Public health: who cares?

I'm (more than) pleased to say the public health conversation is starting. I assume it was already going on but not where we could all hear what others were saying. So let me continue by responding to a point raised at The Pump Handle (TPH) that was also the subject of offline discussion from someone who read the post. Liz and Catherine (at TPH) made special reference to this comment from me:

"If I am an ordinary person, I don't want to have to think about public health. I want it to work well but in the background, like the water system."

Each had a slightly different take on it, as did my offline discussion. First, Liz:

Part of the problem may be that people don't have to think about things like clean water, so they take them for granted and don't factor them into their political decisions. The anti-big-government tactics gain traction because people forget that government provides many important services, from sanitation to drug review, that are extremely valuable and require lots of personnel and infrastructure.

This is why I was pleased when the Center for American Progress started running ads reminding people that we have government to thank for clean water, Social Security, and oversight of drug and toy safety. I don't know whether CAP has continued to push that idea, which was part of an effort to rally people behind the "progressive label, but it's a valuable thing for them and others to be doing.

It's an uphill and ongoing struggle to remind people to be grateful for the easy-to-overlook public health services they have, let alone rally support to put more funding into infrastructure that they didn't realize was broken.

This is quite different than the point I was making. I assumed that not thinking about public health was a normal and rational thing for most people (we in public health naturally like to think about it, but that's an obvious selection bias). Liz identifies what I considered rational to be a problem to be solved. People take public health for granted, or, more generally, take for granted the benefits of having a government do things we can't do for ourselves. It is an important point. If the Republicans want to give me a $600 tax rebate because "people know better than government how to spend their money," someone needs to say that I can't buy better police and fire protection or a safe food and water supply or the many other things that require my $600 to be put together with my neighbor's $600 and her neighbor's $600, etc.

That's true. Does it mean that we want to think about public health, though? I don't want to think about bridge safety, I just want safe bridges. Both Liz and Catherine assume we can't have safe bridges or safe water if people don't think about them. This may well be true, although I consider it an empirical question. I doubt it is a general principle, because very few people think about the electrical grid (until it doesn't work) and yet we have an electrical grid. It isn't a government entity, either, although it's part of the community infrastructure. Catherine seems to go further and identify the failure to think about public health as almost a moral failing:

Sometimes we have to think about the things that we want to pass off to others to think about. The answer isn't in thinking less, engaging less, it is in the exact opposite.

We have been disengaging far too much. Our busy, stressful, lives are not to blame they are our excuse. We do not do, we do not look at, we do not engage ourselves in what is unpleasant.

We leave that to others.

Catherine ends by saying we need to put the public back in public health, meaning in this context I assume, more public participation and the assumption of responsibility of each of us for public health in our community.

A different take came from the offline conversation. The problem isn't that people don't care about public health. It's that they care too much about too many different things: mercury in vaccines, substance abuse, suicide, obesity, alcohol, etc. The "public" in public health is a chaotic world of advocates, not activists, each passionate about his or her own area, neither strategic nor caring that others think other things are "the most important problem in public health." Advocates for their areas of interest, not activists for public health.

Three different takes on my claim that ordinary people don't want to think about public health: they don't, and that's too bad; they don't, and that's a failure to take responsibility; they do, and that's too bad. All three views were more nuanced than this, but my main point is that four people who think a lot about public health didn't see a major but usually undiscussed point in the same way. Because it really does matter for what we do whether average people are genuinely interested in public health and in what way. It matters for what we do, how we think about ourselves and our chances of success. When we do talk about it, we don't seem to agree.

That was just one aspect of the comments to yesterday's post. There are other interesting thoughts in the comments and I am hoping we'll start to discuss them, not just in terms of a list of things to do but in terms of underlying assumptions we make about what we do and why. Maybe we'll find that after subjecting them to a searching examination we were justified and can move on. But I suspect we will find that we haven't bothered to think hard enough about them.

Like whether people do or should care about public health.

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Many people don't like to think about politics, either. To those of us who are activists, we don't get it, but most people hate politics and only indulge when they have to. We call them "swing voters", or "undecided", and don't pillory them.

The analogy holds for public health. Yet the Bush years taught us it's a mistake to disengage (whatever your politics are, it cuts both ways), lest we get what we deserve.

Lack of transparency and disengagement breeds chronic Lyme disease myths, and I know from conversations about flu prep that many in government think the public would panic if confronted with the reality of a severe pandemic. That may be so (it's debatable - rational fear is not panic) but it pales compared to the anger of not being told in advance. Again, there's an analogy about the anger currently felt about handling the economy and bailouts lack of transparency bites you in the end.

There's got to be a better way than the way we do things now. I suggest we watch and learn from the new kids in DC and not accept the old models as the gold standard.

And let me add that we have an obligation to push for newer models that work better. Fear of job loss is no excuse to avoid fighting for improvement.

Lets face a fact here Revere. Public health really means the individuals health. No one really cares about someone elses health unless it affects theirs. That is what it would do, affect mine because I would have less money to take care of myself in lieu of others.

Remember, I just cut my employees to 35 hours and eliminated their healthcare completely. Why? Because my newly elected President has said he is going to soak businesses and people making above 100,000 a year to pay for all of his socialist agenda. The money in my pocket belongs to someone else. Calling it taxes is nothing more than another name for legalized theft.

UHC isnt going to solve anything. Degradations around the world health care systems are occurring in the countries that have it. Why? Because it does in fact simply put money into a box in a grave after 70 or so years. They started the UK's about 60 years ago and they are now feeling the effects of it. That money should stay above the grade rather than below it.

Otherwise they have to print more money to replace that money times two and try to increase the output to make it worth something. Then they have to convince someone later that the now inflated costs are due to something other than this. If we were on a gold/silver system and you could take all of the money spent by government on your body and social services and put it in with the individual it would be more telling. You could see it being buried. You are not a corpse you are SSN 000-00-0000. You had xxxxxx.xx amount spent on you by government while you were alive.

It is indeed the mother of all money pits. It also ensures that all countries will be bankrupted because it becomes a government cost and a cash cow from which to steal from. Cash flow machine. You can cover bills x 1.5 if your cash flow is good. Its how banks make tons of money each night with their sweep accounts.

UHC and healthcare? I havent seen a thing that has come out in recent history that said anything good about the services that are provided. Indeed those that buy private insurance on top of UHC are moved to the head of the line... Just like they are here now with those who have it.

The problem with it here in the US is that 1/2 of the country would be paying for the other half. The other half would never pay one dime and it would finish us off in this economy. Adding a new tax tax to struggling businesses and working class people would finish us off.

Then, there is the paying for it to begin with. How are the future very much minority young people going to pay for those retirees. We cant afford Medicare and Medicaid now and spreading the debt to a paying America will increase inflation even more. We cant tax any more and expect the outcome to be anything different than it is now and moving to worse.

Collapse is imminent. What do we do one day if the Arabs refuse to take our dollars because they are nothing but paper? Alternative energy? Please....You commented on what Zimbabwe's currency was worth recently. What do you do if that happens to us? You cut spending and that means that their newly found healthcare will be gone. Then there is little or NO healthcare. My employees saw that in the last month on a micro-scale. The owner of the healthcare has seen fit to limit or cut it entirely. Now they have to pay for their own. Sure they might get help from the state but the state is a business like mine. They get their money from taxes, I get it from earning it. The same effect happens though when the economy goes to hell. All I am seeing right now is nationalization in a move towards the one world government.

Healthcare is NOT a right as some would suggest. If it were then it would be mandated in the Constitution. It also is the first thing to go in a crisis. Illegal aliens pull on that same system too and would pay nothing into it and the costs spiral would begin at higher and then end when the system ended. They come here to have babies and we get the bills. Healthcare at all costs will never work out. It also goes against the limited govenment proviso's and only the lib/socialists/communists want it. 1/2 of America and very much so the mostly paying America dont. It would be nice but its not reality. Cant use Sweden any longer as an example. Healthcare costs are eating them alive now.

About that Constitution, cant seem to find entitlements either. My biggest fear? What do people who have been sucking on the nipple of government do when the system collapses? It wouldnt take much. Pandemic, SuperQuake, another full on financial disaster the end is the same. What do they do when it becomes limited or not available at all?

Governments ability to spend in our future is going to be zip as hyperinflation begins in about a year from this throwaway we have begun. We have tossed our kids and their kids futures away and it absolutely ensures that they will become general laborers in our future society. Doctors few, lawyers to sue them many.

They will live as a third world nation in what was once the richest country in the world. Everyone I know universally agrees upon this fact and that is that the US is mortgaged to the hilt. How do you spend MORE to do healthcare. Priorities? Pick one. Wars, social programs, defense spending... ALL are the same thing that brought the Romans down and it was the socialism of the time that accelerated it. The end result is collapse from all tangents that lead back to the things socialist/communist in a government.

The answer for this is personal responsibility to become as big a producer as possible so you have the money to pay for the services you desire. Healthcare being one of them.

Government will take incentive away in a UHC and socialist society. Why work harder? If you work harder you make more money and then the government takes more of it away from you. I can remember when there was a 78% tax bracket and jobs were few in this country. The idea is that you make too much money, so that belongs to someone else even though they worked not one whit for it is the concept. What a concept it is too.

By M. Randolph Kruger (not verified) on 16 Dec 2008 #permalink

MRK, talking from a purely financial standpoint, your argument is flawed. It assumes no return on investment, which is a pretty major flaw. A person who is physically well is more productive than one who is physically ill. Productive = money for the economy = return on investment. So the money isn't being simply buried after 70-plus years. (Although I do have to applaud the creativity of that morbid analogy.)

Health care, and any social service, however, is based on more than just financial arguments. And you're right, there is a lot of controversy over who deserves the benefits and who should pay to give them. But I do not believe in "Welfare for none" any more than I believe in "Welfare for all." And I do not resort to one extreme simply because I don't wish to face the difficult questions. Do I have the answers? No. But I at least recognize the complexities of the issues and the ultimate goals we are trying to achieve.

Also, I must finally respond to your argument that "Healthcare is NOT a right as some would suggest. If it were then it would be mandated in the Constitution." because I find this also to be flawed. It is based on the premise that a) the founding fathers were infallible and b) the Constitution is and should be a static document - meaning we should mold our lives according to the economic and social circumstances of the late 1700's. If this were the case then black people would still be 3/5 of a person and women would not be allowed to vote.

Wow Revere. First off. What offline discussion?
Second I am not "in" public health and my comment was from this side of the peanut gallery.

What I was saying, if you would read the post again, was "Sometimes we have to think about the things that we want to pass off to others to think about. The answer isn't in thinking less, engaging less, it is in the exact opposite."

In a pandemic who is going to be there for me and my family. We are not talking about a cold here. Are you going to be making housecalls. This information imparted by public health is lifesaving. YOU have it and WE want it. We need it in order to survive. What part of this does public health not understand? Panic. Yes we might have some panic. But this IS about saving the most lives. Am I being a bit clearer now?

"We have been disengaging far too much. Our busy, stressful, lives are not to blame they are our excuse."

I am talking about the public, me, my neighbors. We have ready excuses for not preparing BECAUSE NO ONE IS TELLING THEM THAT THEY NEED TO. The excuse will win every time.

"We do not do, we do not look at, we do not engage ourselves in what is unpleasant."

I know very well the responses that I got when I, a person in the general public, received when I stepped out of line in order to tell the public myself. I heard "God bless you" and "thank you".

"We leave that to others."
You in public health have left it up to us.

You have the information, you have the credibility, you have the recognition, you have the diplomas, the whistles, the badges....and yet you are silent and are leaving it up to us who have no power, no recognition, and no credentials.

I have the right to moralize right now.

Catherine: I wasn't taking a position on whether you were right or wrong. I was making an observation and trying to get a conversation started about what we think about public health and what it is. Public health is much more than pandemic preparedness. I am trying to talk about public health, writ large, not the part of public health that APHA or APEC or TFAH or you or I are most interested in or even think is most important. My "offline" discussion meant someone who read the post and discussed it with me personally but didn't leave a comment. Nothing sinister. But she did say that there were members of the public who are intensely interested in their notion of public health. She thought I was in error in not recognizing that and you are an example of my error. That's her view, in any event.

Let's come back to the big picture. I was pointing out that we (you, me, Liz, others) don't agree or even see in the same way some basic questions we never discuss, like what do we want from public health.

Public health is not a person. "Public health" cannot leave it to you or anyone else. We are many different people with different perspectives and, in my view, the field has lost its way. I am trying to start a conversation so we can start finding it again.

Regarding your point about a pandemic (although it was not what I was talking about), for the questions that count about flu (which is something I know a fair amount about) it is simply not true that "we have the information." No one has the scientific information we need to know. We started the Flu Wiki because many of the practical things that can help us all are known by you or others, since many of the problems of a pandemic aren't scientific problems.

Tasha-I would say that I am not wrong about any of it. Financially our house has been insolvent since the late sixties. We started bond borrowing and well it got out of hand. The fact is that we are pouring more money into the S. Security/Medicare system, more than it ever took in because it simply wasnt anything more than a Socialist/Liberal slush fund from which to steal. Republicans went along with it too.

But, the numbers are staggering and I have posted on this several times. By my count and without interest, the US owes 63 TRILLION dollars to the rest of the world, to future unfunded mandates and all to take care of unproductive seniors. I am getting into that direction myself but I am not stupid either. I never spend more than I make and I pay my taxes. It may shortly get down to the simple fact that we have to sue to prevent taxes from being put into place because they dont follow the Constitution. My state which was a billion in the black last year is now a billion in the hole. Phil Bredesen is one of only two Democrats that I ever voted for and he has started the budget cuts.

But now the in part federally funded SCHIP program is in jeopardy. This is a program that I personally want to see. It takes care of the kids and their healthcare needs.

There has to be a line though and that means able bodied adults who "wont do the work that the Mexicans do" wont work then there should be no welfare for them. If the system collapses when the autotax AMT kicks in two years from now which is more than Obama ever proposed, we are going to be in deep trouble. A whole segment of this country will have never worked, never going to work and when that other half goes on their butts financially. The other half is going to be out in the cold literally.

You cannot by law mandate equality. Some things that will push it along its way can be though.

Here is the way I like to say it. You cannot legislate the poor into freedom by legislating the wealthy out of theirs.

What one person receives without working for, another person must work for without receiving anything.

The government cannot give to anybody anything that the
government does not first take from somebody else. When
half of the people get the idea that they do not have to work because the other half is going to take care of them, and when the other half gets the idea that it does no good to work because somebody else is going to get what they work for, that my dear friend,is about the end of any nation.

It is a flawed thought and your assumption Tash is that there IS a return on the investment. I have yet to ever see anything other than people who do nothing to move themselves out of poverty. The Katrina 2 refugees came out of N.Orleans in Escalades and were absolutely livid that the government didnt give them money when they arrived here in Memphis. They interviewed a guy who was 25 plus or so and he said he had NEVER had a job in his life... The government took care of him.

There is more. Return on investment? E.g. Revere may remember Sugar Ditch Miss that Johnson visited in the 60's and promised that all would be well. They sent money into the county. After I read almost 540 million dollars being spent across 20 years they people still lived in shacks and couldnt read or write. But they all knew when the first and the 15th were because thats when the government checks came in.

What are you talking about here is creating healthy poor people and the removal of a financial burden from them, and putting it onto someone else. They never pay anything into the system and when we try to stop it, someone screams race and disenfranchisement.

Social welfare is a money mill and we are starting down the tracks again with spend, spend, spend when we are already in debt to our eyeballs.

You cannot multiply wealth by dividing it.

By M. Randolph Kruger (not verified) on 16 Dec 2008 #permalink

Regarding the financial arguments. Congress is reponsible to act in the interests in the general welfare of the people. It also has the power to coin and regulate the value of money. Congress can issue as much of it's debt free money as it wishes. It need not borrow it, or get it from taxes. That it chooses to do so should make you wonder why.

When it comes to health, poverty and public infrastructure, there is no shortage of money. Only those who do not know what money is and how it is created believe this.

No one really cares about someone elses health unless it affects theirs.

You have an unfortunate tendency to think that everyone is as sociopathic as you are. It's not actually true.

I promise not to say the word pandemic for awhile. And I apologize for misunderstanding your intent.

What do I want out of public health?
Leadership,Service,Stewardship,Trustworthiness,Transparency and most of all Compassion

Who can possibly model all of these wonderful qualities?
We do have professional public health workers in the public and private concerns. Those in the public arena like state and local departments are doing some reaching out to the public but in ways that are not engaging the majority of people, not the ones that I have talked with.

Could we be saying that the method of delivery of information is not working adequately? I can see why if no one claims the responsibility of information dissemination to the rest of us.

Should the public be concerned about a dirty bomb, an outbreak, a terrorist attack, a train derailment involving hazardous material and not having the proper instructions ahead of time about what they should be expected to do. Who should notify the public of these things. EMS? Local Boards, Local Government, the State, the Feds?

While we argue over whose responsibility many still are not hearing about the 21st century threats to public health.

EMS may be skilled in responding, but not teaching or informing. That sounds like the local public health departments responsibility anyway. But then we have the a different concern because most local boards of health are not staffed by medical professionals. And medical professionals already have full plates.

So this is what I do see that is working just fine in public health today even if its only from a local small town perspective.

My town is doing an admirable job getting prepared from an all-hazards approach. One Selectwoman even set up an MRC and then helped to set up the larger all Western MA MRC. I would say that this is "public health" leadership in action.

Our young Emergency Services Director has been ensuring that our town departments have their Continuity of Operations Plans ready. He is ready to respond to any hazard. This is public health too, just a different aspect.

The town departments have been largely successful in getting their COOPs written. This is a difficult task when there are only two people in a department, those COOPs are pretty short and to the point. Each town department head is seeing ensuring the success of the mission of their department during an emergency and they are doing so on a meager budget, but they are doing it. This is public health to me too.

The water department also has public health responsibilities. We need clean water to drink and we don't want our sewers backing up into our basements so we really depend on these folks for our public health.

All of the other town departments have something to do with public health. Senior Services, the School Department, they are all part of the greater circle of those having a hand in public health.

And this is not a broken network during times of relative peace, calm, health, etc.

There is no department for something that we have not been able to do before...prepare. All-hazards or whatever. Then again, isn't preparedness public health when we are talking about disaster mitigation? Or resiliency?

People don't know to do if they are not aware that there is a problem.

So this is where this current public health problem coalesced for me.

How does this all get knitted together into a cohesive "response unit" pulling from all available public health resources in any given area. The MRCs fit this bill and I started one I think it was in late 2005 in order to build up this response unit that I am talking about here. Then I realized that there we other issues that needed to be addressed and it is here where I have been stuck as well. The face to face encounter with information to impart - the heart of public health advocacy.

So what is being set up is all good, except, even an MRC cannot shoulder the burden of some disasters all by themselves more will be needed.

Traditionally the mainstream media and communications experts have had the responsibility of giving us the "news" of disasters when they happen.

As some of us have said in other places on the net some things can be planned and prepared for before it is "news". We are getting better at that. But there is a lot to learn.

In a hurricane, we don't force evacuations. There is no place to evacuate to in a pandemic, a terrorist attack, or other disaster scenario.

Are individuals responsible for discovering and fostering along their own public health information and warnings or is there a collective responsibility held by traditional medical and public health professionals?

As I think I mentioned previously, those of us who are amateurs at safeguarding the public's health do not have the credentials or validation to inform anyone of anything. I would if I could and I have tried. I hope people avoid the virus like they avoid me now.

So what do I want from public health? I can only answer this according to the Massachusetts infrastructure that I somewhat know.

I want county public health boards and commissions to inform and instruct, by way of the local boards of health (or other town departments, MRCs, or recognized and trusted entities already in place), all of the residents of this state when and if there is a significant possibility that an event could occur that may seriously impact the well being of the people.

The National Weather Service warns about weather emergencies. Why are public health emergencies not warned about in enough time to do something about them and not when the state of emergency is declared?

Each person in each town in this land has a right to know ahead of time, if there is information that is being widely discussed on the net but barely discussed in public - this type of information divide results in a form of a class advantage that is not necessary or helpful. Can I point the finger at someone to blame? No, and it isn't productive to try. I just want to know how to get results.

So, this is what is my take of what is happening now in rural public health from an amateurs point of view and a humble but a little frustrated one at that.

Phila-Get off your vendetta and quit making personal attacks. You call people all sorts of names here and quite frankly I have heard enough of it.

You can discuss just about anything you want here and you have called me a racist, a sociopath and quite a few others things like it..Knock it off.

By M. Randolph Kruger (not verified) on 16 Dec 2008 #permalink

if you don't want to be judged a sociopath, MRK, quit saying sociopathic things. we're taking your own statements for a guide to your personal nature; really, that's all we've got to go on. don't like the image you're holding up to us? well, why do you tout it at such length then?

(i lived my first quarter century in a northern european welfare state. socialized healthcare, among other things. it worked just fine. sure it was expensive, tax rates on the middle class held around 50% and over --- but it was a very worthwhile investment. unlike here in the U.S., you actually felt like you got some tangible return on your tax moneys there.)

By Nomen Nescio (not verified) on 17 Dec 2008 #permalink

"Healthcare is NOT a right as some would suggest."

Life, liberty and the pursuit of happiness do not need "good health" to be had.

"Illegal aliens pull on that same system too and would pay nothing into it and the costs spiral would begin at higher and then end when the system ended. They come here to have babies and we get the bills."

Illegal aliens probably do not cost the system as much as they could in healthcare right now because tapping that system means swift deportation and the threat of losing ones family who are still here if caught.

Think like an illegal alien and realize that their world is not all about soaking up the good and contributing to the ills of our society. For the most part, they are good people trying to survive in any way that they can. There are a few bad apples but probably not out of line in numbers with the bad apples we already have here. We should be all about opening the gates so that they can do so legally, safely, and with support.

As a traditionalist I see the merit in what my parents and grandparents and further back have done in allowing this wonderful melting pot that is the US to be fruitful and multiply. It is when we grow afraid that there won't be enough for the rest of us that we become tightwads and selfish with our resources. This is to be expected as it is human nature.

The rest of the world looks at us like we look at the fat cat CEOs who took vacations on our dime. While people in other lands have not paid into our system so the analogy is not quite the same, the tease is still there. We have long be touted as having streets of gold and our hedonistic pleasures are known around the world. We worked for it, why not, right? The thing of it is, we have inadvertantly cast a stumbling block for others to trip over. Our nation has
contributed mightily to the welfare of people all over the world. But when it is crunch time and people are really, really, hurting they cannot look upon us who they think have with a form of covetousness.

The real problem is that there is no healthcare for illegal aliens. We are the land of the free and the home of the brave. Can we open our arms to the destitute at our own expense? I can keep on giving and I don't have all that much myself, but I can keep on giving. And I am not a "socialist".

I do recognize that there are times in our world where political systems will fail and our common sense and moralistic, ethical, and yes, religious beliefs must urge us on. Is there room for difference in approach? I cannot think like a scientist, I leave that to scientists. I cannot think like a financial guru, I leave that to the financial folks. But people resent being introduced to varying degrees of discussion about the possibility that there may be a better way morally and ethically.

Can we learn from each others achievements and recognize the good that each person does even though their heart convictions are different?

I am not a globalist, and I don't speak that as if it is a bad word, although I can look down the road and see some horrible consequences to rampant globalism. I respect our individual and corporate differences and actually applaud them.

If we design and embrace one approach that approach, no matter how noble or ethical we may think it is at the time, might be wrong. Closing doors are closed doors, they yield answers.

Is it a common goal to work for the safety and health of the many, to relieve suffering where it is, to compensate for loss when it occurs for the benefit of the most?

Since I am to "do" for the least of these, I should be about that business.

Who are the least of these?
Widows and children are tops on my list.

Who is being hurt by lack of healthcare (even if they are illegal aliens)?
Women and children.

In a socialist society, ultimately, is there a distinction made about services rendered based on those in need of the services...or is that too judgmental? Or would it hurt someones self esteem to make that judgment call? So instead, we try to take away all judgment because we cannot tell who is milking the system and who is not. We are afraid to say "no, you cannot have that because you have not worked for it".

I know not everyone can "work for it" but many more than do now can.

It isn't the least of these who are served, it is all of these. When "all of these" are being served, who does the serving? At some point someone will wake up and say "hey, why work to serve when I will be served anyway."

For those of who do work now, do you resent those who milk the system and don't "do" even though they


in some way contribute to society?

Under universal health care those who work hard, really hard, will grow to resent that they receive the same level of care that those who do nothing but can do something recieve. Money will fly "under the table" so that the haves get what they believe they deserve. Those in healthcare will be compensated. Those who work will receive better healthcare. Those who cannot afford the graft will get nothing...but we will have a UHC that costs the taxpayers even more money. We will have an albatross around our necks.

The pendulum will swing.

From the patient side of the fence, and at this terminal end of the pendulum swing, what fuels the resentment between those who take and those who give will still be there with UHC, it will just take a different form.

We can map a genome and develop third generation vaccines but we cannot solve some of these basic issues...because we are afraid to moralize and apply our learned wisdom about human nature and behavior to these great problems.

Do not hurt the self-esteem has become the driving principle. Truthfully, there are times when I want to stand up and say enough is enough. More and more I have been confrontational.

I see a shoplifter I follow them through the store and stare them down. Last time was a couple of nights ago. Three teenage girls were stealing cosmetics and perfume. They put all that they stole back.

I see someone vandalizing a soda machine and I confront them.

When we see people stealing healthcare, is it wrong to confront them?

It is not wrong to stand against what is wrong. It is how we stand against what is wrong that is the key. UHC is not the answer. Our system is not broken, it is just overburdened by some who want the easy way out of things...and that sometimes is human nature.

Just some more cents in the pot. Sorry, I shouldn't have gone on and passion for this topic keeps me long winded.

if illegal immigrants are a drain on society, the easy solution is to find some way to legalize them so that they can contribute their share of taxes. some sort of guest worker permit, for instance.

making the assumption (a reasonable one, i think) that most illegal immigrants are here to work and improve their lives, it would follow that most of them would jump on the chance to do so legally. they'd get access to legal health care, protection of law enforcement, above-board work, and countless other things, yet would lose very little. why not give them the chance?

By Nomen Nescio (not verified) on 17 Dec 2008 #permalink

I agree with you Nomen.

To me the heart of public health is this...

The more I get to know people around the world I realize that we are all about the same as far as are wants, desires, fears, and heartache go. As parents we want our children to be healthy, happy, and secure. There is wisdom there.

I would have to assume that we also agree that it is right to take care of the "least of these", widows and children because they are the weakest and most vulnerable groups.

For me, I don't care what ethnic group, race, nationality or creed they come from.

I care about the widows and children. If all of us with a passion for public health agree on this, how can we best secure their future and good health? What is good for them is what is good for the rest of us.

If we disagree, where is our disagreement?

Nomen I guess I will just open up each post with Nomen is a Nazi, a pimp and a whoremonger. I have no knowledge whether you are or not but its okay, its a blog. You can say anything you want right. Wrong. Its offensive and points can be easily made without someone making personal attacks. Thats all Phila does here, make personal attacks. She got a load back at her last time when she said she prefers terrorists to food inspectors without knowing the first thing about what the other side of this planet would do to her if she even opened up her mouth. Perfectly legal for someone to put a pop in that face if he is a male and she mouths off. It doesnt matter whether she is right or wrong, just that she violated their tenets.

I try to be respectful of every opinion even when I think they are wrong. I dont open up nearly each and every post with a one or two liner every time and call someone a name. Sorry, thats disrespectful and frankly your support of that is also.

But there I go making sense again. Around here if it got pulled more than once and in person it would be handled on the spot. I for one never start off speaking to someone with name calling, cause generally you'll get the snot kicked out of you down south for it. Well, most generally anyplace really that will happen.

Catherine-You are right. But its the 3 or percent of the world that screw it up for the rest of us. Fact is that saving that world ensures that the 3% will grow. We have seen nothing but worse and worse since the inception of "Save the Children". The population is off the scale and if you buy into the GW mess the total number of footprints are going to tip us over on that. In reality, food may be where it really tips. The price of food almost tripled in two years and millions starved as a result. It is in human nature to help those who cant help themselves but the end effect is that we put too much of a strain on the worlds systems long term. Sustainability. We are simply not able to sustaine what we are doing right now. Water wars are going to be as bad as oil wars as we simply have too much uptake by humanity. The ecosystem is no different as humanity encroaches on the environment in all ways. You are right, they all want the same thing for their kids. But, there is becoming more and more of a reality that even HERE we cannot provide those things to them. Our lifestyles have begun to slip in the US and it could be a major one for many.

So our answer is for over there to try to do more. When we do they simply go on and make more babies. If any major system collapses, then the human dieback is going to be huge. Pandemic, lack of healthcare, lack of money. Doesnt matter what it is it will result in our own demise in this country and as a nation.

There was a whole economics course in the macro of the world and where we will be in 30 years in the War College. Our own efforts will be our own undoing was the message. None said we should stop, but none said we should continue it. Poverty is a spreading disease and very difficult to stamp out. Once you think you have it under control, it pops up somewhere else.

Oh, and by the way I dont have any answers other than GM crops and that too might be our undoing. Look at the Black Plague, we were resurgent at the time. Food supplies were great. The population was exploding all across the planet and humans were moving in, clearing and growing food and babies. Then there wasnt much more they could clear or use. The wood went to mining operations to make weapons to defend your new and old cultivated lands. So, the tip over began.

We are doing the same thing in the underdeveloped parts of the world, creating an artificial situation to keep them alive. Then we hit the tipping point. What and which one it will be is the question, the answer though will be the same.

By M. Randolph Kruger (not verified) on 18 Dec 2008 #permalink

I guess I will just open up each post with Nomen is a Nazi, a pimp and a whoremonger.

and if my words give our fellow readers good reason to believe i am those things, then folks will agree with you and hold you in slightly higher esteem for having spoken that truth. i certainly won't object to anyone judging me by my writings.

I try to be respectful of every opinion

not so's anybody'd notice.

By Nomen Nescio (not verified) on 18 Dec 2008 #permalink

Continuously I have witnessed MRK turning the other cheek. In my mind and in my mind's eye MRK you are a good person.
Therefore, you just read and see what you want to nomen and you too bitch Phila. Frakk off both of you. Peace you arseholes, hope your holiday is filled with unpleasant surprises.

I try to be respectful of every opinion even when I think they are wrong.

And you do - do that MRK. You are my friend and you are right more often than not.

And how dare you allow this onslaught to continue revere.

Look, I'm on record here as having a genuine fondness for Randy (aka MRK). But I will not censure Nomen or Phila for their comments about what Randy has written. It is no more true that he has "turned the other cheek" than most others around here. He has given as good as he's gotten, often in a highly aggressive and for many people offensive way. Randy, you are offended when someone characterizes your position as sociopathic (which I think it is, if you look up the definition) but don't seem to realize that when you call people commies and Nazis it is equally offensive. Much worse you have advocated genocide here, far more offensive than any name calling. You have no compunction about stating the most outlandish views here and I allow this in your case and many others. But when you get a certain kind of pushback you don't like it and claim it's namecalling. Most of it isn't. It's a bloody accurate characterization of your views.

I don't like namecalling around here but I understand that feelings run high on a lot of topics and it's a blog so I allow it as long as it remains within bounds. Randy has more than once come close to the line.

It is absolutely ridiculous to call this an "onslaught." MRK can take it, I'm sure. As for your remarks, Lea, over the line. Way over the line.

Revere, name me ONE instance where I called someone except Phila a name here that isnt a public figure. She is the only one that I ever vented on and that is because she said she preferred terrorists and in that she has called me every name in the book along the way here.

Over the line? Yeah right. My comments may be offensive but they are opinions and I never call anyone a name. Only TWICE in four years Revere have I ever done that and only when they first went to name calling. I dont say it because I want to incur their ire. Its because they are as full of crap about the real world that they simply dont get it. The war is joined and they dont get that we are targets in body now. I am supposed to sit back and be called a racist, sociopath and just allow continous PERSONAL attacks?

No where on any blog, anywhere is that allowed. I even brought it to everyone attention in September with the SEED policy. It aint allowed and while I have gotten up on the line before I have rarely crossed it and never without being the victim of the first attack. Its a different blog without a doubt. Vent the bowel but not on someone else. Public figures of course do not have the same protection. That includes GWB and your favorite Karl Rove.

I have a comment because I am not coming back until well after the first of the year. Randolph is off to Afghanistan for a bit where I will be training the troops on contract and the locals in the art of war. But as it will be over the Xmas holidays I have a message for all. This way I wont leave all pissed off and full of venom and angry. Its just not good for the soul...Which you all will likely not believe in.

I will return around the 15th having taught soldiers how to act like one and to ensure that when firing a weapon that proper etiquette is followed after capping a bad guy.

Airstrikes R US for Xmas.

But on to my message....

To My Democrat/Progressive/Liberal/Socialist and ah-hem Communist Friends:

Please accept with no obligation, implied or implicit, my best wishes for an environmentally conscious, socially responsible, low-stress, non-addictive, gender-neutral celebration of the winter solstice holiday, practiced within the most enjoyable traditions of the religious persuasion of your choice, or secular practices of your choice, with respect for the religious/secular persuasion and/or traditions of others, or their choice not to practice religious or secular traditions at all. Please remember that if you are a Democrat/Progressive/Liberal/Socialist and ah-hem Communist that you MUST provide each and everyone for two city blocks the same gifts that you would be providing to your own family for this season. You do not have to call it a gift... You can call it a bail out. Remember, all you have to do is pay more taxes.

I also wish you a fiscally successful, personally fulfilling and medically uncomplicated recognition of the onset of the generally accepted calendar year 2009, but not without due respect for the calendars of choice of other cultures whose contributions to society have helped make America great. Not to imply that America is necessarily greater than any other country, nor the only America in the Western Hemisphere.

Also, this wish is made without regard to the location, race, creed, color, age, physical ability, religious faith or sexual orientation preference of the wishee. For those of you who will take your own life having decided that the thought of having GWB as President for even one more minute is too much, please have the good Grace to leave a note so that we will not have to go to the expense of a state
provided investigation and funeral.

To My Republican Friends:

Merry Christmas and a Happy New Year!

By M. Randolph Kruger (not verified) on 18 Dec 2008 #permalink

And to you, Randy, I have only one message, which I mean sincerely:

travel safely.

See ya guys.

But please don't take offense. I turn off the television when there is bickering too.

Have a Merry Christmas to those who celebrate the birth of Jesus Christ. Happy Channukah to those who celebrate the glory of G-d's provision and the miracles that He does. And a very happy (and healthy) New Year to us all.