Normativity, or why everyone should be open.

Recently, causes I care about have been in the news. Sometimes for good reasons; the NFL now has its first active openly gay player (while numerous former players have been gay, none of them have been out while active; Michael Sam is out and has been drafted) and sometimes for bad reasons; the Supreme Court has expanded the scope of allowable ceremonial prayer, despite its previous acknowledgement that prayer endorsed by a government agency is unconstitutional. Both of these matter because of the concept of normativity. My friend Justin has written about heteronormativity over on Ninja Blues, with a particular focus on a controversy regarding a video game, but normativity extends beyond sexual orientation.

Bluntly, normativity is the assumption that everyone is exactly like you, except in the ways they differ from you. Everyone makes this assumption; I assume all the people I deal with daily are human, that they want to get things done, and that they're generally nice people. I also assume, with no rational basis, that they're probably heterosexual; that's heteronormativity at work. I try to avoid the assumptions with no basis, but I'm not perfect. Nor is anyone else, which is why the Supreme Court's decision matters so much.

There is a very strong assumption of Christianity in American culture. The language is soaked in religious references, and the default assumption of almost everyone is that any given person is a Christian. This leads to problems with trust; people distrust atheists, because they don't know who might be an atheist. We're invisible. That makes public prayer an issue, because now we must either fake a belief we simply don't have (and most atheists strongly dislike dishonesty) or expose ourselves and be vilified. That doesn't even touch the problems caused by religious people who aren't Christian being coerced into Christian prayer.

This is why atheists should be out of the closet. Silence in the face of encroachment is tacit permission. We need to speak up, to say "Actually, we do not believe as you do", and to be visible. Acceptance can only come when people know there is something to accept.

Things you don't get used to.

I've been living in the USA for six and a half years now, and I'm used to much of it. I'd have trouble driving on the left, for instance. There are some things that still get to me, though. Here are some of them.

The time I punched myself out

I've made oblique reference to this online a few times, and even told the story to people I know offline, but this is going to be the first time I've written it up. Technically, I didn't punch myself out, but it was unconsciousness as a direct result of body parts meeting each other violently, and so...

An unnecessary headache.

Every year, I get a physical exam. Nothing invasive, just a quick set of questions about my health and how I'm doing. Usually, it comes with a request to get some lab tests done, which until recently hasn't been a problem; the umbrella organisation of which my doctor is a part ran its own labs, they had reasonably convenient locations, and it was all nicely joined up. Now, though; oy. Sometime last year, the organisation closed its labs. They now have a contract with a nationwide lab firm, and it's very difficult to determine whether my health insurance covers getting lab work done by these people, and with other changes that have been made, it's very difficult to determine if all their locations are what's known as in-network or not.

What this means is that I am now dealing with lots of new worries about my healthcare provision, none of which should be happening at all. The only thing I should have to worry about with respect to my healthcare is "Am I sick?". Any other question should be unnecessary.

Odds are good at this point that I simply won't get the lab work done because I don't have the spare time to call my insurance company and figure out if they'll pay for it. It is frankly ridiculous that this is the case, and yet another perverse healthcare incentive; it's in the insurance company's interests to make determining this sort of thing as opaque as possible, because then IF it even gets done (not a certainty; and if it's not done, no payout) then it's going to be a non-zero probability of getting it done at an out-of-network provider by mistake, which lets them get away with paying less. Once again, the quality of my care is distorted and lessened by the profit motive.

I keep hammering on this point, and it bears repeating again and again: healthcare is a public good and should not be subjected to the profit motive. Pay the providers fairly, but cut the insurance companies out of the loop. They yammer on about "freedom of choice" and arbitrarily restrict our choices to confuse us.

What I should have been doing...

The LA and No. 1 Daughter have been out socialising for much of the day, while I've been at home. I was supposed to have been writing, since I'm currently working on a piece which has a chance of earning actual money, but I've not had enough uninterrupted time all day, because I've been working through a backlog of laundry. Burp cloths and towels, adult clothes, baby clothes, and now sheets. It seems like every time I've sat down, a laundry machine has beeped at me again.

In other news, I've been feeling distinctly cold of neck recently, since I decided that the baby's habit of firmly grasping a lock of my hair and wrenching my head around was beginning to do nasty things to my neck. So the LA and I repaired to a haircut place, and as it turned out I had just enough hair and in good enough condition that it could be donated to an organisation which makes wigs for children suffering hair loss. Once that was done, some cleanup was in order, and my hair is now shorter than it's been since sometime in 2002. In the years of being long, it's apparently been trained towards the back, and so the short top sort of fluffs upwards away from my forehead - thus avoiding one of the things I disliked about my short hair in years past. My hair becomes greasy fast, and it would fall onto my forehead, clogging pores and resulting in volcanic acne. The cut I have now is very much a low-maintenance affair; every couple of months, I'll need to go back and have it cut again, but other than that I just need to shower regularly and it's good. I can even choose whether or not I want to comb it; it's too short to tangle. So my daughter has accomplished what her great-grandmother never could; she's persuaded me to get my hair cut.

A perverse incentive, illustrated.

Back in November, I suffered a mental health crisis, and wound up in my local county hospital's psychiatric emergency room. I'm still dealing with the paperwork and financial fallout from that, which is a distinctly suboptimal state of affairs, but I've just realised that there is in fact a perverse incentive operating here; it's in the hospital's interests to suck at accounting.

Now I should mention that part of the delay was due to their billing the wrong insurance provider (in most US states, Blue Cross and Blue Shield are in fact one and the same, while in California they are NOT the same; I have Blue Shield insurance, they initially attempted to bill Blue Cross, and naturally got an answer of "Who's he? Never heard of him." when they provided my name. The fact that they somehow managed to overbill by two orders of magnitude, leading me to suspect a failure to hit the button that puts in a decimal point, is a mere bagatelle) but still, one might expect things to be done promptly.

Not so, unfortunately; it's more in their interests to drag things out so that the patient wants this to just be over, and stops scrutinising the bills they receive. It's also in their interest to be distinctly less than wonderful at actually connecting payments to services.

You see, once they finally managed to bill the correct insurance company, they were paid promptly. Unfortunately, their accounting system is apparently a mess; the payment for $x-100 (since for this service, I have a $100 co-pay) didn't actually get applied to the account for my services, so when they generated a bill for me it was for $x, not the $100 it should have been for. Had I not been a good boy and kept my insurers' notifications of payments made, this might have slipped by me; they'd have ended up with $2x-100, instead of $x. When x is the thick end of a grand, it becomes clear that it's very much in the hospital's interests to suck at matching up payments with accounts.

I don't have a plan to fix the broken healthcare "system" in the USA, but I very much feel that perverse incentives like that are a big part of the problem.

I don't want sympathy, just help.

As most of you will know by now, I have some health issues. Well, a lot of health issues; at 33, my daily prescribed pill count (when things are going as they ought, which at the moment is not entirely the case) is 9 pills. Five to adjust my brain in various ways, and 4 to allow my body to avoid tearing itself apart.

And for all the pill-popping, sometimes I go out and have to deal with being visibly disabled. It's mild, but it's there; I sometimes have to use a cane to help me walk. Normally, I present as a relatively healthy youngish man, and so people see me using the cane and assume it's a transitory thing. I'm frequently asked if I've suffered a sports injury.

And that's where the trouble starts, because I'm now forced into discussing my medical history with strangers. I can be churlish and impolite, refusing to discuss why I need a cane; but this upsets people. I can fake it, pretending it's a sports injury; but I dislike lying. I can be honest, and say that I have arthritis; and that's the option I take most often, despite my distaste for the inevitable result.

Every single time, when someone finds out I have arthritis, the response is along the lines of "but you're so young!" Yes, I am aware that osteoarthritis at age 33 is uncommon, but that doesn't change the fact that I have it. All you're doing by saying that is making me feel ashamed of something I cannot control. I wouldn't have chosen arthritis; no sane person would choose a life of impaired mobility and constant pain.

I have similar issues if I have to go out while suffering effects of migraine, or side-effects of the medication I take to defuse them. I'm invariably looking unwell in those circumstances, and people will insist on trying to be sympathetic, usually by rattling off a huge list of helpful suggestions, of which I've invariably tried all the sensible ones and the nonsense ones are so incredibly off the wall that I can't imagine why people would bother.

I am, in fact, fed up to the back teeth with people offering sympathy. I have health issues; they suck; if you're willing, I'd accept your help in dealing with the consequences of said issues. Such as, if you're limber, fetching me up a jar of pickled jalapenos from the bottom shelf, because bending down is going to be excruciating for me. Or turning the music down so I'm not having to strain to hear while my brain is full of rotted wood. Words may cost nothing to you, but that means they're no fit substitute for deeds. If you must talk about my medical status in public, keep it to a "how can I help?"