Lest We Forget Joe Strummer

August 21, 1952-December 22, 2002

All Things Must Pass

I began Citizen K. three years ago because I wanted to write about whatever I wanted to write about. I have made some wonderful friends in the process, and have enjoyed every minute of it. I've also learned and, I trust, honed my writing skills.

In the past several months, I've discovered something that I want to write about in particular. So, in the next couple of weeks, I'll be transitioning my efforts from Citizen K. to Health Matters, which I hope will serve as a forum for reasoned discourse about health care, ranging from policy to specific issues such as public health, health technology, health literacy, compensation, and overtreatment. In particular, I want to explore the health care systems of other nations with the idea of learning from them, something that Americans resist to near pathological degree. I invite you to join me.

Citizen K. will be around until the first of the year. Whatever you may have learned from me pales compared to what I have learned from you.

Sunday Funnies and Arts

As always, click to enlarge...

The annual Famine Walk in County Mayo commemorates the death of hundreds of Irish peasants who died seeking emergency food supplies during the Great Hunger...

History, Memory, Technology: Marronage in Saint-Domingue (Haiti)...

The Republicans explain a financial crisis with politically correct dogma...

In the stacks: The Boston Public Library...

The Virginian and Hollywood's Old South...


PHOTO GALLERY
C&A Seafood: Hot Lunch Shrimp Crawfish...

Visions of corned beef danced in her head...

Art of the Poster: The Birds...

Fall free as old confetti...


FROM THE JUKEBOX
Emmylou and Dick Gaughan transcendant on "Wild Mountain Thyme"...

John Waugh explains why Hank Williams sang as well as Frank Sinatra, Tony Bennett, or anyone else for that matter...

Just A Song: "The Night They Drove Old Dixie Down"...

Woke up this morning, had them Statesboro blues:

Jamaicans for Justice: Victim's Voices

I'll believe when I see it, but with 63 senate votes to cut off debate, the end of the stupidity of DADT is in sight. Saxby Chambliss (R-GA), whose alleged football injury and (for good measure) student deferment allowed him to spend the Vietnam war in the comfort of a fraternity house and who later accused triple amputee and Silver Star winner Max Cleland of being soft on defense, echoed past arguments against integrating the armed forces: "It the middle of a military conflict, this is not the time to do it." When would be the time, Senator?

James Inhofe (R-OK) claims that "it is working very well." How does that explain the 14,000 soldiers discharged for their sexual orientation, including Arabic linguists and others with mission critical skills? And why is it working, Senator? Because 14,000 is the right number, or because thousands more can't serve their country with suppressing who they are?

DADT has accomplished nothing but lying, shame, and subterfuge. It has deprived the military of dedicated, honorable men and women just when it needs them most. Retaining it says that it is the victims' duty is to adjust to the bigots, when it must be the other way around.

Heads They Win, Tails We Lose

Fred Kaplan writes that the situation in Afghanistan is worse than ever.

We're in a position of having to depend on an unstable  nation (Pakistan) with a political agenda that does not sync with ours. Moreover, that country's stance is dictated by its acrimonious relations with a third country that are beyond our control or influence. Moreover, we're in bed with a notoriously corrupt regime. This is the definition of an untenable position.

If containing the Taliban in Afghanistan is a vital national interest, then Americans must accept the reality of an indefinite and dangerous police presence there.

If containing the Taliban is not a vital interest, we must withdraw.

Those are the realistic terms of the debate. We should cease the fiction that any sort of conventional victory is in the cards.

Much Good Work to Be Done

One quarter into my MHA, here's what I learned/think about health care reform:

• An acceptable level of overall population health at a reasonable cost requires universal access to health care via single program. This means that residents of all ages are in the same program, without the fragmentation of Medicare/Medicaid, employer insurance, self insurance, and out-of-pocket payment. (I'd leave the VA alone because those patients have unique needs that civilian health care is not set up to handle.)
• Universal access is a prerequisite, not a guarantee
• Improved outcomes and savings require robust federal, state, and community public health policies aimed at containing the dangerously rapid increase in obesity, and the major chronic diseases of asthma, cancer, depression, diabetes, and heart disease. (Obesity is a risk factor in all five)
• Improved outcomes and savings also require a system based on primary care, not specialties. Currently, 30% of U.S. physicians are primary care doctors. The number should be 50%, at least.
• Overtreatment in some areas and undertreatment in others is a problem traceable in part back to the high proportion of specialists
• The state of health information technology is dismal
• As politically significant an accomplishment as it is, the Affordable Care Act mostly buys time and doesn't address the issues of cost or quality. (In fairness, it isn't designed to.)
• Only so much can be accomplished by government at any level. Much reform must come from within the system
• Regarding the economics of American health care, it is supply driven and not demand driven. That is, an area with more heart surgeons with have more heart surgery than an area with fewer, but it is unlikely that overall cardiac health with differ significantly between the two
• My right to access a health care system and the public interest in community health supersedes your right to choose to not access the system

In short, there's much good work to be done...

Yesterday, U.S. District Judge Henry Hudson struck down the portion of the Affordable Health Care that mandates the purchase of health insurance on the grounds that the individual right to not purchase health insurance supersedes anyone else's right to purchase it and the community interest in public health. Ian Millhiser thinks that Hudson's opinion reveals the weakness of the hand being played by the opposition. I think the ruling is not only misguided, it places ideological correctness ahead of addressing what should be considered a threat to our national security. It's simply foolish to be taking an option off the table when it doesn't involve shipping people off to gulags.

No Sunday Funnies Today

I'm heads down on final project for school. The Sunday Funnies and Arts will be back next week.