A pandemic could be bad, part 2, US version (in case you hadn't heard)

I think t hat everyone agrees that Gerberding was the worst choice for a hard job. Doctors and politics shouldnt mix. Koop was a great surgeon general and called the administrations hand at every turn. Result-more funding for the nasty little projects out there because everyone trusted him.

The estimate for a pandemic is 5%, and how they get that in the face of a 100% CFR in Indonesia I cant understand. There are arguably supplies to support a 2 week pandemic in most of the hospitals and a month in the big ones. Since we dont know the average death rate in the pandemic if and when it comes we cant adjust to the needed and necessary items. Most of that stuff that comes from Central Supply (name of the in hospital facility) who in turn orders it from the Baxters/Wellcome etc of the world who have about a month supply on hand at all time. Its Just In Time for them too (JIT). At any given time there are ships with containers on the ocean bringing them from SE Asia where this stuff is made because its time dated. About three ships a week port up in the US and happily we globalize.

Now for the ugly facts. Oxygen masks, intubation sets, resuscitation bags are expensive and no one is gong to shelve these things up because of the costs. One re-bag goes for almost 200 bucks. Masks about 5 bucks a piece and they get old. I latched onto 300 of them for children early on. Yep, ponied it up and willingly because the toll on kids is going to be huge. Oxygen might not be in short supply, but the ability to get it into their lungs is the difference so far in whether they live or die. Cant operate a ventilator so you go with the resuscitators instead. Next best thing.

How do you prepare for a pandemic? Two weeks into it all of the supplies run out, with the second and last wave for about six months of supplies hitting just about that time. After that-nothing. Doctors are geniuses most of the time and easily frustrated because they dont like to lose. Who does? But if they dont have equipment to work with its like taking your car to a mechanic with a crescent wrench and a screwdriver.

Any answers? Stockpiling it by "time definition" of when the next pandemic will start might be. They say we have three years and we are now into six months of that. Surge the orders for a mid 07 delivery and then again in mid -08 and draw down with FIFO to normal levels during the summer months and surge each couple of months. The timing would save several thousand without a doubt. It would at least provide hope and there is going to be severe loss of that in a high path event.

If its a 30% event lasting in four waves, then all bets are off. It will turn the country into a shambles and only federal intervention will prevent massive starvation and further deaths. Revere is right, the medical system is heading for third world status soon in this country and while we agree about that, we dont agree how to fix it. There is a mind set in this country that health care is a right, but no one seems to know how to pay for it. All of the other systems around the world that have health care provided have at least minimal care for the people and there are lot of varying degrees of minimal. We still have that here but as far as prevention, on going care and taking care of the elderly we are as bad as Indonesia. Bird flu will clear this out if it comes and end health care as any of us know it if it comes in high path. No economy, no infrastructure etc. If we can hold for a year or so it will create opportunities of untold proportions for those that remain but they still wont have healthcare. We come full circle Obi-Wan.

It is extremely unrealistic to think that hospital bed capacity should reflect a volume needed in a worst case scenario. Anyone familiar with hospital economics knows that our "system" simply not produce the structure that this post and study is implying is needed in the case of a pandemic. The incentives are not there to build and sustain excess capacity in the inpatient health system.

Also, isn't the hospital the last place you want someone with HPAI? Four reasons for this; 1) hospital staff will be depleated and not able to care for the volume of patients predicted, 2) equipment such as respirators will be in short supply, 3) there is not much you can do for an HPAI patient in the hospital without 1 & 2, and 4) admitting HPAI patients into hospitals that are not adequately staffed or otherwise prepared will only result in exposing and infecting other hospital patients, many of whom are immunocompromised.

Finally, many hospitals are not warm to building the capacity to care for this type of event because they know that they will lose money on this. Ask any hospital executives you know; 1) whether they have developed and/or mocked up a claim for an encounter or episode of HPAI, 2) whether they can predict the services that will reasonably be provided to HPAI patients, or 3) whether they have shared and negotiated this with their major private and public payers. The responses might suprise you.

Here is the Swiss pandemic flu plan, just out. In English, PDF docs.

http://www.bag.admin.ch/influenza/01120/01134/03058/index.html?lang=en

Haven't read it myself yet. But the second paragraph of the brief intro. mentions struggling health services or some such.

Anonomous: No one is saying we should build hospitals to accomodate a pandemic flu surge, only that the problem of surge be adequately addressed via plans to expand acute care beds and take account of the greatly increased need. Note that we have far fewer beds than we used to and that economics has driven it. In fact we clealry have less than we need as many hospitals are overfull and their ERs are on "diversion" at frequent intervals.

There are some things that you allow inefficiency and redundancy in. I am suggesting that hospitals are one of those places, especially as in the 21st century the challenge will be in emerging and re-emerging infectious diseases. Engineers "overbuild" their structures for the sake of safety. That is very expensive in the aggregate. But we do it anyway.

I agree that it is unreasonable to expect a health system to have enough beds for a catastrophic event. I work at a university hospital in a major city and there is barely enough space for day to day operations. Real esate is costly and every square inch of it is put to use. I would like to see the CDC and public health practitioers giving your average American patient information that he/she could use. Handwashing/staying home when ill/how to cough and sneeze in public. PSA's on public transit, in newspapers, magazines etc. would go a long way toward changing habits that would decrease the spread of communicable diseases-all of them, not just bird flu. For those of us at a certain age, we well remember Koop. He used the media to get messages to the American people and resisted political pressure to say things that were false. He also mailed AIDS info to EVERY American household. So, if you give me the name of our current surgeon general, I will drop him a line to remind him (or is it a her) that he is still on the clock....

The Surgeon General
Office of the Surgeon General
5600 Fishers Lane
Room 18-66
Rockville, MD 20857

For media requests, please call 301-443-4000.

There is no doubt that we are always "right-sizing" our capacity and that, true to Milton Roemer's theory, a bed built is likely a bed filled. Hospital system preparedness likely rests not on "hard" inpatient hsopital beds but on "soft" beds (swing beds, "field hospitals," etc.) What we all need to do is work toward "fighting the good fight" and try to change the incentives that characterize our health system but this, to me, is less of a panflu preparedness issue and more a health reform issue. Sure, they overlap a little, but let's choose our battles.

Anonomous: As we have argued here ad nauseam, panflu preparedness is about hardening and making more robust our public health system -- all of it, especially the invisible infrastructure elements that no one seems to support but are vitally important: surveillance, vital records, MCH, substance abuse, etc. If our system were strong instead of disastrously weakened, our ability to respond to a pandemic would be much stronger in ways that extra beds (and the beds have to be staffed, remember) cannot do.

M. Randolph Kruger: " All of the other systems around the world that have health care provided have at least minimal care for the people and there are lot of varying degrees of minimal. We still have that here but as far as prevention, on going care and taking care of the elderly we are as bad as Indonesia."
I agree with you about the prevention, on going care and taking care of the elderly, but in this country there is very minimal health care provided at all under any circumstance, particularly for low to mid income workers with no insurance. Emergency rooms, at least in my area, only treat and stabilize life threatening illnesses, accidents, broken bones, heavy bleeding, severe burns, ect. (Not the hospital's fault, this is necessity and our hard working doctors and nurses provide excellent care, kudos to them!)Otherwise, see your primary care, which is not available to someone who has no insurance and has to choose between the very basic necessities of living and expensive office visits and unaffordable prescriptions. So the lack of medical treatment can eventually become life threatening. And while it is true that a lot of employers offer group health insurance to their employees, a lot of employees cannot afford to have even that amount taken from a weekly paycheck: mortgage(rent), utility costs, auto and home insurance(required by law)are all cost increasing, not to mention food, clothing, cost of operating a vehicle to even get to work. Medicaid is not available to this group of people, and clinics usually are not either unless the person working has had to receive food stamps to even make ends meet. So there are degrees of minimal health care, and in the U.S., some get treatment and a lot do not. Unlike Indonesia, and Nepal, we have doctors and hospitals all over the place. But what good does that do those whose health is neglected because the door is closed? Preventive and on going care would certainly save lives and help ease the emergency room and hospital overcrowding. But who has the solution to that thorny problem, or the funds?
Revere: It is obvious to me, and always has been, that many will die during the pandemic due to lack of medical care, and not just due to avian flu. But that is also true now.

Judy-Exactly my point. We have goat roped ourselves into a corner now with all the other entitlements and we simply cant afford it going or coming. The biggest companies out there still provide some assistance as a benefit, but thats going away too. So do we double bankrupt the country with universal health care and Social Security and Medicare, or do we just leave it at the current mess.

Is it bad when someone cant afford it? Yeop and I just dont have an answer for it. Prices will always rise to whatever is being charged and thats what Tan06 was alluding to. We as I said have come full circle. There will always be someone who will say it can be done, but realities are that it will end up in healthcare rationing and that is what is happening in the Netherlands as she said. Now in their "universal health care" system they are having to pay for what they are already paying for. She's a shrink and they want them to finish up with nutcases in a administrator prescribed time. Good luck on that one.

The fix for the health care system would be a takeover, then okay for a while, then prices rise, blow the system out and then its dumped. Like TennCare here that bankrupted the state just four years after it was implemented and then was allowed to continue for another six until the cash reserves of the state were gone. Be prepared to pay for health care folks and dont think that the government is going to do anything about bird flu except maybe on the side applaud it because it will end a massive amount of problems in this country, and the world for that matter. Mean sprited? No, realistic.

As MRK mentioned the Just in time Supplies are coming from the Far East - so we have a problem with not having enough stocks. Beyond that however we have a problem with the people who work on those ships - I suspect that most have a contingent of workers from Indonesia and other places in the Far East - so either the ships could become death ships, flu vectors or just not sail. And back there in the Far East where they are making the masks and all the other supplies is just the location where they might get hit first and due to less health care hardest. Probably even before we have a bed shortage we have a supply shortage. All these anonymous poor people working as our virtual slaves and like all good slave owners we are oblivious to them...until they have the nerve to crap out and die just when we suddenly realize we want them to make more masks.

In the words of Douglas Adams, "It is difficult to be sat on all day, every day, by some other creature, without forming an opinion about them.

On the other hand, it is perfectly possible to sit all day, every day, on top of another creature and not have the slightest thought about them whatsoever."

Time we all start thinking about just what it is we have outsourced....

Office of the Surgeon General, Rear Admiral Kenneth P. Moritsugu, M.D., M.P.H., Acting Surgeon General. It wasnt hard to find with a google search. Guess you meant because we are hearing nothing from him.
revere said: Whether the public believes we are better off is a question of whether you ask them or not. Mostly they don't think about the sorry state of the public health system as a whole. --- The public doesnt think about much except their pleasures, until TSHTF and then suddenly they are the victim.
Posted by: M. Randolph Kruger: Doctors and politics shouldnt mix. -- Government and the military should not mix either. The military knows how to do their job, the government does not.

I'm going to say something politically incorrect for which I will be scourged and berated. but oh well.

I was born and raised in Southern California, lived and worked there my entire life until moving to Hawaii 4 years ago. I am not sure how it is in other states, but in So Cal the failing, overburdened health care system is the direct result of the impact of thousands upon thousands of illegal aliens from south of the border getting free emergency room service for which they cannot pay. I'm not blaming them, the individuals. They come to America to survive; they are in poor health to begin with, making them more susceptible to all kinds of ailments, and most are doing the kind of manual labor that leads to job related accidents. Their religious doctrines insist on no birth control, thus multiple pregnacies are the order of the day...all on the US taxpayers' tab. Certainly the culture of poverty and barrio existence they live in also lead to health care issues: gunshot and knife wounds, auto accidents, brawls and other avoidable injuries requiring care. But whatever the cause and whatever the need, the huge demand placed on our health care system in border states by people who cannot and do not support those systems with either taxes or by paying their bills, has caused the bankruptcy and closure of many many health facilities, and the chronic overwhelm of others who cannot serve the public as they should. The hard solution, if we want to save our own from what is predicted to be an era of increasing epidemics, is to shut our clinic and ER doors to illegal immigrants and send them back to their countries of origin. We are the loving and kindhearted caretakers of the poor of other lands, yes, but at the expense of our own citizens. There may come a point when we have to make that choice. Or maybe that point has passed.

MiH: Except that they do pay taxes (for which they are often denied any benefit), contribute to the economy (at wages your fellow citizens won't accept but whose services they gladly use) and if they get sick they are a danger to you, too. Those same hospitals are staffed by invisible people who clean it at night, tend the grounds, work in the cafeterias and allow the place to run cheaper than if they weren't there. They pay for more than the share they are given back. They go to the ER when they are sick because your felllow citizens given them ill paying jobs with no benefits so they can't go to the doctor. Most ER visits aren't knife fight visits. They are earaches and asthma and heart attacks and lower respiratory infections.

They are responding to the market. The job market. If you don't want them here you shouldn't patronize places that give them jobs and they won't come any more.

I'm sure there are people in Hawaii wish you mainlanders would go back to your country of origin and stop driving up prices. It used to be a nice place before you people over ran it. No one asked you to go to Hawaii. It's not your state. You weren't born there. Why don't you go back to So Cal where you belong?

MiH: I barely agree with you on a lot of things you say however you hit the mark on this one. Southern California used to be beautiful. The influx of illegal immigrants has all but ruined what the area used to be like. Clean being one of the losses. While I resided in Southern California I chose to live in the mountains because after a number of years the crime, graffiti, and changing landscape was heartbreaking. While driving home from work one night I spotted a car from Mexico pulled off the freeway, as I drove by trash was being tossed over the embankment. The next day going home I stopped at that spot and saw a dirty diaper and sack full of garbage. Grant it, other people do that too, thats not the point of this particular discussion.
Revere: Obviously you have not encountered this situation yet, or you too would have a different mindset. America cannot save the world, only Americans. The illegal immigrants are takers, not givers. Sure they work crap jobs but that is where uneducated, illiterate people go to work. There are legal citizens in the US who will do the jobs the illegals have taken away from them. Only its too late, greed again has taken hold of employers and they are drooling like dogs because they have a person they can push around, control, and abuse because they know that person will not say or do anything to jeopardize their pathetic job. They could get deported.
I dont care if the Mexicans or whoever come to America, really, just do it legally for crying out loud. Poor victims of a corrupt Mexican government, victim my behind.
My husband and I have crap for health benefits. And he served in the U.S. Navy for 22 years. I go to the doctor now and the waiting room is filled with non speaking English Mexican women with 3, 4, 5, children and their Medicaid cards. Tell me how far that is to me.
Tourism is the main money maker for countries now, Hawaii has promoted tourism and thereby attracted thousands to move there because they wanted to be part of the greed and make more money. Teachers are in short supply in the U.S. too if you havent heard, and Mary is helping to fill that need.
By the way, most ER visits in San Diego are from drive by shootings. Oh, they just happen to be non English speaking people too.

Thanks, Lea. Revere, I am surprised at you. You spew alot of rhetoric, but you really don't know what you are talking about. I have lived it. I taught in the predominantly poor hispanic areas of LA for years, areas filled with both 3rd generation latino gangs as well as lots of fresh non English speaking immigrants. Sure many are good hard working people, (I never said they weren't) but there is, none the less, a huge plethora of illegals who work under the table for cash, and do NOT pay taxes. How can they, when they don't have green cards? Even if they wanted to, they couldn't because they would be caught as illegals. And the companies that employ them would be dinged for hiring illegals. So where exactly do you get your data that they all pay taxes? Cite your sources please. Also, if those working at what you admit are very low paying jobs do pay taxes, the amount would be very very low compared to the cost of the services they receive. A simple visit to an ER for an earache or flu costs hundreds of dollars. And as Lea pointed out, they fill the ERs day and night. I am also pretty sick of the argument that they take jobs nobody else wants. That is a crock. Teenagers would happily take those jobs: busboys, common laborers, entry level positions. These used to go to our kids. Now there are few ways for kids to make spending money and learn how to work. There are also a great many immigrants - legal and illegal - who are members of some of the scariest mexican mafia gangs you could ever imagine. You speak as a liberal in an ivory tower. How would you like to be threatened in your own classroom by a whole family sporting tattoos and clenched fists because you had their son suspended for throwing a chair at another student in the middle of class? There is a whole underclass of criminals that enters So Cal in droves, and they surely don't pay taxes on the drugs they sell. And by the way, lest you brand me racist, let me give you my last name, my maiden name. Quijano. Spanish. My grandfather immigrated from Mexico with his wife and children back around the turn of the century. Legally. So I am not being racist, I am merely stating what I have seen first hand. I think it uncalled for and rude for you to make an analogy re illegal immigration with my moving legally to Hawaii to take a job that is very socially worthy and needed (and incredibly underpaid, by the way...I make only $36K a year despite 20 years experience, and National Board Accreditation ) by saying "why don't you go back to So Cal where you belong". I am working over here to help protect the environment and restore the culture through education. I am paying taxes. I am paying health insurance. I give $60 per month to save the children and mercy corps. I spend hundreds of dollars per year on classroom materials. I do fundraisers to help the poor here. I am, as Lea pointed out, filling a need in Hawaii for good teachers and doing a damn good job of it. As I always did in California for all my students of any color. But we were talking about health care issues, Revere. And statistics totally back me up on what I said. I stand by it 100%.

Here's a reference re illegals and taxes you might respect.

http://www.immigrationline.org/commentary.asp?opedid=1314

MIH: "You speak as a liberal in an ivory tower. How would you like to be threatened in your own classroom by a whole family sporting tattoos and clenched fists because you had their son suspended for throwing a chair at another student in the middle of class?"

Mary, the situation you describe sounds traumatic -- it's all in the personal delivery, you know (did you play it in a "snobby superior" or R*E*S*P*E*C*T mode with that Latino family)!?!

Guess what, surprise surprise... Australian Centrelink (social security) have decided to (((NOT))) process a Xmas payment cos I haven't had the courage to contact my doctor and ex-lover, Ric Chaney, to fill out a med certificate stating my PTSD symptoms -- PTSD caused by Oz homophobia enacted by a rabid dogpack of Western Australian medical and police folk back in 1997/8 (when H5N1 first began its transgenic dance across the species barrier to humans).

Frankly Mary, when H2H H5N1 (first wave) hits our lovely civilized species it'll be a collective reality check for the generation to which you belong -- the Babyboomers, who have treated their queer children (GenX/Y/Z of all colors) like criminals to be "psychosocially raped"!!!

Mary, The situation with illegals varies in different parts of the country. Here in Alabama I don't hear of major problems like you report. Quietly they mow lawns, pave roads etc. If they take jobs that US citizens would take that is the fault of the employer not people who want to feed their families. I have sold chickens to many of the local people from south of the border - they like our nice muscular birds. They are pleasant people. The INS devastated the Vidalia Onion industry a few years back with a raid - causing documented aliens to run and hide along with any illegals. I don't know of many US citizens who want to do that hard farm labor anymore.

Having a spanish name does not mean that you are the same race as most illegal aliens. If your ancestry is from Spain instead of from the native indians that were in south america before Spain invaded then you are of a different race from most illegal aliens. Most blacks have white mens names but that doesn't make them white. Most of the descendents of Incans, Mayans, etc have spanish names but that doesn't make them Spanish. Racism is about skin color, facial features and a legacy of poverty associated with those differences.

Giving health care to the people who pack your meat, pick your vegetables, care for you children just makes good sense. The movement to Public Health was in part about realizing that if your maid had TB you could get it. Do you want people with TB coughing on the meat they pack. Do you want people with heavy loads of parasites picking your strawberries and taking dump in the field because bathroom facilities and breaks are few and far between? Do you want to pay the higher prices for many items that we would have to pay if unionized americans getting a fair wage, health insurance, etc. were doing the picking, packing etc.

Lea: I just came back from SD when I read this. I've been in big city ERs and of course what you are saying is hyperbolel so I won't hold you to saying most cases in SD ERs are from drive-by shootings. My guess is that the actual percentage is a fraction of 1%. Most people are in ERs because they have an urgent condition and have nowhere else to go. Don't blame them for the fact that you and your husband find yourself in the same position because we have failed you with respect to health care and insurance. That's your problem. Not people who don't speak English. Why don't you learn Spanish if you need to communicate? You speak English by an accident of birth. And you have no idea how many people that irritate you so have papers or not.

I'm not going to argue about how "knows" what it's llke more. Everyone has a different set of experiences and the spanish speakers that bother you could probably give you an earful, too, on what it's like. Meanwhile the people who produce this by making us the last industrialized nation in the world without a national health isurance scheme are only too happy to see you arguing with the other victims of that ridiculous situation. I know that if a hundred years ago we would have listened to the anti-immigrant crowd (even more vociferous than today's but otherwise same rhetoric) many of us would have grown up somewhere else.

K...my father's birth certificate lists him as "mestizo"...that is a mixture of local indian and spanish. They fled for their lives during the revolucion and came to Los Angeles sick and dirt poor. They worked hard, learned English, gave back. Never rich. MAID??????? MY MAID has TB? I've never had a maid a day in my life, thank you.

You, Jon, revere all make alot of very negative assumptions about me because I said that the cost of providing health care to illegal aliens is causing emergency rooms and clinics in Southern California to shut down. I did not say I hated the illegals, I did not say they did no service, I did not say they were personally to blame. Go re-read my original post.
You all forget one thing: I worked with that community for 17 years, I taught their children and if you were to talk to any of them they would say I never treated them with anything but the utmost caring, love and respect. The fact that they are victims in a large extent does not change the FACT that their impact on our health care system is tremendous, and in the red. That was the point.

K asks "do you want to pay the higher prices"...yadayada.
Yes. That is exactly what we all should do, either to provide these people with a work visa, living wage and health care insurance, or to send them back for their own countries to care for (they didn't just arrive out of the ether you know, they do come from somewhere, and many of them send a large portion of the money they earn back to families there, not spend it in the states) and provide our own young people with those jobs. The argument above just proves that we are too cheap and selfish to do so, and that all we ever think about is our own bottom line, our own ability to acquire a surplus of goods. So yes, K, exactly. While you are bleeding hypocritically about the state of poor illegals in our country, are you willing to pay more for that meat and produce you mention they produce, if it will help these people out?

Mary from Hawaii couldn't be more right in every aspect of her discussions regarding illegal immigrants. Not only are they a huge social and in many, but certainly not all cases, a significant criminal problem, but their influx is about to bankrupt our country. In addition they are a huge medical problem which only can get worse. The impact on the many, many hospitals that have had to close because of them is already legend.

But there is much much more that goes on beneath the radar. A 2000 Journal of The American Medical Association article by Talbot and Moore (JAMA, 284, No. 22, pp. 2894-2900, 2000) clearly stated that among foreign-born persons ine United States, Mexican immigrants topped the list of the highest case rates for tuberculosis. So let's tie things together. Anyone who practices medicine, not from their computor table, but in the clinics know that "Flu-like" symptoms are a common characteristic of tuberculosis and Multi-Drug-Resitant (MDR) tuberculosis, so is pharygitis or sore throat and a plethora of other symptoms that might bring one to the emergency room, but worse still it is contagious and in the early 1990's spread like wild-fire in many locations within these United States.

This is the study that no pro-illegal immigranion politician or their appointee wants you to know.

M. Randolf Kruger has said doctors and politics shouldn't mix. And I more than agree. But in fact, that is exactly what's happened. And even the Surgeon General of the United States, let us not forget, is a politically appointed office.

And we, the people of America, are causght in this political vice, which is crippling both our medical infrastructure, our health, and in the event 1918 returns, our Pandemic preparedness. We are not able to break this politcal death grip because of certain politicians which we can only hope suffer the consequences of what they have wrought upon us...both those Republicans who cater to securing a cheap labor supply for corporate America and those Democrats who would gladly sell their country down the river for a few hispanic votes. Both groups call it a "guest worker program" or "comprehensive immigration". What they are referring to is amnesty, forgiveness for those who have broken and have total disregard for our laws, just by virtue of the fact that they are here illegally, something that our forbearers who immigrated to this country would never have even thought about. Are we a nation of laws, or a nation of I'll go ahead and vote for what will line my pockets and political reputation?

There will be a high price to pay for all of this nonsense and I'm affraid its not too distant in the future.

I agree mary; They are here illegally - they should be put out and kept out. Why are we making nice with the countries who profit from letting their citizens come here illegally? At our state's costs? Making human trafickers wealthy, so they abuse more people?

"Do you want to pay the higher prices for many items that we would have to pay if unionized americans getting a fair wage, health insurance, etc. were doing the picking, packing etc"

Yes, I would. (Not health "insurance"; Health Care, including preventative care.) If more food and goods were made locally in the USA, that would help, too. I remember seeing "buy American-Union-made" ads on tv -where did those go? (Seeing American teenagers having better work ethics instead of being handed things like electronics, cars, very expensive clothing, money for partying, ect, that just adds to their parents' credit card debts would be less of a nightmare, too.)

Hospitals that are closing their pediatric wards, or making provisions that look to keep them from taking panflu patients, or even just when those hospital adminstrators are playing along and not educating the public about how to get their households through a pandemic influenza year in time before a pandemic starts; what sort of health care is this?

(3 years, 6 months gone? Not sure I'd bet lives on that say-so, but it would be nice if we had a couple of years yet; Nature doesn't care about govt timetables.)

Bet the reveres could come up with some PSAs that would make Koop proud.

(Is the Surgeon General quite plucky and adventure-y? Pandemic knowledge brought to the beginning of the century?)

Revere-I dont know how many illegal aliens you have where you are but they are falling out of the woodwork here. I spent all last sunday in 41 degrees slipping into low 30's getting an illegal that had frostbite back into old mexico. Kid was 20, weighed 100 lbs at six feet tall, wearing cotton pullover and cotton pants. Hadnt eaten in 3 days. Cops wouldnt take him and INS isnt open on the weekends. After five hours and a HUGE ration of shit directed at my local sheriff for not taking the kid into custody so at least he would be warm, I sent him back myself.

Gave him 140 bucks and a very expensive bus ticket. He had been brought here by a slaver named Manuel Cepada who got 25% of everything he made. For the last 3 months he had been living with ten other guys in one room apartment and Manuel told them to go out and get job or he would kill them. I got that from my daughters friend from Spain who was acting as our interpreter. So at 9 that night I put him on the bus with the help of a Greyhound employee and I called the Dallas PD who said they would ensure that he kept going. He did and the kid called me from Mexico City on Tuesday morning thru a girl named Maria.

This is just another failed policy of both sides of the aisle. They dont want these people not to come here. They dont pay taxes except sales taxes and that is a pure fact. WE on the other hand pay sales, income and property taxes and it costs about 15,000 per student (reverence of MIH) in Tennessee and we booted 1800 of them out of here last year. IN ADDITION, the goddamn banks are starting to make illegal loans to them so they can acquire a house. Once they get a utility bill and a residence they are in. And they never pay their income taxes.... Their response? Sell the house, move back to Ciuadad Juarez and live like kings on the income from the house that had dozens of people in it paying them rent!

In no case can anyone justify the breaking of the law because we are a country of the law. Once that thread is pulled and it starts to unravel you will see what we are seeing now. In ten years we will be bankrupt as a nation and the system will collapse. The Mexican influx will hasten that.

Yeah, we are dying the death of the 1000 cuts in this country. God love them though, at least they do work!

MiH: The hate and filth that is spewed out of revere is nothing I want to be a part of any longer. Perhaps you should also consider dropping this site.
K: Having read some of your posts here you never make much sense. We will just send all the illegal immigrants to your state and you can see first hand how they will abuse you and the system.
MRK: Was wondering when you would chime in, thanks for your words. They fall on deaf ears though, that being revere. Will truly miss reading your comments too MRK.
Revere: I live in America where English is the official language, if I moved to Denmark then I would learn the Danish language, if I moved to France then Id learn French. The Mexican people are pros at portraying themselves as the victims. Like MiH I too have spent years around these people, and guess what, they hate you and they hate me. You are so filled with hate yourself revere and if someone doesnt agree with you, you spew your filth out left and right. You are not a person I want to be associated with. That may be your point though, gather only those who agree with you. You are so closed minded I actually feel sorry for you. Good bye and Baraka Bashad.

Lea: No comment.

Lea,

Baraka Bashad doesn't nullify the anger in your comments. Go in peace, bro.

Lea,

In case you peeeeeek back...

Everyone's doing their dance, having their experiences. It's tough on all of us.

And Baraka Bashad doesn't nullify the anger in your comments.

Go in peace.

Mary, I didn't say you had no Indian blood - I said that the name didn't prove it. I didn't say you were racist. I just said that giving your spanish name didn't prove that you were not because it didn't prove that you had the same skin color and facial features. Heck even blacks can be racist against other blacks compared on the skin tone.

And yes, I would be glad to pay more for everything I buy if the money would go to the workers. I live on $6,000 a year in a 600 sq foot house. I would be willing to pay $12,000 for the same lifestyle.

I didn't say you had a maid - I said that years ago when people were thinking we should have better public health some of the richer people probably had figured out that they could get sick from their maids.

THEY are all bad seems to be the theme here. Well some of them are bad and some of us are bad. Has any illegal alien cheated anyone out of as much money as Jeff Skilling did?

Part of the solution to the problem is to end the imperialistic policies of our country towards South America. Mr. Chavez is giving oil money to the poor in his country. No doubt they will feel less need to risk coming to the US for work. But since we want their oil and want it cheap in order to sustain our way of life ("non-negotiable" says our Prez.) we want to oust their democratically elected President. Do that, install another US friendly dictator and you will create another group of poor people headed to the US.

PS - Mary, every time I read Revere's comment that got you so hot under the collar I am sure you misunderstood him - it looks to me like he was not saying anything personal, just saying what native Hawaians might think about any of the mass of non natives that have filled up the Islands. Revere can correct me if I am wrong but it seems to be an example of the type of thing a native might think, not his personal feelings towards you. Personally I expect that Native Americans feel much the same towards whites in this country as we do towards illegal aliens but they were so decimated and crushed that they probably keep those thoughts mostly to themselves.

K: Yes, that's what I was saying. But I forgot to put the tag on it.

If an when we have a pandemic our health care workers are going to be stretched to the limit. They will have to make choices on who gets their limited energies and supplies. Many of our health care workers in this country are imigrants, Arabs, Persians, Pakistanis, Indians, Hispanics, Africans (mostly legal I am sure but none the less recent imigrants of different races and religions from the invader Europeans and the offspring of their slaves). These people who got lucky enough to get the right documents and education may have your life in their hands. Treat them well even if you want to continue to disparage their less fortunate countrymen who pack your meat, cut up your chicken, pick your strawberries and mow your lawns. And since those folks will not get first access to health care, after the pandemic be prepared to be forced to pay more for those jobs to be done, just as the landlords had to pay more to the work of serfs after the Plagues.

Lea-Revere is certainly entitled to his opinion as you are yours. He might live in a world up on the Canuck border states where illegals are not running across the streets with pregnant wives in tow just so they can have a baby on US soil. The situation is simple. Start charging the people who hire them with slave trading and purveyance. The work for slave wages, but its more than Mexico. Start nailing those produce people to their own little crosses.

The key word here is illegal and believe me MIH believes in God and the rule of law. Her complaint is also simple, those people shouldnt be here. I agree with that and the illegals are reaping the benefits of our system and we are doing absolutely nothing about it except bankrupting the system. Very simple, catch a guy falsifying documents-charge him under the terrorism statutes. Catch a hospital providing care for someone other than emergency and only long enough to stabilize him and take him/her to the border, pull their federal funding. WE are creating a fertile ground for them and if you build it they will come.

Dont go Lea. Revere wouldnt want that and I certainly dont. Believe me when I say that free speech is one of the reasons we have these kinds of things on the internet. Suppression of anykind is wrong and that applies when I hammer Revere for taking that left wing swipe at just about anything to the right. He believes I think that things could be better and as long as we have people like him that want utopia things will always try to migrate towards it. I will always try to make the users pay for it rather than that typical Democrat answer to everything which is to take it from the rich and give to the poor. To me that is a crime when the money you make is according to government, someone elses. Who earned it? Not the poor thats for sure. I was given the same right to earn it as they have, I was just successful is all.

Revere IS NOT a racist by any rant. He is an equal opportunity do gooder and he would do so with my money and yours... So how could he be? Hell he wants us to fund African Aids, Mexicans on the street, Canadians and even the goddamn French. So racist the old boy aint.

Feel free to stick around and join in the making of steel from iron in the great forge of life. Hit him again and again, but do stick around.

K... Thank you for clarifying that you didn't SAY I had no indian blood and was a racist, that you merely implied it by saying my spanish surname doesn't prove I am not one. And thank you for clarifying that revere was merely speaking for all the native hawaiians when he told me to go back to So Cal where I came from, intimating that was how they really felt about me. Oh, that does so make a difference. Seeing as how I hang out with a number of native Hawaiians surfing and at work, I'll go tell them I now realize how they feel because revere and you told me so.

I think many of you might find the following article interesting: It's an Illegal Employer Problem.

"Mass deportations" and "Fences" are hysterics and false choices. Start penalizing "Illegal Employers" and non-citizens without a Social Security number will leave the country on their own. And they won't have to confront death trying to cross the desert back into Mexico - Mexican citizens can simply walk back into Mexico across the border at any legal border crossing (as about a million did every year for over a century).

Tax law requires that an employer must verify the Social Security number of their employees in order to document, and thus deduct, the expense of their labor. This is a simple task, and some companies, like AMC Theatres, are already doing it.

For example, Cameron Barr wrote in The Washington Post on April 30, 2006, that: "At one area multiplex owned by AMC, the Rio 18 in Gaithersburg, 11 employees 'decided to resign' this month after they could not rectify discrepancies that arose during the screening, said Melanie Bell, a spokeswoman for AMC Entertainment Inc., which is based in Kansas City, Mo. She said such screening is a routine procedure that the company conducts across the United States."

Not wanting to be an Illegal Employer, the Post noted that AMC "has long submitted lists of its employees' Social Security numbers to the Social Security Administration for review. If discrepancies arise, she [company spokeswoman Bell] said in an e-mailed response to questions, 'we require the worker to provide their original Social Security card within 3 days or to immediately contact the local SSA office.' She said the process is part of payroll tax verification and occurs after hiring."

Easy, simple, cheap, painless. No fence required. No mass deportations necessary. No need for Homeland Security to get involved. When jobs are not available, most undocumented workers will simply leave the country (as they always did before), or begin the normal process to obtain citizenship that millions (including my own sister-in-law - this hits many of us close to home) go through each year.

I don't endorse everything that article says, but I remember the general gist giving me a lightbulb moment aha! That gist being: if there weren't corporations creating a huge job market for illegal immigrants, they wouldn't come here. The supply, so to speak, is here because the demand is here.

At the end of the day, it doesn't matter where they're from, what language they speak, or what color they are. They are cogs in the business machine. And until there is some enforcement against employers who exploit people who are here illegally, they'll keep coming. Recently there have been raids on meat-processing plants employing illegal aliens. Tell me, do the businesses face any repercussions for systematically employing illegals? Of course not.

That article says Republicans won't let the discussion of the employer aspect happen I don't happen to think Democrats will either. Many of them are too eager to be seen as "business-friendly."

MRK:"Who earned it? Not the poor thats for sure. I was given the same right to earn it as they have, I was just successful is all."
From reading your previous posts (and I always try to read your posts), I know you are not as hard hearted or hard nosed as you would have us believe from that statement. I believe you are referring only to government intervention. From your post above at 12:59, 12/15: "Gave him 140 bucks and a very expensive bus ticket" and that is not all you did, you went above and beyond what most people would do to help their own neighbor, much less someone they didn't even know. Kudos to you, and I sincerely mean that.
I live in Florida and have also seen a lot of drug use and other illegal activity from the illegals, and by example the children are learning to do the same with arrogance and violence. They know how to get around our system better than the people who were born here,are much more aware of who to see and where to go to get help than your elderly neighbor, and are much better off financially than our minimum wage earners who make up much of this tourist state. Someone has to run the register at the grocery store and the gas stations, example only, and the pay will never equal the hard work they do. They scramble to make an honest living for their families and if everyone in the low paying service positions walked off the job tomorrow the country would very nearly shut down. Yet these are the very people who cannot afford preventive and on going health care. I have also seen quiet, hard working illegals who just want a better life, who would be a credit to any country and are trying to become legal citizens. But the key word here is illegal. United States citizens are bound by the law, and there is no reason why we here should allow non citizens to flaunt our laws and reap the benefits of our country. And while we are at it, they are not only of Hispanic origin.
Revere: "..wages your fellow citizens won't accept but whose services they gladly use" Here I beg to differ with you. Not all of our citizens are in high paying jobs or ever will be, and it is patently not true that U.S. citizens would not accept those jobs. Who did the work before the illegals? And if you want to blame lack of education, that is something else that needs overhauling in the U.S., but that is another whole story.
Mary in Hawaii: Thank you and your fellow teachers for your hard work and your dedication to our little ones. Teachers are one of our greatest assests and when this country truly recognizes this, maybe they will get the due respect and compensation.

Thank you Judy. That brought a mist to my eyes. I feel like I can go to bed and get some sleep now; really. Sometimes a kind word is worth more than gold.

Aloha,
Mary

Mary, as I see it you did not take the time to understand that Revere was saying "some native Hawaiians might want to say the same things about non Hawaiians as you are saying about the current set of imigrants in the US" I myself have misunderstood posts on web discussion sights. When the meaning was corrected I am sorry I was so quick to jump to judgment and aplologize. So here we all are blasting each other largely over misunderstandings. For instance I don't doubt that immigrant populations in Los Angeles have bad gangs as do non immigrant populations in Los Angeles. I reported on Alabama (and I should have said rural Alabama) as a situation where as far as I know this is not the case and imigrants from south of the border have never been a problem for me. A young white man with tatoos however has called me a Nigger Lover for suggesting that the failure of a black owned MacDonalds to include fries in my order shouldn't have him wanting to burn the place down. I have had crosses burned on my lawn in impoverished TN for helping poor people by bringing in groups to build houses that included blacks - the notes next to the burned crosses said "get the hell out of Morgan County or we will get you out the hard way". I have never had a problem with a Central or South American immigrant. I am sure others have. I just thought people ought to know that the immigrant situation is not uniform. The sons and daughters of less recent immigrants can also be a big problem. And I am sure the original immigrants, the Native Americans, wish we would all go home.

We are so busy putting people into categories, and then despising all the people in that category....when the veneer of civilization comes down as it well may do in a severe pandemic, the shooting will begin. Any of us may get caught in the crossfire. It is not H5N1 I fear.

As I fed chickens this morning I realized I need to apologize and clarify. Mary, I do not think you are racist. I think you are a nice woman, who, from your other posts, cares deeply about your students and want to do an excellent job of educating them. I apologize for posts that gave a different impression because I feel so strongly about the immigrant issue. I just want people to distinguish between people who cause harm to others and people who do not. This crosses all groups in society. I want us to do what is necessary to stop gangs and bad behavior by recent immigrants, earlier immigrants and the first immigrants. I want us to recognize how much those of us who are middle class (I live on less by choice not by necessity) and up benefit from the hard work that the underpaid chicken processors, meat packers, agricultural workers, textile workers provide. I believe that their are powerful people who always work to stir up bias against groups rather than individuals for their own ends. I just ask that people not lump the hardworking mexicans that work in many pork growing facilities (I have it from a pork geneticist that supervises them that this a correct charectarization) with other immigrants who cause trouble. Lets blame the imperial powers (present and past) that have increased inequality in the world and lets blame the Catholic church for scaring generations of people from the Irish all the way over to the new world to keep having babies so they don't go to hell. We need to be much more scared of these powerful people for they have much more power to do harm.

Again Mary I meant no personal aspersion and I apologize for letting my anger at the powers of the world seem to be directed at you.

K. Thank you for your apology. I tried in my first post to make clear that I was not blaming the immigrants personally, and that I was not sure how things were in other states.
I think we have unfortunately thrown the baby out with the bathwater on this issue. It is not a minor one to contemplate, when considering what may happen in Southern California if a pandemic hits. There are truly very very few emergency rooms left open to serve the public. I did not make this up, this is true. Southern California, unlike Alabama, is hugely overpopulated, an enormous megalopolis that stretches almost unbroken from LA to the Mexican border. Its freeways, housing, and infrastructure are strained to the limits by immigrants from every state and around the world, yet it is a fragile semi arid reclaimed desert completely dependent upon imported food and water. The farms are up north in the San Joaquin valley; there are no farms to speak of from LA to San Diego, with rare exceptions. So I wasn't thinking of indigent farm laborers when I refer to illegals, as you do from your experience there in your state. The cities are so converted to the hispanic culture that non hispanic residents truly feel as if they have moved to another country. REvere needs to understand Lea's complaint in this light. English is the second language, and one is made to feel like an unwelcome outsider if you do not speak and adapt to this new majority culture. Hispanics in Los Angeles are, by far, the majority population, with huge political and economic clout. Many many are highly educated and worthwhile contributing citizens, to be sure. But I wasn't speaking of those hispanics either. I was quite specifically raising the very real issue of the impact of illegal immigrants - of which 98% in So Cal are latino - on our health care system. And regardless of how noble one's sentiments and magnanimous we want to be, there are certain natural laws that are in effect in this situation: supply and demand, carrying capacity, limiting factors. We are exceeding them in So Cal in so many ways. And when this pandemic or some other natural disaster hits, the people of So Cal are going to be s o o l in terms not only of available health care but water and food and other basics of survival. This is not all the fault of illegal immigrants, by any means. But they certainly add to the problem. And beating the drums for universal health care is not going to resolve this issue. We are in a dire emergency, the train is roaring down the tracks at us, and yet when something is suggested that could mitigate at least a fraction of that harm possibly in time, one gets flogged by liberals. I would like you (and revere) to consider where these working poor might be better off if a pandemic roars through So Cal...back on their farms in Mexico, or in the barrios of LA and San Diego? What is more humane to them? Or is all these talk of pandemic just academic discourse, just intellectual exercise for an issue that you truly don't think will happen?

I would like to hear from some of you in other countries regarding the issue of illegal immigrants on your soil and what social services they are given, so we can think how to resolve this problem before it's too late.

Mary, when I lived in So. Cal in the late 70's I thought there were already too many people there even tho the balance was different at that time. The whole world has become overpopulated and all the soils on the planet are stretched to their limit. Our trying to make things better - saving lives with vaccines and antibiotics, growing more food per acre have backfired. The planet is gaining about 70 million new people a year. Perhaps a pandemic population correction is better than starvation. I suppose we obsess about it here because we don't expect to starve but we know a pandemic of flu has ravaged the US in the past and can do so again. This population correction may hit us as it will be no repecter of persons

Only here for a moment to extend a heart-felt apology to revere. Please accept this apology as its genuine.

In closing:
MRK: You are a sage, and please dont let that go to your head. Ego can crush the best in us. You are also an over-opinionated teddy bear, kiss-hug, kiss-hug, kiss-hug. revere is so fortunate to have you as a comrade in arms.

Racist I am not, just believe humans should employ ethical behavior and if they cannot, then they should be held accountable.

I love America, regardless of its obvious problems.

Baraka Bashad means May the Blessing Be; Arabic origin.
It was said the first time around in anger, now its being said in love.

Good bye

K,
It is exactly your last staement that "this population correction may hit us as it will be no respector of persons" that has me most concerned.

Once again:
A 2000 Journal of The American Medical Association article by Talbot and Moore (JAMA, 284, No. 22, pp. 2894-2900, 2000) clearly stated that among foreign-born persons ine United States, Mexican immigrants topped the list of the highest case rates for tuberculosis. And that includes the Multi-Drug-Resistant (MDR) strains that are the stuff of epidemics and yes, pandemics:

Sep 22, 2006 6:59 am US/Pacific

More Drug-Resistant TB Seen In U.S.
(AP) SAN FRANCISCO The worst forms of the killer tuberculosis bug have been gaining ground in the United States, alarming public health officials over imported drug-resistant strains of a disease that is mostly under control in this country.

Although the number of drug-resistant TB cases in the U.S. is small compared to developing nations, health officials here warn that visitors from other countries who are unaware of their infections are bringing over the deadliest mutations.

The states with the highest numbers of multi-drug resistant cases in the last decade were New York, California, Texas and Florida, according to the CDC.

Bravo, Lea.

Baraka Bashad.

Lea-you have me all wrong. I am as hard nosed as they come. There are just things that happen on my shift in life that have to be taken care of when no one else will. Look, I hate illegal aliens and it sticks in my craw when I see one. But when I see someone who is in deep trouble I dont hesitate to help them out. That kid would have died out there that night in all likelyhood. He was suffering from exhaustion and exposure and I guarantee you he isnt the only one out there even as we write that is willing to take a chance at death to get a chance at the big marbles the US holds. One day though and soon, those marbles will be gone for even us.

I think that if they want to influx the US with new citizens that they do it and now. Make them LEGAL and make them PAY THEIR DAMNED TAXES. I have friends of Americans of Mexican decent that I went into combat with and they are fierce warriors and I would have died for them and they me. On the other hand both my friends and I want that wall to go up and if they need to, mine the access points with all of the attached problems with that.

I want them to stay in Mexico and come here legally, just as my family did and likely MIH and yours (MIH's were already here). I want the laws followed and enforced and if there is a AMERICAN drug dealer screwing up your Chi then either they deal with him, or I do. Very simple. You dont enforce the laws you have no order or society and then I put my beret on to fix it. That fabric that is American society begins to rip with what is going on and its tough to repair. Revere can say what he wants about this, but if we continue business as usual they will overload the healthcare, social welfare systems and bye-bye to all of the research money as we use it to take care of illegal aliens.

The Dems registered almost 1.5 million illegals to vote in the election that put Gray Davis in and Bill Clinton. They then used those voter registrations to obtain government services. The State of California went almost insolvent in under two years as a result and Davis got recalled. It aint perestroika folks its an economic invasion and an act of war under the UN Charter. War with Mexico? Lobbing a couple of 155 rounds into Mexico every couple of hours or two might make them think about it. Old ammo anyway.

I told that kid not to come back unless he was legal next time. He understood that he would have been dead the next morning. Sometimes surviving in Mexico is better than dying in Tennessee.

Lea: Apologies to me are never necessary here. We are all doing the best we can and sometimes one or the other of us doesn't do as well as we'd like (I include myself in this, obviously). But we will need our energy to struggle on. We believe (on the basis of 40 years in medicine and public health) that we will get through whatever comes better together, helping each other, than if we separate from each other and try to look afer just ourselves. Anything that is a barrier between us I react to strongly. I don't believe in borders or language differences or color differences or accidents of birth. I've cut people open and inside we all look the same. Some people behave better than others and I think some people behave in ways that can only be described as evil. But most people are pretty decent.

So you needn't apologize but I am glad that we are back together. We will need each other.

Randy: LOL. It's OK to be a decent person. People genuinely like you here, because of that. Everyone here knows your true nature but you. Maybe someday you'll learn to appreciate yourself for what you are -- a compassionate person. Meanwhile, despite your talk, the rest of us have you figured out.

About some things Revere I am. Me, I want to find that slave trading bastard and give him a night on the town with a few of my friends and then do a Vietnam tour guide helicopter ride back into old Mexico. E.g. without the chute. I have done questionable things in my past and I did them on behalf of my country. The polarization is working against us all and I just cant understand why neither side will do anything. It pisses me off and I can tell you that if BF drops in for a four month visit I will be out there doing whats necessary. That necessary might mean the end of it. Might just be atonement for some of the things I have done.

Compassionate maybe, a lot more mean though when there isnt a logical flow...This stuff just kills me and reminds me of Honduras.

Tony, exactly - so while the politicians are trying to figure out how to solve the immigration problem, lets treat the illegal aliens that are here for our own saftey. Surely the large employers of illegal aliens have the ability to figure out who is illegal and who is not. Or are a bunch of wetbacks smarter than the people who head our corporations?

The raid on the Swift packing plant was not in LA but in the midwest- these people were not in gangs - they were fathers and mothers with children - human beings who want to provide for their families. I am quite sure that if the Swift plant was willing to pay US workers a decent wage with decent benefits including health care, and US shoppers were willing to pay a little more for their meat we wouldn't have to worry about people from Mexico with drug resistant TB coughing on their meat. The fact is that Corporate American likes having scared workers who work hard for low pay - that way they can break the backs of the unions and get rid of the costs of health care for American workers so US workers can be as sick as Mexican workers.

K, couldn't agree with your statement on the greed of corporate America more. And I can only hope that they and those politicians, on both sides of the isle, that decided by themselves that this is no longer a nation of laws, but rather a nation to promulgate their own advance,should personally suffer from the diseases they have wrought upon us.

However, I only wish that it was drug resistant TB, the stuff of potential epidemics, that is implied. It is not. For there is also a plethora of parasitic and intestinal diseases traveling with the subjects in point, not the least of which are amoeba and virulent E. coli. Is it then a coincidence that you have been hearing overtime in the media that these E. coli infections are from agricultural sources. Me thinks not. Not only do food (and crop handlers) have to wear protective gloves, but adequate waste facilities have to be available for workers in the field. This is of national interest, not to mention the nightmare of municipalities having to recyle sewage material laced with parasites and microbes they never had to contend with.

Well, as a Dutch inhabitant I can say the problem will never be solved. I don't have the illusion a pandemic would stop 'illegals' from entering a foreign country and violate the laws over there. If there are any survivors left, the immigration probably will be augmenting but who will care by then?
Like the idea Piaget once applied to mental processes, I use to apply the following to some problems: when the quantity continues to grow at some point the quality changes to a completely new level of organization.
On 16 million inhabitants we have about 26.000 illegals here. They are political, economic (job seeking) and/or traumatized individuals and families originally asking for asylum here (so-called asylum seekers). Usually they are caught at the airport and openly starting some procedure to be legalized inhabitants in the Netherlands, but they can be smuggled all the way from China or entering the EU at the borders after risking their lives in a small boat on the Mediterranean Sea. A lot are joining their native comrades and working illegally in restaurants etc. But there are the families who, caused by a dreadful years consuming admission procedure, are living here a long time and finally they hear they are not welcome and have to be sent back to the country they came from.
All ins and outs I 've read in the comments of all of you I do recognize and some individuals are going illegal as soon as they know they aren't officially admitted here and others are committing suicide and some are murdered in their 'own' country when they are sent back. But about the economic illegals, often men, but also women from East European countries that joined the EU who are a very cheap working force in rural industry, they are taking the jobs from youngsters who should have a job after their educational career. Our truck drivers for instance are not allowed to complain or protest about the competing by East EU members but the statistics are clearly speaking for themselves.
Let's say there are 'legal' illegals (by EU law) and 'illegal' illegals here. Refugees who stay here without a legal passport are getting a hard time because laws are passed to assign a universal financial number to them (sofi number) that has to be used by all instances they need to live on: schools, banks (a huge identification campaign is going on here), hospitals, mental healthe care, welfare and the like. It's a matter of time and all data systems will be connected and people will be traced by it.
No number, caught or excluded. Funds are suspended or one risks a huge fine for having illegal workers. Hospital financial managers are complaining about the financial risks of uninsured illegal patients. Illegals are a substantial part of the burden hospitals have to accept by the Oath of Hippocrates but are not getting any compensation for. Maybe a national fund could be a solution but I didn't hear how it has been worked out until now.
A national political battle last weeks was about a general pardon for all 26.000 to take them up and legalize them. Verdonk said she wouldn't let it happen because it will cause a world migration to the Netherlands. And see, from Italy and further away potential illegals have already heared about it and are planning 'here we are!'
People can be admitted here when they have passed an exam about Dutch culture, politics, habits and social systems and I can assure you it's not a joke to answer those items.
But even then.
At schools the class mates are protesting when little Selsej or Anuba are expelled and are lawfully forced to leave the school they have attended for five or more subsequent years; he/she is one of the others, speaking Dutch and knowing all about Christmas and the plays at the schoolyard.
Some young males (but essentially families with little children) are protected by churches and others have to steal car radios and shopping items to stay alive. They won't go away; they even don't have the money to leave.
There are voices who shout all criminals should be sent back to their native country (maybe they do enjoy the humane prison and prefer it to the barbaric custody in their original country). For youngsters some rule like that is negotiated on with the Antillian islands. (As I learned in the above I do have to be more careful than at other comment lines about my words; this doesn't imply the custody at the Antillian islands is barbaric. But the rule is part of the situation I am describing for my country.)
But at least we do have an estimation on the number of illegals over here and in general we do know who they are.
It's one of the big issues in politics over here in elections and school attrition and in society as a whole.
Another aspect of it is we had an immigrant wave in the sixties when economy was boosting. We asked them to come, this is the old immigrant generation now and their children are experiencing characteristic problems by now. One is norms and values and it is officially admitted our society has grown harder by influence of their way of thinking. By now it's easier to have a fight or to be robbed in a violent way than say 15 years ago. Also, like Ayaan Hirsi Ali (who left the Netherlands because she was talking too openly about delicate issues according to the imported generation) mentioned violence against women at home and the right to speak about those issues was being threatened constantly many others are not able to speak freely about their concerns. I do stress the point this is not as a comprehended issue being attributed to secularization but to the way some Turks, Marokkans, Antillians are 'using' society.
It has nothing to do with Islam but with rural customs and it's a burden on the Enlightment heritage and the emancipation process (women's lib AYMS) they weren't exposed to when the Dutchies were.

For the good understander, I'm not defending anything of the described facts and processes here and my concerns are more about anti-social personality disorders and traumatized clients. But when a 'black' school is of bad quality I am glad my child is going to a Christian school and receiving education of an acceptable level. And I do like to talk to the Islamic mother at the schoolyard about our children and their problems. And I do vote for preserving some Christian values, as I myself was raised that way in 'my' society.
When living in Indonesia for a couple of years I learned one may critic one's 'own' country but it really feels weird when outsiders join and start doing the same. Indonesia was 'my' country at that time and boy we were mentioning all wrong details of that system by then. While by Indonesian law we were still forbidden to accept any wages for our working over there, had to deliver our finger prints every year to the immigration office and have been thrown at with tomatoes at the local market.
But I loved the people and I am sure some did love me.

Maybe what I am trying to say is, when all systems, be they economic, logistic, care or what are being stripped of their humanitarian surplus by the rules of efficiency and money, we lose the possibilities to keep these systems running smoothly and doing something extra without charge when necessary. Why should we compete with other people in the world when it means our IT industry is moving to India and those boys and girls in our economy education classes will be jobless as soon as they leave school? What's the final stage of this global competition process? I guess it's being broke, while we were told we would be touching high profits. But that's another part of the story.

Tan06's last para covers it all. Sure for those people who say they are Christian and those that are supposed enforce the laws wont, its easy to look the other way. We on the other hand are supposed to just smile and say welcome. The ability of all of the NATO countries and the US to compete is to force the companies not to leave first and that is to make it so expensive if they leave, they wont come back. Then tarrifs. The GATT signed with the EU years ago has helped us both compete against the other side of the world. But its not enough. They dont let one damned thing in from the US but we are supposed to just say ah and take it. Those days are leaving and fast. My bet is that illegal immigration becomes the senior issue in the next presidential election and the trade imbalance with China/India on the other. The EU cant do anything to affect that relationship even though their contacts are better because of GATT.

No one will pay to ship illegals back and no one will enforce the law. There were no restrictions in the late 18 and early 1900's for inbound ailiens. We took them all and they and the Irish, Italians, Poles, Swedes, Germans, Norwegians etc. all came to America to build it. Now we are destroying it dollar by dollar going out, and taking care of the illegals that come in. In the 1980's it was a nuisance, now its a matter of national security. They can penetrate the belly of the country and then marry up with illegal documents and start work on their next big attack. Hence the reason for putting land mines in and a shoot to kill zone up. Illegal immigration would slow to a trickle and then they would try boats. Boats though are easily detected and the sharks would take care of the swimmers. Sorry, we all are legal here and paying taxes but they are here and they dont.