Public health policy on TB, H5N1, influenza, SARS, HIV: incoherent

Our handling of public health issues indeed seems schizophrenic and inconsistent. The government treated a young lawyer with unusual drug-resistant tuberculosis (which turned out not to be quite so unusual) almost as a criminal, isolating him in Denver, and invading his body to take out infected lung (I guess the patient consented). We did that for a disease that in practice is extremely hard to transmit and that often causes no symptoms for life.

Since about 2003 or so, we have seen an escalation in public panic over the possibility of an avian influenza epidemic, a recurrence of the 1918 Spanish Flu. In fact, yesterday I received a printed flier from the local health department on it. Back then, theaters and public gathering places had “health rules” about coughing in public; some of the public posters have been printed in history anthologies like “The Century.” The 2006 ABC TV film “Fatal Contact: Bird Flu in America” demonstrated the public panic that could ensue were H5N1 to mutate into a readily contagious form. An unusual feature of Spanish flu was that it hit young and healthy adults harder because of more robust immune response (generally most infectious diseases hit the frail or very young harder). Extreme economic disruptions would occur, people could be quarantined, entire industries could be destroyed, and health experts warn that waves of such disease could hit an area several times and last several weeks or months each time, and will not be winter-season dependent. While clusters of bird flu appear in southeast Asia and appear to possibly have short chains of person-person transmission, the chains seem to die out. A similar possibility existed with SARS in 2003, and public health officials claim that their diligence prevented a major outbreak in the West.

In fact, over the past several decades, we have become accustomed to the idea that the rapid circulation of people in an urban environment, particularly when they are young, probably builds up resistance so that many adults can tolerate most common respiratory or digestive infections without much disruption; they can go to work and cause the problem of “presenteeism.” We hear about outbreaks of Nora virus on campuses and nursing homes, and sometimes cruise ships; we hear about meningitis on campuses (one form can cause catastrophic circulatory damage because of bacterial endotoxins, leading to amputations). Generally, these occur with people who are younger and have less lifetime exposure to develop immunity, or to the very elderly or sick . (Colleges should, however, insist on vaccinations for bacterial meningitis, because of the possible catastrophic outcomes.) Some families are sensitive to the possibility that socially active adults can bring new or common infections home as carriers because they, having built lifelong resistance, have fewer symptoms.

The bird flu scenario even can question our modern assumptions about individual sovereignty. Like other disasters, it leads to discussions of families and communities planning to survive together while external public services and utilities, necessary for normal personal autonomy, are suspended or compromised. Persons who survive a pandemic might even be expected to care for those still infected.

Indeed, some worldwide patterns now becoming apparent with globalization, such as the tendency in SE Asia and some of China for people to live close to farm animals and poultry, may increase the likelihood that novel infections spread person-person could upset the normal pattern where active adults develop resistance to common infections through normal social circulation, as in crowds, subways, airports, bars, etc. The ability of the pharmaceutical industry to respond with vaccine manufacture depends partly on limiting their liability, and Congress needs to address vaccination health policy. It has not done so satisfactorily, as there have been spectacular failures with ordinary flu vaccine manufacturing in the past few years. It is possible to make a vaccine for H5N1 (Indonesia is already using it, against WHO recommendations) and our own public health community needs to get its act together. It has done so in the past, with other pandemic flus. But this one at least has the potential to be much worse.

Not to be lost in all of this is the grim possibility of bioterror, particularly smallpox, the subject of at least one major TV film in 2002 (by Dan Percival: "Silent Weapon", from the UK). That's why it's important to rebuild smallpox vaccination supplies and might be wise to start revaccinating people. Anthrax is not transmissible person-to-person, but could (as in 2001 by mail, or as demonstrated in a 1999 fictitious ABC Nightline series) be introduced deliberately into the air if possessed illegally.

One issue of particular importance is the speculation over viral mutation. Estimating its possibility seems to be like estimating the likelihood of extraterrestrial life; we have no Drake Equation. The presence of a large population of people with active ordinary influenza might increase the likelihood of mutation through gene exchange.

One comparison that interests me is that with HIV, AIDS, which is strictly bloodborne. (That is true of a number of other diseases like Hepatitis B and C; it is less clear with some catastrophic infections like Ebola or Marburg). In the 1980s, responsible public health officials repeatedly reassured the public that HIV (or HTLV-III as it was first known) could not be spread through casual contact. (There was a notorious medical column in 1983 from Anthony Fauci where such a speculation was actually made.) Members of the religious right (Gene Antonio, Paul Cameron) would jump on the “there is always a first time” paradigm are argue that HIV could mutate into a contagious form, and if so, it would be the “fault” of tolerating male homosexual behavior. How is this different from current speculations about H5N1? There is no room for “failure of imagination” here, so people go around speculating, “What if ….?”

There are, in principle, major differences. For HIV to mutate into something spread like flu, it would have to change the cell types that it infects. It would have to change into a different disease. In the course of doing so, it is likely that it would become milder and adapt to its host. Viruses do not thrive by killing their hosts. What was so unusual about HIV was the very long incubation period before symptoms, as well as the apparent irreversibility of disease (until modern anti-retroviral drugs were available). HIV did become pandemic in Africa, but in third-world conditions where there were rampant sexually transmitted diseases that made bi-directional heterosexual transmission more likely. In the West, it thrived in relatively closed communities (gay men, and then IV drug users) where certain practices could sustain a chain of transmission.

There is still another public health twist, that takes us back to the TB case. Immunocompromised people are more susceptible to both unusual TB’s and the more common tuberculosis. TB, “the white plague” or “consumption” has been greatly feared, and teachers have to take TB tests. Theoretically, it would sound as though an immunocompromised population (HIV positive) could incubate TB and then infect (through “casual contact”) “innocent” others (especially those whose immune systems are compromised by chemotherapy, genetics or aging). In practice, that has not really happened to any significant extent (after 25 years of experience with HIV). Why? Because TB really is, in practice, very hard to catch. That’s what was so baffling about the way the government treated Andrew Speaker (and about his exposure to civil lawsuits). It should be added that Mr. Speaker probably was “infected” with drug-resistant TB by travel to remote primitive areas of the world as media reports indicate (that is, not by HIV or other immune system compromise). The practical risk to others around him probably was negligible to non-existent. If I had sat next to him on a flight, I would not be concerned.

See also Sept. 12 2007 posting on this blog on MRSA staph.

Update: Oct 18, 2007

The Washington Times, p A1. has a story by Sara Carter and Audrey Hudson, "Man criscrossed border with TB" (Mexican border) and the story reports that health officials insist that people with drug resistant TB should not fly in commercial airliners, although it probably takes a while to have any risk of airborne transmission. Link.

Congressman James Moran's letter on avian influeza, here.

Home prices, stocks: What goes up, must come down, then up again? A sine wave?

“Real Estate” is supposed to increase in value forever because, in theory, the amount of available land is finite. Now, that isn’t exactly true as high rise buildings sell condos (Donald Trump loves to talk about “air rights”) and as Dubai builds artificial islands that could get wiped out by a rise in sea level.

Despite all the pundits who claim that you must own a home to become financially respectable, real estate has been subject to ups and downs like everything else. In Texas, in the late 1980s, it plunged as oil prices dropped after the Saudis were jawboned by the Reagan administration into increasing production. Various land scandals were exposed, leading to a savings and loan crisis than are now part of long memory. A nice townhouse that I bought in 1984 in Pleasant Grove in Dallas, VA, for $39990, plunged in value into the teens and didn’t climb out of it until sometime in the 1990s. Earlier in the 1980s, conversions had been popular in North Dallas; some of them made a profit for their sellers in the early 80s, but then would plunge and even be back-converted into garden apartment complexes.

There is a lot of technical discussion of jumbo loans (the threshold magic number of $417000), subprime loans, combinations of those. But there has always been a structural problem when a market encourages consumers to get something for nothing, particularly in the context of reinforcing societal roles of family providers. I can remember that up through the 70s, saving for a down payment (which could wipe out a cushion of net worth) was considered a financial virtue for a young family. We had a period of low interest rates, no down payments, sometimes no credit or job check – so what can one expect? Eventually, as Isaac Bentov wrote in a 70s modern physics book, the wild pendulum must be stalked. Is that cube of space that is somone’s one bedroom condo really “worth” $500000 as a consumer item. Get real.


Les Christie has a Chicken Little “Sky is falling” story “Home prices: No relief on horizon: The S&P Case-Shiller Home Price Index says price declines are worsening, with no sign of slowing down. Link here. This is now supposed to be the biggest drop in home prices since the Great Depression.

The talk is that it is all about investor behavior. You know the adage. If interest rates rise, yields rise, but the value of bond funds falls (and I have some of them). I don’t know if the two countering forces balance out.

But the biggest worry is the underlying financial unsoundness. Consumers suddenly have much less net worth (sometimes negative), and as in the late 80s, some could face deficiency lawsuits after foreclosures (maybe even for those who sold properties under unqualified assumptions, which are not supposed to be allowed any more), and be forced into bankruptcy, and even that has been made tougher. This does sound dangerous. The IRS will tax forgiven foreclosure deficiencies as ordinary income.

You pre-calculus students, school is starting. (Yup, I've taught math before. Maybe again.) Go to the trigonometry textbooks and study periodic functions. Stocks and real estate prices seem to make good examples.

School Districts struggle to fill teacher vacancies

The difficult of recruiting enough qualified teachers, especially in the context of “no child left behind,” still attracts major media stories. On Monday, Aug. 27, 2007 The New York Times ran a front page story by Sam Dillon, “Schools Scramble for Teachers Because of Spreading Turnover: Retirements and Stress Hit Poor Classrooms,” here; In some school districts around the country, there are many unfilled permanent teaching positions at the start of school, especially in lower grades or with special education, leading to larger classes or more substitutes.

New Orleans, as reported before, has been trying to recruit "pioneers" to become teachers to replace those who will not come back, and rebuild the school system.

Retiring baby boomer generation teachers are part of the problem. Many school districts offer incentives for new teachers to accept jobs in poorer performing districts. Many school districts are recruiting special education teachers from overseas. Many politicians have proposed raising teachers' salaries to the approaching the level of other professions.

Career switcher programs may encourage those laid off from other fields to consider teaching. In today’s world, with more adults not marrying and not having children, fewer adults may feel comfortable working with younger students or children than in the past, where the culture was more child-centered. Moreover. persistent sensational public media reports of teacher misconduct (particularly in the past three years or so), while they may represent a miniscule percentage of teachers, may frighten away some people, especially men, who fear false witch hunts. That possibility was mentioned on ABC “Good Morning America” today, but the “logic” of that supposition can be turned on its head. Persons switching to teaching must often invest several thousand dollars in education courses to get the necessary licensure for permanent jobs, and some people will be unwilling to make the investment if there is any uncertainty at all, even because of political reasons or, as with gays, past or feared future discrimination in some areas of the country.

The issue of a shortage of male teachers is discussed at Menteach, especially this article, "How to advertise to recruit male teachers for early education," here.

Update: Oct. 20, 2007

AP writers Martha Irvine and Robert Tanner have a long story "Sexual Misconduct Plagues US Schools," appearing in the Wichita Falls (TX) Times Record News and later Yahoo!. The link is this.
DC Examiner summarized this story on p 33 on Monday, Oct. 22 and indicated that California will not pass information about fired teachers to other states, even those convicted of offenses. NBC's justice correspondent Pete Williams reported on this story on the NBC Today show on Oct. 22. About 90% of those fired for misconduct with students are men (which contributes to other men becoming reluctant to enter teaching because of the "risk" of unfounded accusations). The slang term for allowing other school districts to hire teachers who get in trouble is "passing the trash."

The Washington Times weighed in with a Metro Section story on Oct. 22 about DC's lack of participation in reporting teachers fired for misconduct, AP story (by Sarah Karush) is here.
The general tone of these articles is that school districts need to be able to share disciplinary information (particularly teacher dismissals or loss of or non-renewal of licensure) that does not get processed by law enforcement, as convictions are often not obtained and sometimes police or DA's do not think they should press charges. Possibly Internet content posted by teachers could be relevant here (the old "Touching" controversy). Still, as frightening as the media has made this look, real problems occur with only a small minority of teachers compared to the total number. A few bad "apples" run the bushel for everyone, it seems.

Please look at the Oct. 1 2007 entry on this blog for more references about the shortage of male teachers.

Teenagers take on caregiving responsibilities

The Washington Post today (Saturday Aug. 25, 2007) has a troubling story by Michael Alison Chandler, page A1 print, “When a Kid Becomes a Caregiver: Like Thousands of Teens, Va. Students Looks After Chronically Ill Relative.” The link is here. In the example here, the illness was multiple sclerosis, but it ranges to everything, including Alzheimer’s. According to the story, over 1.4 million minors in the US care for chronically ill relatives.

There are legal questions about this, as well as variations in how much help social service agencies and particularly teachers and public school systems can give such kids. The problem is international, receiving attention in England.

Obviously, kids with such unchosen responsibilities can lose out on many opportunities and have the courses of their own lives determined by the random needs of others. If one wants to talk about social justice and fairness, this seems like one of our biggest “moral” issues. Loyalty to blood and family responsibility, coming to people without choice, is linked to the moral values of the heterosexual world, with all of our ideas about family, abstinence, marriage, and so on.

It’s particularly problematic for me to ponder this story. As a teen, I remember needing to focus on myself and my own studies. Had I been in the situation of these kids, I could not have done so.

My "retirement" blog (look at the Blogger profile) has been covering filial responsibility laws recently.

Mountaintop removal strip mining rules may be relaxed

Today, Thursday Aug. 23, 2007, The New York Times has a front page story by John M. Broder, “Rule to Expand Mountaintop Coal Mining: U. S. Plan Intended to Ease Confusion Over Techniques.” New rules to be published in the Federal Register on Aug. 24 would allow mountaintop removal to continue and expand, with loosely defined rules as to what kind of damage to streams from valley filling with debris is acceptable. The rules are likely to draw legal challenges and litigation. The link is here. The rules are coming out on the same day that Leonardo Di Caprio's film about global warming, "The 11th Hour", starts in many cities and seems like a blow below the belt.

The Times website has a graphic color picture of typical mountaintop removal near Hale Gap, VA It also has a detailed diagram ("Mining Mountains") explaining how mountaintop removal works. The overall result is, besides leaving debris, to flatten the landscape somewhat. It is true that dragline equipment can remove several hundred feet of overburden. Some defenders of strip mining note the risks of underground mining, as in recent disasters in Utah and Indiana, as well as earlier collapses in Pennsylvania.

In the past, other publications had discussed auxiliary methods of stripmining, such as the "box cut" method leaving steps of highwalls.

In some areas coal companies have done a reasonable job of at least restoring greenery to a striped area, although not the original contour. This seems to be the case near Mt. Storm, W Va as well as near Clinchwood and Norton in SW Virginia near the “Trail of the Lonesome Pine.”

I have written about this issue on this blog Sept 17 2006 and June 8 2007.

I also have a discussion of how to look at satellite views of stripmines from Google here. Look at footnote 0 on this file.

The following websites oppose mountaintop removal. As far back as 1970, a Kentucky politician said “my beautiful state is being destroyed. In a few decades the mountains will be gone.”

http://www.stopmountaintopremoval.org/


http://www.ilovemountains.org/ This website has a short video "Kilowatt Ours."

Update: Sept. 7, 2007. Bill Moyers on PBS depicted the problem of mountaintop removal, showing graphic shots of mines in southern W. Va. (near Barrett W Va), that look like moonscapes, although they really are not flattened. The program interviewed evangelical Christians in the area who see coal companies as behaving in a way contrary to Biblical teaching.

Picture: Near Mt. Storm, W Va, behind Allegheny Front Mountain, stripmined heavily in the early 1970s.

Canadian "single payer" health care system sometimes winds up with families paying for care in U.S.

On Tuesday, Aug 21, 2007 The Washington Times ran an interesting op-ed (print p A15) “Oh Canada? A unhealthy health plan,” by Robert Goldberg, vice president is the Center for Medicine in the Public Interest, which appears to be connected to the Center for Media and Democracy

The writer discusses Arnold Relman (former editor of the New England Journal of Medicine), who recently wrote a piece "What Americans Should Learn from the Canadian Health Care Disaster" Aug. 15, 2007, in the Toronto Globe and Mail opposing a Canadian Medical Association proposal to allow some private billing of patients and allowing the Canadian health care system to purchase services from for-profit sources. (The newspaper link may require registration and credit card purchase).

The writer notes efforts by the Canadian single-payer system to pump resources to reduce waiting queues and improve specialties have not always worked. He cites a case were a family paid an American facility cash to care for an MRI for a child with a brain tumor because of a four-month waiting list in Canada.

Rust-belt cities like Buffalo, Cleveland and Detroit are reported to have booming hospital industries caring for Canadian and foreign paying patients.

Michael Moore’s film “Sicko” gave a glowing report on Canadian single payer health care, and on Britain’s National Health Service. Of course, we know from more recent history that Britain’s lower salaries for physicians (compared to the U.S.) has represented a security issue. Many families in these countries report that the socialized system (more so in Britain) works well for them. Indeed, it sounds as if recommended screenings (colonoscopies, mammograms) during middle age can be scheduled and diagnosed conditions treated before they become life threatening. On the other hand, I wonder if I could have gotten an immediate state-of-the-art repair of my acetabular fracture from a fall in 1998 that I got at the University of Minnesota from employer-provided health insurance, and got back to work in three weeks, never to miss a day again. I wonder if I would have laid in traction for three months in Britain or Canada.

Goldberg’s article raises the specter in a single-payer system, other family members could be “shaken down” to pay sacrificially to pay for quicker treatment, setting up a long list of potential social conflicts over “filial responsibility” discussed elsewhere. However, I have not heard about this kind of problem before from Canada.

It should be noted that neither Canada nor Britain pays for long term custodial nursing home care for the aged unless they are indigent. Nursing home issues resemble those in the U.S. and are becoming more serious as there are fewer children and longer periods of disability at the end of life. Some Canadian provinces have filial responsibility laws (like many American states) although they seem to be rarely enforced.

But, of course, the debate over single payer for regular health care should go on. It needs to be understood, however, that nursing homes present a separate issue.

Adoption (foster care, sponsorship): a social duty? How does this affect GLBT?

I recall an op-ed in The Washington Times about three years ago that claimed that about one in 450 legally married heterosexual couples adopt children in the United States. I also recall a statistic claiming that about a half million foster children in the U.S. needed adoptive parents. Many of them are older children and are of minorities. I can’t find the exact source, and if a reader knows what it is, I would appreciate it’s being left here as a comment. But the political point is important.

NBC4 in Washington DC runs a weekly segment called “Wednesday’s Child” in which it presents a foster child in need of adoption. In Minneapolis, local family newspapers (at least when I was living there up to 2003) and advertisements at bus stops beg for adoptive parents and note that singles are welcome both as adoptive and foster parents.

It’s clear that there is a need for adoptive parents, even if some sources claim that the need has gone down in Western countries because of lower birth rates and the increased acceptability of singles parents (as well as the legality of abortion). A critical question of public policy – one worthy of being posed to presidential candidates, especially the Democratic candidates – is whether more incentives or programs would increase the participation of heterosexually married couples (with two opposite-gendered parents) in adoption and reduce the need for other individuals to step up and adopt.

This is, at least philosophically, an important question for LGBT people. Ability to take responsibility in important intergenerational functions is part of being politically, socially and psychologically “equal.” If there were no reasonable way to increase the participation of heterosexually married couples (in the attempt, as conservatives want, to satisfy the “birthright” of every child for a married mother and father at home), there would be more justification for welcoming GLBT people as adoptive parents. Here is a relevant article from San Francisco SFGATE.COM:; another from New Jersey


That’s not to ignore the track record of GLBT couples as parents, which seems to be good, even if kids have trouble explaining their circumstances to peers. Here is a statement from the American Academy of Pediatrics.

Many states allow gay singles to adopt (a few, like Florida, prohibit it – as Rosie O’Donnell has battled, and a few have tried to prohibit gay foster parents); relatively few allow same-sex couples to adopt as couples.

Factual information on this changes quickly, and facts have been harder to verify than with many other comparable political and social issues. Here are Wikipedia sources, which do need more specific references.

http://en.wikipedia.org/wiki/Adoption

http://en.wikipedia.org/wiki/LGBT_adoption

Dr. Kenneth Morgen authored an important book “Getting Simon” in 1995 (Bramble Books) on his own experience as a gay adoptive parent in Maryland. (Miniature review here.)

It's important to note that there are many charities (Save the Children, Christian Children's Fund) which encourage individuals to "sponsor" indigent children overseas. I did this with STC for a number of years, but is seemed like "Conscience Money." John Stossel covered this charity once on ABC "20/20". When one sponsors a child, one may get mail and letters from the child overseas and an opportunity to interact.

I put this entry in the "Major Issues" blog rather than the LGBT blog because it is more general in nature, about the whole question of "responsibility for other people's children."

Note: The entry on CNN's "God's Warriors" was mistakenly posted on this blog on 8/21/2007 last night. It was moved this morning 8/22 to the correct location, here.

Redux: understanding old fashioned public morality and "family values"

Although I’ve talked about this in various postings in recent weeks, it’s good to walk through again what social conservatives mean by “family values” – especially those that center around the teachings of the Vatican and the Roman Catholic Church.

According to this mindset, the nuclear biological family should organize most or all of productive human activity. (I speak here in the subjunctive mood, easier to show in most other languages, like French!) Sexuality should be reserved for married people, so that as many people as possible will share the experience of procreation and shared intergenerational family responsibility going in both directions, with some legitimate emotion and “heart” and without a sense of undue personal burden. Affection for blood relatives and loyalty to them should trump when there is a conflict with outside interests.

There are some central subconcepts in this view of sexual “public morality.” They include monogamy, fidelity, and abstinence outside of marriage. Another component of modesty, that sexual matters are not shown or discussed openly in public. This is how things were in the 50s, before advancing technology and a civil rights movement led to a more individualistic view of morality in terms of personal autonomy or individual sovereignty.

One point of restricting the experience and expression of sexuality was to encourage as many people as possible to marry and have children and to protect the emotional satisfaction that they got from normal family life, particularly as expressed through complementary gender roles which tended to require a lot of emotional gender-based pampering. The “rationing” or “one to a customer” concept (and heavy Victorian pressure against divorce) gave more marginal and less competitive men and women a chance of “normal real life.” (No matter that this represents a complete turnaround for young men, who are told that they must “compete”.) This view accepted that the external world was not “fair” in the sense that a modern activist expects, and that life had to be set up so that happiness always started with family and church so that it was available to everyone. It was a kind of psychological socialism. An important corollary of family loyalty was that individuals accept the purposes of the family (and sometimes church) as their own, and deal with the idea that, because burdens in a family are shared, a given individual may not always get to do with his life what he wants. This is the old-fashioned idea of “fairness.” The social approbation and support itself became a major component of marriage, enabling a couple to remain intimate as they dealt with all kinds of issues including aging and sickness. Without that reward, many couples would not find rearing a family “worth it,” or so the fear goes. And men would not be able to toil in dangerous jobs, making life better for those “above them” socially, without the prohibitionist social supports of marriage.

Unfortunately, this kind of arrangement, while gradually transforming into more freedom, invited authoritarian family structures and patriarchal or tribalistic thinking. Men would do horrible things to get and stay in power and keep their spouses (just watch any soap opera). Because people felt that family loyalty limited their personal responsibility to the outside global world, it tended to encourage and tolerate horribly unjust practices in the past, like slavery and segregation.

The objection of society to homosexuality, which has always seemed “irrational” when viewed in terms of the libertarian idea of the “harm principle” seems, in this context, to relate to two major complaints: the homosexual is freeloading society and not doing his payback by giving his parents grandchildren, but the deeper complaint seems to be that the homosexual’s open existence questions and discredits the idea that everyone ought to try to reproduce and can reproduce, or at least remain subordinate to those who do.

Do I believe all of this? A few cultures (such as the Mormon Church today or Singapore) seem to have prosperous, corruption-free and semi-free societies conforming to his old model or "morality" but in these cases there are complications involving the other cultures around them. So, no, I don’t subscribe to this capitulation. I think in the Twenty-First Century we have to do better than this, despite all the challenges that we face. But it is at least necessary to have an intellectual understanding of what the Victorian paradigm was and how it worked.

It's interesting to me how the "institution" of marriage is predicated on emotional support of those outside of a marriage, and (in conservative parlance) how it views intrinsic differences in people (leading some people not to try traditional marriage with children at all) as undermining things for "everybody". I would think, in the modern world, that knowledge differences and pluralism ought to strengthen the experience of traditional marriage.

Nevertheless, authoritarian societies predicated on loyalty to family and the group (before the individual's own talents are used) or on avoidance of technology (the Amish model might have inspired that Luddite manifesto, as narcissistic as it seemed) can persist and survive, and they tend not to be able to tolerate differences. But what a price for stability, one's own soul.

Related article on Catholic morality.

Bush administration general concedes draft reinstatement could be considered

The Washington Post is reporting that a top Bush administration official admitted publicly that a return to the draft (conscription) could be put on the table again if military needs become serious enough. There is obviously considerable public pressure to withdraw from Iraq (despite the need for heavy troop presence to stop insurgencies) but one scenario could be the eruption of another war (like Korea).

The story is by Josh White, “Army Recruiting Rebounds in July to Exceed Goals: War Czar Says Draft Still and Option,” page A3, Saturday August 11, 2007 here:

The article reports that Lt. Gen. Douglas E. Lute said in a National Public Radio (NPR) “All Things Considered” interview, [the draft] “has always been an option on the table” and “it makes sense to consider it.” The Pentagon and President have repeatedly said, however, that the all volunteer military has served the nation well ever since Nixon ended the draft in 1973 (and there was brief talk of reinstatement in 1980 after the Soviet Union invaded Afghanistan, a development now seen with a certain historical irony).

The story summarizes the Army’s recent performance in recruiting. The Army exceed its goal in July but had fallen behind in May and June.

Of course, many people regard the extended and repeated deployments in Iraq, especially of Reserve and Guard units, as a “backdoor draft.”

During the Vietnam war General William C. Westmoreland repeatedly asked Johnson to increase troop levels about the time I was drafted. I had finished my M.A. in Math and was put in a “sheltered” position (Mathematician 01E20). A draft lottery was put into effect in 1969 (I went in February 1968). For several years there were student deferments, a cause of social divisiveness as they implied that some young men’s lives were more “expendable” than others, a moral inconsistency in a society that is supposed to value human life for its own sake. The deferment issue helped shaped many of my own internal attitudes about others, because with it the government is suggesting that some men are "better" than others. The need for “brainpower” in the military helped favor the “survival” of geeky people with better grades, at the expense or greater risk of the “Average Joe” types, and this angered many activists greatly. But in the early 60s (when Kennedy was president) there had been attempts to defer married men and fathers, and these were eventually ditched.

Right now, the draft would apply to men only. The Supreme Court has upheld a male-only draft. Men 18-25 must register for Selective Service. However, if a draft were reinstated there would obviously be considerable pressure to draft women. A likely alternative would be universal national service, with strong carrots as well as sticks. This has come up a couple of times in the presidential debates.

Another issue that could come up with the draft is, what happens to “don’t ask don’t tell.” During the Vietnam era, as Randy Shilts pointed out (in “Conduct Unbecoming”), the Army often looked the other way on the rules against homosexuality in the military in order to prevent “malingering” by falsely claiming homosexuality, in an era where it was starting to become more socially acceptable. Often the Army silently accepted it even within the ranks when troop needs were dire enough, which would again be the case during the Persian Gulf War. It has been more mixed in the wars since 2001. Media reports indicate that the Pentagon has quietly begun to accept that scrapping "don't ask don't tell" (by having Congress reverse an enclosure in a 1993 law) is desirable, and public polls are now favoring letting gays serve with some openness. All 2008 democratic presidential candidates have favored repeal of DADT.

Hillary Clinton rebuked Bush and encouraged him to "say it isn't so", politicalticker blog here.

On Aug. 14, Gen. William Casey said that the Army was stretched very thin in Iraq, and that demand exceeded supply, but he denied that this means a draft is near.

Update: Aug 27. Josh White writes in The Washington Post "Many Take Army's 'Quick Ship' Bonus; $20000 is Lure to Leave Within Days, p A01, link.

Earlier essay (2004) here.

Consumer Reports on health insurance

The September 2007 issue of Consumer Reports has a major story on health insurance in the United States: “Are You Really Covered: Why 4 in 10 Americans can’t depend on their health insurance,” starting on p 16. The story is the first in a planned series. The story traces the history of managed care back to the early 1990s, which seemed to work for a while; then state laws started mandating coverages that have political sympathy, such as bone marrow transplants for some breast cancer patients, but that have poor medical utility. The story claims that doctors have interfered with discounts, but in my own experience (with United Health Care) I have found that in network discounts are very large (about 65%) even before deductibles are met. The story encourages consumers to do their own math, and make sure that every physician treating them is in their company’s network. Consumers constantly have to battle with insurers to prove that proper referrals were obtained or that services were in network. Insurances companies have a fiduciary incentive to deny claims or reduce payouts, as Michael Moore pointed out in “Sicko”.

The article did not go into single payer arguments, but at least one obvious question comes up. What if routine screenings (like colonoscopies, mammographies, etc) and follow-ups could be put on a single payer plan, as well as children’s care?

We still don’t have consistent information on how well single payer works in other countries, Michael Moore notwithstanding. Salaries in Britain are lower, and Britain, as we know, had a recent security issue importing doctors. Information on other systems seems fragmented, as think tanks earn money for churning out biased reports, and even the major media outlets, with all their journalistic fact-checking, don’t have a real good objective handle on it.

The article mentions the 2002 film "John Q" but John Grisham's "Rainmaker" is also worthy of note.

Northern VA property taxes, and maybe a new controversy

The DC Examiner, on Thursday Aug. 2, 2007, on page 5 (print) has a story Marla Hegstad, “Arlington considers increasing commercial property tax rates.’ The link is here.

On the surface, the story seems to refer to a law passed by the Virginia General Assembly to allow jurisdictions in northern Virginia to charge higher property tax rates on commercial property than residential. One would expect this practice to be common in many parts of the country. Residential property taxes have been criticized as indirectly regressive, and have inspired voter revolts in many areas, like California.

In Arlington and other northern Virginia communities, the proposal is controversial because there is such a high concentration of new commercial property (as in Ballston) with many companies and significant employers. There is another, somewhat speculative sense in which such a proposal could become controversial, and that could include home based businesses.

Compared to many other communities around the country, northern Virginia zoning rules for home-based businesses have been reasonable, and tended to focus on legitimate property management issues, like traffic, parking, noise, and hazardous materials. A related controversy in the minds of many homeowners has been home expansion (and oversized new homes – “McMansions”) – a practice that is popular and with which I, with libertarian property-rights leanings, have no objection (area utilities seem to have trouble keeping capacity up to serve them, however).

In other communities, there have been some John Stossel “give me a break” rules that have put entrepreneurs out of business. In Charlotte, a woman was forced to shut down a cookie baking business because she did not have a commercial kitchen. In Kansas, an African American was forbidden to have her own specialized hairbraiding business without a cosmetology school and license that would enable her to service “all” customers. In New Jersey, Chicago, and Los Angles, in separate incidents in the 1990s, writers were fined or enjoined from writing at home, although this may have happened before communities really understood the Internet or more modern ideas like networked journalism, or even the economic (and environmental) benefits of telecommuting. (I've since heard from a friend that there have been no such incidents in the film community in LA recently.) I’ve discussed these in more detail here. Another potential area of problems could be homeowner’s associations, especially condos, as well as the wording of residential apartment leases.

Local governments have records of home based business permits, including those that generate no business taxes because of inconsequential revenues, as well as (in northern Virginia) personal property taxes (on computers), which are low but give local governments a potential ability to spy on residents. One question that would come up seems to be, could the presence of any home based business activity justify the local government’s charging the residential property owner full commercial rates? Speculative, but alarming.

Some people object to home-based businesses on turf grounds: they are perceived as threatening “legitimate” jobs or denying commercial real estate rental revenue – fears (as with networked journalism) that are greatly overblown in practice. There can be security issues, too (as with laundering businesses set up with fake land addresses), but these are largely speculative. All of this goes against another grain as more companies offer people (such as retired people) “legitimate” employment at home (one example being catalog telephone support, as with Alpine Access and a few similar companies). That leads to other potential arguments: are these companies getting a free ride on “commercial” rent and taxes, or are they doing a good thing by giving amateurs “legitimacy”? I wonder.

Update: Aug 8, 2007

The Washington Post has a similar story by Kristin Downey about Fairfax County, "Fairfax Looks at Increasing Taxes to Pay For Roads," p B01 print, here.

WJLA (Channel 7) has a story here. The noon broadcast suggested a legal challenge will occur in Virginia to commercial tax increases, but few specific details are available yet. Visitors should comment if they know something about this.

There is an update on this blog entry on Monday, Sept. 10, 2007.

Important bridge in Arlington VA needs immediate attention (lesson from Minnesota)

The Minneapolis I-35W truss bridge catastrophe (that’s what the old 50s board game “Star Reporter” would have called it, worse than a “disaster”) has led to a call for inspections of bridges all over the country. This link for one list is here (pdf).

There is an overpass above Columbia Pike (Route 244) in Arlington VA, underneath Washington Blvd (Rt 27) as the latter approaches I-395 and the Pentagon. Just east of this location, there was a three-way underpass beneath the old Shirley Highway in the 1940s (that later became 395 – for years it was just two lanes each way). That underpass fascinated me as a boy; I wonder if someone has a picture somewhere.

I took a picture of the underpass, walking down from the Air Force Memorial parking lot. On both sides, the concrete is crumbling and exposing wire mesh. Ironically, VDOT has an office in that area on Columbia Pike. This bridge should have immediate repairs. I mean immediate.

In the early 1970s I rented an apartment up Columbia Pike, the Dorcester. In that area there was a “singles social club” where I remember dancing lessons for heterosexuals, with an offer from the “cigarette smoking man” for a package of lessons for $80 back in 1972. Those were the days, my friend.

About a mile west on Washington Blvd, there is an underpass underneath US 50 (Arlington Blvd) that has been repaired properly.

As I noted in another blog entry, I lived in Minneapolis from 1997-2003, about a mile from the bridge collapse.

Pictures: The Columbia Pike bridge needing immediate repair; the Arlington Blvd bridge now in good shape.