Public health is a truly public good.
Let me give an example.
Yesterday was the Biggest Guy’s last day here before he headed back East. So here were our schedules:
Tenacious G took me to the doctor, where the packing was taken out of my nose…wow!! Who knew all that stuff would fit?? And I don’t even have that big a nose!! We stopped off and had brunch at a café on the way home from the Doctor’s office.
Biggest Guy slept in, as he’d been out with friends the night before. When we got home from the doctor, we went to the car wash, then I crashed for a few hours (made easier, now that I can breathe). When I woke up, we took Biggest Guy down to the beach in Redondo for a walk, some time to talk, and a snack. Then we came home, he went out to dinner, and when he came home, we took him to the airport, where, after secondary screening, he left.
What the hell does this have to do with public health? Here goes.
I’m guessing that we each swapped germs with maybe a hundred people that day. TG and I shook the doctor’s hand; we were served brunch by a server at the café, and water and tea by the busboy; the guys at the car wash sat inside the car; we walked down the bike path in Redondo, where we brushed against (as opposed to walking past) thirty or forty people; we had lunch, where we were again served and bussed; finally, we handed bags over to screeners, got tickets from ticket agents, and probably brushed against another ten or fifteen people. I’m sure each of us used a public restroom at least once that day.
So our health…our physical health, as opposed to our moral, or spiritual health, is dependent on the physical health of roughly a hundred strangers we each encountered that day.
For a long time, the growth of cities was essentially self-limiting. It was limited both by economics, in that the ‘support area’ for the city had a size limited by transportation technologies. But there was another, darker limit, which was plague. Periodically, a germ culture would arise in the human petri dishes of cities, and lots of people would die.
As noted above, it’s hard to prevent this, because it’s hard to live in cities and not contact lots of other people.
So you and I have a direct interest in the health of every person we contact in the course of a day.
I want everyone I contact to have access to a doctor for that ugly rash, dripping nose, draining sore…not only out of humane considerations, but because I want it to be cured before they come in contact with me and mine.
The ultimate social capital a society can create is embodied in healthy and productive people. But so far, we have three systems for delivering health care in most of the Western world…and none of them seem to work.
Our system here in Southern California is imploding as we speak.
The LA Times (intrusive registration required, or just use ‘laexaminer/laexaminer’ – thanks Matt) has one of the ‘deep and slow’ series running on this. The first story is on the slow-motion collapse of the trauma network, triggered by the crisis in emergency room healthcare.

“People call 911 and they think if we bring them in, they’ll get seen by the doctor faster,” said Los Angeles Fire Department paramedic Orville Wright, who waited more than two hours last week with a respiratory patient at Martin Luther King Jr./Drew Medical Center. “That’s not the case.”
Hospital officials say the most critically ill patients are treated immediately. But paramedics and some emergency physicians say the congestion is endangering patients’ lives.
The danger extends beyond the ER. While paramedics are waiting for a bed to open up in the emergency room, ambulance responses are often delayed in the communities they cover. If an ambulance is taken out of commission, response times in its service area increase by four to five minutes on average, fire officials say.
Ambulance backups are worsening because more patients are seeking emergency-room care, even as hospitals are closing ERs. In the last decade, more than 20 ERs have shut down in Los Angeles County, narrowing treatment options in a sprawling region of 9.6 million people.

Today’s story is about the larger decisions being made to try and keep the public health system afloat.

One night a few years ago, a man crashed his car into the side of Los Angeles County-USC Medical Center. In his hand, doctors recall, was a crumpled piece of paper from a local physician’s office. On it was a map showing how to get to the Boyle Heights hospital and the words: “You are having a heart attack. Go to County-USC.”
County-USC doctors recount this story to illustrate a dynamic that makes them both proud and frustrated: People who are turned away from other medical facilities for lack of funds come from across the region and the state, even from abroad, to L.A. County’s public hospitals for a wide range of essentially free medical care.
But the strain of caring for the poor and uninsured is forcing local officials to reconsider the amount of care they offer. The health department is asking the Board of Supervisors this week to adopt a strategy that would reduce the number of places patients can receive general medical care but, for the time being, preserve high-end hospital care and emergency rooms.
By doing that, the county will be attempting what critics say is an impossible balancing act—maintaining its commitment to take all comers, even while making it more difficult for patients to find medical help. It may also run the risk of flooding already overburdened emergency rooms with patients who have been unable to get basic medical care.
“We have been providing a higher level of services to the uninsured than any other county in this state,” Supervisor Gloria Molina said. “We’re going to have to downsize the number of services we provide. They’re just going to have to drive farther, wait longer.”
The supervisors will debate what would be the deepest cuts ever made to the $2.4-billion health department—closing nearly a dozen clinics, reducing beds at County-USC by more than 10%, and ending inpatient services at High Desert Hospital in the Antelope Valley.

I’m not advocating specific policies yet. Along with a lot of other people, I’m jumping up and down pointing at the horizon, and saying “there’s an iceberg right up there!! DID YOU HEAR ME?? THERE’S AN ICEBERG UP THERE!!”…as the band tunes up to play “Nearer My God to Thee.”
More tomorrow, gotta go.

War Liberal scores in talking about core Republican values.
Crime is up, the deficit is up, foreign policy is a mess, the War on Terrorism is taking a breather. And business…the country-club Republican (as opposed to pickup-truck Republican) bastion appears to be unwinding as all the CEO’s and board members head for Club Fed.

Alex Frantz, my fellow Slug over at ‘Public Nuisance’, has an even better response to Sawicky (although he was responding to Demosthenes)than mine. Go check it out, but here’s the payoff:

Since the Palestinians still massively support terror bombings, I can only conclude that the payoff the bombings produce is, in their minds, worth the cost. And that payoff isn’t improved chances of statehood, or reduced oppression. In both areas, the payoff of terrorism has been negative.
The only payoff the bombings get is dead Jews. And for the Palestinians, dayenu. That is enough.
Demosthenes’ own example shows it:`Ahmed is twelve: “calm, together and determined to kill Israelis.”` Not ‘determined to gain independence.’ Not ‘determined to get an education and help build his country.’ Just determined to kill.
In game theory terms, the Palestinians aim only at the strategy which has the worst payoff for their opponents. That the payoff is even worse for themselves they have deemed irrelevant.
And that is why I and many others are reconsidering our past support for Palestinian statehood. It’s why Glenn feels they are becoming a psychotic death cult and I pretty much agree. It’s why bloggers are saying that the terrorism has to stop and aren’t interested in talking grievances until it does. Not because they made a bad choice – anybody can do that. Not even because their bad choice was also immoral. It’s because their bad choice has led them into catastrophe and they don’t appear to regret it. They have made the decision that the ruin of their current and future prospects as a people is a small price to pay for the joy of murdering Jews. It isn’t violence for the sake of their homeland but violence for the sake of violence.

Go slugs! Slime ‘em!

From today’s LA Times (intrusive registration required):

San Francisco State announced Friday that it placed a Palestinian student organization on probation and cut off its funding for one year because of a campus confrontation last month.
The university also issued a letter of warning to a Jewish student group whose pro-Israel peace rally ended in the clash with pro-Palestinian demonstrators.
…
Nabeel Silmi, a San Francisco State junior serving as spokesman for the General Union of Palestine Students, called the sanctions against his group unfair.
“Things were said on both sides. However, the whole GUPS [being held] responsible for everybody’s comments on May 7 is completely unacceptable. We have sanctions put on us now, but we are going to continue to work with the administration, let them know what our opinion is, and where we stand. On an organizational level, we didn’t do anything wrong,” Silmi said.
Orli Bein, graduate program coordinator for San Francisco Hillel, said the university “has taken some important steps” to improve the atmosphere on campus.
But she said the warning letter campus officials sent to Hillel was inappropriate because of “the extreme care we’ve taken to abide by the rules.”
Bein called the letter a misguided “effort to criticize both sides to seem impartial.”

Max Sawicky is linked over on the left, and I read his blog regularly. He currently has been mirroring Tim Blair’s “critique a day” of Fisk with his own of Instapundit, which I’ve found pretty amusing. Up until Friday.
Friday’s post triggered a response, because in part here Max and I part company pretty dramatically in our interpretation of what’s going on in the Middle East, and, by implication, what should go on.

First I have to say a few things before I get to the thing I can’t say. The bombings create awful tragedies. I’m agin’ ’em. As a recent statement by Edward Said confirms, they have greatly harmed the cause of Palestinian self-determination.

But other than instrumentally, they’re OK, Max? Is that really what you want to say here? They create tragedies, but if they worked, if they got the Palestinians their state, they’d be fine?

I wish the Palestinians had launched a Gandhi movement. If they had, no doubt the IDF would have started shooting them down and blowing them up, as it has for the past 65 years. In any case, under this scenario I believe that by now there would be an authentic Palestinian state on the West Bank and in Gaza. Imagine if half the Palestinian lives sacrificed thus far had been martyred in the context of non-violent resistance. (But have you ever wondered why nobody ever says, “I wish Israel would embark upon the path of non-violent resistance?” Never mind.)

The Israelis might have started by shooting, but British, who were easily more bloody-minded as the Israelis, lasted maybe what … ten years? … in the face of Gandhi’s movement? The Israelis, with their progressive politics, dependent on the goodwill and funds of Europe and the US, would have folded like wet matzoh if confronted with a coordinated, genuinely nonviolent nationalist Palestinian movement.
And the Israeli’s have tried nonviolent means in the past. An Israeli PM was assassinated for moving the country toward peace, while political figures in Palestine are assassinated for proposing peace.

Now the part I can’t say. The point of all this, getting back to IP, is that the Times article gives no hint of the bombers being either psychotic or a ‘cult.’ To the contrary, the dilemma reported is that the bombers seem to fit no profile that would facilitate their neutralization. Apparently, anyone could be a bomber, and this is said, understandably, to have the Israeli government perturbed.

Actually, Max, it’s funny. I grew up in California in the late 60’s and 70’s, and saw the heyday of the cults here. My second wife was aggressively recruited by a cult, and I had friends who fell into cults from EST to Lifespring and others. So my antennae are fairly cult-sensitive, and as I read the article about the failed murder bombers, my immediate thought was “Wow! They’re being processed like new cult members!” Quick decision, isolation, and…boom! From the Times article:

’ A chain of events was dragging her down with a speed that left her frozen, unthinking.
It was only five days before that she had offered her services and maybe her life to a member of a violent Palestinian group in Bethlehem. It was only the day before, she recalled, that her offer had been suddenly, even greedily, accepted.
It was only on this day, Wednesday, May 22, that she had been pulled away from a marketing lecture at Bethlehem University, shown the backpack and how to trigger the bomb inside, put in a beat-up car with another would-be killer, and sent on, dressed to pass as an Israeli woman.

From an article in Ha’aretz, about a meeting between the Israeli Defense Minister and the failed murder-bombers:

Ben-Eliezer: ‘You have parents, brothers, sisters, family, friends. Did you think about them?’
Stiti: ‘Yes.’
Ben-Eliezer: ‘Did they know?’
Stiti: ‘Yes. My parents begged me not to do it. My father told me that I’d be very sorry if I dared to go ahead, but it didn’t convince me. What they told me at the mosque was more powerful. They told me to just think about the commandment and the reward, up above, in Paradise, with the virgins that would be waiting for me and all the honor I would receive.’
…

Woody Allen’s prescient 1966 take on the Palestinian State question:
Majah: Good afternoon. I am the Grand Exalted High Majah of Raspur, a nonexistent but real-sounding country.
Phil Moscowitz: Uh-huh.
Majah: Yes. We’re on a waiting list. As soon as there’s an opening on the map, we’re next.
From ‘What’s Up, Tiger Lily?’. His first, and funny film. They aren’t any more. But sometimes that’s just the way the Jell-O judicates…

Why write it yourself when Den Beste says it perfectly for you?
– There will be a Palestinian State.
– If it is to happen without triggering a far worse war, it must happen after the current Palestinian culture of death and conquest is destroyed.
– The question is what it will take to destroy that culture.
Note: Just noticed that N.Z. Bear made pretty much exactly the same comment here. Charles Fort raises an eyebrow…

JULY 4 WARNINGS??
A lot of news coverage on potential Islamicist threats to US targets on July 4 (see this CNN article); something jogged my memory, and it occurred to me:
July 4 is also the date of the famous Battle of Hattin/Tiberias, at which Saladin defeated Guy, King of Jerusalem and his army of Crusaders and effectively ended the Frankish occupation of Palestine.
Since we know Al Queida knows their history, I’d be definitely be in Condition Yellow that day.

I’ve read Cold Fury for a while, and only through boneheaded oversight haven’t put a link to him up. I’ll fix that this weekend.
Found this today, in response to the Asparagirl hooha. Go read the rest, it’s great.

No matter how Churchill might have felt in his darker private moments during WW2, he never gave in to the kind of defeatism implicit in Jeff’s reading of Brooke’s post. If he ever even expressed the smallest navel-gazing doubt, I’ve never heard about it. Maybe my knowledge of the man isn’t what it should be, but it seems to me the free world needs all the Churchills it can get; it always does, but especially now. There are quite enough doomsayers out there on the left side of the political equation, and they neither need nor deserve any encouragement from the rest of us. They can’t be allowed to win the day, because if they win, all of us lose. ALL of us.
The great conflict of our age will be resolved. Whether it will be resolved in a way favorable to freedom and the advancement of the human spirit or to repression and religious despotism will be decided by our own resolve both as a nation and as individuals. In fact, in the end they’re one and the same thing. Those of us who truly believe in freedom must not give up. It’s that simple. If our leaders lose sight of the objective, they must be brought back around or they must be replaced. The leaders must themselves occasionally be led.
The last few months have been especially frustrating, with Bush failing to adequately support Israel as they fight what we all know is the same war he once seemed so committed to. There have been a few encouraging signs of life lately, although not near enough yet, as far as I’m concerned. The rest of the world condemns every reflexive move Israel makes if such moves threaten to make the enemies of freedom, whether in Ramallah or Jenin or Riyadh or Damascus or Cairo, slightly uncomfortable. A great many opinion-shapers and world leaders appear to be wearing some sort of strange blinders which allow them to see fault only on Israel’s side and enabling them to ignore the most elementary lessons of history. The idea of a Palestinian state has become something of a fait accompli in certain quarters, without regard to what form such a state might take, the effect it might have on Israeli security, and even whether such a thing is historically justified or not.
And meanwhile, not just coincidentally but as a result, the suicide-murderers have continued to wreak their bloody havoc. The people who put these simple-minded dupes up to their despicable acts are not stupid; in fact, they are descended from a line of Machiavellian tribal despots stretching far back into human history who know how to manipulate events and gullible people and who have no moral strictures against using any means whatsoever to hold onto power. Dishonesty is merely another tool of statecraft for them. They know that there are some fools in the world who, whether motivated by pity or something more sinister, will want to buy the particular brand of snake-oil they’re selling. And as long as that remains the case, they’ll keep right on peddling it. It’s their only hope.
But I think their hope might just be fading. Call me a Pollyanna if you like (yeah right), but I’m beginning to feel in my gut that the more astute among the Arab world know the tide is turning against them and their phony concern for the “rights” of the Palestinians. I don’t have anything to back that up with, but I feel that way just the same. With each new round of outrages the Palestinians lose a little more sympathy, because each time the veil of lies their leaders hide behind is lifted a little higher, and sympathy is what they absolutely must have to continue to survive. It’s the one thing they cannot live without. It’s hard to claim to occupy the moral high ground when you’re murdering children, and it’s even harder to maintain the illusion that you care about morality at all when the world sees you murdering children every damned day.
So we all need to hold onto that anger. Losing our sense of outrage over, well, outrageous acts is not something we can afford to do. Not now, not ever. Because as long as we still have the capacity for outrage, we can still win this war.

I had hopes that GW had some Churchill in him, at the State of the Union Address back then. I stopped calling him “shrub”, and everything. I’m still hoping, but I’m an optimistic bastard by nature. For a while, anyway.

Just coming out of the post-general anesthesia/day of painkillers haze; I stopped the painkillers (anyone want a month’s supply of Vicodan?) before I went to bed because they make my brain turn into sludge and make me want to throw up…I’ve broken my nose before, so it’s not all that big a deal.
Started me thinking about the Dawn/Eric Olsen dialog about their child’s birth and the hassle they had between them. First, I think it’s amazingly cool that partners can sit down and be so publicly honest; something tells me that’s a very strong relationship.
My take on the whole childbirth/drugs thing was settled during the Lamaze class I went to with my first wife for our Biggest Guy’s birth. The moms were all talking each other up about ‘making it through’ drug-free as we husbands all looked nervously at each other in the background. Then one mom…a pert young actress we called ‘Annie Hall’ at home, looked around the room and explained: “most of my adult life I’ve been trying to get good drugs. Now, the first time I really get to take them for any kind of a reason, you’re telling me I shouldn’t?”
Biggest guy was with an epidural; Middlest Guy was born so damn quickly the OB never even got there…the nurses delivered him without drugs or complications. Littlest Guy was induced after about twelve hours of desultory labor, so epiduraled there again.
Fundamentally, childbirth is amazingly physically and emotionally stressful; I give incredible honor to the women who go through it, and I’m jealous at the same time. I can’t imagine what it must be like outside a modern hospital…
Notice that I didn’t try and talk the surgeon out of giving me a general yesterday…but believe me, I felt miserable yesterday, and the pain/discomfort today is much less than the nausea-stupidity/discomfort yesterday.
BTW, the war on drugs is a farce. I’ll add that to the in-box and see what I can do.