose and, in the process of stabilizing my pressures, my doctor tried all of them. One was inadequately effective and one resulted in significant redness and irritation. But the third was, as Goldilocks might say, just right. (In conjunction with another eyedrop which works slightly differently)

So everything is just fine.

Until this week.

When I went to pick up my prescription I found that Aetna, my insurance provider, decided to move Travitan Z, one of my essential eye medications, off of their formulary list. What this means is that it is no longer covered at my standard deductible rate. In this case, the out-of-pocket monthly price of this medication went from $35 to $60.

Now moving a medication off the formulary list is not necessarily unreasonable. Sometime a generic is available, at other times there are comparable less expensive options that work identically. Unfortunately, this is not the case for me. There is no generic available and the alternatives were determined by my physician to be either less effective or a source of irritation.

So I called Aetna to discuss the situation. What I found was incompetence, arrogance, and condescension.

My first call resulted in a fellow telling me that he “went on Google” and found a generic, which would certainly have been fine with me. But after calling my pharmacy, I learned he had simply discovered the medication’s non-brand name but that this medication was not available as a generic drug and won’t be until 2013

The second call was when Aetna’s policy of deflecting criticism was revealed.

I was first told that the problem was due to my choices in the open enrollment period. So we walked through the options available that I so very foolishly ignored and, no surprise to me, in each option my eye coverage would be the same. Because the issue was not my “choices” at all, but rather that the drug had been moved off of the formulary list that was used for each of my options.

Having exhausted that avenue of blame, Aetna then told me, “that is the price at which your employer has chosen to cover that medication”. That, of course, was a flat out lie. My employer never said, “hmm, Travatan Z, yeah let’s raise the price on that”. Instead, my employer (or rather the large employment data processor that my real employer uses to process payroll benefits) set a rate for all non-formulary drugs and left the decision up to Aetna as to which drugs would be on the list.

The young lady to whom I was speaking then went for the “I didn’t decide that” route. Well, no, of course not.

But I wasn’t calling her to discuss my options, I was calling Aetna and she was just the voice of the company at that moment. But that simply generated another round of “well this is the result of your choices that you made during open enrollment and this is the amount your employer decided to pay for this drug”. It seems they trained her well; at no point did she acknowledge that the decision resulting in my increased co-pay was made by Aetna.

After finally having the young lady tell me that I had no options whatsoever, I thought for a moment about what I had hoped to achieve from my call. What could Aetna have done differently to avoid having me publicly vent my complaint?

  • Aetna could have owned up to the responsibility of the decision that increased my monthly prescription budget. They could have explained the reasoning behind the decision and not tried to lie and claim that it was due to choices made by me or my employer. I might not have been happy, but I would not have felt manipulated.
  • Aetna could have treated me like a client, someone that they want to retain and satisfy. They could have expressed concern rather than try to blame me and my employer for their decision.
  • Aetna could have provided a means for which exceptions could be made. If there are adequate medications that provide alternatives to most glaucoma patients, that is fine. But some provision should be made for those for whom their doctor has determined that alternatives are inadequate.
  • Aetna could have avoided the appearance of profiteering. I might be less resistant to paying an extra $300 per year if Aetna’s CEO was not paid in excess of twenty-four million dollars ($24,000,000) in 2008.

In summation, I’m screwed. Aetna made a decision and I get to pay for that choice. I can pay more with a smile, or I can pay more and vent my frustration to the entire world (clearly, I’m choosing the latter).

Now I know that I am fortunate. Even after the increase, I’ll likely pay less than $2,000 out of pocket for medical care this year. Some people face monthly prescription costs in excess of that amount. It hardly seems worthy of this rant.

But my experience with Aetna addresses a bigger issue.

I am, by nature, favorable to capitalism. I believe that a system that rewards investment and research is more likely than any other to result in continued improvements in treatment for my condition. But capitalism relies on competition, on the ability of the customer to pick up their custom and go to the store next door, which is not an option that many Americans have.

And I do not object to insurance companies making a profit. It is reasonable that providing a service should be compensated. But egregious salaries and bonuses secured through a political system that secures insurers’ advantages and disallows or discourages cross-state shopping or foreign nation pricing are offensive if not downright immoral.

So I have now joined the ranks of those who think of health insurance companies, Aetna in particular, with contempt. Not because of what they provide or really even the profit they make, but because of the limitations on choices that lobbying has created and the arrogance and contempt that it has bred within a smug corporate culture confident that it need not compete for my patronage.

And unless insurers want moderates and conservatives to join with more collective-minded Americans and seek to dismantle the entire system, they should seriously rethink their approach to business.


For those interested in the outcome, there may be a solution.

After ranting, I started searching the internet and Aetna’s own website and found that they had issued a Pharmacy Clinical Policy Bulletin which allowed for a medical exception specifically for glaucoma medicine if the patient was allergic to the one drug on their “preference list”. After reading this bulletin to Aetna’s employees, I was able to finally reach someone who was familiar with the exceptions that their customer service claimed did not exist.

After four calls from me (speaking to six different people) and two calls from my doctor, Aetna may be making a “tier override”. I’ve paid the larger co-pay but it looks like I may be refunded the difference.

But how many Aetna members do not have BTB readers to encourage them not to give up, are unskilled at searching, and are willing to believe what they are told by customer service? How many are just too sick to spend hours trying to resolve the problem?

Aetna should start caring about the concerns of their members. All the insurance companies should. In the current political culture, arrogance will not serve them well.

My Concerns about the Public Option

This commentary is the opinion of the author and does not necessarily reflect that of other authors at Box Turtle Bulletin.

Timothy Kincaid

November 9th, 2009

On Saturday, the US House of Representatives voted for the Affordable Health Care for America Act, a healthcare reform bill which has been the highest priority of the Democratic Party leadership since the party took control of the presidency and both houses of the legislature. There are a number of very positive inclusions in that bill, including some that deal specifically with the GLBT community.

Probably the most specifically significant to our community is the incorporation of the McDermott/Ros-Lehtinen bill to remove the special ‘gay couples tax’ on spousal benefits provided by an employer. Currently, heterosexual spousal benefits are provided tax free and employers may claim them as an operating expense, but same-sex spousal benefits are considered to be part of the employee’s taxable income. This can result in thousands of dollars of tax demanded from our government solely because the spouse of the taxpayer is the same sex. Removing this tax is a tremendous relief on gay taxpayers.

Also included are changes in treatment for HIV patients, heath data collection related to the LGBT community, new sex education rules, and non-discrimination language.

However, the bill, as passed by the House, also provides for a “public option”, or insurance provision by the federal government. This government run health care mechanism is by far the most controversial aspect of the bill. And, depending on where you fall on the right/left scale, you may well have strong arguments either for or against such a move.

But while I have opinions in general about the decision on the part of the government to compete in the world of service provision, that is not the point of this commentary. Rather, I wish to express specific concerns about how this effort may impact our community negatively.

Continue reading after the jump.

Gay Healthcare Reform

Timothy Kincaid

June 19th, 2009

If we believe our politicians, health care is broken in America and the Federal Government is the only one who can fix it. Our President is so concerned about implementing healthcare reform that he can’t spare a moment to work on equality for gays and lesbians.

However, a more cynical observation may be that for gay and lesbian Americans, the Federal Government is the problem rather than the solution to our immediate health care concerns. And before we focus on the controversial and highly combative effort to overhaul the country’s methods of providing health care, let’s at least make sure the rules are applied fairly and equally.

Here are four things that the administration could work with Congress to make health care more affordable for gay people… should they want to.

  • Provide federal employees with domestic partner health care benefitsThis is a no-brainer. To deny health care benefits to the spouse of an employee solely because they are gay is un-American.

    Pass the Domestic Partners Benefits and Obligations Act.

  • Stop taxing partner benefitsIf Joe’s company provides his spouse with health care, everyone is pleased. But if Joe’s spouse is the same sex as Joe, and only if so, the federal government treats this as part of Joe’s compensation and requires him to pay income tax on the benefits.

    This tax based solely on sexual orientation is probably unconstitutional, is definitely immoral, and is entire unjustifiable.

  • Allow ‘Married Filing Jointly’ tax status for legally married AmericansJoe and his spouse Fred cannot file jointly on their federal returns. Which means that costs spent for Fred’s medical care cannot be deducted on Schedule A of Joe’s income tax return. For households in which only one spouse works or in which income is not proportionate, this can be a huge financial burden without any consideration.
  • Reverse the ban on HIV travel and immigrationThis requires nothing but the signature of the President.

The President can try to sell us on his medical overhaul based on its merits, benefits and costs. But I’ll not be impressed in the slightest if it does not correct the inequities that the government has set up to unfairly deny health care rights to gay Americans and to unfairly tax them on the ones they do get.

Research: Anti-Gay Harassment in Childhood Leads To Poor Adult Health

Jim Burroway

January 28th, 2009

Mark S. Friedman, Michael P. Marshall, Ron Stall, JeeWon Cheong, Eric R Wright. “Gay-related development, early abuse and adult health outcomes among gay males.” AIDS and Behavior 12, no. 6 (November 2008): 891-902. Abstract available at DOI 10.1007/s10461-007-9319-3.

The Urban Men’s Health Survey (UMHS) has revealed a lot of useful information in the decade since it was conducted. Much of it “dismaying,” in the words of Ron Stall, who worked on the survey at the Centers for Disease Control and Prevention and is now at the University of Pittsburgh. Stall was one of four researchers from the University of Pittsburgh (joined by a fifth researcher from Indiana University – Purdue University Indianapolis) who analyzed a subset of that data and concluded that “experience of homophobic attacks against young gay/bisexual male youth helps to explain heightened rates of serious health problems among adult gay men.”

The UMHS was a telephone interview of a probability sample of men who have sex with men (MSMs) living in four cities: San Francisco, New York, Los Angeles, and Chicago. The survey was conducted between November 1996 and February 1998, with 2,881 UMHS participants being asked a wide-ranging battery of questions resulting in 855 variables. The results of that survey were fed into a database, which scores of researchers have been mining ever since for dozens of studies covering many different topics. Dr, Mark Friedman, who has previously investigated the link between anti-gay hostility and suicide among young gay males, led a team which poured over responses to key questions in that database to see if a link could be established between anti-gay hostility against young gay men and adverse health outcomes as adults.

Among the many questions in that survey, participants were asked about their experiences, if any, with parental physical abuse, gay-related harassment during childhood and adolescence, and forced sex. They were also asked about four gay-related identity milestones: the age at which they became aware of their same-sex attractions, age of first same-sex sexual activity, age of deciding that they were gay, and age of first disclosure that they were gay.

Participants were also asked about current depression, HIV serostatus, sexual risk behavior during childhood, partner abuse during adulthood, anti-gay victimization during adulthood, and suicide attempts during childhood.

Dr. Mark Friedman and associates used the responses from these questions from 1,383 men aged 18 through 40, and divided them into three categories (early bloomers, middle bloomers and late bloomers) according to how participants answered questions based on the four gay-related identity milestones. Then, by looking at the answers to the other questions, they were able to demonstrate three principle findings:

1) Gay males who developed early with respect to their sexual orientation were much more likely to experience anti-gay harassment and sexual abuse during adolescence than middle bloomers and late bloomers. This might be something of a “duh” conclusion since it stands to reason that those who are more visibly gay draw more attention than those who aren’t, and those who are visibly gay earlier have more time in which to experience anti-gay harassment and sexual abuse. Nevertheless, it’s important to establish this finding statistically, because it leads to the next finding.

2) Those early bloomers were also more likely to anti-gay victimization, depression, and become HIV-positive as an adult. Taken alone, this finding might play into the hands of anti-gay activists who contend that gay youth should remain closeted and continue to deny their true experiences for as long as possible. Well, not so fast, because…

3) While early bloomers were more likely to experience adverse health outcomes as adults, it wasn’t just because they were early bloomers. Friedman and associates found that harassment and violence were very common experiences among all young gay and bisexual males. Regardless of “bloomage,” 74% reported experiencing anti-gay harassment and 24% experienced parental physical abuse before the age of 17. And these experiences were capable of statistically predicting specific negative health outcomes as adults:

  • Early gay-related harassment was found to be positively associated with gay-related victimization in adulthood;
  • early parental abuse was found to be positively associated with partner abuse, gay-related victimization, depression, attempted suicide and becoming HIV-positive;
  • and early forced sex was positively associated with adult partner abuse, depression, engagement in high-risk sex, and becoming HIV-positive.

The men in this survey became adults, on average, in the mid 1980’s. We don’t know whether adolescents today experience statistically the same levels of abuse and harassment as adolescents did then. But the authors conclude that regardless of the extent of anti-gay harassment today, that:

“…a compelling case can still be made that the three sets of findings above, as a whole, support the hypothesis that the experience of homophobic attacks against gay youth contribute to health disparities among gay men. … [T]his suggests that their experience of abuse is related to homophobia and that these experiences in part determine the adult health problems that gay men often experience.

“To summarize, some of the health disparities of gay and bisexual men may have their genesis in these individuals’ childhood and adolescent years given that these disparities are already in place by early adulthood. The findings described above support the hypotheses that the disparities appear to be due, in part, to the timing of [gay-related development] and the violence these individuals experience related to being gay during their formative years.”

This week is National No Name Calling Week, sponsored by the Gay, Lesbian and Straight Education Network (GLSEN). According to GLSEN’s non-representative survey of 6,209 middle and high school students, 86% of LGBT students experienced harassment at school in the past year, 61% felt unsafe at school because of their sexual orientation, and 33% skipped a day of school in the past month because of they felt unsafe. This survey isn’t statistically representative nationwide, but that’s beside the point. They found an awful lot of harassed and frightened kids out there.

Of course, Focus On the Family is against No Name Calling Week, complaining that it has a hidden agenda. And they’re right; it does. The “hidden agenda” consists of safer youth and healthier adults, which Focus continues to oppose at all costs. After all, they’ve invested a lot of energy in maintaining the image of gay men as depressed, suicidal and unhealthy. Now we know that their own policy solutions will only serve to perpetuate that image.

Study Identifies Link Between Rejecting Parents and Negative Health Among LGB Youth

Jim Burroway

January 6th, 2009

Caitlin Ryan, David Huebner, Rafael M. Diaz, Jorge Sanchez. “Family rejection as a predictor of negative health outcomes in White and Latino Lesbian, Gay and Bisexual young adults.” Pediatrics 123, No. 1 (January 2009): 346-352. (DOI: 10.1542/peds.2007-3524)

In a new paper published this month, Dr. Caitlin Ryan and her colleagues at San Francisco State University were able to demonstrate a predictive link between specific, negative family reactions to their child’s sexual orientation and serious health problems for these adolescents in young adulthood. According to this study, such adverse health problems include depression, illegal drug use, risk for HIV infection, and suicide attempts. This study appeared in the January issue of the journal Pediatrics, the official journal of the American Academy of Pediatrics, and is being hailed as a landmark departure from previous studies, which tended to look at a wider range of sources of social rejection — schools, peers, etc. This study looked specifically at parental acceptance or rejection and its impact on LGB youth health.

The study was based on questionnaires administered to a sample of 224 white and latino LGB young adults, aged 21 to 25, and open about their sexual orientation to at least one parent or guardian. (Twenty-one additional participants who identified as transgender were also recruited, but their numbers were too small for statistical analysis, and thus were excluded from this particular study.) Participants were recruited through various venues, including bars, clubs, LGBT service agencies and community groups, all within 100 miles of San Francisco.

On average, participants became aware of their same-sex attractions at the age of 10.76 years. They came out to themselves at age 14.16 on average, came out to others at age 15.32 on average, and came out to family at age 15.82 on average. Men were on average aware of their same-sex attractions about two years earlier than women, and they came out to themselves about one year earlier than women.

Study participants were asked a series of questions resulting in 51 close-ended items that assessed the presence and frequency of each rejecting parental or guardian reaction to the participant’s sexual identity when they were teenagers. The questionnaire used, the FAP Family Rejection Scale, has a high internal consistency (Cronbach’s α = .98).

Levels of depression were assessed using the Center for Epidemiologic Studies Depression Scale. Substance use and abuse were quantified in 3 ways: heavy alcohol drinking in the past 6 months, use of illicit drugs in the past 6 months, and substance use–related problems in the last 5 years. Sexual behavior was assessed in the last 6 months by asking about number, gender, and type of sexual partners, type of sexual activity, and whether condoms were used when activity involved anal or vaginal penetration.

Compared to peers who reported no or low levels of family rejection, LGB young adults who reported higher levels of family rejection during adolescence were:

  • 8.4 times more likely to report having attempted suicide,
  • 5.9 times more likely to report high levels of depression,
  • 3.4 times more likely to use illegal drugs,
  • 3.4 times more likely to engage in unprotected sexual intercourse.

To give you an idea of how dramatic an effect that higher levels of family rejection can have on an individual, here’s something else to ponder. Compared to peers who reported no or low levels of family rejection, LGB young adults who reported only moderate levels of family rejection during adolescence were:

  • 2.3 times more likely to report having attempted suicide,
  • 2.9 times more likely to report high levels of depression,
  • 1.4 times more likely to use illegal drugs,
  • about as likely (1.04 times) to engage in unprotected sexual intercourse.

Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence.

While these findings are very important, it’s important to keep in mind some of the study’s limitations. The biggest one that jumped out at me — and one the research authors didn’t address — was whether there were any confounding factors leading to these outcomes. For example, in this particular sample, what were the subjects’ experiences with peer rejection, bullying or violence? If subjects who experienced a high degree of rejection by their parents also happened to experience a greater degree of bullying, for example, then outcomes attributed to rejecting parents could have been affected by bullying as well. Since the researchers weren’t able to control for those outside factors, we don’t really know what, if any, external influences may have contributed to these outcomes.

And also, this study has all the usual weaknesses of virtually every other social science study. The authors caution:

There are several limitations to the study. This is a retrospective study that measures young adults’ reported experiences that occurred several years earlier, which may introduce some potential for, recall bias. To minimize this concern, we created measures that asked whether a specific family event related to their LGB identity actually occurred (eg, verbal abuse), rather than asking generally about “how rejecting” parents were. Although we went to great lengths to recruit a diverse sample drawing from multiple venues, our sample is technically one of convenience, and thus shares the limitations inherent in all convenience samples. Thus, these data might not represent all subpopulations of LGB young adults, as well as individuals who are neither white nor Latino. The study focused on LGB non-Latino white and Latino young adults to permit more in-depth assessment of cultural issues and experiences related to sexual orientation and gender expression, so it did not include all other groups and drew from 1 urban geographic area. Subsequent research should include greater ethnic diversity to assess potential differences in family reactions. Lastly, given the cross-sectional nature of this study, we caution against making cause–effect interpretations from these findings.

Nevertheless, this study highlights some important implications for identifying youth at risk for family violence and for being ejected from their homes. We know that LGB youth are overrepresented in foster care, juvenile detention, and among homeless youth. And we also know that conflict over an adolescent’s sexual and gender identity is one of the primary reasons for being kicked out of the home. And for whatever reason, this study seems to suggest that Latino gay and bisexual men are at a particularly higher risk of being rejected by their parents.

This study opens a long-neglected area of research. Further research which replicates and improves on this study is badly needed. But one thing for certain, those groups — specifically, certain ex-gay groups come to mind — which encourage parents to engage in rejecting behaviors with their children bear a tremendous responsibility. The cost to the well-being of LGB youths can be staggering.