Kevin

The rain misted down around me as I hurried into the Laundromat.  He was carefully settling his teal colored, decorated cart underneath the awning of the building.

As I began loading my clothes into the washing machine, I could smell a faint scent.  Uncomfortably, I thought, “Is that me?”

After a moment I realized it was the man with the cart; his slight odor floating over to me as he loaded his clothing in the machine next to mine.  After pushing all the proper buttons and listening with satisfaction to the sound of the coins dropping into the machine, I sat down and opened my book.  For a time, I escaped from the over bright Laundromat and found myself in the world of late 19^th century New York.

“What are you reading?” he asked.

“It’s about Emma Goldman,” I replied, holding up the book for him to see. “She was an anarchist.”

“Ah, a person with no leader, except themselves.”

“Interesting,” I mused, “He seems educated.”

He had also been reading, so I queried about his choice of material.  He explained that he was nearly finished with the Haunted Mesa by Louis L’Amour.  He recounted the basic story and then qualified his interest.  He was not an avid fan of Westerns because so many had predictable plot lines.

As we chatted, I surveyed his appearance.  His clothing was clean and old, but well maintained.  His stocking cap matched his brown glasses frames and his beard, though long, was groomed.  His eyes were also brown, although the left was nearly closed tight.

He explained that his favorite writers were Hemingway and Steinbeck.  He especially liked Hemingway because he wrote of northern Michigan, an area familiar to him.  In explanation, he told me that he had been raised in Temperance, Ohio just seven miles from the Michigan border.

He then took off his glove and extended a hand.  My name is Kevin.  I shook his hand and replied that mine was Kyle.  We continued to chat as I folded my clothes and stacked them in teetering piles in my mesh laundry bag.

After a few more stories, he quietly revealed that he would be going and planned to snuggle down in his sleeping bag to stay warm.  He wished me a good evening and walked out into the rainy night.

Reliving a Memory

Much of the time it feels like ancient history.

It used to come rushing back much more frequently.  I would be walking past the fraternity house on the corner of San Jacinto and Park.  The big house just beyond J. P.’s Java.  I would be headed toward the law school.

And I would freeze.

And then—I would be gone.  Reliving a memory.

I am lying on a bed.  I am on my stomach and he is pushing his penis into my anus.   I can feel my skin stretching and tearing slightly.  And I am wondering why he took off his condom. 

And suddenly, I would be standing on the street corner with the sun peaking out from behind the stray clouds.  And I would resume my walk to class.

Much of the time it feels like I’ve forgotten.

But then I will be standing in a crowded bar and someone will slide past me, barely grazing my back.  Or I will be standing on the edge of the dance floor and someone will try to dance with me, pushing their crotch against my ass.

And I will freeze.

And then—I will be gone.  Reliving a memory.

I am sitting on the toilet in the bathroom next to his room, trying to cry quietly so he won’t know.  And I am wiping the blood and semen off of me.  And I keep thinking over and over again, “You can’t call the police, you don’t even know the name of the apartment complex.  You are such an idiot.”  

And suddenly, the sound turns back up and I am standing in a crowed bar or on the edge of a dance floor.

But then November comes and I am wondering why I feel so off kilter.

And I freeze.

And then—I am gone.  Reliving a memory.

It is late on December 2^nd, and I took the LSAT just hours before.  I am standing in a crowded bar on 6th Street with one of my friends and her roommate.  And we decide to go back to their place to continue the party.

And suddenly, I am sitting at the desk in my office and counting the years.  I reach five this time and I cry.  

Contraceptives and the Debt Ceiling

I spend much of my day reading and writing about health care reform and often it seems as if it is all bad news.  But today I was pleasantly surprised.  The Department of Health and Human Services adopted all eight of the Institute of Medicine’s recommendations on women’s preventive health services.  This means that after August 1, 2012 more women will be able to access the health care they deserve.  Stop and think about that for a moment; a woman will be able to go to her doctor for a well-woman visit without worrying about whether she can afford another co-pay.  More women will be able to access their preferred contraceptive method.  More women will be able to obtain HIV testing.

More American women will have access to the tools they need to become and stay healthy.  This is a historic moment.

But before we get too excited we have to acknowledge that we’re in the midst of another historic moment and it is also particularly important to women.  Unfortunately this one is not good news.  Congress is currently in the process of passing legislation to raise the debt ceiling and address the deficit by making cuts to important social programs.  The process itself has been maddening and confusing.  If you want to know more about the specifics of the current deal go here, but the exact details are not what I want to address.

What we should focus on is the stark reality that women, and women of color in particular, are the ones who will be most affected by this legislation.  Poverty has a female face.  Women are the ones who are utilizing Social Security, Medicaid and Medicare to ensure that they are able to eat and go to the doctor.  It is unacceptable that we are jeopardizing the long-term well being of women in order to maintain a taxation system that only benefits a select few.

Contraceptives Aren’t the Only Important Preventive Service

On Monday afternoon the Secretary of the U.S. Department of Health and Human Services will announce which of the Institute of Medicine’s recommendations the department will adopt.

In late March of 2010, Congress passed the Patient Protection and Affordable Care Act (ACA) more commonly known as health care reform.  The ACA included a provision that requires private health insurance companies to cover certain preventive services without cost-sharing.  In other words, a consumer will pay for these preventive services as part of their premium and will not be required to meet a deductable or pay a co-pay.

The ACA developed the list of covered preventive services from several different evidence based sources.  The full list can be found here.  In addition, the Department of Health and Human Services charged the Institute of Medicine (IOM) with reviewing preventive services that are specific to women.  On July 19^th, the IOM released its list of recommendations.

The IOM recommended that health insurance companies cover eight preventive services without cost-sharing.  These recommendations include screening and counseling for domestic violence and coverage of equipment to help women who choose to breastfeed do so successfully.  A brief report and the full list of recommendations can be found here.

The media latched on to only one of the IOM’s recommendations and the headlines trumpeted the possibility of free birth control.  In fact the IOM did not recommend free birth control; instead it recommended that insurance companies use money consumers had already paid in premiums to cover any of the Food and Drug Administration’s approved contraceptives.  This recommendation is significant because it will help women prevent unwanted pregnancies as well as plan and space wanted pregnancies.

However, focusing solely on birth control ignores the importance of the other seven recommendations.  Each of these recommendations will improve health outcomes for women with private insurance and will help lessen health disparities faced by women of color.  I would like to highlight two of the recommendations.

The ACA requires that health insurance companies cover the cost of a pap smear without cost-sharing, but the IOM recommended that they also cover DNA-based testing for women over 30 years of age.  Pap smears and the DNA test are used to check for cellular changes in the cervix caused by the human papillomavirus (HPV) that can lead to cervical cancer.   Access to these tests is especially important for women of color as Latinas have the highest cervical cancer rate in the country and African American women are the most likely to die of cervical cancer.

The IOM also recommended that health insurance plans cover counseling and screening for HIV without cost-sharing.  This is significant because women account for one in four new HIV/AIDS infections in the United States.  Of these newly affected women approximately two-thirds of them are African-American.

Adoption of these recommendations will help ensure that women are better able to access the health care they deserve. The IOM based their recommendations on evidence based information.   Given the enormous benefits of these preventive services, the Obama Administration should adopt each of these recommendations without qualification.