World Suicide Prevention Day

Today is World Suicide Prevention Day, so I’m going to talk about it a little bit, as I do every year. But first: If you are feeling like you might hurt yourself, or just want to talk, you can call the National Suicide Prevention Lifeline at 1-800-273-8255. (Want an LGBTQ+ youth specialist? Call the Trevor Project Lifeline at 1-866-488-7386, or follow that link to chat.)

Now then.

Have you ever felt suicidal? I have. I even came very close to doing it once or twice. Thankfully and obviously, I did not.

It’s something I live with, though. Like jaw pain from grinding my teeth, it pops up during periods of high stress, and floats, in a low-grade way, in the back of my mind. But it is managed, with therapy, medication, and lifestyle choices.

Some of the management takes the form of morbid self-talk. People really hate it when I narrate this, but here goes:

Me: “Bullshit problem x is intractable and you should just kill yourself.”
Also me: “Well, how about we finish writing these tests, and then we can kill ourselves over bullshit problem x.”
Me: “…You finished the tests, and bullshit problem x is still…”
Also me: “Look, if I don’t finish writing this story, nobody’s ever going to read it. I can kill myself after that, okay? Great.”
Me: “…The story is out to readers now. It’s late at night and you’re alone. This would be a great time to kill–”
Also me: “Nope, can’t, somebody is wrong on the internet. Let’s pick this back up when that stops.”

Not today, satan, as they say. Don’t get me wrong: My life isn’t entirely, or even mostly, a mad scramble away from such thoughts. It’s just one tool in my toolbox for when things get especially hairy.

But enough about me. Today I would like to talk about my friend SP. We met when I was thirteen, and starting high school a touch early. I didn’t know anybody. SP was fifteen, probably, a sophomore. She was great, one of my first new friends in that new part of town. Always happy to show you around, lend a hand as needed, or listen to your dumb problems. Sort of the school mascot for the weird kids.

SP was bi, though I sorta figured she was probably totally gay. She was the first queer person I knew who didn’t have HIV, no joke. It seemed like her hair was always a different color. She wore Doc Martens and these ridiculous military surplus outfits, that bright red camo stuff. I remember she used to joke it was in case she needed to blend in with a pile of flaming moose. Her family was also a bunch of religious fundamentalists, including her parents, so that was fun for her.

I remember the phone call my parents got when she died. I picked up the phone and somebody I didn’t recognize asked for my parents. I assumed a telemarketer and said they weren’t there. Then she said she worked for the school and started to cry. I got my mom. A few minutes later, my mom sat me down on the white leather couch in the living room, and I started to learn a very confusing lesson about life.

SP’s family was so ashamed of her, they didn’t even have a memorial service.

Here are some facts about LGB people under twenty-five.

  • They are almost five times as likely to attempt suicide compared to heterosexual youth.
  • Their attempts are five times as likely to require medical intervention.
  • If their families reject them, they are 8.4 times as likely to have attempted suicide as their LGB peers with low levels of rejection–peers who are already many times more likely to attempt suicide than heterosexuals.

We don’t have great statistics on trans* youth, but here’s one we do know: 40% of transgender adults report having made a suicide attempt; of that group, 92% did it before the age of twenty-five.

These statistics are via The Trevor Project, a suicide-prevention nonprofit for LGBT youth. It is a very important organization to me. At my wedding, I requested donations to them in lieu of gifts. Perhaps you would like to donate something today too.

Thank you for reading.

Late Night Open Thread: Why Diversity Matters

Five years now

Five years ago, I made a serious miscalculation.

I was a low level bureaucrat trying to get Exchange networks to work for UPMC Health Plan.

I was exhausted that first fall as we were scrambling with interim solutions for several months after the ACA individual market went live.  We then had to go crazy to ramp up HealthyPA, a convoluted Medicaid expansion waiver program in Pennsylvania.

I was in Pittsburgh living an anonymous life.

I thought I would only have a couple dozen health insurance related posts spanning twenty or thirty thousand words in me.

Now I’m in Durham.

I’m now at 1,550 + Mayhew on Insurance posts and several hundred other general purpose posts.  My health policy word count is closer to a million words than half a million words.  There is a mostly written book somewhere in these posts and I will sooner or later need to convince myself that I can write a book on health policy.


Then, I could never be quoted nor would anyone want to hear what I wanted to say besides a couple of co-workers as we slammed espresso shots before another analysis run cycle.  Now, I’m part of the usual quotable suspects when major ACA news breaks out.

Writing here at Balloon Juice has been and continues to be an amazing experience.  I get to play with ideas that fascinate me, and John gives me the keys to write to an audience.

One of the big changes since I’ve come to Duke, beyond saying good bye to the persona of Richard Mayhew, is that I’ve changed my writing targets.  When I was Richard Mayhew, I had to write at Balloon Juice.  I could and would poke a few people here and there that something big was coming down the pipe but I was limited.  Now, the audience is sometimes all jackals.  Other days, the intended audience is a few score of geeks and policy professionals who need to know about some esoteric corner case.  I apologize when I take over the blog for those purposes as I feel like I am hijacking your attention to pay the cost of entry into conversations that I want to be in.

As I have been drafting this post over several days, I’ve talked to reporters from local and national general interest press, I talked to a reporter from the trade press, I submitted a pair of long and very technical pieces to Health Affairs, and a revise and resubmit just went back to the editors of a good peer reviewed journal.  If you spend enough time reading Balloon Juice, you could figure out 85% of the article excluding some of the regression based analysis.

I feel guilty about this at times.

Last week, was a good example.  I wrote a Medicare shared savings post that I was aiming at a few dozen academics and several dozen think tankers, journalists and very targeted policy wonks. It is a very specific, nerdy, and incomplete idea.  It was not worth an op-ed as it it too geeky. It was not a Health Affairs blog or a journal perspective piece as the idea was not polished enough for that purpose, so I went Balloon Juice. And that post got three comments.  And I was fine with that as this was not a general purpose post but a very small part of a very different conversation that I participate in.

I’ve moved away from some general purpose health insurance and ACA blogging and at times over the past year, I’ve chased personal shiny objects down rabbit holes.  And you guys put up with that. And for that I am greatly appreciative as I love writing here at Balloon Juice.  I have a scratch pad and a place to get first drafts (seldom second drafts as you see my grammar and spelling) of reactions and thoughts.  I can dig into something that fascinates me on my own time and my own schedule until it makes sense to me.  I hope that this is not pointless intellectual public indecency as this entire creative process is extraordinarily valuable for me.

Balloon Juice is a very different form of writing than writing a journal article.  Under the best case scenario, a fast journal timeline from “umm, that is a cool question” to publication is a year or more.  It is very different writing than a multi-author Health Affairs blog where commas can become fighting marks while the critical point that I want to make might be the lead melody or become subsumed as a backing bass line.  It is a very different writing process than pumping out a New York Times op-ed where I first truly appreciated the value of a wonderful editor.  That process makes me sound a whole lot smarter by the end.  The final 750 words are a tight 750 words instead of a 5 post, 3,000 word series here.  But I was worn out both times I went through that process.  This is a fun place to write  and it allows me to get into awesome conversations of a variety of stripes.

But mainly, I just want to thank all of the jackals, the front-pagers and John for a community where I can nerd out on something that I find fascinating.  I’ll figure out what Year Six looks like, but the first five have been wonderful.


The good is oft interred with their bones

Digby is right — this clip (starting at the five minute mark) is the best way to remember McCain at his best. It’s also a reminder that, even if one thinks, as I do, that Trump is just the GOP showing its true colors, there are certain ways in which the GOP didn’t used to be as bad as it is today.

Trumplosion Open Thread: Tick, Tick, Tick…

Of course this is not exactly new “news”, but if true, it would certainly explain this morning’s xtra-spatial tweet-rants…

Special Counsel Robert Mueller’s office wants to ask President Donald Trump about obstruction of justice, sources close to the White House tell ABC News. According to sources, the president learned within the last day that the special counsel will limit the scope of questioning and would like to ask questions both orally and written for the President to respond to.

According to sources familiar with the President’s reaction Wednesday morning, that was the genesis for his early morning tweet storm…

Negotiations over a potential presidential interview have gone on for months, through several different iterations of the Trump legal team. Current lead attorney, Rudy Giuliani, told ABC News a week ago that his team had submitted a response to Mueller asking to limit the scope of an interview with Trump especially as it relates to obstruction of justice…

The president’s legal team declined to comment when reached by ABC News about specific details on the special counsel’s responses.

The special counsel’s office has not responded to a request for comment from ABC News…

I wouldn’t buy a car or a political campaign from Rick Wilson, but he *is* a longtime professional at this stuff:

Read more