Month: May 2014

Several more readers share their stories:

I have a “Dish Double” for you! First, thanks for your recent series on Truvada. Somehow I hadn’t been aware of the Truvada PrEP. I’m a 47-year-old gay man who is HIV negative but I had recently found myself engaging in riskier behavior. After all these years, condom-fatigue had set in and with AIDS becoming a manageable disease, the fear that once kept me from indulging in barrier-free sex has passed.

Don’t get me wrong; I was and am not seeking to become positive. I just was finding myself in a position where the idea of using condoms forever was no longer an option for me. In other words, I’m a perfect candidate for a Truvada PrEP regimen.

Which brings me to the view from my Obamacare.

I’m one of the people who was not able to keep my old insurance policy and is now paying more than double each month for my policy. I should mention a few things about my old policy. When I first purchased it back in 2002, I was 35 and had never had any major health issues, so it seemed like a great policy. The premiums were low. Sure, it had a $3500 deductible and no prescription coverage, but so what. I was young and healthy.

Until I wasn’t.

Just before I turned 40, I experienced some medical issues that resulted in hospitalization and ongoing care. Everything is fine now, but for about six months I was seeing doctors once a week. While my insurance did cover most of it, I still faced some large bills due to the deductible and prescription costs. The experience revealed the severe limitations of the policy. It was basically a catastrophic coverage plan. Of course now that I was the proud new owner of a “pre-existing condition”, it was the plan I was stuck with up until this year.

The view from my Obamacare is that my new policy has a premium that is a bit more than twice what my old insurance cost. My new policy also has prescription coverage and a very low deductible. I added things up and with my new policy, I am expecting to save thousands of dollars each year. My Obamacare may cost me more in premiums but it will offer significant savings elsewhere.

Which brings me to my “Dish Double”. After your articles about Truvada, I made an appointment with my doctor to see about starting a PrEP regimen. My doctor was immediately open to it. I had the required blood tests and my doctor called in the prescription. When I went to pick it up, I was expecting the worst. I wasn’t sure if my new Obamacre would cover it but If I had to pay the full $1,700 monthly cost I would. It was just too important to me. When I got to the counter, I discovered that my monthly cost for Truvada is …

$15

Right now the view from my Obamacare is fantastic, and as of last week I’m on the pill.

Another is paying even less:

I’m just writing to say that thanks to the recent thread on the Dish, I just took my first dose of Truvada for PrEP. There are a lot of reasons I’d been skeptical of it in the past, and my HIV risk these days is not nearly what it was when I was, say, 23. But I’m still single and gay and sexually active. I use condoms, but on those occasions where it doesn’t happen for whatever reason, I can quit torturing myself for the next two weeks worrying. I do not expect it to change my behavior (although time will tell), but it will liberate me from these cycles of excruciating worry.

So thank you. Bonus: It is costing me precisely $0.

Update from a reader:

Thank you for your post on gay men’s health. I feel compelled to say that I definitely relate to the 47-year-old man who wrote to you. As a 47-year-old man myself, I am also considering going on Truvada. I think we need to have an adult conversation in the gay community about widespread use of this drug as a HIV-prevention strategy, rather than just relying on someone just using the same, tired 30-year-old safer sex campaign, and wagging his finger at younger gay men saying “use a condom every time”. Even if I go on Truvada, I still plan to use condoms for there are other STIs out there that I don’t want any more than HIV.

That said, “condom fatigue” is a REAL issue in HIV prevention campaigns in the gay community. When many of us were working on safe sex campaigns in the 1980s, most of us never imagined we’d STILL be telling people to simply “use a condom” three decades later. I know gay men of my age who had been practicing “safer sex” for twenty to thirty years and eventually just got sloppy with safer sex, a handful of whom then seroconverted even after two straight decades of having safe sex. Truvada might have been of help to them.

Also, with crystal meth use being a tragic problem in the gay community, if Truvada can help spread the stop of HIV in these cases, where the crystal overwhelms any safe sex message, and most people I meet nowadays who have seroconverted admitted to drug use as a contributing factor, how can we not spread this drug as widely as possible?

For those who say that Truvada will only encourage unsafe sex, I laugh at them as much as those who preach abstinence-only birth control; both are people who have no connection with real life or the real world.

Another dissents:

So we’ve heard over and over again in the press coverage concerning Truvada PreP that it doesn’t lead to riskier behavior. This evidence comes from a single study (though it was conducted on a variety of gay male populations around the world). Your two emailers in the Obamacare post, and my own experience so far in the gay community, give the lie to this claim (at least for gay men in the US). I’m not saying I disagree with PreP – but it is simply dangerous to be anything less than honest about what PreP means to many gay men like your reader with “condom fatigue” who will now engage in riskier behavior because of the protection of Truvada. There is danger down this road …

All of your Views From Your Obamacare are here.

(Photo by Yoon S. Byun/The Boston Globe via Getty Images)

Nate Cohn claims that, if “the country’s growing diversity dooms the modern Republican Party, then Florida will be the first exhibition of the party’s demographic death spiral”:

The problem for Republicans is that Mr. Obama was a terrible fit for the state’s eclectic mix of white voters. The Florida Panhandle is full of the culturally Southern white voters who rejected Mr. Obama, as they did across Dixie. Mr. Obama also struggled with older whites over age 65, who represent 30 percent of the state’s white voters, and among Jewish voters, who represent about 15 percent of self-identified white Democrats in Florida. Mr. Obama’s strengths — like his appeal to young, socially progressive voters in well-educated metropolitan areas — lack pull in Florida.

All of this will be reversed if the Democrats nominate Hillary Rodham Clinton, who is a good fit for the state’s odd combination of Southerners, New York expats and older white voters. Mrs. Clinton doesn’t even need to outperform Mr. Obama among Florida’s white voters anyway, as she’ll benefit from four more years of demographic change.

Ben Highton clarifies the GOP’s 2016 disadvantage:

While swing state trends look good for the Democrats, the same is not apparent in the rest of country.  In the remaining states, there is more movement toward the Republicans than the Democrats.  In the 23 safely Republican states, continued movement toward the Republicans is occurring at a rate about 25 percent faster than the average movement toward the Democrats in the 14 safely Democratic seats.  In fact in 10 of the 12 states that are changing fastest, the movement is toward the Republicans, not the Democrats.  However, these trends have virtually no influence on the chances of victory in a presidential election because with a winner-take-all system like the Electoral College, additional votes in a state that is already safe for one party are “wasted.”

His model finds that “that to have a 50 percent chance of winning the Electoral College the Republicans would have to win the popular vote by a margin of between one and two percentage points.” Jonathan Bernstein ponders the Democrats’ apparent advantage in the Electoral College:

I’m increasingly convinced this is something real, and it’s a pretty big deal. As Ben says, that large a bias would almost certainly have flipped the 2000 election to the Democrats; other elections close enough to have been affected by a bias this large would include 1976, 1968, and 1960 (if the losing party had been helped by an Electoral College bias of this size).

If these results hold up through 2016, expect the parties to begin flipping their positions on the Electoral College, perhaps very rapidly.

https://twitter.com/HalaJaber/statuses/464052929620869120

Syrian rebels have ceded the central city of Homs to the regime:

Rebels are attempting to portray the deal less as a military defeat and more as a strategic compromise. Anti-regime activists say that besieged residents have been so weakened by the siege, which has caused chronic shortages of food there. “Revolutionaries inside have nothing at all. You would think it’s impossible for them to survive, but they did for two years,” says Samer al-Homsi, a 27-year-old activist in Homs who goes by a pseudonym to protect his identity. “At this point, they are facing sure death so it’s best for them to leave and maybe resume the fight later. For them it does feel like a victory that they’ve managed to survive.”

In practical terms, the deal appears to offer the best possible outcome for the rebels considering their position, says Syria analyst Noah Bonsey of the International Crisis Group. “Given that rebels lacked the means to gain ground within the city or to secure their exit militarily, this safe passage holds clear value.” Still, says al-Homsi, the capitulation will be a permanent “lump lodged in the rebels’ throats. Homs was known as the capital of the revolution.”

The regime is being unusually magnanimous:

As part of the truce, rebels were allowed to leave the besieged city peacefully under the supervision of regime forces and UN delegates; they were also permitted to keep their personal weapons. The rebels promised to open a safe passage to allow for food and medical aid to reach the government-controlled enclaves of Nubul and Zahraa outside the northern city of Aleppo, another big battleground. For months, rebels had blocked access to these two cities.

To uphold its end of the deal, the government promised to grant amnesty to 50 people who defected from the regime to the rebel forces in Homs. The government also promised not to arrest the rebels once they reached regime checkpoints; earlier this year, a more limited evacuation led to the detainment of several rebels at checkpoints.

Juan Cole explains the strategic significance of the city:

The rebel strategy last year this time was to take Homs (they held part of the city) and its hinterland, towns like al-Qusayr. The rebels, mainly Sunni Arabs and increasingly leaning toward extremist groups, hoped to use their dominance of Homs to cut Damascus off from both Latakia and from the Lebanese ports. At the same time, they intended to take the airports, including small military ones, so as to prevent resupply by air from Russia and Iran. Damascus would be under siege and gradually would weaken and ultimately surrender.

The rebel plan was defeated by several regime responses.

A reality check:

According to classified briefings on legislation that would lower visa restrictions on Israeli citizens, Jerusalem’s efforts to steal U.S. secrets under the cover of trade missions and joint defense technology contracts have “crossed red lines.” Israel’s espionage activities in America are unrivaled and unseemly, counterspies have told members of the House Judiciary and Foreign Affairs committees, going far beyond activities by other close allies, such as Germany, France, the U.K. and Japan. A congressional staffer familiar with a briefing last January called the testimony “very sobering … alarming … even terrifying.” Another staffer called it “damaging.”

The Israelis have responded forcefully to this – by denying that they spy at all and – surprise! – by accusing the writer, Jeff Stein, of being an anti-Semite. Stein responded today with more reporting, including this gem from a source at a congressional briefing on Israeli spying in 2013:

“I was in this briefing — there were several,” … a former congressional aide told Newsweek. “The one I was in had senior staffers from foreign affairs, the full committee, the subcommittee … from judiciary, Republicans and Democrats, senior leadership staff. I don’t think there was anyone in there who didn’t work for a member that wasn’t ardently and publicly pro-Israel,” he said. “And afterwards, we were saying, ‘No way. You’ve got to be fucking kidding.’” The evidence of Israeli spying was overwhelming, he said. Visa waivers was off the table. “The voices in the room,” the aide recalled, were, “‘There’s just no way that this is possible.’”

Oh yes there is.

German Lopez highlights it:

About 80 to 90 percent of Obamacare enrollees are paying their insurance premiums, major health insurers testified before Congress on Wednesday. The insurers’ testimony undercut a report from House Republicans that found only 67 percent of enrollees on Obamacare’s federal exchanges had paid their premiums. Insurers only start coverage after they have received a first month’s premium payment from an enrollee, making the percent paid an important metric to gauge how many people will actually gain coverage.

House Republicans’ report, insurers explained, got that metric wrong.

Allahpundit wonders why the House Republicans rushed to issue that 67 percent number:

Theory one: Stupidity. If and when the final payment numbers are released and it’s confirmed that 10-20 percent of new enrollees, a.k.a. 800,000 to 1.6 million people, will be tossed from the rolls, the White House now has some handy spin. “Once again Republicans underestimated ObamaCare,” they’ll say. “They thought we’d top out at 67 percent payment and we made it to 80 percent. Another victory!” Always a bad idea to lower expectations for your opponent. Theory two: Cynicism. Maybe the committee suspects (correctly) that most people don’t follow the news consistently but get it in bits and pieces at irregular times, especially when it comes to a subject as complex and long-running as ObamaCare. As such, they may have decided to float the 67 percent figure knowing/assuming it was bogus but confident that some low-information voters would notice it and conclude that O-Care was underperforming in yet another metric. Some of those voters will miss today’s news and the White House crowing to come about the correct figure and remain convinced that fully a third of new enrollees haven’t paid.

Suderman puts a negative spin on the new numbers:

The House GOP report was too early, ignored deadline issues, and turned out to be problematic as a result. But based on insurer testimony, the administration’s much-touted total of 8 million sign-ups is likely to be reduced by a million or more when converted into paid enrollments. In other words, the administration’s figures were too rosy by quite a bit—just not as much as House Republicans suggested.

Cohn frames the story very differently:

“What you have here is very solid first year enrollment, no matter how you slice it,” Dan Mendelson, president of Avalere Health, told Bloomberg’s Alex Wayne.

If an account of Wednesday’s hearings by The Hill‘s Elise Viebeck is accurate—I didn’t see them—the testimony from insurers didn’t sit too well with members of the House majority. “Republicans were visibly exasperated,” Viebeck reported, “as insurers failed to confirm certain assumptions about Obamacare.” Republicans have had plenty of chances to embarrass Democrats over Obamcare and, given the law’s very real shortcomings, they’ll be sure to have plenty more. But on Wednesday, it seems, Republicans mostly succeeded in embarrassing themselves.

Many readers are protesting along these lines:

Did you actually listen to the context of what they were discussing? If you don’t have the time to actually listen to a few minutes worth of what you’re passing on as “The Closed Mind of Neil DeGrasse Tyson“, then you probably don’t have the time think about the meaning of the word “meaning”.

Another goes after Damon Linker:

Rather than calling Linker’s hatchet-job a “must-read”, go and listen to what Neil DeGrasse Tyson actually said. Linker completely misrepresents him.

Yes, I did listen to the context and now I have listened to much more of it. Tyson reeks of scientism and rank condescension to philosophy and to philosophy’s role in humanity’s understanding of itself and the whole. The more I listened the more the philistinism deepened, the more the sophomoric cliches about philosophy proliferated – you “can’t cross a street”, for Pete’s sake, if you’re concerned with the ultimate questions! I’ve heard freshmen with sharper insights at 3am. Most troubling to me is the notion that all human thinking must somehow have some “productive” end or is worthless. One thing that distinguishes human beings from other animals is our self-consciousness, and all the questions that raises. But Tyson “doesn’t have time for that.” Another reader elaborates on the dissent:

I’ve listened to the clip, and I call bullshit on Linker’s hyperventilation over Tyson’s comments. Tyson was pretty clearly talking about the diminishing practical returns on philosophical debate, and he has a great goddamned point that many a liberal arts major should consider.

At what point does a person’s philosophizing cease to provide positive societal value, and become, in essence intellectual masturbation? At what point would society as a whole benefit from focusing more on the practicalities of modern science versus the arcane twaddle of modern philosophy? Tyson clearly believes that recent “discoveries” in philosophy are more masturbatory than helpful, and that we should focus our energies more productively.

Were his comments glib? Sure. (Although, Tyson and his fellow podcasters had just finished riffing on comparisons between Newton’s development of calculus and reality programming on TMZ, so the tongue-in-cheek nature of his comments is hardly out of line.) But that comment does not make Tyson “every bit as anti-intellectual as a corporate middle manager or used-car salesman.” It makes him a sarcastic SOB who thinks the world would have been better off if your six years of philosophy study at Whitman College had been spent studying electrical engineering at MIT. And its hard to argue that he is wrong.

Actually, it’s very easy to argue that he is wrong. If humanity had always had that perspective the very concepts of math and science would not exist. Another reader:

Tyson was referring to thinking big in the sophomoric, pseudo-intellectual way of someone taking their first philosophy class as an undergraduate. “What if we’re all brains in vats, man?” “What if I am all that exists?” “All of life is chemical reactions, so how do I know what is even real?”

These are all totally unanswerable questions that don’t lead anywhere. They don’t further knowledge in any meaningful sense. They just lead you into a cul de sac of admiring your own cleverness. It’s like the old bit from Gilbert and Sullivan: “If this young man expresses himself / In terms too deep for me, / Why, what a very singularly deep young man / This deep young man must be.”

Another who listened to the podcast:

It is my understanding that for philosophy to be effective, it needs to be rooted in logic. Which is why listeners need to start their assessment of Tyson’s point back to to at least 15:00, where Dr. Tyson states:

I don’t have a problem with these philosophical questions, just give me a way to test it. Math is about getting finite answers to infinite regressions. It it is measurable whether you like it or not. If you are distracted by your questions, you are being productive and not contributing to the real world.

As in, why is a pound a pound? What does the answer to that contribute to anything? Linker starts his rant on the Giordano Bruno overblown kerfuffle, to which I say, “What’s your point”? I find it laughable that Linker equates Tyson’s comments as derogatory to Plato, Aristotle, Aquinas, Hume, Kant, Hegel, Nietzsche, Heidegger, or Wittgenstein, as the latter references Aristotle in Cosmos as one of the great thinkers and that many of his ideas were proven once the logic and results of calculus was applied. In short, Damon Linker is quite thin-skinned.

I’d say my readers are. Look: I understand why DeGrasse Tyson is so popular (I’m not engaging in our long twilight struggle as to who will win the final battle for the most appearances on Colbert) and I’m a big believer in better and wider understanding of science. But when he responds to first order questions of meaning by demanding how he can test them, he is simply engaging in an irrelevance. The ways to test one school of thought is not the same as for another. Tyson is asserting that only science’s methods are valid as a search for truth. My view is that it is one way of seeking a particular truth – but that humanity, over the millennia, has developed others, just as relevant to the human condition, but with different forms of logic and understanding. In glibly dismissing any such claims, Tyson is, I believe, in this podcast, as Damon describes him.

Update from a reader:

I want to respond to your reader who claimed that “the world would have been better off if your six years of philosophy study at Whitman College had been spent studying electrical engineering at MIT.” I’m a senior web developer working on very large, complicated site builds. My undergrad degree focussed on oil painting, and my postgrad degree is an MFA in creative writing. A good friend of mine, one of the most talented network architects in the NY area (who is likely responsible for your NY readers being able to access your blog reliably), has an undergrad degree in philosophy and no formal training in his field. An informal poll of my colleagues reveals that almost none of them have an engineering or comp sci degree. As much as I appreciate your reader’s advice on our educational choices, I think we’re doing fine for ourselves. The dirty secret of engineering is that experience matters more than education, and knowing how to think and solve problems trumps all.