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PaperclipPerfector  19d ago (text post)   35134 thread views

Culture War Roundup for the week of February 3, 2025

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St. John's Well Child and Family Center, a network of public health centers in South and Central Los Angeles, cannot access $746,000 remaining from a $1.6 million grant used to provide prevention, testing and treatment for about 500 transgender people at risk of HIV, sexually transmitted infections, tuberculosis and hepatitis C.

When I was younger, I had developed pretty libertine attitudes about human sexuality and I still mostly have the same gut feelings, but every now and then, I bump into things that make me think the conservatives have a point. This is roughly $3K per person for STI testing and treatment. Why? Why do these people insist on doing such consistently risky behavior that they need constant STI surveillance? Even being somewhat promiscuous doesn't result in constant infections, the behavior here really just has to be completely outside the range of anything that most people would consider normal. As you note, the other Life Center apparently spends about five times that much per capita, clocking in over $15K per person.

Making everyone else pay for egregiously bad behavior is just galling.

his is roughly $3K per person for STI testing and treatment. Why?

I can tell you from being adjacent to the porn industry for a while that they were testing constantly and it doesn't cost that much when purchased on the competitive market with clientele that are motivated to get tested.

I expect that this is a combination of:

  • Expense bloat from doing it in a non-competitive environment
  • Having to chase and accommodate irresponsible/flaky/implusive/crazy patients to get them to comply
  • Constant handholding for patient that can't or won't fill out basic paperwork correctly, on time, at a 3rd grade level of accuracy

This isn't behavioral at all. Give it back to the free market and demand that patient be responsible for their own screening and it would be done for a hundred bucks a test.

I can tell you from being adjacent to the porn industry for a while

Respectful request for stories. You must have several good ones.

I heard they are tested a lot. . ironically it is safer than sex with a stranger

Yes, they have a system of record that logs every intercourse on the set and takes the potentially infected parts of the networks offline as soon as someone fails an STD test. Performers usually fail their tests because they hooked up with someone outside the industry and had unprotected sex with them.

Correct. There was also an air of “if we don’t self regulate effectively , OSHA or some other dept will and the result will surely be far worse.

Lesson there eh

Depends on which portion of which state's OSHA you're dealing with. I recently had a professional reason to run something by a particularly-specialized branch of Cal-OSHA and it was an absolute piece of cake. Incredibly business-friendly...I think every single person I talked to was at least a 10-year industry veteran who migrated over to the government side once they were ready to work fewer hours per week and get started on accumulating a pension (or at least gave that impression to my jaded eyes). Super easy to work with, very clear in terms of expectations and bright-line rules that the client was also happy with.

I can’t stress enough how certainty is far more valuable to regulated businesses than leniency.

Indeed, hence the focus on the "very clear in terms of expectations and bright-line rules"

I can tell you from being adjacent to the porn industry for a while

I'd love to hear you expand upon this.

What makes it add up is that it's apparently transgender specific- everything we know about transgenders is that they have very poor health and cost a lot to treat.

This stuff never stays confined to one community forever. In addition, the US medical system guarantees anyone access to healthcare (if they don’t pay for it, the state and/or all insurance users do), so you’ll be paying for much more expensive AIDS treatment in the long haul. If reducing promiscuity is the goal, cutting funding for PrEP seems like a poor place to start; gay men were highly promiscuous even at the height of the AIDS pandemic (that is in fact how it happened) and I doubt they will become less so today, when the disease is more easily treated and no longer a death sentence.

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

Monkeypox was where it became obvious gay men were just uninterested in restraining themselves. Just wrap it up became akin to genocide by gay activists claiming discrimination, then immediately after that there was endless concerns about how gay men were being unfairly stigmatized for spreading monkeypox. Of course they should be stigmatized! They were barebacking against medical directive, complaining about being discriminated against and then demanding the external public make restitution foe the hurt feelings. Its pure moral hazard combined with crybullying to externalize responsibility and liability.

The narrative of the 90s were that gay kids were just normal people that happened to like the same gender. Sometime in the 2010s this got morphed into gays being a protected class, and now the chemsex degenerates have decided to lump their irresponsibility under the ambit of kink. If NAMBLA wasn't annihilated in the 80s it would be the vanguard of pedophilia, and it would be homophobic to not let them cavort with our children.

The usual rules about specific groups, outgroup-booing, and heat vs. light still apply. Even when you really don’t like the people involved.

Given the number of times you’ve been warned or banned for more or less the same thing, this shouldn’t be news to you. On the other hand, you keep doing interesting stuff when you can keep the vitriol in check.

One month ban, then.

The narrative of the 90s were that gay kids were just normal people that happened to like the same gender. Sometime in the 2010s this got morphed into gays being a protected class, and now

This reminds me of when The Onion was still funny (2001):

“After centuries of oppression as an ’invisible’ segment of society, gays, emboldened by the 1969 Stonewall uprising, took to the streets in the early ’70s with an ’in-your-face’ attitude. Confronting the worst prejudices of a world that didn’t accept them, they fought back against these prejudices with exaggeration and parody, reclaiming their enemies’ worst stereotypes about them and turning them into symbols of gay pride,” Thorne said. “Thirty years later, gays have won far greater acceptance in the world at large, but they keep doing this stuff anyway.”

I also don't care for that lifestyle, but "engaging in risky behavior argument" as justification to deny care can be used for almost everything. Car accident while going too fast and not wearing a seatbelt? Snowboarding? Downhill skiing? Smoking? Football in high school? etcetera .

Wisdom involves judging and drawing up permissible and impermissible risks.

Playing football in high school is risky. Self-testing novel chemical amphetamines you bought online is also risky. But they're not the same kind of risk.

Having sex with a 17.9 year old or an 18.1 year old doesn't seem very different. But it doesn't then follow that 35 year old men should have ready access to 12 year old girls. At some point a line must be drawn on a qualitative, continuous and complicated scale. And people must fundamentally reason out a series of rules, guidelines and reasonable applications of flexibility in special cases to make this work.

Isn’t there a difference between denying care and paying for it?

Jesus Christ

  • -25

Please don't post low-effort one liners just to express your outrage.

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

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

One way in which this would come back to bite right-wingers is that it would be taken as precedent to raise premiums or deny coverage for $disease-related costs and deaths to the unvaccinated. From what I can tell, this was already being bandied about around 2021-22, but seemingly not implemented.

Some other possible targets: anti-abortion women (liability from not aborting dangerous pregnancies and genetic defects where the parents' insurance may be on the hook), Christian sects that refuse blood transfusions (though you might not care if the interdenominational solidarity of the Waco era is gone).

No, right-wingers don't have to pretend that something that is related but very different is somehow indistinguishable, nor worry that they're somehow giving the other side ideas -- since obviously the left has already thought of that.

Well, they've for sure thought of it, but why didn't they go through with it? The simplest explanation could be that the other side does in fact have people who are concerned about principles or at least have other considerations than mashing the "defect" button as fast as they can.

If your reaction to that is to spy an opportunity and defect first, then this only makes my (and, I imagine, others') defector-punishing instincts tingle. I figure it would be a mistake for the Right to mistake the current situation for one in which they actually have a stable base of loyalists, as opposed to a temporary alliance that depends on people (such as myself) who got tentatively convinced that they are the lesser evil. Trying to defect first in any domain could flip that perception rapidly.

The vaccination stuff, probably because public sentiment was moving anti-Covidian. Liability for "not aborting" is still outside the Overton window. Christian sects that refuse various medical treatments have been targeted for many years (e.g. by taking their children away from them); the problem with trying to charge them more is that if they refuse blood transfusions they tend to cost less (being dead).

But all that misses the larger point, which is that it is possible to distinguish "paying thousands of dollars a month to gay men so they can have unprotected sex with a lower risk of an STD" and "refusing insurance to women who refuse abortions in principle".

But all that misses the larger point, which is that it is possible to distinguish "paying thousands of dollars a month to gay men so they can have unprotected sex with a lower risk of an STD" and "refusing insurance to women who refuse abortions in principle".

Yes, it's possible to distinguish, which means that when the other team is back in power they will happily distinguish to enact the exact opposite of your preferred policy.

It's always easy to come up with just-so stories how the other side not having escalated in the past must have been due to contingencies that will be totally unaffected by your side escalating, and surely not because someone somewhere did not just want to stoke the fires of Moloch's furnace higher.

The vaccination stuff, probably because public sentiment was moving anti-Covidian.

I didn't get the sense that it was moving anti-mandatory-vaccinations, except in communities that the Democrats had largely written off as a voter base anyway. In an era where generating hype (stealing this expression from a pop culture engineer interview I read recently, which randomly put a good label on this propensity to just want to be betting on the winning team) is a crucial political strategy, punishing anti-vaxxers more would probably have actually energised the base.

Liability for "not aborting" is still outside the Overton window.

Would it stay there if normie Democrats found that the infrastructure supporting their own sexual lifestyle choices (as opposed to those of a loud but small utility monster minority) is being attacked? Your enemy, too, is capable of making sacrifices to punish and spite.

Christian sects that refuse various medical treatments have been targeted for many years (e.g. by taking their children away from them); the problem with trying to charge them more is that if they refuse blood transfusions they tend to cost less (being dead).

That doesn't apply to life insurance, where living longer means more profit.

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

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

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

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

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

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

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

Free cigarettes at 50?

Unless you're at like 40 BMI.

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

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

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

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

are we also going to stop subsidizing treatment for smokers

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

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

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

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

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

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

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

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

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

Isn't that how kidnapping insurance works?

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

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

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

Yes.chad.

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

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

Meh. Fuck around and find out, literally- I don't think it's practical to criminalize straight casual sex outright, but the government shouldn't be in the business of making it a less risky decision. Perfectly fine with fornicators getting diseases as a consequence of their sinful decisions.

Government pays for treatment, but your name and photo are added to the state social disease register, linked to you Tindr / Grndr profile?

On the other hand, consequences removed also remove any incentive to stop doing stupid things. Maybe cutting funds to treat active disease is a bad idea, but I do think that much more of the burden for these kinds of lifestyle diseases (not just promiscuous sexual activity, but obesity, drug use, smoking, and high risk trill seeking) that add burdens to the public, and often not nearly as much for the person who brought the problems on themselves. If they were to see others like themselves forced to pay for treatment after a lifetime of risky behavior catches up to them, they’d likely take at least some warning. It’s much like what’s happened in the student loan crisis— more and more kids are choosing options other than college because they see how much trouble their older siblings and parents got themselves in by going to college without a solid plan. If we’d actually managed to forgive the loans, that would not happen. And I think the same might well work to a degree for lifestyle choices that cause disease or injury— if you had to spend yourself into poverty undoing the damage of I.e. obesity, then a lot of people would look at people having to do that because they couldn’t put down their forks and decide to download a weight-loss app and control their eating and exercise plan. If they see their future as “I’ll just get free ozempic at taxpayer expense when it gets bad enough,” tge lack of negative consequences give them no reason to avoid the problem or take positive steps to fix it.

We don't have to do any of that. Paying thousands of dollars per month to gay men so they can have sex without consequences is not the only answer. And it's an answer that is extremely unfair to all the rest of us.

Yeah, I guess I just don’t see Donald Trump ending gay promiscuity in the next 3 years so in its absence handing out PrEP to anyone who wants it protects the wider public. It’s not like the number of closeted / bi dudes with wives and girlfriends is nonexistent, you can’t have HIV spreading and not eventually see normal (even chaste) people get it.

How many of these wives and girlfriends got the comparably more contagious monkeypox? That more pets and kids(and this probably says that monkeypox is highly contagious within households more than it does that gays are all pedophiles- after all, adopted kids of gays don't seem to get HIV very often) did than beards indicates to me that being a beard is very low risk, either because there's very few of them or because their husbands/boyfriends are unusually non-promiscuous.

Eh, the whole PrEP thing came out before it was determined it was acceptable to lock down the entire world to try to stop a disease. I don't think your premises are true (consider the spread of monkeypox), but even if they were, there are alternatives to taxing incels and the monogamous to keep the party going for gay men.

This is roughly $3K per person for STI testing and treatment. Why?

Maybe it includes the opportunity cost of not providing other services.

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