One more reason to avoid watching presidential addresses on the teevee

Our friend Roger is managing with a diagnosis of hypertension. In case you didn't think I could squeeze a political rant out of this, the epidemic of high blood pressure in the United States happens to be largely a social problem with a clear policy solution.

Because you are vile commoners, I can only give a link to the abstract, but Havas, Dickinson and Wilson, on behalf of the American Medical Association, discuss this problem in the new JAMA. Not that I didn't already know all this, but the JAMA commentary is a good occasion to talk about it. Hypertension contributes to more than half of all deaths from heart disease, which is the leading cause of death in the U.S. Of course something's gonna get you sooner or later, but high blood pressure will do more than just about anything but tobacco to hasten that day, and put you at risk of stroke, heart attacks, and disability along the way.

As Roger points out, about half the population has high blood pressure (that's if you include so-called "pre-hypertension," i.e. systolic pressure above 120 and diastolic above 80), but as the incidence increases with age, almost 90% of us can expect to develop it eventually. Is that just nature? Nope. The main reason the condition is so prevalent in the U.S. is that there is so much sodium in our diets.

But that isn't because we're wearing out our elbows with the salt shaker, it's because there are incredible amounts of salt in restaurant meals and processed foods. As Havas et al point out, it is nearly impossible for an American to consume a low-sodium diet. You would have to make all your meals from scratch, from raw produce. Average sodium intake in the U.S. is 4000 mg/day per 2000 kilocalories -- which is a good amount of calories to consume but most people consume considerably more than that. You want to get your daily sodium consumption down to no more than 2300 mg, equivalent to about a teaspoon of salt, but good luck with that -- one restaurant meal will put you over the top, and may well double it. One hot dog roll will give you almost 300 mg, and the hot dog gives you 500 more. Add ketchup, thats 200 more per hot dog, and you're done for the day.

Don't eat hot dogs? How about a can of beans? Almost 1000 mg right there. Like pizza? One slice will give you more than 1500 mg. Do you cook Chinese style at home? Two tablespoons of soy sauce contains 2000 mg of sodium.

Well guess what. In Finland, the health ministry has required labels on high sodium foods and has worked with the food industry on voluntary reductions. Combined with public education, that alone has reduced sodium intake by 40%. In Britain, the government has set standards and threatened regulatory action if they aren't met. But since we get 80% or more of our sodium from restaurant and packaaged foods, we just can't do it as individuals. This is a political problem and it requires a political solution.

Here's a place to start. Check the label on a can of V-8. It says, in huge letters, "100% vegetable juice." Then, in tiny letters printed in a subtle color that blends in with the background so as to be nearly invisible are the words, "with added ingredients." And what's the main added ingredient? You got it. Salt. And lots of it. Now, if there are added ingredients, it is not 100% vegetable juice. Therefore, the words "100% vegetable juice" are a lie. So let's start by making it 100% illegal to print blatant lies on food packages. Is that too much to ask?

I once again invoke my awesome powers of prognostication

A report today in the New England Journal of Medicine, free to the uncredentialed masses because the editors have been forced to yield to my relentless pressure (credit where it's due, masters of NEJM, but you still need to make the whole journal open access, all the time), is guaranteed to achieve the exact opposite of enlightenment and clarification.

This is a perfectly well done study and the results, to people who understand statistics, are fairly clear. The problem is, that's very few people. This is what we call a retrospective cohort study, in which they examined a lot of children age 7-10 on various measures of neurological functioning, and also reconstructed their history of exposure to thimerosal in vaccines -- that mercury-based perservative which a whole lot of distraught parent blame for their children's autism. (This study did not include autism as an end point because a separate CDC-funded study of that specific issue is underway.)

On most measures, there were no statistically significant differences associated with thimerosal exposure, but on a few there were small but statistically significant differences, about equally divided between apparent benefits and apparent deficits. In other words, if you believe these results, thimerosal is actually good for kids in some respects, and bad for them in others.

But, as the authors explain in passing at the very end, and as I knew long before I got there, you shouldn't believe the results. "Statistical signficance" refers to an arbitrary threshold of probability that an observed result is not due to chance. When most people hear that a difference is "significant," they interpret that to mean that it matters, that it is substantial. But that is not necessarily true. A difference that is too small to matter clinically could be statistically significant if you have a fairly large sample, as in this case.

What is even more important in this case, if you make numerous comparisons, some differences that are in fact due to chance will appear to be "significant." If you try something that has a fairly low probability a sufficient number of times, it's eventually going to happen. Some of your scratch tickets will pay off; the Buffalo Bills might win a football game. In this study, the authors made something like 400 different comparisons, and 19 of the differences turned out to be significant -- exactly what you would expect if thimerosal in fact had no effect whatsoever.

And really, is it plausible that thimerosal would be beneficial in some respects and harmful in others? And that the effects would only show up in one sex or the other, but never both? Pish tosh.

But sure enough, after I had made my prediction, I happened to read the New York Times article on the study.

But Sallie Bernard, executive director of SafeMinds, a nonprofit parent organization whose members contend that thimerosal injured their children, said the study was inconclusive. Ms. Bernard served on a board of consultants that helped design and oversee the study, but she withdrew her support for the published version of the study, saying its conclusions were not supported by the underlying data.

“There are some red flags here,” Ms. Bernard said.

Nearly 5,000 families have filed claims with the federal government contending that vaccines caused their children to become autistic. Even if the government dismisses their claims, many families have vowed to continue their fight in the courts.

What we have here is yet another battle between faith and science. Sallie Bernard believes. She will always believe. Faith is unassailable.

More Misery

It seems I am expected to comment on the cholera outbreak in Iraq. Actually cholera has appeared sporadically in Iraq for many years, maybe forever, so what is surprising, at least to me, is that it's taken this long for a notable outbreak to emerge, given the general destruction of Iraq's water supply system. I assume most readers basically understand what cholera is, but if you're interested you can basics from CDC here.

About 5% of people who are infected with cholera become severely ill, specifically with indescribably profuse watery diarrhea. Untreated, severe cholera is likely to lead to death from dehydration, but as I noted in a previous post, it doesn't require high tech treatment to get people through alive -- basically, what you need to do is drink large quantities of Gatorade™ (plug there for my friends from the University of Florida, which still gets royalties) or any similar solution that rehydrates, and contains electrolytes and sugar. (The sugar helps combat the diarhhea.) In advanced cases, intravenous rehydration may be needed.

Cholera is not spread from person to person directly, but rather through contamination of drinking water or food by feces. Yuck indeed. Unfortunately in Iraq, where sewage flows in the streets in many places and drinking water treatment plants are out of operation, the spread of cholera once it gets a foothold seems inevitable. Water treatment plants are down because of the general deterioration of Iraq's infrastructure, and because chlorine is in short supply due to restrictions on storing and transporting it, as it has been used as a weapon. In many places, there is no running water at all, and people get water directly from the Tigris. It's hard to see how the Tigris won't become contaminated. Given that hospitals in Iraq are already overwhelmed, with a severe shortage of medical supplies, I have to wonder whether they are at all prepared for what may be coming. I would hope that the WHO and Iraqi Red Crescent are moving to pre-position adequate stocks of rehydration solution, but I haven't heard anything to that effect. The occupation force could certainly contribute to such an effort, but I haven't heard that they are.

There's no telling how bad this might get, but while we hope for the best, I have to point out that even a very widespread outbreak will contribute only marginally to the suffering of the Iraqi people. The basic situation in Iraq is fundamentally misrepresented by U.S. politicians and by our corporate media. The essential dynamic is still that the United States armed forces are propping up a Shiite-led government closely allied with Iran. The "insurgency" which is now engaged in a campaign of attacks on Iraqi Interior Ministry forces is in fact a civil war. The Interior Ministry is controlled by Shiite militias and the Iraqi "police" are among the principle perpetrators of sectarian cleansing. The bombing two days ago in Baquba has not been placed in context for Americans. Baquba is a largely Sunni city ruled by the Shiite governing party.

The posture in which the occupation finds itself -- sacrificing blood and treasure on behalf of Iranian power -- is so bizarre, given that the U.S. is preparing to attack Iran, that our public discourse cannot even acknowledge it. But how do Iraqis feel about the occupation? Well, let's see. One of the first things the U.S. started doing after cake-waking to Baghdad was to round up young men at random, by the thousands, and ship them off to Saddam Hussein's dungeons to be tortured. In the process, our brave young men would kick down peoples doors, rough up the women, break all the furniture, and in many cases steal their cash. (This has been absolutely documented.) Soldiers and mercenaries routinely murder Iraqi civilians with total impunity. The latest revelation is particularly piquant: the U.S. scatters items such as detonators, fuses and ammunition around, and then shoots to death anyone who bends over to pick up one of the objects.

Now I don't know about you, but if I saw ammunition lying on the sidewalk in front of my house, I'd probably pick it up. Just sayin'.

I don't need to tell you that whatever the CIA agents who run Iraq Body Count tell you, something like a million Iraqis have died since the invasion from direct or indirect consequences of violence. More than two million have been driven from their homes. At least 1/4 of children are malnourished. The invasion was an illegal war of aggression in the first place, and the United States, on orders of the Commander in Chief, has routinely committed atrocities and war crimes throughout the occupation, and is doing so today, this very moment -- to no discernible end or purpose except for the sake of continuing.

I was, shall we say, amused, by the outrage over inviting Mahmoud Ahmadinejad to speak at Columbia University. No one in this country seemed outraged by the UN inviting the terrorist and war criminal George W. Bush to speak. Ahmadinejad has never invaded any sovereign nation, and in marked contrast to the United States, he limits himself to torturing Iranians, in Iran. Unlike the United States, Iran does not possess weapons of mass destruction, although the United States encouraged the use of chemical weapons against Iranians in the 1980s. If Iran is "interfering" in the internal affairs of Iraq, at least they don't have 165,000 soldiers and 30,000 mercenaries in that country. Nor has Iran ever overthrown the legitimately elected government of the United States and replaced it with a puppet phony king, as the U.S. did to Iran.

Most Americans now want the U.S. to get out of Iraq, but I wonder what the sentiment would be if the news media told them the truth, for a change? But that will never happen.

Slacker Tuesday -- continued

Oh yeah, and this too:

The House and Senate have negotiated a compromise bill that would provide health insurance coverage for nearly 10 million children through the State Children's Health Insurance Program (SCHIP). The House is set to consider the bill tomorrow, Tuesday, September 24 and the Senate could consider the bill as early as Wednesday. This critical legislation will ensure that the current 6.6 million children who receive benefits under SCHIP continue to receive coverage. Additionally, the bill will likely reduce the number of uninsured children by nearly 4 million. The compromise will provide an additional $35 billion for the SCHIP program over 5 years by increasing the federal tobacco tax by 61 cents. Please tell your Senators and Representative to support the House/Senate compromise bill to ensure that millions of additional uninsured children will have access to health care and urge them to tell President Bush to sign the bill.

But you already knew that. The CapWiz link under Chimpy has this one pre-loaded for you -- go for it!

Slacker Tuesday

Too busy to write anything original today, here's an e-mail I got. You know what to do! (Hit the link right under Chimpy.)

Dear Member of Congress:

We are writing as members of the HIV Medicare and Medicaid Working Group (HMMWG) to offer our strong support for H.R. 1424, The Paul Wellstone Mental Health and Addiction Equity Act of 2007. HMMWG represents more than 80 national and community-based organizations from across the country and includes people living with HIV/AIDS, medical providers, advocates and program administrators that deliver HIV-related healthcare and support services. We strongly support the fundamental principle embraced in the legislation that mental illness, alcoholism and drug addiction are medical conditions that should be covered by insurance plans in a fashion comparable to coverage for other medical conditions.

Mental illness and addiction are common conditions in persons who are HIV-infected in the U.S. These conditions, if not effectively treated, can undermine the ability of persons with HIV/AIDS to access and fully participate in the medical treatment that is essential to arrest HIV disease progression and restore individuals to health. Moreover, untreated mental illness and addiction place individuals at high risk for acquiring HIV by making it more likely that they will engage in high risk sexual behavior and/or share injection drug equipment. From the perspective of the HIV community, mental health and addiction services are both essential components of comprehensive health care for persons living with HIV as well as a critical primary prevention strategy to reduce HIV transmission.

The provisions of H.R. 1424 would help assure that persons living with or at risk for HIV infection who are insured in the private insurance market have adequate coverage for mental health services and alcohol or drug treatment. We believe that H.R. 1424 offers the most effective legislative option currently pending before the Congress. In particular, we support the legislation’s requirements that ensure that coverage is available for a broad range of mental health and addiction disorders; impose penalties on health plans for non-compliance; require parity for out-of-network benefits for mental health and substance-related disorders with comparable benefits offered for medical and surgical conditions; and explicitly allow stronger state protections for coverage of these conditions to prevail.

We urge you to proceed rapidly to move this legislation through committee and on to the House floor; so that persons in the private market, including those living with and at risk for HIV infection, have access to the coverage they need to access care for these treatable medical conditions.
Please contact Christine Lubinski with the HIV Medicine Association at (703)-299-1215 for further information.

Sincerely,

[List in formation]
AIDS Action, Wash, DC
AIDS Alliance for Children, Youth & Families, Wash, DC
AIDS Foundation of Chicago, IL
The AIDS Institute, Washington, DC
AIDS Project, Los Angeles, CA
American Academy of HIV Medicine, Wash, DC
Community HIV/AIDS Mobilization Project, Providence, RI
Gay Men’s Health Crisis, New York, NY
Health and Disability Advocates, Chicago, IL
HIV Medicine Association, Arlington, VA
Housing Works, New York, NY
Indiana Minority Health Coalition, Inc.
Lifelong AIDS Alliance, Seattle, WA
National Alliance of State and Territorial AIDS Directors, Wash, DC
National Association of People With AIDS, Silver Spring, MD
National Health Law Program, Los Angeles, CA
National Minority AIDS Council, Wash, DC
New York AIDS Coalition
Project Inform, San Francisco, CA
San Francisco AIDS Foundation, CA
Title II Community AIDS National Network, Wash, DC
Treatment Access Expansion Project, Boston, MA

Ask a Stupid Question . . .

Barbar Ehrenreich asks, "Why does everyone bow down to the health insurance industry?"

Bow your heads and raise the white flags. After facing down the Third Reich, the Japanese Empire, the U.S.S.R., Manuel Noriega and Saddam Hussein, the United States has met an enemy it dares not confront -- the American private health insurance industry.

With the courageous exception of Dennis Kucinich, the Democratic candidates have all rolled out health "reform" plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton -- why are we not surprised? -- has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles?

Why can't we just hunt them down and defeat them? Aetna isn't hard to locate, after all. I think Ms. Ehrenreich already knows the answer, although she slyly invites us to provide it rather than spelling it out. We don't live in a democracy, and our political system is not presently constructed to produce public policy in the public interest. As Ehrenreich points out, the "health insurance" industry took in about $776 billion last year. That pays for a lot of legalized bribery campaign contributions, scaremongering TV ads (remember Harry and Louise? This article, from 2000, actually provides an important hint about the genesis of the new Hillary Clinton proposal.), and phony scholarship.

Hillary and John and Barack can capitulate in advance and make their concessions their negotiating position, but the rest of us don't have to. Write your Representative and Senators. If you live in New York, so much the better. You can automate the process with the link right under the Emperor Chimpoleon the First. Just enter your zip code.

We need universal, comprehensive, single payer national health care. Nothing else. Nothing less.

One small step for humankind

That's pequeño, chiquitito, itty bitty, teeny weeny, but it's something. You may not have noticed what with the plane landing on I-95, more OJ, the MIT student wearing a fake bomb in the airport, and MoveOn.org publishing the single most offensive, treasonous, worthy-of-the-death penalty advertisement since uh, I dunno, Swiftboat Veterans for Truth -- oh, no, sorry, that wasn't offensive at all -- but Congress finally passed a reconciled version of the FDA reform bill. The LA Times makes it sound maybe a little too good: "Congress gave final approval Thursday to legislation designed to transform the Food and Drug Administration from a passive monitor to an active detective seeking out medications that have been approved for sale but turn out to be hazardous -- a problem linked to an estimated 15,000 deaths a year."

Yeah, that's sort of the idea, but the legislation isn't going to fundamentally change the drug approval process. It does include increased resources for post-marketing surveillance, and, if the FDA has good reason to think a drug might have a safety problem, it has more effective means of making drug companies do new safety studies. Right now, it often orders the studies, but the drug companies just ignore the order and there are no consequences. The legislation also requires public disclosure of more studies, including those unfavorable to a drug, and create greater transparency in the drug approval process.

This is better than nothing, but we still have only reduced, not eliminated major conflicts of interest in the drug approval process, nor have we required real proof that a new drug is better and safer than existing alternatives before it gets approval. Furthermore, efforts to ban direct to consumer advertising within the first six months after approval of a drug were eliminated from the bill thanks to the pharma lobby, although the FDA can "review" ads somewhat more aggressively. So we'll see how much of a difference this really makes.

But, at least it isn't nothing.

The Boy Scout Motto

That's "Be Prepared." I commend the work done by Revere at Effect Measure and Daily Kos diarist DemfromCT to promote public awareness of the threat of a flu pandemic posed by the H5N1 strain currently epizootic in birds. This has been a useful handle to sling the issue of public health emergency preparedness generally. But now I think it's time to move this discussion onto much broader ground.

Frankly, in my view, the more time passes without the H5N1 bird flu evolving into a human transmissible strain, the less likely it is that it will ever happen. Meanwhile, after a few years of raising the alarm, it's starting to sound to a lot of people like Chicken Little. As far as I'm concerned, the issue was never one particular strain of one particular virus, and the leadership of the World Health Organization clearly agrees with me. WHO has just released the World Health Report for 2007, and it focuses on public health emergency preparedness -- but it never once mentions bird flu. Here's the WHO's blurb on the document:

The World Health Report 2007 - A safer future: global public health security in the 21st century marks a turning point in the history of public health, and signals what could be one of the biggest advances in health security in half a century. It shows how the world is at increasing risk of disease outbreaks, epidemics, industrial accidents, natural disasters and other health emergencies which can rapidly become threats to global public health security. The report explains how the revised International Health Regulations (2005), which came into force this year, helps countries to work together to identify risks and act to contain and control them. The regulations are needed because no single country, regardless of capability or wealth, can protect itself from outbreaks and other hazards without the cooperation of others. The report says the prospect of a safer future is within reach - and that this is both a collective aspiration and a mutual responsibility.

Chapter 2 of the report presents examples of several categories of threat. WHO believes that the absence of any major, widespread communicable disease outbreak in recent decades has lulled people into a false sense of security. And that's exactly the attitude Revere and DemfromCT have tried to shake up by the focus on H5N1 influenza. But by offering a broader range of concerns, I believe the WHO is more persuasive and also provides a more sound basis for effective planning. WHO first discusses the worldwide HIV epidemic to illustrate the importance of surveillance. They then discuss the following categories of public health emergency:

Emergencies created by armed conflict. Trying, I suppose to avoid getting embroiled in current politics, they do not discuss Iraq but rather recent conflicts in Africa such as the Angolan civil war that ended in 2002. Iraq, however, is very much on point today, with the collapse of the public health and health care infrastructure now further complicated by an incipient cholera epidemic.

Microbial drug resistance. This is a major, looming threat to humanity which I have discussed here before. Since the latter half of the 20th Century, we have just taken it for granted that children will live to adulthood and that a minor wound or a sore throat isn't going to end up killing us. If we lose antibiotics, we'll be back in the 19th Century with a 45 year life expectancy. It's really that simple.

Animal husbandry and food processing. Okay, here's where they could have talked about bird flu, but they use instead the example of Nipah virus, which emerged in Malaysia in 1998 and turns out to have come from pigs. It did not, fortunately, become human-to-human transmissible on a large scale but there is evidence that it may be developing that capability. Who needs bird flu?

Weather-related events and infectious disease. The current African floods have this on the front page. Will we have a typhus or cholera outbreak the next tie New Orleans is destroyed?

"Other" public health emergencies -- chemical or radiological events, whether intentional or accidental, or even natural.

We absolutely need to be promoting emergency preparedness as an essential role of government, in partnership with private institutions and communities. Let's have the vision and courage to encompass the full range of dangers confronting us and base our preparations on a comprehensive understanding of the threats to public health.

An even more inconvenient truth

Alas, it's time to shift the terms of the discussion about global warming. Yes, there's still an urgent need to try to reduce greenhouse gas emissions, but it's really too late. I had to link to The Guardian because we're all too busy over here with OJ and the obnoxious kid who got tasered at the John Kerry blahathon to cover it, but the Intergovernmental Panel on Climate Change has issued its full report on the consequences of global warming and, as David Adams reports:

Martin Parry, a climate scientist with the Met Office, said destructive changes in temperature, rainfall and agriculture were now forecast to occur several decades earlier than thought. He said vulnerable people such as the old and poor would be the worst affected, and that world leaders had not yet accepted their countries would have to adapt to the likely consequences.

Speaking at a meeting to launch the full report on the impacts of global warming by the Intergovernmental Panel on Climate Change (IPCC), Professor Parry, co-chairman of the IPCC working group that wrote the report, said: "We are all used to talking about these impacts coming in the lifetimes of our children and grandchildren. Now we know that it's us."

He added politicians had wasted a decade by focusing only on ways to cut emissions, and had only recently woken up to the need to adapt. "Mitigation has got all the attention, but we cannot mitigate out of this problem. We now have a choice between a future with a damaged world or a severely damaged world."

snip

Prof Parry said it was "very unlikely" that average temperature rise could be limited to 2C, as sought by European governments. That would place 2 billion more people at risk of water shortages, and hundreds of millions more will face hunger, the report says.

You can read the IPCC report here, along with their other reports. But it's even worse than the report indicates, because we have learned only very recently of both increasing positive feedbacks and evidence that climate change related phenomena are moving faster than previously known. These include the shrinking of the arctic sea ice, which lowers the albedo (reflectivity of sunlight), and so warms the water during the summer and is therfore self-accelerating; the melting of permafrost and release of trapped carbon and methane; and the erosion of the Greenland ice sheet. This is all happening, and buying a Prius isn't going to do a damn thing about it.

While we bid a sad goodbye to Miami Beach, we really need to refocus the policy debate on responding to the effects of global warming, as well as constraining use of fossil fuels. This is serious, folks.

Weird Science

Canadian investigators Peter Gernburd and Alejandro R. Jadad set up some e-mail accounts without spam filters to see what they'd catch. They got more than 14,000 spam e-mails in November, of which they deemed about 1/3 to be for "health related products." As we all know, although they don't break it down for us, the number one health problem in the world, based on analysis of spam, is deficient penis size and/or erectile endurance.

Then these brave souls set out to actually order the products on sale. They found 19 different active web links that purported to process orders. Most of the products were not delivered, and in fact quite a few of the web sites failed to process their credit card order, which seems an odd way to make money. They ended up getting nine products delivered, with only one of the sites actually ripping them off -- well, that's if you count the "natural products" that were delivered as non-rip offs. They received benzodiazapines, and a synthetic opioid called Tramadol, as well as a couple of witches' brews purported to enlarge the deficient body part.

They wonder whether the Internet will render national regulatory regimes irrelevant. It doesn't seem that way to me, at least not the spam component of the Internet, unless the spam industry develops a higher standard of reliability in delivering the goods. Meanwhile, they need to work on better methods of actually taking our money. Until they get that part figured out, I'm not all that worried. And for me, Postini is doing an excellent job of steering all this crap to the dustheap of history without my even being aware of it.

So my take is, this is actually not a big problem. There will always be a few suckers out there, but they're gonna get taken one way or another and this doesn't seem to be a particularly effective way, at least not so far. And if a few people manage to get benzos this way that haven't been prescribed by their doctor, well, they could have gotten them on the street or, most likely, just gone to a doctor and complained of anxiety. Hell, my mother's doctor pushed benzos on her without here even asking. At least it's easy to say no to the spammers.

Half a solution to half a problem . . .

does not equal 1/4 of a solution. Today Hillary Clinton announced her big health care reform plan, which looks a lot like Obama's and Edwards's and oh yeah, nobody's actually saying it but they all look a whole lot like the legislation that is now in the process of implementation here in the People's Republic of Massachusetts.

The basic idea is:

1) Push a little bit -- not too hard -- to encourage employers to offer health care insurance to more people, or at least discourage them from dropping people at the rate they are now. In Massachusetts, this ended up being a trivial penalty of $295/year per employee, but that may end up being increased. As far as I can tell so far, Clinton has yet to specify the amount employers would be required to contribute but given what we know about Who Runs Congress (answer: K street lobbyists for large corporations) it's unlikely to be much. Also, the definition of "providing insurance" is not clear, in that the possible amount of the employee contribution to the premium and the deductibles, co-pays, benefit and coverage limits that define acceptable insurance need to be spelled out.

2) Create subsidies on a sliding scale to let people above current means thresholds who are not affluent enough to purchase insurance to buy into public insurance programs. In the Massachusetts case this basically means the state Medicaid plans, in a federal reform this would be an expanded version of Medicare. Here, we're getting the revenue from raising the cigarette tax (yet again) and theoretically, drastically scaling back the so-called "free care" pool which compensates hospitals for treating uninsured people, on the theory that there won't be uninsured people in the future. These are moving parts that have to fit together, and they don't. At the federal level, there isn't any free care pool to drain anyway, so we're talking tax increases. HRC and the other dems want to rescind some of the Bush tax cuts on the wealthy, which is fine, but of course we already have other uses for the money.

3) Impose a mandate on individuals that they must be insured. If they can't get it from an employer, they have to go out and buy it. In order for this to work, insurers have to be mandated to use some form of community rating, i.e. not to charge people based on their individual medical history or health status, but based on a larger pool. In Massachusetts they are allowed to discriminate by age, but that's it. Insurers have to offer so-called "affordable plans," which in the case of young people can be very stripped down, with annual benefit limits and high co-pays and deductibles. People who don't buy at least a minimum approved plan get fined.

What's wrong with this picture? It forces people to buy insurance, but in many cases, it's insurance they can't afford, which won't actually provide the coverage they need if they should suffer a catastrophic illness or accident. It leaves the system of competing private insurers in place, doing most of the same nasty stuff they already do -- consuming 25% or more of the health care dollar on marketing, administration and profit, and trying to maximize the latter by using the former two components to avoid enrolling riskier people and avoid paying for services. It does absolutely nothing to achieve rational allocation of resources and constrain costs. The financing is insufficiently progressive so that the already beleaguered middle class ends up paying more than it can afford for a lousy insurance product.

The end result is that it doesn't work, just as the Massachusetts reform isn't going to work, according to our friends Steffie Woolhandler and David U. Himmelstein. Among other points they make:

Why has progress been so meager? Because most of the promised new coverage is of the "buy it yourself" variety, with scant help offered to the struggling middle class. According to the Census Bureau, only 28 percent of Massachusetts uninsured have incomes low enough to qualify for free coverage. Thirty-four percent more can get partial subsidies - but the premiums and co-payments remain a barrier for many in this near-poor group.

And 244,000 of Massachusetts uninsured get zero assistance - just a stiff fine if they don't buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up.

While the middle class sinks, the health reform law has buoyed our state's wealthiest health institutions. Hospitals like Massachusetts General are reporting record profits and enjoying rate increases tucked into the reform package. Blue Cross and other insurers that lobbied hard for the law stand to gain billions from the reform, which shrinks their contribution to the state's free care pool and will force hundreds of thousands to purchase their defective products. Meanwhile, new rules for the free care pool will drastically cut funding for the hundreds of thousands who remain uninsured, and for the safety-net hospitals and clinics that care for them.

If president Clinbamdwards gets this passed, and it fails, as it is going to fail in Massachusetts, it will set the cause back another decade and do grievous harm to the Democratic Party. Actually, what ultimately passes will be even worse, of course -- less progressively financed, more grievously underfinanced, even more generous to the insurance and drug companies -- so it will fail even more spectacularly.

We need universal, comprehensive, single payer national health care. Nothing less, nothing else. Anybody who won't say so is a coward.

State of Nature

I told the bums I'd put up a couple of wildlife pics of my own, so here goes.



Click the thumb for the big pic -- it's pretty cool. This mantis is huge -- maybe five inches. Why it chose to hang out on a pile of rocks, where prey is likely scarce, I don't know -- the grass below was teeming with insects.



Commercial honeybee hives may be in trouble, but wild bees swarm over the goldenrod and other wildflowers in Windham County.

Whenever I go to my country place, I'm astonished anew by the din. The city is much quieter, but out there, the buzzing and chirping and trilling and skirling adds up to an arthropodal roar that you almost feel like shouting over. When I mow, which regrettably I have to do from time to time, butterflies rise up from the grass before me in a cloud.

I see plenty of those big animals - turkeys and deer and rabits and foxes and all that and yes, I saw something that few want to believe but I'm far from the only person in Windham Country who's seen one -- a powerfully built, six-foot long tawny cat with a long tail. (Say what you will about me.) But I'd venture to say that the bulk of animal biomass is six-legged. The suburbs and even the margins of the city, where I live on weekdays, have been invaded by everything from coyotes to mooses (meese?), but they are still profoundly impoverished in insect life. We hear that amphibians are endangered everywhere, but I have toads hopping around in swarms. Well, they have plenty to eat.

We tend to be worried about the loss of charismatic species -- bug mammals and birds mostly -- but the profound effects of ecological degradation begin with species most of us aren't very interested in. These bugs are essential to life, in myriad ways, from being food for birds and bats and toads, as well as each other; to recycling waste and maintaining plant diversity. A tiny proportion of them eat our crops or otherwise bother us, so we massacre them indiscriminately with chemical poisons. We have got to stop doing that.

I love those insects, they are the very pulse of life on the land.

View from the East Bank of the Atlantic

Suzanne Goldenberg, in The Guardian, explains our mysterious ways to the Brits. Nothing my loyal 4 1/2 readers don't already know, of course -- I could have written this myself, and who knows, maybe I did some time, I can't remember:

America spends more money on prevention and treatment of disease than ever before, yet it is falling behind on such basic indicators of health as infant mortality and life expectancy.

The US spends about 16% of GDP on healthcare, a proportion expected to climb to 20% by 2015, according to the National Coalition on Health Care. At present spending levels of $1.6 trillion a year, which works out at $6,700 per capita, is double what is spent in countries such as France. And yet that still leaves some 47 million Americans entirely without health coverage, and tens of millions of others under-insured, according to latest census figures.

It also fails to guarantee a better service to those Americans with access to healthcare. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a report in May 2007 from the Commonwealth Fund, which studies healthcare.

"The US healthcare system is considered a dysfunctional mess," writes Ezekial Emanuel, chairman of the department of clinical bioethics, in a recent issue of the Journal of the American Medical Association.

But, "None of the mainstream proposals would move America towards the national healthcare systems of Europe or Canada. That idea remains taboo." Here, Goldenberg's explanatory powers falter. Why is the idea taboo?

This is a two-part answer. First, drug companies and insurance companies are among the biggest contributors to political campaigns and the most powerful lobbies in Washington. Our political system is not structured to produce good public policy, it's structured to reward the most powerful vested interests, and they're it. Physicians, sadly, have not been much help. The AMA was for many decades the leading opponent of national health care. It has now backed off that position, but is not doing anything proactively to promote real reform.

The second part of the answer is that our corporate news media, instead of featuring informed explanation like Goldberg's, features dishonest propagandists like John Stossel. The main issues in health care are actually pretty simple, although the truth doesn't quite fit on a bumper sticker. But the corporate media won't allow the basic facts and logic of the problem to be laid out simply and directly in a way the people can understand, because that wouldn't be balanced.

Since none of the Democratic presidential candidates who are considered to have a legitimate chance are willing to tell the truth about this, I think we need to eschew all strategic compromise and refuse to endorse any halfway measures. And by "we" I mean my friends at Health Care for All and the Center for American Progress and all of those institutes and think tanks and advocacy organizations that fooling around with the margins of the eligibility standards for S-CHIP and employer mandates and bare bones insurance products for 20-somethings. There is only one legitimate message, only one cause worth fighting for, so let's keep saying it, as clearly and as plainly as possible until it doesn't seem radical or taboo any more.

We need universal, comprehensive, single payer national health care, and nothing else. That's the way to save money -- lots of it -- make the people healthier and the economy stronger, achieve equity and justice, and give us a chance at still being a great and prosperous nation in the 21st Century. No compromise.

Shona Tovah!

And it will be a somewhat happier new year for many families, because UNICEF today reported continued progress on reducing child mortality around the world. Well, most of the world, but we'll get to that in a second.

UNICEF is making a big deal out of the "milestone" that deaths of children under 5 have fallen below ten million. Of course that's an arbitrary number that only seems important to us because we have ten fingers and so use a base 10 numbering system. Nevertheless, the continuing trend in the right direction is encouraging, and for more than just the obvious reasons. In the long run, this will actually reduce global population growth and help raise the status of women. Where child deaths are very common, people have extra children as insurance, and of course women have more pregnancies. When children can be expected to live, families can invest more in each child, and women have more years free of childbearing and care of very young children. So ultimately, this doesn't mean more mouths to feed.

There are several reasons for this progress: near eradication of polio, extensive immunization for measles and other childhood diseases, insecticide treated bed nets to prevent malaria, vitamin A supplementation, the successful campaign against Nestle corporation's promotion of formula feeding, and rising standards of living for many people, particularly in China and India. In much of the world, however, there has been little or no progress on reducing poverty or providing basic infrastructure such as clean water, so we are benefitting to a large extent from technical fixes. As I say, making these technical fixes can help reduce poverty in the long run, but that hasn't really started to happen yet.

The bad news is in much of sub-Saharan Africa, where HIV and continued profound poverty have led to negative trends; and, although UNICEF doesn't mention it, Iraq. These statistics do not reflect the grim situation in central Iraq at all, as far as I can tell.

We still have a long way to go to meet the Millenium Development goal, which would get the toll to under 5 million. Will this be as important to the Right to Lifers as saving the blastocysts? It hasn't been so far.

Reflections on National Bullshit Day

National Bullshit Day, September 11, is too new of a holiday to have acquired the rich traditions associated with our long established annual commemorations, such as the picnics and fireworks on July 4, or the furious mobbing of shopping malls to buy overpriced garbage that you can't afford to give to people who don't want or need it, in memory of the birth of Jesus.

But we can already begin to see the outlines of future National Bullshit Day traditions. Just as there's a guy who dresses up as Uncle Sam for the Memorial Day parade, every town will have a character who dresses as Rudy Giuliani, with a bald wig and a suit with the shoulders just a touch too big, who will give a speech extolling his own heroism. The president will issue the traditional National Bullshit Day proclamation, beginning, as did this year's, with the stirring words, "We are attacking Terrorism at its roots by advancing freedom, liberty and prosperity." He will be referring, of course, to the perpetual occupation of Iraq.

Each year, the general in charge of the occupation will make his traditional National Bullshit Day appearance before Congress. Every year, he will be wearing more medals, until they extend around under his armpit and up his back. By the year 2060, he will be unable to walk without assistance. The general will make the time-hallowed proclamation that whatever the current strategy may be named -- The Bump, The Shove, The Ramp Up, The Slam Dunk, The Big Bang, The Whiz Bang, The Ramalamadingdong -- it is working. We just need to give it another six months before we can decide on the next steps. After six months, of course, Tom Friedman or his successor as Mustache of Wisdom at the NY Times will issue the traditional declaration that we just need another six months, enabling the cycle to renew on the next National Bullshit Day.

The CIA will be responsible for producing the annual NBD Osama bin Laden video, traditionally released on NBD eve, to great anticipation. In order to keep the public entertained and the pundits guessing, they'll have to come up with new and more preposterous special effects each year. One year, his beard will be bright purple; the next, he'll be wearing women's clothing, or he'll be nude, or he'll play the fluglehorn. A grand time will be had by all.

But of course, the most important way of celebrating National Bullshit Day will be for the corporate media to compete to produce the biggest steaming piles of bovine excrement. Justin Cole at Media Matters has been bombarding me with e-mails compiling some of this year's best efforts. For example:

● Both The NY Times and The Washington Post neglected to mention in articles on the recent report by the Independent Commission on the Security Forces of Iraq that the report called for the U.S. to reduce its “footprint” in Iraq.

● In discussing the same report, Katie Couric touted Iraq’s “first class” special ops force, but neglected to mention the report’s criticism of Iraqi security forces.

● On Fox News Sunday, Brit Hume falsely claimed that Al-Qaeda in Iraq “was there before we got there.

● The Washington Post uncritically quoted Sen. McCain’s assertion that Democrats were voting “against funding for the troops.”

And so on and so forth. It's going to be a lot of fun every year, don't you think? I'm certainly looking forward to it.

Happy National Bullshit Day

My mystic powers of precognition vindicated. 'Nuff said.

The unrecognized tragedy of Iraq

Due to my mystical powers of precognition, I can report that Gen. Petraeus will tell Congress today that the so-called "surge," in other words the escalation of the U.S. troop presence in Iraq, has brought about substantial reductions in violence and improved the prospects for political reconciliation. These gains are fragile, however, and we must not risk losing them by reducing the troop presence or making any changes in strategy. We should take another look at what we ought to be doing in six months.

Now that I have demonstrated my psychic powers, let's consider the situation in Iraq from a reality based perspective. I'm not an expert on Iraqi "politics," which would really mean the byzantine and largely secretive pattern of shifting alliances among various armed factions -- the kind of situation the political scientists call "praetorian politics." I doubt that anybody really is.

But I do know something about public health. Iraq today doesn't have functioning vital records or disease surveillance systems, so we don't exactly know what's going on in terms of population health. Here's the WHO page on Iraq, and as you can see, GDP per capita, life expectancy at birth, probability of dying under age five, and probability of dying between 15 and 60 years are "not available." Somehow they came up with a number for healthy life expectancy from 2002, but that's irrelevant now. Health care spending per capita is given as $135 per capita in 2004, but who knows where they got that from. Given the corruption in the health ministry, I'm sure a lot of it was stolen. If you click through to health indicators, you'll see that they do give numbers for 2004, with life expectancy at birth given as 51 for males. I doubt that number has any substantial basis, which is why they kept it off the front page, I assume.


The health care resources in central Iraq, where most of the violence and instability are concentrated, are overwhelmed. Two-thirds of the physicians have fled the country, hospitals face shortages of drugs and supplies and don't even have electricity most of the time. Much of the population doesn't have safe drinking water, and childhood malnutrition is widespread. (UNICEF's last report on this is based on 2005 data, and the situation has surely gotten worse. UNICEF's data on under 5 mortality are from 1999.) It's a pretty fair bet that the direct effects of violence account for a small percentage of preventable deaths in Iraq right now.

It is worrying, to say the least, that there is now a substantial cholera outbreak in Iraqi Kurdistan, the most peaceful, stable, and prosperous part of what was once Iraq. (Kurdistan is now de facto independent, and is not occupied by foreign troops, so it has to be considered separately from the conflict zone, with the exception of the southern area around Kirkuk which is contested between Kurds and Sunni Arabs.) Whisker sent me this link to an update on the outbreak, which is concentrated in Sulaymaniyah, Kirkuk and Erbil provinces. This does not appear to be a highly virulent strain, and it has been persistent but has not shown obvious signs of becoming more prevalent, although statistics are not of the highest quality.

The real danger, however, is that this outbreak could spread south, to the most troubled parts of Iraq, where an already debilitated population, a health care system in a state of near-collapse, and sewage flowing through the streets would almost certainly produce much more severe consequences. As I'm sure most readers already know, cholera is a water-borne disease that is spread through contamination of drinking water by feces. With many people now taking water directly from the Tigris, it is actually surprising that we haven't yet seen this epidemic emerge in Baghdad and environs. If we do, it will be really bad news. Cholera sufferers can be brought through successfully with a simple sugary rehydration solution, but in central Iraq today, most people will not get even that, without a major mobilization. It is hard to imagine that the Iraq disaster could get a whole lot worse, but this is one way it very well might, without any sectarian bloodbath or terrorist depradations. I wonder if General Petraeus is planning for this particular eventuality?

Update: I probably should have linked to this Oxfam international report in the first place. Oxfam estimates that:

# Four million Iraqis – 15% - regularly cannot buy enough to eat.
# 70% are without adequate water supplies, compared to 50% in 2003.
# 28% of children are malnourished, compared to 19% before the 2003 invasion.
# 92% of Iraqi children suffer learning problems, mostly due to the climate of fear.
# More than two million people – mostly women and children - have been displaced inside Iraq.
# A further two million Iraqis have become refugees, mainly in Syria and Jordan.

But hey, we're kicking ass!

A curious complacency

Although it is widely regarded as essentially a folk belief, in fact there has been at least suggestive evidence dating back decades that artificial food colorings, and perhaps other additives, contribute to the behaviors classified by the DSM-IV as "attention deficit hyperactivity disorder." You may have heard that British researchers have confirmed this association, as reported here, rather curiously, in the CNN business section. I can't link to the original Lancet article, which is subscription only, but I have read it, and I can tell you that this is an absolutely gold standard study which absolutely nails it.

The researchers had children consume juice drinks which looked and tasted identical -- and they put that to a separate test first -- but which contained one of two different mixes of food colorings plus sodium benzoate, or none of the above (designated "placebo," something of a misnomer in this situation). They assessed children's hyperactivity based on structured ratings by parents and teachers, and a computer test for older children, 8-9 years old. The parents and teachers had no knowledge of whether the children were consuming active mix or "placebo," otherwise known as natural fruit juice. Children who consumed both active mixtures had higher hyperactivity scores, although the difference was below the arbitrary statistical significance threshold of .05 for mix B. (Although it did meet a less stringent signifcance level of .1 which is sometimes used.) Not all children were affected equally, of course. It is a subset which was susceptible, which suggests that a larger sample would likely show highly significant effects for both mixtures.

While the headline of the CNN story blames sodium benzoate, in fact it is impossible to determine whether it is sodium benzoate, artificial colors, or both, which are responsible for this effect. But what I want to emphasize is the vast, collective yawn which has greeted this news.

Let's be clear about this folks. I have been quite critical of the widespread diagnosing of children with a supposed "disease" which largely consists of normal childhood behaviors which are incompatible with the regimentation required in school. However, whether the problem is the behaviors themselves, the diagnostic label, or the drug treatment, it's a big problem which causes great disruption and damage to the lives of innumerable children and their families. It turns out that chemicals added to foods that children consume in large amounts -- notably soda and candy -- contribute to these behavioral problems. In other words, the "food" manufacturers -- Coca Cola, Pepsi, Hershey -- are massively poisoning children. It has been proved as cleanly and completely as you can prove anything. It's a fact.

Now, you would think that there would be a lot of attention paid to this. Maybe members of Congress would be talking about banning these substances from food. Maybe this would be a front page story here and there. Maybe people would be upset by it. But it's getting less attention than the search for Steve Fosset.

It's a weird world indeed.

We Report. You Decide.

Dueling headlines, same incident.

Fox News: Iraqi Police: 14 Shiite Militiamen Killed in Battle With Coalition Forces

Agence France Press: US strikes in Baghdad kill 14 sleeping civilians



Let's see what AFP has to say specifically, shall we?

Iraqi defence and interior ministry officials said US helicopters fired on houses in the Al-Washash neighbourhood of Mansour district in west Baghdad between 2:00 am and 3:00 am.

Abu Ali Saad, a resident of the mainly Shiite enclave, said US military vehicles had arrived in large numbers in Al-Washash during the night.

"There were tanks and armoured vehicles and many troops," 35-year-old Saad told AFP while surveying the rubble of his neighbour's house.

"The tanks started firing then the helicopters came. Missiles were fired from the air. Houses were destroyed. A family of five were killed in this house," he said, referring to his neighbours.

"We are a peaceful neighbourhood. There are no militia here. There were no exchanges of fire. We were all sleeping."

A US military statement said Iraqi and US forces had engaged Shiite extremist militants who were part of a "terrorist cell" operating in Al-Washash.

When Iraqi and US forces entered the area they came under fire from "more than a dozen extremists firing from the rooftops of surrounding buildings," the statement said.

The fire was returned and air strikes were carried out against "positively identified armed gunmen directing small arms fires on to the assault force."

SNIP

Amid the rubble of one house was a mattress covered in blood with human body parts scattered about. Neighbours said a family of six had been killed in the house, including a 12-year-old girl.

Bloodstains could also be seen amid the wreckage of the other houses, where angry residents gathered to denounce the US military.

"They prevented me from trying to get two of my wounded neighbours to hospital," said Ammar Assem. "They fired on my car when I tried to leave the area. I had to go back."

Now let's get the Fair and Balanced take on the same story.

American and Iraqi Special Forces clashed with suspected Shiite militiamen Thursday in western Baghdad, the U.S. military said, in a gunfight that saw at least 14 people killed, according to residents and police.

Acting on intelligence information, the U.S. and Iraqi troops launched the early-morning raid in the capital's Washash area against the suspected terrorist cell, which was believed to be responsible for attacks on police and sectarian killings, the U.S. command said in a statement.

As the troops entered the area they came under fire from more than a dozen militiamen firing from the rooftops.

"Iraqi and U.S. forces then responded with well-aimed and suppressive fire," the military said. Forces also directed proportional aerial fires onto targeted buildings against positively identified armed gunmen directing small arms fires onto the assault force."

The military reported that four buildings were damaged, "including two enemy strongholds that sustained major damage and two surrounding buildings that sustained moderate damage."

There was no mention of any civilian or suspected insurgent casualties, but local police said 14 people died.

So, just out of curiosity, what do you believe happened last night?

The road ahead

I highly recommend this essay by Tom Engelhardt. I'm not going to quote from it or summarize it because I really want people to read it.

As the decline and fall of the American empire is upon us, what consequences should we prepare for, beyond the essentially emotional pain that Engelhardt foresees? He mentions more concrete costs only briefly, near the very end, when he refers to our shamefully low place on the global scorecard of health status indicators. In my view, it may well be that quite serious pain and turmoil is upon us, and may well be hastened by a cyclical economic downturn, in other words the recession of 2007 is likely here.

We can no longer sustain the cost of empire, and yet our political system is addicted to empire and will not put down the crack pipe no matter who is president in 2009. The price of petroleum will continue to rise, employment will continue to flow abroad (see the NYT today, even U.S. farmers are moving their operations to Mexico and Central America), the physical infrastructure of the nation will continue to rot away, and we'll keep borrowing a half a trillion dollars from the Chinese and the Saudis every year to manufacture weapons and to maintain hundreds of military bases around the world, until they call in the chits and the ponzi game collapses.

The American Century is over. What will be next for us?

Hey, I do have a life

I believe it's a provision of the FISA Act that bloggers have to post every day, but I've decided to become a lawbreaker and skip a day once in a while. I do have other stuff to do, including today when I have both a dentist and a doctor's appointment. I'm snatching this opportunity to sneak in a post between appointments.

Both are for pretty minor problems. I have a sensitive tooth, and right now I'm deafer than Beethoven due to a wax buildup, which I'm going to have blown out in an hour or so. Over the years I've had a couple of dental crowns and a bunch of fillings, and of course my doctors have also done various things to me large and small with effects ranging from keeping me alive, to nearly killing me, to minor cosmetic maintenance, to probably nothing at all.

We here in the US of A, and elsewhere in the earth's wealthosphere, consider it a basic right to get this kind of ongoing maintenance. A couple of friends of mine went on a medical mission to El Salvador not so very long ago. She's an M.D., he like me is a useless and generally inept social scientist. Well, it turns out the main thing the people wanted was to have their teeth pulled out. They had absolutely no hope of getting their cavities and cracks and abscesses fixed, so they just wanted the teeth pulled. Even healthy ones, in many cases, because they were just going to develop problems later. So Becky became an instant dentist and Johnny an instant dental assistant and they just went down the line yanking teeth. The people were most grateful.

I bring this up not to guilt trip anyone -- Well, actually, I guess that's wrong. I really do want to think about the basic ethical issue here. We have an assumption that U.S. national resources by right belong to United Statesians, and it is on that basis that we can construct a discourse of human rights that first of all defines basic needs in terms of what is readily affordable here -- "decent" housing, which is luxury housing by most people's standards; an acceptable diet, ibid; education, ibid; dignified employment, an astonishing idea to the people who scavenge dumps in the Philippines or sell their bodies in Calcutta; and health care, and here we aren't just talking what most people would consider a luxurious standard but something that most of the earth's people really have no access to at all, except perhaps sporadically.

Indeed, despite my passionate advocacy for universal health care, I have always considered it rather odd that many Americans want to elevate health care to the status of a basic right. There is a program here in Boston called Health Care for the Homeless that has been working with the Red Sox to collect socks to give to homeless people. We are supposedly providing universal health care here in Massachusetts, but we haven't gotten around to universal housing, universal nutrition, universal dignified employment, or universal higher education, and hardly anyone is even talking about those things.

Is the foremost need of those homeless people really doctors? I don't think so. And does it really make sense to get outraged when an insurance company doesn't want to pay a half a million dollars for a heart transplant, when all those people in El Salvador are lining up to have their teeth yanked out because they can't get a cavity filled? What should we progressive humanists really aspire to?

While we're on the subject of the big questions, after yet another substantial break, I've started posting again on the Dialogue blog. My interlocutor Missy has been out of action temporarily. I hope she'll be back soon, but meanwhile I'm pressing on.

A brief labor day reflection

My friend who is a carpenter told me yesterday that he had been deeply offended by Alberto Gonzales's resignation speech, and particularly that bon mot about how Gonzo's worst day as Attorney General was better than his father's best day as a construction worker. Every day as a lying, fascist war criminal (as Mark put it, a characterization which I condone) is better than any day of honest work. Mark and his wife have worked hard all their lives and managed to raise three daughters, but the former Attorney General has contempt for them, and for his own father, because they struggle to make ends meet and they don't have power or social status.

Gonzo is particularly artless as a public figure, to be sure, but for once he was honest. He's just telling the truth about the conservative movement and the Republican Party. They have contempt and disdain for working people. They despise the vast majority of people who vote for them, and they laugh at them behind closed doors. Yet somehow they have been able to label liberals and Democrats as "elites" who are out of touch with average Americans, and make it stick for a big segment of the electorate.

The 2004 Bush campaign effectively attacked John Kerry for being wealthy. Think about that. One of the most privileged human beings on the planet, a lazy mediocrity who was able to attend Andover, Yale and Harvard in spite of poor grades and irresponsible behavior, purely because of his patrician family; who went on to fail at everything he tried but was repeatedly bailed out and enriched for his failures by his daddy's rich friends, and who as a politician has been an absolutely consistent champion of the ultra-wealthy and an enemy of workers and middle class professionals, is a man of the people, apparently because he speaks with a phony bumpkin accent. I can assure you, he didn't learn to talk that way at Andover.

The blame for this, of course, falls on the corporate news media. They gives us a politics of theater, of invented narratives about individual politicians' character or cultural meaning, rather than a politics that is about public policy, which is supposed to be the point, after all. Will the upcoming election be fought out on the same ground of fictitious character studies? Stay tuned.