Whew!

I sure am glad President [Johnson] was re-elected instead of that scary [Goldwater] guy. Now that [Medicare] is in full swing, the [War on Poverty] can’t fail!

I’m worried about the situation in [Vietnam] but you know, someone with this kind of social commitment isn’t going to escalate the situation over there. Maybe with an increase in troop levels we can get the [Vietnamese] government back on its feet and not be there much longer!

Jesus H. Christ, we’re playing MadLibs with 1965.

Who is my neighbor? A lesson from the Fire Department.

Today I’d like to talk about the fire department.

Let’s get something out of the way first. I’m not going to talk about firefighters. Firefighters define heroism in the popular imagination. Especially after the terrorist attacks of September 11, 2001, the fireman is a condensed symbol of personal sacrifice, courage, expertise, tenacity, and total devotion to a cause. And because there were no front line soldiers to celebrate after that disaster, anyone wrapping himself in the bloody flag made sure to pop on the FDNY hat as well.

Professional firefighters are neither the most endangered nor the most selfless of people in America. They are well-equipped, well-trained, and well-paid. “Firefighter” is not in the top ten most dangerous jobs. It’s way worse to be a farmer, a cab driver, or a fisherman. Firefighters do dangerous things every day for excellent pay in the best possible circumstances.

So what distinguishes firefighters from other people who are paid well to take risks? The difference lies in the character of their employer, the fire department.

No city or town can exist without a fire department. As industrial cities grew, city-consuming fires became a threat to public order and commerce. If you can barely see your neighbor’s stove smoke, your house fire is your problem. If you’re in a cluttered row of shops in London, a fire three doors down grabs your interest right away. Private fire departments on a subscription basis didn’t quite do the trick, for obvious reasons. If half the town burned but your store didn’t, there wasn’t much to celebrate.

So, inevitably, firefighting services were expanded to include more and more places. If the whole city’s resources could be thrown at one nasty fire, it wouldn’t consume everything else. Stopping the destruction was far better than insuring against it. Like public health, the fire department was accepted as necessary, compulsory, and authoritative. Nobody could opt out of paying for the fire department, or object to their regulations, because it would endanger everyone else.

Fire departments themselves looked beyond municipal boundaries. When big disasters happen, sometimes they overwhelm one city’s resources. Other nearby departments have agreed to mutual aid, so that any fire department will help any other fire department in these circumstances. Today these arrangements are large and sophisticated enough that departments will send their resources a thousand miles away if a serious incident requires it.

The fire departments also took on the job of medical rescue. It made sense that the first to respond to fires and other disasters knew how to care for the injured, and this progressed to the point that fire departments had medics as well as people who just put out fires. Today every town has medics in their fire department, who work with private ambulances and hospitals. If someone is ill or injured, those medics will respond right away and help, and then figure out what can be done further.

I’m sorry to bore you with all of that detail, but there’s a point to this. The universal presence of these fire departments represents a commitment by the people in each town. The commitment is this:

If there is any fire, natural disaster, or other physical threat to life and property in this city, we are willing to pay a large sum of money to make sure that the problem is fixed as quickly as possible, without regard for who owns the property involved or why it happened. If any of our neighboring cities is overwhelmed by such an incident, we are willing to send as much of our own as we can to help. We will never go back on this, because the city and its neighbors are interdependent and we’ll all go up in flames if we don’t keep our promises.

Furthermore, if anyone is injured or becomes ill in our city, whether it’s a resident or not, we are willing to pay a large sum of money to see that this person receives the best in immediate treatment and transportation to a hospital. We’ll never go back on this, because we are committed to the health and safety of our own residents, and without the good hospitality of offering this to everyone, we can’t offer it to anyone. We trust that other cities will treat our residents likewise.

This is quite a statement. This means that if anything catches fire or falls over or floods anywhere in town, it’s our problem, we got it. And if anyone falls on the sidewalk or overdoses or gets food poisoning or tries to commit suicide here, that’s our problem too, we’ll take care of it. Always. And we know you’ll do it for us.

Here’s a good example, from the blog of the Los Angeles Fire Department:

On Tuesday, August 15, 2006 at 1:53 PM, eleven Companies of Los Angeles Firefighters, three LAFD Rescue Ambulances, two LAFD Helicopters, one LAFD Swift Water Rescue Team, two LAFD Dive Teams, one LAFD Rehab Unit, one LAFD Hazardous Materials Squad, one EMS Battalion Captain, one Battalion Chief Officer Command Team, one Division Chief Officer Command Team and Los Angeles Police Department resources, including the LAPD Underwater Dive Unit, under the Unified Command of Los Angeles Police and Fire Department Command Officers, responded to a Water Rescue and Recovery Effort near 1555 North San Fernando Road in the Los Angeles community of Glassell Park.

In this case, some teenagers were messing around fishing in a flood control channel and one of them fell in. The city sent what must be tens of millions of dollars in equipment and more than a hundred people, all moving as fast as possible including by air and water, to save one person who screwed up. No one asked if he was from Los Angeles, or even if he was from the United States. No one asked if he’d paid up his fire and rescue subscription. The city, in the form of a huge commitment of resources, said “No problem. We got that.”

There’s a big fight in America right now about health care. It’s actually a fight about money, of course. Currently the economics of health are hilariously broken, and there’s a war of ideas on what to do about it. Some want very much for the public to provide care for those otherwise without, and other people resist the idea of paying with their own tax money for people they disapprove of, or dislike, or fear.

For those of you who don’t want to pay tax to support the medical bills of others: I invite you to consider the fire department. It’s terribly expensive. There’s a lot of waste. There’s corruption. And worst of all, they take our tax dollars and spend it on any idiot or loser who falls asleep smoking or does a y’all-watch-this stunt or texts while driving. They even spend our money saving whorehouses, dive bars, criminals, illegal immigrants, and people who’ve taken a vow to kill us all. .

And you wouldn’t have it any other way, because if the fire department isn’t for all of us, it just won’t work. There’s no time to check green cards or get out the big book of moral ideas and decide whether this conflagration or severed artery meets our local standard. There is only time to help, or not.

So whether this influences your view on the current health care debate or not, I hope you will take the time to ask yourself: which town do you want to live in? The one who says “Yeah, we got that, no problem”? Or one that can’t figure out whether you’re worth their trouble in time to save you?

I just lost my sense of humor about American politics.

Hired mobs yelling. Incoherent demagogues. Race hate. Incitements to political violence by broadcasters. Guns brought to political rallies. The worst values pushed by the worst people who have control of media empires.

It feels like a slow rolling coup. I’m nauseated, and I can’t deal. My neighbors are spouting deranged propaganda. The broadcast media is filling up with McCarthy clones and bullies. There’s so much money behind this garbage, from unfunny people who are serious about derailing even the smallest bit of social change.

I used to say that I had confidence in the American people that we would always return to a safer, blander, less crazy vision than the one we might fear. I don’t believe that now. Things don’t look very good to me.

Current mood: somewhere between “this fucking sucks” and “stockpile ammo.”

In Praise of Death Panels: A Modest Proposal

The current conflict over health care policy in the U.S. is painful to watch. One of the bizarre and dishonest claims made by opponents of the President’s plan is that it would result in "Death Panels." By this they mean that the aged or those with life-threatening diseases may be forced to endure a kind of star chamber in which officials will determine their fate, rather than the supposed current situation in which patients can choose their own path.

This isn’t in the plan, of course. It’s a dishonest propaganda claim intended to stir up fear.

However, the death panel is a fine idea and I support its introduction as soon as possible.

As things stand today, decisions on treatment alternatives result from a murky process. The health plan, the physicians, the patient, and other agents are all involved somehow. Sometimes patients don’t get all the information they need to make an informed decision. Other times physicians aren’t given authority to make their own decisions because they are employed by the health plan. And other times the health plan declines to authorize treatment. Finally, the health plan and other care providers employ cost control experts who also act as advisers, whose job it is to reduce expenditure. This last is called Utilization Review.

Who decides who lives or dies? Who decides how much pain is worth how much money? Who decides what is cured and what is only managed? The process produces different results each time, and we see its workings as through a glass, darkly. One patient may get the newest drug or surgery, another may get a less effective treatment, another get no treatment at all, and another may wait so long for the decision that Nature finishes the argument. I personally have seen an HMO slow down on paperwork in hopes that the patient may die before an expensive and possibly life-saving surgery is scheduled. The patient and family had no idea.

Now let’s imagine a Death Panel. This would include a judge, a medical doctor or highly skilled nurse, a medical social worker, and at least one outsider such as a publicly selected juror or an elected official. They would review the documents and the patient’s state of health, hear statements from the patient and family and involved physicians, and converse with the payer, whether it is government or private.

Then they could issue the decision: what treatment, if any; eligibility for organ donations; end-of-life counseling. All of it. The decision could be appealed to a higher court, or even to an executive authority. But it would be final.

This is in every way preferable to the current situation. Someone under 65 who becomes ill now is at the mercy of an opaque bureaucracy that does not have the patient’s best interests at heart. Decisions are made by employees hired specifically to reduce costs. Physicians and other medical professionals are not given freedom to choose their own treatments, and patients are considered last of all. The only reason that the public isn’t up in arms already is that the health care decision system, like the sausage factory, is behind a wall. Crack open that wall and it’s screaming pigs and blood everywhere, and suddenly the sausage looks a lot more expensive.

So let’s have death panels. It will be depressing, frightening, oppressive, and full of flaws. Many will die who shouldn’t, and many will be given treatment that cannot help them. Those with influence will live longer. The poor and uneducated and confused will die sooner, and elderly patients without strong advocates will be quietly euthanized by tired bureaucrats.

In short, we’ll have just what we have now. The difference will be openness: transcripts, filings, histories of decisions, debate, and accountability of officials will all be on record. We will know exactly what is happening as it occurs, sausage by sausage. Then we will see face to face.

Bring on the death panels! We deserve nothing less.

Major Barbara (slight return)

My new job is in the neighborhood next to the airport where all the aerospace companies sit. It’s creepy.

Raytheon and Northrop Grumman and Boeing and the others all have huge compounds of factories and offices. Silos emit gusts of white gas, roofs grow antennas and dishes, and big trucks arrive and depart with lumpy tarp-covered cargo.

Satellite systems, missiles, aircraft, God knows what else all come out of these compounds. The bearded 50-ish guys I see going to lunch make this stuff. They remind me of the dads of my friends from childhood, but these guys are now just 10 or 15 years older than I. They look worn. From my own experience I know that some of them are drinking themselves to death or just eaten up inside from the awful machines they design and build.

The only cheap lunch in walking range is a choice among some bad fast-food chain places around the corner: generic pizza, Subway sandwiches. Today at the Starbucks there I had one of my odd imagination moments in which I see an overlay on the scene in front of me. I imagined the Hellfire missiles and cluster bombs and lasers and supercannons and 2000 lb bombs arriving on this mini-mall scene: flaming debris and shrapnel, screams, office people writhing in burning Dockers, blood spatter on the Z Pizza sign.

There is what people now call a “disconnect” between the sterile and pleasant mediocrity of the Starbucks patio and the horrors of war machines. I’ll go back to just drinking my half-good coffee and taking a break, and that shocking filter on the camera will go away at least for a while.

It’s instructive to be closer to the business end sometimes. I’m too wimpy to be radical and it’s easy to relax and avoid big problems too. Maybe a few more reminders will help me change?

PROJECT!

I want to write a self help book.

And it will be for america’s ruling upper middle class.

And it will be called:

OFF WITH YOUR HEAD: BUILD A BETTER AMERICA AND A BETTER WORLD BY BEING SLIGHTLY LESS LIKE MARIE FUCKING ANTOINETTE

The Masque of the Wing Nut

Could everyone please tone down the crazy a little bit with regard to the influenza?

Strains of influenza virus like this show up. It’s happened before and will happen again. This one might go big and cause a lot of suffering, and probably won’t. The WHO and national agencies are doing a good job of coordinating and sharing information. All you can actually do right now is hope things go well and not cough on each other, and wash your hands regularly. That’s it. Really.

Conspiracies, fakes, government-created viruses, the national politics of your country and others, the bad behavior of pharmaceutical companies, and the current oncoming worldwide financial depression are possible but unlikely sources of the problem. None of these exciting things are necessary to explain an influenza outbreak.

Conspiracies do exist, and many are successful. They are boring, and unsurprisingly they don’t show up on CNN. Fat white men in suits conspire to start wars, fix prices, steal natural resources, poison people, and crush the rights of individuals. They get away with it most of the time. Keep your eye on those bastards.

These guys don’t need to create an influenza pandemic, or fake 9/11’s plane crashes, or kill Princess Diana, or hide the UFOs. Those are things that happen in movies where our heroes run in slow-mo from an explosion at the end.

In short, it’s very unlikely that the swine flu is engineered by some shadowy cabal. It’s much more likely that it’s an outbreak of a nasty flu strain.

But almost everything about your daily life is in some way made worse by those fat white men in suits cutting deals with your birthright. Maybe they deserve more of your attention.