Hap -- penstance

For some reason I recalled this morning a little ditty from my past. Years ago a comedian (Joe E. Brown?)* was known for a bit where he'd say, "Hap.....py New Year," delaying that second syllable for several beats. My brother and I, nine months on either side of ten years old or so, found it pretty amusing. So we'd repeat it, prolonging the interval for many seconds, then minutes. Then for a few hours, when one of us, having banked a couple of "Hap"s for future use, would regale the other with a semi-unexpected "..py New Yearrrrr," laughing hysterically.

Ultimately, predictably, it became a matter of days, weeks, months. June or July, one of us would spring it on the other, hopefully in such an inappropriate situation that the recipient's laughter would bring severe admonition.

In that spirit, as this most awful of years, bundled with the most horrendous of presidential octades, comes, unmourned, to a blessed and very belated end, I say to everyone, heartfelt and full-throated:

HAP...

* Well, wouldn't you know it: my wife, who is a talented internet searcher, came up with the actual deal. Thus, I have modified this post to include the original source material.

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Family Style

Nothing wrong with a little fluff once in a while, right? That would be the birth of Sarah Palin's grandson, aptly named Tripp. During the campaign, this unwed teen pregnancy; this "choice," as it was called, to have the baby; this product of a household that believes in abstinence-only sex education; this blessed event was trotted out and ballyhooed by the McCain campaign as some sort of symbol of real America. The young man who uncondomated the relationship was greeted personally by John McCain, full frontal, at some airport, like a concubining hero. Way to go, champ. My kinda guy, heh, heh.

So I found the official statehouse response to the birthing amusing. "No comment." "A private family matter." Private, suddenly, after playing it like a ten-cent peepshow? Private? As in selling the photos to the highest bidder. (300K, or not, any bets that there won't be a sale?)

They do hypocrisy big, in the biggest state.

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Remember The Pain

More than once commenters on this blog have questioned why I continued to harp on George Bush. He's leaving after all. Get over it.

Get over it? Will our country get over it? That's the real question, a positive answer to which is far from certain. And as the Bush brigade is mobilized now to rewrite history to promote his "legacy," it seems more important than ever to be sure they fail. How ironic, if the only success of the Bush years were the inducement of forgetting of his catastrophic failures! In this short attention span era, where news fades as fast as the next story appears, where people care more about Joe The Plumber than Joe The Biden, where a strong and free and inquisitive press has been (permanently, for sure) replaced by the likes of Sean Hannity and owned by Rupert Murdoch, it's not at all unlikely to happen. George who?

Which is why Bob Herbert's column in today's NYT is required reading. He says, in part:

"When Mr. Bush officially takes his leave in three weeks (in reality, he checked out long ago), most Americans will be content to sigh good riddance. I disagree. I don’t think he should be allowed to slip quietly out of town. There should be a great hue and cry — a loud, collective angry howl, demonstrations with signs and bullhorns and fiery speeches — over the damage he’s done to this country.

This is the man who gave us the war in Iraq and Guantánamo and torture and rendition; who turned the Clinton economy and the budget surplus into fool’s gold; who dithered while New Orleans drowned; who trampled our civil liberties at home and ruined our reputation abroad; who let Dick Cheney run hog wild and thought Brownie was doing a heckuva job."

Read the whole thing: it says nothing new, I suppose, but it catalogs well and forcefully why we need never to forget, and why, if there's any justice at all in this indifferent universe, the very least George Bush will get is our ongoing scorn; and he ought to be continually aware of it, for as long as he lives.

Not that he'd care.

[Update: I don't hold Bob Shrum in particularly high esteem, but he's occasionally right on, as in this.]

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File Under... Duh

Who coulda guessed?! Virginity pledges, not unlike abstinence-only sex education, don't keep kids from having sex. They do, however, not unlike abstinence-only sex education, lower the likelihood of using birth control. Family fricking values.

The reason I consider it at all newsworthy is that it's but another example of religious thinking entering into the arena of public policy, and screwing things up. As it were.

I get that the idea of sex education is controversial. Difficult. Nor is it surprising that people who are uncomfortable with it willfully ignore the data showing that comprehensive sex education lowers the number of teens having sex, and getting pregnant. After all, ignoring data is exactly what such discomforts are all about. It would make more sense to me if a school district decided to have no sex education at all, than if it chose to teach abstinence only. What sort of policy is it that opts for an approach that is obviously wrong?

Religion, is what it is. In our schools. In the public square. Where it neither belongs nor adds to the common weal.

What makes the most sense, of course, is teaching based on facts. If parents don't want their kids so educated, they can opt out of those classes; or -- the refuge of the most unrepentantly indoctrinaire -- home schooling. (Sex is perfect metaphor: of course I'm not just referring to that.)

And yet, we must be tolerant. Even-handed. Inclusive. Fairness dictates, so we are told, that the weight of decades of research, of science, of irrefutable fact, is to be countered equally by fantasy. As is the left hand, so is the right. It's not enough that, in this (formerly) great nation people are free to believe and practice as they wish and to pollute their own; since they're not satisfied by that, neither must be the rest of us. We must allow those ideas, from the silly to the severe, into our lives as well: into our schools and into our politics. No matter how much it might wound us all.

Me? I'd rather abstain.

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Season's Greetings

By definition this blog is for ranting. Using it as the only point of reference, one might surmise I'm a pretty unpleasant guy. Whereas I can't argue otherwise, the data at hand are insufficient, even if the conclusion were accurate. I do have a heart, however small and underperfused. Therefore, let it be said, heartfelt:

Merry Christmas, Happy Hanukkah, Festive Solstice. And here's hoping the new year compares favorably to the hopes I have for it. We'll need it.

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World News

Well, even if George Bush has failed to create jobs here, it turns out he has made a difference overseas.



And speaking of overseas, Dougie sent me this:


Technical Notice

Dear World

The United States of America, your quality supplier of ideals, liberty and democracy, would like to apologize for its 2001-2008 service outage. The technical fault that led to this eight-year service interruption has been located, and the parts responsible for it were replaced Tuesday night, November 4. Early tests of the newly installed equipment indicate that it is functioning properly, and we expect it to be fully functional by mid-January.

We apologize for any inconvenience caused by the outage, and we look forward to resuming full service --- and hopefully even improving it in the years to come.

Thank you for your patience and understanding.

The USA.

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Sore Point

So George Bush has been going around the world and into TV studios patting himself on the back for his eight years of presidential perfection. What happens when you do that, ignoring reality?

This.

Neener.

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Sports Blah

'Tis the season for non-stop football viewing and, once again, something there is that grates. A small thing; but aren't those the most effective at annoying?

When did "of" and "in" get replaced with "on?" That was his fifth interception on the year. He now has a hundred rushing yards on the game. Nor is it limited to football: the word is u-fricking-biquitous. I'm pretty sure it got started less than ten years ago, didn't it? And now they all (high-paid pros and local high school pronouncers alike) use it as if it's always been the way.

Stop it. Just stop it. And that's the one and only time I'll say it on the year.

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Missile Test

Among the many challenges facing Barack Obama, military spending will be one of the toughest, not only because of the essential questions involved, but because of the political ramifications. At the merest suggestion that he's "weak on terror" or "anti military" or whatever hammer the right wing chooses, Obama will be jumped on by them like a choirboy at a Ted Haggard convention. And yet there's an obvious opportunity, if only the neocons would close their mouths and open their eyes.

Star wars. The missile shield. That craziest of ideas, that thorn in the foot that marches toward peace. That distraction, that flier in the face of reality, that sprinkling of fairy dust around the front door while the back door is wide open.

Costing gazillions and showing effectiveness only when the game is rigged, the missile defense system has, to date, served only to fracture relations with the Russians, with whom, sooner or later, we need to find reconciliation. (Not so, of course, say the wingnuts.) And now, there's an opening. Win-win: we get to save billions on a foolish system, the Russians get a bone tossed, the world says goodbye to a couple more weapons, everyone's happy. Everyone is by any measure better off.

It's obviously the right thing to do. And just as obviously, there will be screams from the right. Hannity and Limbaugh and Coulter and O'Reilly -- my god, can you even imagine??

I'm not saying it's the ultimate litmus test for PEBO. But if he does kibosh the system, he'll have shown more wisdom and strength than even I could have hoped for, and prove he really is the real deal.

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Hallelujah, Core, Us

My religious views to the contrary, I love choral music and Christmas carols. In high school I was in the Acappella Choir, singing religious music with gusto, because the harmonies thrilled me. (I was in a few musicals, too, in high school and college, playing the gamut from Pore Jud to Sir Joseph Porter KCB to Conrad Birdie.) Get a caroling group together, and I'm there (used to be, more accurately), baritoning or bassing my way from porch to porch, harmonizing my ass off. Testing my wife's tolerance (of me, not of the songs), I'll belt it out in the car, too, any time a good carol comes on.

One time, at the old County Hospital in San Francisco (long since torn down and replaced), where I cut my teeth and the skin of others, the night OR crew included several who'd been in choirs, and we managed pretty much all parts as we sang The Hallelujah Chorus while I attended to the latest trauma case. In that ancient OR of the amphitheater variety, with its tile walls and high ceiling, it sounded like a church! I wondered if the poor guy on whom we were operating might have heard through his anesthetic fog and thought he was being welcomed to heaven. Probably would have surprised him, since he'd been shot by the cops while committing some heinous crime or other.

In any case, as good as we thought we sounded, it probably was nothing like the above girl group, giving it a whole new twist.

(And from the other side of the universe, there's this.)

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Do As We Say...

So Congress, having bailed on the auto bailout, is giving itself a pay raise. With the words of railing against UAW salaries still warm in their mouths, they said "aye" to their own pocketbooks. Without, one would assume, a second -- or first -- thought. To save the auto industry and the economy, congressionalists (especially, exclusively pretty much, the Republican variety) demanded auto workers accept less money, or no deal. People are losing jobs by the boat-load; others are seeing wages or hours cut; awash in public debt, we hover at the very brink. Yet those tone-deaf and self-serving politicians don't even have the decency to be embarrassed. I doubt it even occurred to them.

I suppose I could laugh. I guess I could just say, "So what's new?" Politicians saying one thing and doing another? Using crisis to push a partisan agenda while ignoring the implications for the country as a whole? Looking out for themselves while screwing everyone else? This is news? Blogworthy?

Not to the extent that it would change anything. One by one those smug Republican senators got up and claimed that auto workers (who already had agreed to many cutbacks and revisions of contracts) and their salaries were the problem. How selfish of those unions continually to demand more! In these dire days!! How unAmerican. How...

What's that you say? Time to vote ourselves a pay raise? Gotta go.

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Embarrassment

"Alone among major Western nations...."

George Bush can't go away fast enough, taking his minions with him. There are no more words.

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Conscience of a Conservative

In merely the latest outgoing outrage wreaked by the trasher-in-chief, George makes yet another move toward theocracy. In doing so, he -- and those into whose recti he's inserted his head (most especially his own) -- has once again revealed the hypocrisy that is the religious right.

"The Right of Conscience Rule," is what it's called. If your feelings are hurt, it says, or if you see something that offends your religious beliefs, you don't have to participate. Boo fricking hoo.

Evidently it takes 127 pages to codify such a thing, and I'm damned (no doubt!) if I'm gonna plow through the whole tract. Clearly it's an anti-abortion effort; but it evidently extends to providing birth control, or information, or, I'd assume, anything that might relate to premarital sex, gay relationships. With no obvious endpoint. In short, pretty much anything. Janitors? Sweep the floor of a classroom in which evolution is taught?? As if!!!!

Here's the hypocrisy (well, including, but not limited to...): when a soldier refused to go to Iraq because he believed the war was illegal, the right wing bloviators all but exploded on air. Exophthalmos. Aneurysms aplenty. "HE SIGNED UP FOR IT!!!," they ejaculated. "HE VOLUNTEERED!!! YOU GONNA BE A SOLDIER, YOU TAKE IT LIKE A MAN!!," they certaintated, from their non-volunteering, sand-free studios.

I respect religious beliefs. (Well, actually, there are many I don't respect at all: those that require a person to reject the most real of reality; and those that lead people to harm others. Which, sadly, are pretty inclusive categories. But I digress...) More accurately, I respect the right of people to have those beliefs, and, insofar as they don't harm the rest of us, to follow them as they choose. If eating meat offends me, I'd not work in a butcher shop. If I believed pigs aren't kosher, I wouldn't buy a ham sandwich.* If I were a pacifist, I'd avoid signing up for the military (although I could see doing so with a guarantee of not having to kill someone; maybe, say, in the medical corps.)

So, fine: don't wanna hand out BCPs? Don't be a pharmacist. Don't wanna clean up after abortions? Work in a bank, ferchrissakes! Because, where does it end? Does an evangelical firefighter not rescue a gay couple from a burning building? May a Christian cop refuse to protect them? Teachers opt out of teaching science? See, it's like I've been saying: to the extent that religion slops over into public life as policy, it's a pernicious influence that threatens to tear us down. When the line between personal belief -- which, by definition, is the cleaving to the unknowable and the unprovable and which, therefore, ought to be kept within one's breast -- and public policy is crossed, we are at risk of ceasing to function.

Conscience is one thing. (Notice the word at its heart: science.) I'd argue that we indeed have one, based on the evolution of the need for cooperation and community as elements of protection and procreation. I know right from wrong, and I didn't have to study the Bible to figure it out. This bill isn't about conscience. It's about religion, which is entirely different, and, in this instance, destructive. The thing is, even as it becomes more obvious, it becomes more prevalent. Christian cries of persecution to the contrary, they're taking over everything and everywhere, breaking us apart.

It must be nice to believe in the Rapture. They're gonna need it.
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*Reminds me of one of my grandpa's (Jewish, need I say?) favorite stories: Jewish guy is traveling across the country from New York, stops in a cafe in Texas, sits at the counter. Cowboy type next to him says, "Howdy, stranger, where ya from?" "New York," says the traveler, a little nervous. "Well, hell, then, let me buy you a beer," handing him a bottle. "I'm sorry," says the Jewish guy, "I don't drink." "Well, okay. How 'bout having half of my ham sandwich?" "I don't eat ham," replies the poor soul. Now the Texan is getting annoyed. "Listen, stranger. Around here we don't turn down hospitality. Drink the goddam beer." "I'm really sorry, sir, but I can't." At which point the Texan pulls his gun and says, "Take the beer, you sonofabitch, and drink!" Hands shaking, the poor guy takes the beer and has a sip. "Well, then," he says, trembling. "As long as you have the gun on me, how about passing the ham sandwich?"

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The Real Deal

I've said from the beginning that I thought Barack Obama would be less ideological and more inclusive than most were expecting -- especially those on the right, with their theories of terrorist sympathizing, Marxism, radical leftism, stealth Islamism, hating America. But liberals, too.

Whatever else it might be, choosing Rick Warren to give the inaugural invocation is a bold statement; and a bit startling, disquieting even to me.

It will surprise no one to hear I'd be happiest were there no invocation at all. Barring that, a self-important, mega-churched, evangelical gay-rejecter would not be my first through hundredth choice. Nor that of several others. On the other hand, it'll be Joseph E. Lowery giving the benediction. To that, I find myself looking forward.

Meanwhile, as he assembles a cabinet of people experienced and smart, but mainly of the middle, having now perturbed both lefties and righties with choices such as Vilsack and Holder, PEBO has been making good on his intention to reach out to the other side of the aisle.

More than ever, I'm convinced he's precisely what this country needs at this precarious time. The real deal.* The question is whether Congress -- so many idiots in such a small space -- will rise to the occasion. It's gonna be a hell of an interesting ride.

* a bluesy cultural reference to the title photo.

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Ay Yi, Robot

I add to my recent posts on medical cost issues: In our local newspaper (I still have a fondness for ink) there recently appeared a news article profusely exhuberating the arrival in town of a 1.5 million-dollar surgical robotics device. Not a wait-a-minute word among them. The mentioned surgeon is sure to have an instant waiting list; the hospital, another feather in its heady hat.

Here's an opinion piece I submitted to the paper. I'm told it'll be published soon:

In response to a recent article in The Herald, and recognizing the risk that my duddy might be seen as fuddied, I’d like to comment on the arrival of the 1.5 million-dollar robotic surgical device in Everett. Allow me a few drops of cool – if not entirely cold – water.

Years ago, with the arrival of laparoscopic surgery (done through small holes with cameras and special tools), I learned how to remove gallbladders in that new and highly important way. At the time, lasers were used for much of the internal cutting; in fact, the word “laser” was part of the name of the operation: Laser Laparoscopic Cholecystectomy. Exploring the technique in learning labs, we used both laser and traditional electro-surgical machines. I found no advantage for the former, and since lasers cost several tens of thousands of dollars, I asked the instructor (an employee of the laser company) why we should buy one. “Because,” he said with no evident irony, “it’s what patients want. If they hear you’re doing the operation without a laser, they’ll go somewhere else.”

Gathering dust in hallways of hospitals all over the country are lasers bought for the purpose. Virtually nowhere are lasers used in laparoscopic gallbladder surgery any more: they were indeed found to confer no special benefit. Which calls to mind a quote from the recent story: “A lot of patients have been reading about it as the newest and best thing and asking for it…”

Don’t get me wrong. Robotic assist devices have an important role in the future of surgery. In fact, perhaps the greatest potential was not even mentioned in the article: because the robot is in the operating room and the operator is at a separate console, the surgeon doing the work can be, theoretically, anywhere in the world. (Anywhere with a highly reliable broadband connection, that is.) Herr Doktor Emmenthaler, while sitting in his office in Geneva, could remove your tricky brain tumor right here in Everett! In fact, similar things have already been done. Originally, surgical robotics were developed with battlefield surgery in mind. We surgeons could sit safely behind the lines while the poor medics hooked up the machines as the bullets flew.

So what’s my point? Just this: to date, there really isn’t much evidence that outcomes of robotic surgery are significantly better than those of more standard approaches. In fact, some studies have shown no difference other than higher cost with robotics. Specifically, the advantages mentioned in the article – small incisions, magnified views, short stays – are already the norm with, for lack of a cooler term, flesh and blood laparoscopy. So far, much of the excitement is because surgeons (speaking not only for myself!) love new toys and fresh challenges, and because, as the article confirms, hype directed at patients has rarely fallen on deaf ears.

Times are tough, and getting tougher. Ultimately, fixing our struggling economy will require fixing our failing health care system as well. At the heart of it is cost. So far, most of the effort at cost containment has been in cutting reimbursement to providers. Ain’t no more blood in that particular turnip. At some point, we’ll need to take a really hard look at the actual delivery of care. What works, what doesn’t. Which ways to solve a particular problem make the greatest overall economic sense. Most of the cost of an operation is generated in the operating room; an hour there can cost more than a day recovering in the hospital. So it’s not just about sex appeal. It’s about hard numbers, carefully generated. When we get around to that, not everyone will like it.

Funny story: in my career I developed a way of removing gallbladders through a single very small incision, without the tools and troubles of laparoscopy. Like the laparoscopic operation, it was done mostly as an outpatient, with as rapid recovery and return to work, and (trust me on this) fewer complications. Because of the much simpler equipment and shorter operative time, someone saved well over a thousand bucks every time I did it that way. But it never caught on among my peers. The secret will die with me. There’s a lesson in there, somewhere.

The hospital folk might not like it, but it won't be the first time I wrote something that caused their ire. It happens to be an excellent hospital, consistently highly ranked nationally for its heart services, and statewide for pretty much everything else. Given the current realities, they must do what they must do to attract patients, particularly the surgical kind, from whom they have a chance to make a buck or two. If this tack is cynical, it doesn't follow that it's unnecessary: in this ass-backwards era of ineffective cost-management, it's reality. The purchase and publicizing of a million-and-a-half dollar machine of dubious value is seen as appropriate. And until we get around to the hard stuff, maybe it is.

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Sweet Caroline

There seems to be a tradition in this country of legacy selections/elections to the Senate -- and, of course, other offices as well. The first inkling I had of this was in high school, when I was hardly of a mind to have much of an opinion. I know I've mentioned it before: my parents -- especially my dad, who had some impact in the state, in the law and in education -- were close to a number of Oregon's politicians. Realizing it was some sort of honor but not sure exactly why, I had the opportunity at a young age to meet a few governors, senators, congresspersons. My brother spent a year in D.C. as a Senate page, chosen by Senator Richard Neuberger.

When Senator Neuberger died, after a somewhat arcane process that involved the appointment of an Oregon Supreme Court justice who served (as planned, I think) only a few months, Maureen Neuberger, Dick's wife, was elected to his seat. Having known her mostly as a very nice friend of my mom, it somehow seemed like a non sequitur. But I guess she served honorably, if not particularly notably. And she had, at one time, been a Congresswoman.

Hater of statuary, John Ashcroft lost his senatorial bid to a dead man, whose wife was then appointed to the job. Elizabeth Dole, who disliked spending time in the state she represented, presumably rode her husband's name into office. Evan Bayh paddled in on a Birch canoe. Lisa Murkowski (with whose mother I once had a professional relationship) might not have got there had her dad not been there first. And so it goes. Kennedys, Clintons, Bushes. Adamses, Roosevelts.

Which brings us to Caroline Kennedy.

She seems a smart and nice lady. I was quite moved by her speech endorsing Barack Obama. I assume you know she's the actual "Sweet Caroline" in Neil Diamond's song. (Whenever I hear it, I'm taken back to Vietnam, where it played regularly ((along with "We've Gotta Get Out Of This Place" -- a much more evocative song, then and now)) in the Danang Officers' Open Mess, accompanied, during the "dah-dah-dah" part, by the banging of glasses on the bar. "Touching warm?" yechh. She was, what, eight years old when he wrote it?) Accomplished in other areas, she hasn't spent time in politics. Neither has Al Franken, of course; and I guess it's not a requirement. Still, given there are only a hundred senators, and given the disproportionate power they seem to have, it strikes me that fame alone isn't enough. Nor family. (I like Al Franken. I liked his book. I wish they'd have come up with a better opponent to that noxious Norm.)

Can you say no to a Kennedy? Would Governor Paterson's career end if he did?

I have nothing but admiration for Caroline Kennedy. It's not about her, really, that I find myself conflicted over the concept of her possible appointment. It's that at some level I'm amazed and off-put by the regularity with which celebrity seems to trump other criteria in national office. (And, sorry John McCain, Barack Obama was a celebrity because of his political craft and gifts, not the other way around.) Football players, actors, crats from Pluto, can start right at the top, no experience needed. Others, typically, start closer to the bottom. School boards, city government, state, tooth and nail. I like that way better.

Not that I'd turn down a Senate seat if it were offered.

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Hair Trigger

I suppose I should have something more to say about the Blagojevich mess. Setting aside the thing itself -- which is a rewarding combination of high farce and low road -- it's the glee with which the right wing, with no evidence whatsoever to date, are trying to tar Obama with it. In numbers that reflect the recent election, lots of folks (those in the FOX hole) believe he must be implicated. Stories like this don't help.

The Associated Press, now run by a right wing hack, has, in the story linked above, left out what is the most salient point of all: the reason the Obama team is delaying release of the final report of their inquiry is that they were asked to do so by Fitzgerald!! You'd think a so-called news organization would have included that little datum.* Here's the full statement from the Obama team:

"At the direction of the President-elect, a review of Transition staff contacts with Governor Blagojevich and his office has been conducted and completed and is ready for release. That review affirmed the public statements of the President-elect that he had no contact with the governor or his staff, and that the President-elect's staff was not involved in inappropriate discussions with the governor or his staff over the selection of his successor as US Senator.

"Also at the President-elect's direction, Gregory Craig, counsel to the Transition, has kept the US Attorney's office informed of this fact-gathering process in order to ensure our full cooperation with the investigation.

"In the course of those discussions, the US Attorney's office requested the public release of the Transition review be deferred until the week of December 22, in order not to impede their investigation of the governor. The Transition has agreed to this revised timetable for release," said Obama Transition Communications Director Dan Pfeiffer.

Until I got to that last paragraph, I, too, thought the soup was a little thin. Maybe the AP didn't have enough cash on hand to pay their reporter to look at the whole statement. Maybe s/he spilled coffee on the page. But it reflects badly on them, and is emblematic of the whole right-wing response: outrage first, facts later. If at all.

It's a safe assumption that Obama knew Blago was being investigated. It's clear as the snow on my lawn that Obama is smart as hell. To think he or anyone on his team would offer the hairman of the board a quid for his quo is to ignore everything that's self-evident about PEBO. (I love that acronym, which I saw elsewhere.) If -- as likely as the sun rising in the West -- it's found that there are fingerprints, my outrage and my disappointment will know no bounds. But unlike Foxophiles, I'm waiting for actual information.

*Interesting: the AP article seems now (a few hours after I started writing this) to have been revised to include, in the second paragraph, the words "at the request of prosecutors." They weren't there originally, which explains the sentence which makes up the fourth paragraph, now no longer relevant: "The U.S. attorney's office did not immediately respond to a request for comment." And the gist of the article is the same: the Obama press release leaves out much -- ignoring the obvious reason why that is so.

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If The Shoe Fits

I know that as an American I should be outraged, no matter how I feel about George W. Bush, that someone -- a foreigner in a foreign land! -- would throw a shoe at our president. And on some level, I guess I am. The guy winged it pretty hard, and had it hit, it might have done real injury. (Which raises questions of its own...) And yet.

In Iraq and elsewhere in the Middle East, many are throwing in with the perpetrator. As it were. Nor is it hard to understand: the timing may not be a coincidence. Only a couple of days earlier we read the Senate report on the administration's torture policy. A damnable travesty, wrapped in a pack of lies. The shoeter is a journalist, and might well have read the report. Even if he hadn't, it's not hard to understand that there's anger in many Iraqis -- deep outrage -- at the fact that we invaded their country. And then made a horrible mess of it. Sitting in a press conference where Mr. Bush claimed, once again, that the invasion was necessary for the safety of America and for world peace, a man who himself had been kidnapped might well be expected to lose his grip. As it were.

"Those things happen when freedom prevails," said George Bush, with no sense of irony, as the guy is hauled off to jail. Uh, no, Mr. President: those things happen when people are put out of their minds. Freedom isn't about throwing shoes.

I suppose our president should be forgiven for his misunderstanding. To him, freedom means the ability to arrest citizens and hold them forever, without charges; to act without regard to laws. To cook the books, to invade on false premises, to ignore contrary facts. Throwing shoes is the least of it.

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Thank Hank

Nope, there's no caption: it's the latest in The New Yorker caption contest. I've entered a few times, never got any notice. Were I to enter this one, it'd probably be something like, "So, do you think Hank is stupid, or nuts, or does he just really like us bankers?" But I don't think they're into political humor.

With some reservations, I bought the idea of the Wall Street bailout when it first rolled out. I'd known little or nothing about Hank Paulson, but he seemed a serious person. Wealthy from Wall Street, but serious. His original three-page plan, which boiled down to "give me the money and then go away," seemed presumptuous; but I had no reason then to assume he was a ripoff artist. Now, I simply don't know. He's still a smart guy. So hopeless naivete doesn't explain it.

How can it be that no one knows what has happened to all of the bailout money? How can it be that of that which is known, much went to bonuses and to stockholder dividends? Congress, as I understood it, acted to add oversight to the original proposal. What happened? Clearly, they blew it somehow. But I'm still left to wonder: was the transfer of all that money the final act of naked deception by the White House? They've done much, over the last eight years, to suggest that they view the government merely as a cash cow for themselves and their pals. Is it really that? Or is it the final vestiges of their discredited belief in free markets? Could they simply not fathom that, given billions in unstringed money, banks would have a party at our expense? It's not as if contrary data in other areas has ever opened their eyes.

By their well-documented incompetence, or by their hardly-concealed ideological blindness, the Bush administration has once again pulled one over on us. They can't go away fast enough. The question is, have they taken us past the point of no return? Will the fixes required be enough; or will they, like desperation chemotherapy, finally kill the patient?

[P.S.: For an enlightening, depressing, scary, infuriating interview by Bill Moyers with someone who knows much more than I, watch this.]

[Update: for those who blame the whole mess on Congress, there's this.]

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Heartless

Riding my indoor bike in front of the TV, working on my own heart, I saw that the owner of the Carolina Panthers, age 72, is awaiting a heart transplant. I'm sure he's a nice guy.

Until we have so many extra hearts that they're being thrown away, seventy-two year olds ought not be getting them. Football team owners are among the very wealthy, so I assume he can and/or would pay every nickel himself. Even so, it's not right. Whereas it brings up that age-old question about whether the wealthy ought to get better medical care than the not-so, and whereas I'm not entirely unsympathetic on one level (the level that says rich people get better cars and bigger houses), medical resources are finite, and getting finiter. No matter if he plans to leave a big tip: unless everyone under fifty already has one, he shouldn't get a heart. That's not just rationing: it's morality.

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Standing Pat

I grew up surrounded by lawyers, and not because I was always in trouble, which I wasn't. Not only that, they were of the honorable variety. I loved to listen to my dad -- I miss it regularly -- talk about the law. On the Oregon Supreme Court for a year, and then Chief Judge of the Oregon Court of Appeals from its inception, he was partial only to the law. It was clear to me that he was able to set aside his own point of view in favor of that of the law as written. Nor was he ever grandiose, or self-important. Brilliant, but sober.

That background has given me something of an ear for the law, and a smallish sense of how it works. Or would, if everyone were as principled as my dad. (I should mention my brother as well, since it's just as true of him. Quoting from a source I've never heard of: "In the 2008 Chambers USA guide, Mr. Schwab received a Band 1 ranking in securities litigation in California. Chambers wrote: "A 'masterful, creative and tough litigator,' (redacted by me) Schwab is a 'class act and a gentleman. You can take his word to the bank.'' So there you go.)

My point, however, is this: I agree with a column in today's NYTimes, in which Patrick Fitzgerald is taken a bit to task. As I heard him break the news of his investigation, I felt the same way as the writer. I admire the guy; I feel certain he's a man of principle: he went to Amherst College, ferchrissakes! But there was a bit of unseemly -- even unprofessional -- grandiosity in his commentary. It's clear he's properly on to ol' Blago (although I've also wondered about the nuts and bolts of the case: ought they have more than conversations about bribery and quids pro quo?) But the Lincoln-in-his-grave stuff? I thought it a bit much.

More than at any time I know, we need a little respect for the law. Having survived (so far) a president who believes he can legally kidnap an American citizen and hold him indefinitely without charges or access to a lawyer, our country can do with all the respectable US Attorneys it can muster. So I hope our man Pat isn't flying too close to the sun.

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Get The Picture?

I may not know much, but I know this: the only reason Republicans blocked the auto bailout is that they want to bust the unions. In particular, the UAW. For days the meme has been the outrageous wages of workers, repeated by every right wing talking head. And now they had their chance to act. (For the record, I'm not a knee-jerk supporter of all unions all the time: I might even write about that at another time...)

Having approved 700 billion for Wall Street, with virtually no restrictions at all, they balked at a tiny fraction thereof going to auto makers, with all sorts of strings. Having spent all the money on which they could get their hands for the first six years of Bush, happily running us into staggering debt (and, let us not forget, happily blocking all legislation to enforce higher CAFE standards, which might have saved the industry), it can't be about a trifling handful of billions. It's politics, pure and simple. Damn the consequences, damn the country, damn everyone's life savings, damn their futures. Mitch McConnell and his cronies see a chance to bust up the UAW, and take it come hell or high water. (We've seen the high water. Howdy, hell.)

What a pathetic bunch of unctuous, self-righteous and self-serving assholes. As long as idiots such as these keep getting elected by their thoughtless constituents, there'll be no such thing as bipartisanship. Those guys are not about solutions.

Not in the slightest.

We're screwed.

[Let it also be said: at some point the sponge-spined Democrats need to force the Republicans actually to stand there and filibuster, rather than let a small number of zealots kibosh legislation, one after the other. Let Americans see the spectacle; let them watch long enough to figure out what's going on. Why not? Because they're afraid of having the tables turned when they're back in the minority? Screw it. If it's worth doing, it's worth doing right.]

[Update: I'm not alone.]

[Even more.]

[More still, famouser and better-looking.]

[And now, a day later, the LA Times chimes in. I'm starting to think I'm right.]

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To Our Health!

"Now, some may ask how, at this moment of economic challenge, we can afford to invest in reforming our health care system. Well, I ask a different question – I ask how we can afford not to." [Barack Obama, today.]

On the occasion of Barack Obama's rollout of his health policy team, and given that, according to a couple of pieces of paper I have around here somewhere, I'm a doctor, this seems a good time to spout off -- yet again -- on the state of health care in the US. What it really boils down to is this: we need to reduce cost and raise quality. As long as the discussion is only about paperwork, ie, single payer vs current insurers, electronic vs paper records; and as long as the only real efforts to control costs are in reducing payments to providers, we'll be getting nowhere. As usual.

I've written about why I favor single-payer, and have acknowledged that among physicians I'm in a distinct minority. I've said pretty much all I know about that aspect of it. Moreover: as controversial as it is, it's really only nibbling around the edges. Solutions --REAL solutions -- will come from fundamentally changing the nature of care itself, and how we provide it. And if you think addressing insurance is complicated and daunting, you ain't seen nothin' yet! If we were ever to get to the nitty gritty, we'd hear screams of bloody murder from providers and patients alike!! If and when you hear the noise, you'll know we're almost there.

As I try to elucidate, two things might become apparent: 1) I can only talk about my personal "style" (for lack of a better word), and 2) I probably don't know what I'm talking about. Specifics, anyway. But I think I'm right, looking down from a few miles up.

Inevitably, quality of care delivered differs wildly from provider to provider. It should be no surprise, of course; there are good teachers and bad, competent lawyers and lousy ones (insert malpractice comment here), engineers and architects and scientists and machinists who vary greatly one from the other. To the extent that quality control and outcome assessment have been instituted, it's been pretty superficial. And pathetic. Surgeons, for example, (a subject with which I have particular familiarity) are "judged" on whether preoperative antibiotics are given within an hour of surgery cut-time. (The criterion used to be the opposite; or, at least, in days of yore I was taught that antibiotics should be given at least an hour before, in order to allow time for equilibration within tissues.) They're assessed for application of anti-clotting techniques (pressure devices and drugs), and for proper recording of various patient data, not the least of which is assurance that the operation and patient match up. Worthy and important, all of it, without doubt. But pennies on the dollar.

To save real money, it's necessary to get doctors to agree to practice evaluation. Or, at minimum, to be open to self-assessment based on data from others. Tough stuff. Here's the part where it becomes personal horn-tooting: practically every operation I did, I did faster and cheaper than my peers, with as good or better outcomes. And for those who might find taking my word for it a bit of a stretch, let's just assume it's true that one might be able to find ways to rank surgeons on those criteria. (I speak here of surgeons; but I have no doubt it can and must be applied to all specialties. Especially critical care!!) And having done so, that it could be possible to look at the "best" and find out what separates them from the "worst." Technically. Methodologically. Behaviorally. Finally, assuming such information could be amassed, imagine that surgeons could be "encouraged" to adopt the good methods and toss out the bad. It would require, since doctors are in many ways like humans, a combination of carrot and stick: rewards for adopting cost-effective methods, penalties for being out of range. And reasonable (easier said than done) criteria on which to make such assessments.

Over the objections of many surgeons, and until those voices eventually prevailed, a large insurer in my area used to publish data comparing average total hospital cost of a given operation among all the surgeons in the state. For every one listed, I was near or at the top (or is it bottom?) -- meaning my total costs were very low. It stemmed from being efficient in the OR, and from efforts that made the postoperative stay as short as possible. There's no point in going into detail here; but there are very specific items to which I could point: choice and conduct of operation, and things I did in the recovery period that affected length of stay. (Not the least of which was willingness to make hospital rounds two or more times a day!) (Nor, might I add, was I kicking people out before they were ready!!) For every operation there are specific choices and efforts to be made, the adoption of which would save gazillions of health care dollars.

It's not just doctors that would have to climb on board: patients would have to face reality as well. My favorite example: laparoscopic surgery. It's sexy, it's the latest thing, it's hyped like the newest iPod. But for many operations, it greatly increases cost, while adding nothing to outcome. (Here's where good data are needed: studies comparing, for example, laparoscopic colon resection to open techniques generally use numbers that are nothing like mine: my routine colon resection patients were in the hospital four days or less, whereas the numbers to which laparoscopy are compared are of patients in for closer to a week! Time in the OR -- very expensive, hourly -- is way less for a properly done open operation. Equipment cost differences: staggering!) Patients would have to accept the data as well.

Which gets us to the hardest part of all: when we're at the point of getting truly serious about health care costs, we'll have to bring the "R" word into the conversation.

Rationing.

Call it something else: prioritizing. But until we look at the enormous amounts of money spent in the final days of life, and until we're willing to make hard choices and take difficult -- maybe impossible -- stands on who gets what, and when, we'll just be dancing around the fire.


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Fitz

I agree with those who think Barack Obama ought to keep Patrick Fitzgerald on as US Attorney in Chicago, and it has nothing to do with the fact that he's a fellow Amherst man. I do find cause for amusement, however.

In another example of the, uh, fluidity of political points of view, we hear Republicans demanding that he remain. Fair enough. But can we forget their outrage, and their attempts to discredit him as a political hack, when he was going after Scooter Libby? Just wondering. And smiling.

Personally, I like this idea:

"...Congress should give Patrick Fitzgerald the job of investigating the Bush administration's war crimes. Give him complete freedom from interference, and let the chips fall where they may."

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Impossible

The more I read about India and Pakistan, the less I understand. And, more importantly, the less I think there's any hope for that region, or for the world. This opinion piece in yesterday's NYT did nothing to help; nor did this one. (And here's a none-too-reassuring piece from today, by the president of Pakistan.) The unifying theme, both there and in the Middle East, is misery being conscripted by religion; most particularly by intransigent and zealous haters, unyielding in their own certainty. It takes a lot to hate that much, and to believe that much. And whereas it seems there is no religion you can name (with the possible exception of Buddhism) that is free of the guilt of fanning the flames of hatred, the common thread within the worst violence is that of radical Islam. Many Muslims -- those in India, it seems clear -- deplore the trend. But it seems to take only a few to propel the hatred to suicidal levels: enough to threaten the entire world. All-consuming conflagration seems inevitable.

The solution -- if there were one -- would require the end of those who teach, and those who accept, the kind of hatred that leads to suicidal (literal and figurative) behavior. The "liberal" answer, I think, is addressing the cesspool: the poverty and hopelessness of those regions. I doubt it. Mankind, in its frailty, is destined to kill itself off. If there weren't radical Islam, there'd be something else. The inevitability is tied directly to need for religious belief, irrespective of one's station in life.

That our inadequate and fragile brains need to construct religions is proof of our imperfection. No surprise there. There's such an overwhelming and intrinsic need for belief that faiths pop up like flora, everywhere: in isolation, in jungles, in riches, all around the world. The one and only thread connecting them is the eventual evolution of devotion so strong that it leads to hatred and violence toward the others. That, to me, is proof that it's about hapless human need and not about any sort of deities actually existing, behind it all. Our overwhelming impulse is to believe, sprouting an array of forms differing wildly one from the other but holding in common that need to hate: it's a thing which disproves itself. A THING WHICH DISPROVES ITSELF! What more potent argument against the existence of god/gods is there, than our demonstrable need to believe in them? If he/she/they existed, why would there be such a variety of beliefs, and such a need to destroy the others? Clearly, it springs from within us, not without.

Which is why there's no hope for us as a species. There's simply no way to put an end to the sort of insanity that we see in the Middle East and South Asia. It's who we are! If we're still evolving, it ain't nearly fast enough.

That in "our" corner of the world the dysfunction seems milder -- Prop 8, Newt Gingrich, James Hagee, etc., ad nauseum -- is only a matter of degree.

And of time.

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Take A Gander At The Goose

In the teapot of my state's capitol there brews a tempest. Among the seasonal holiday displays in the capitol building, which include a Christmas tree, a Nativity scene, a Menorah, there is for the first time an atheist entry. With the passing of each hour, the outrage grows. Posted by the Freedom From Religion Foundation, the sign has been stolen, found, and replaced at least once.

"It's offensive to my beliefs!!" say the offended. "Freedom of speech is one thing," says another, "but when it insults my religion, that crosses a line." (That one was on a TV news report.) "What is troubling is that by placing such a tablet on government property Washington state is contradicting the roots of the nation’s founding," says this guy.

I'm trying not to laugh.

In response to the insistence of religionists that Nativity scenes be allowed on public property, the courts have been very clear: government entities that choose to do so must make space equally available to other views. Bill O'Reilly's feigned (and altogether fatuous [see, he's the leader of the pack railing against the term "holiday" in place of "Christmas"]) outrage notwithstanding, the state of Washington and its governor are doing nothing but following the law. It's not enough for you to have your Christmas celebrated all over the nation in homes, churches, shops and malls? Fine. You wanna agitate to have it at your capitol, too? Okay. But then you have to accept the entirely democratic and constitutional consequence: other voices may be heard as well. Even offensive ones.

I find the shocked responses highly ironic: welcome to my world. As a non-Christian, I've always been mildly to moderately annoyed at these annual rites of rigidity. I love the decorated houses, the simple and elaborate displays everywhere. It's all but impossible for me to understand how the religious fail to see how insisting that their side gets onto the courthouse lawn is annoying to and/or disrespectful of and/or actually threatening to those of differing beliefs.

Now, one infers from those pained responses, at least a few people understand. Or would, if they had any sense of empathy. Or irony.

Which, clearly, they don't.

Sounds Good

Actually, looks good, too. Wonder what those books are, and who's in the picture. Ovoid office, is the gestalt.

To my economically deficient mind, the idea of a massive government investment in infrastructure of all sorts makes sense. As a physician (as I recall), I like the generic concept of electronic medical records, but I think we're a long way from being able to get them into every office and clinic and hospital and to have the kind of interconnectivity Mr. Obama implies. This is for two reasons: the perfect software doesn't exist; and even if it did, lots of doctors would resist it. In my experience, it's a huge step forward; but I understand the reluctance.

I guess I had the best of both worlds: not long before I left, my clinic switched to entirely electronic medical records. But, unlike the systems today, back then what it meant was digitizing all info for instant accessibility. We still dictated our op notes, our office records, but they were instantly transcribed, by human beings, into digital form. The benefits were immediate: no longer did my office have to search for the records of the patient arriving for consultation: they were online. As were the most recent notes of the doc who sent that patient to me. Lab data were available within moments of finishing the tests; as were Xray images and (in theory) the reports of the radiologists. And since the hospital had dedicated computers linked to our clinic, all of the above was available there as well, any time of day or night. It's impossible to exaggerate what a boon that is. So what's the problem?

This: the electronic medical record (EMR) systems now are aimed at eliminating the middle man (or, more likely, woman.) No longer can the doctor dictate his/her reports: they are to be entered electronically, using various algorithms and pre-packaged phrases. Likewise the ordering of labs, onto which are often imposed various protocols for confirming the necessity and/or appropriateness. The results, too often, are the forcing of square pegs into round holes; and dramatically to slow down the process. Op notes, for example, which I could roll out of my head as if a CD had been inserted, may -- depending on the particular program being used -- require several extra minutes to finish, and that has an obvious cascading effect on all subsequently scheduled operations and all the people involved therein. The better the software, the more familiarity with it, the less this is an issue. But it's still significant.

Nor is there any standardization. I could be wrong, but to have perfect communication between providers across the country, there'd need either to be universal acceptance of a single program (investors, anyone?) or some pretty brilliant intercessory software (more investors, anyone?).

It's been a while since I've been deep into the medblogosphere, but I think it's safe to say the majority of doctors are unhappy with their experiences with EMR. Mine, before the square peg/round hole era, was nearly perfect: it was nothing but a vast improvement over paper records. And it's absolutely certain that universality is inevitable. Mr. Obama's aim is highly worthy. But much of the pie remains airborne.

Truth-Tellers?

It's my opinion that among the clergy is a disproportionate number of people (men, it seems, nearly exclusively) who are sincerely screwed up, compensating in some weird way for their less-than-honorable proclivities. For them, taking up the cloth is a kind of reaction formation. How else to explain the regular revelations of the very behavior (sexual, generally) against which they rail? Youth pastors seem, often enough to be newsworthy, to see their flock (and flockettes) as personal playground. The bigger the church, the more prominent their proclamations, the more likely it is (unscientific assessment, but this is a blog) the preacher has something to hide. The more lavishly they spend on themselves. And, of course, all the more amusing when it all comes out.

But that's not my point. This is.

From there, I hardly know which direction to choose: the bizarre theology, the fact that people like these are given political -- or ANY -- credence, that politicians make pilgrimages to their doorsteps; or that people by the uncountable tens of thousands flock to hear what they have to say. Some guy, basically, who has a mammothly inflated view of his own rectitude, of his own righteousness (to the extent that he's managed to subvert his real desires), who has the good business sense to put together a megamillion dollar enterprise and use it as a platform to promote whatever the hell comes into his head. And people eat it up; give him time on their talk shows, consider his concurrence a blessing for their own inadequacies. (For is there a more inadequate personality than Sean Hannity?)

I've said it before, because I mean it: I have nothing but respect for a person's individual beliefs, insofar as they allow that person to manage in this strange world. And insofar as they don't try to force their beliefs into our schools, and onto me. I recognize and honor the personal need, and the personal purpose. But it's this wholly undeserved national stage...

It's self-evident that the Bible (I'm talking Christianity here, as usual, but only because it's the driving religious force in our politics; I feel the same about all organized and proselytized religions) is a mirror of oneself. Vague, internally contradictory, translated, edited and revised to the point that there's literally no way to know the original meaning or intent of its various authors, the reading of and response to it is entirely individual. It means to you what it means to you, and you are quite free to find your own way into and out of it. Which is, I suppose, a significant part of its attraction. Once again: I bear no ill towards those who find solace in it. I envy their certitude.

Where I entirely part company is with the idea of imparting to some (possibly quite damaged) individual primacy of pronouncement. Why is Rick Warren's view, or Pat Robertson's, or Billy Graham's, any more noteworthy than yours? Why cede to these people the power of persuasion? What do they know that you don't? In what way are they closer to God than you are? And, for that matter, other than better clothes and more soap, what do they have that the guy on the street corner doesn't?

Of all the mysteries of religion, near the top for me is the willingess -- or whatever it is -- of those who flock to a given minister, to accept his interpretations and imprecations as gospel (as it were) when not very far down the street is another, with quite different views on those same fungible and willowy words. Why the one's, and not the other's? Why, in fact, the need to rely on another's at all over one's own?

And why, why, why, choose self-important power-mongerers like Warren, and Robertson, and Hagee? What's wrong with the humble little church down the road, with the pastor who drives a beater car and has a flock of a hundred or two? Why the need to be part of some sort of movement of millions? What's up with that?

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The (S)hits Just Keep On Comin'

My recent post comparing Bush's last-minute antics to a burgler crapping on the bed on his way out the door needs updating. It really is pretty awful: it's hard to see it as anything but a middle finger in the eye of the public -- particularly those librul earth-lovers.

It's as if, in a perverse sort of way, he feels liberated: the "permanent campaign" is over, his approval ratings are crap. Gone is pretense; no need to make up empty phrases like "compassionate conservative." So this is he, the real George Bush.

Surprise. I still don't like it.

Rewrite!

I wonder if George Bush and Karl Rove will get away with their attempts to rewrite history, even while the bodies are still warm. Given the complicity -- by virtue, mostly, of laziness, I think -- of the press, it's entirely possible. The truth, as they say, is out there; but future journalists will have to expend a little energy to find it. It's not as if they're famous for doing so.

Among the many facts so easily revised, so ignored, is the Iraq WMD issue. In the past couple of days, we hear Bush regrets the failure of intelligence. And Rove says (in a statement Bush himself isn't so damn sure about) that if they'd known there were no WMD they'd not have invaded.

Bullshit. They knew it. There's no way they didn't.

Everyone who tries to justify the "failure" likes to say how many others believed there were WMD: Europeans, Bill Clinton, Congress. Well, yeah, for a while they did. But they didn't invade. And there were serious questions raised, and ignored. But most important of all: before Bush invaded Iraq, there were inspectors there. THERE WERE INSPECTORS THERE!! Finding nothing. Given the reservations, and the fact that THERE WERE INSPECTORS THERE FINDING NOTHING, there was no reason to invade -- assuming WMD was really the reason. It's simply a lie to say otherwise. Rantings notwithstanding, I'm not particularly quick to call people -- even George Bush -- liars. But in this it's impossible to think otherwise. Because -- stop me if you've heard this -- there were inspectors there, finding nothing. And then Bush pulled them out! How easy it seems to be to ignore that fact, to forget it entirely.

George Bush has a right to say whatever he wants, and to try as hard as he can to rewrite his own history. I hope to hell that he doesn't get away with it.

Thank God for the internet.

[Update: it's even worse than I thought!]

Does A Bear?

Well of course the stock market is driving me crazy, swinging wildly nearly every day, with no particular rhyme or reason. But what's maybe even more insane than the market itself, is seeing headlines like these, a mere sampling from Monday, or very recently:

Dow loses 679.95 as economy, Bernanke revive fear

Stocks fall sharply on consumer spending worries

Dow Plunges 680 Points as Recession Is Declared

Stocks slump as U.S. recession is officially called and signs point to a prolonged slowdown.

Dow falls amid fear over car makers

The Dow falls 679, fear has set in now.

Here's my point: DUH!!!!

What's different today, from yesterday??? Are enough people waking up each day from a year-long slumber to notice something? JFC, people!!! This has been going on for a LONG time!!!

Fully retired for the first time this year, dependent entirely on savings, it's been a little tough. And scary. Not to mention infuriating. I've always been pretty thrifty: my car is nearing 200K miles. Same house for twenty six years, paid off long since. Own one suit which I haven't worn in fifteen years. Travel too little. Never made anything near what most general surgeons make (owing to my career-long loyalty to a large clinic with a larger overhead), despite doing twice as much surgery as the national average. Nor have my investments been greedy or crazy (stayed out of the dot-com boom. And bust. A buy and hold sort of guy). So it's disheartening to have seen half of it disappear.

But it's literally crazogenic to be buffeted by these daily gyrations and to realize that my future is dependent on the whims of idiots, who seem to have no sense of proportion, nor to know what's going on on a daily -- let alone yearly -- basis. If I weren't so old and stupid, I'd go back to work. If the economy didn't suck so bad, maybe I could even find a job.

'Tis

Lo, the holiday season arriveth, which means the annual rituals of resentment are already in full flower, profuse poinsettia. Like candies at the check-out counter, offense is easily taken. "There's a war on Christmas," we are told, sulum annus, right on schedule. More than mistletoe and mulled wine, it's ubiquitous, indignation polluting the air like spray-on snow. Irate letters fill the op-ed pages, red-faced radio ranters and television talkers spew their righteous anger. There's war, alright. The liberals, the atheists, the Jews, the infidels, rolled into an all-purpose receptacle of rage, are vilified as threats to life itself. Killers, once again, of Christ. Sodomizers of Santa.

What bunch of caterwauling crap!

As surely as the earth has found its way anew around the sun, as predictable as Christmas sales before the turkey is cold, on cue we hear, rising and shrill, in high dudgeon, voices of those demanding Nativity scenes on courthouse lawns, at City Hall. Nothing is of higher import; society is at no greater risk -- our very existence is at stake! -- than from those who think creches and churches are a perfect match. May the joy of Christmas be upon us: Jab the Jews! Mash the Muslims! Bash the Buddhists! Heck with the Hindi! They'll hijack our holiday!!!

What a load of fabricated fury!

Where's the problem? The US has more churches per capita, and a lower percentage of atheists than any other Western country. Christmas is everywhere this time of year: can anyone deny it? So there are some merchants who -- because they think it's good business!! -- prefer to say "Happy Holidays" to their customers. So what? For that matter, what does all the selling and buying have to do with the birth of Jesus anyway? And in what way does the substitution of a phrase in your local mall prevent anyone from celebrating Christmas? Are there more churches in 2008 than there were in 1958? Do they have Christmas services? Is the Pope in the woods? If there's a war, who's winning?

If every church in every city in every state had a Nativity scene on its lawn, you couldn't drive five blocks without seeing one. They're everywhere. So why is it that some expect their governments to provide them as well? Well, as it turns out that's actually an easy one: those who demand it do NOT believe in religious freedom; they simply REFUSE to make the connection between respecting religion and keeping it separate from government. They don't get -- and they never will -- that separation is the greatest protection of religious freedom that there can be. Not to mention that it's generous towards one's fellow man. But they're not interested in that -- couldn't care less, matter of fact. What they ARE interested in is having THEIR religion prevail, officially, over all others. For some reason I'll never understand, it's not enough for them to be able to say "Merry Christmas" to whomever they want, to decorate their own houses and strew wise men over their lawns like fertilizer, to cradle the baby on the grounds of their church, in their homes, dangle him from their rear-view mirrors, slap him on their bumpers. They demand to see it in the public square, state buildings, stuck in the faces of everyone. Not only do they have no concern for those who believe differently, they'd like them to go straight to hell, thank you very much. Toss 'em down the hole themselves. O'er the coals we go, laughing all the way.

There's no war on Christmas. What there is, among some people, is sensitivity to diversity of thought. If there's any degradation of the significance of Christmas, it's by those who seek to cash in on it, whether commercially or by their circumsolarcyclical and well-compensated rants. Those who don't celebrate it -- let's pretend I speak for them all -- have no problem with others who do. Hell, I like seeing nativity scenes on church lawns. If someone merrychristmasses me, I merrychristmas 'em right back. And I can harmonize on Christmas carols better than anyone I know. But Jesus people! Where's the harm in drawing a line? Just for this four weeks, pretend you give a damn about the rest of us. Make like you not only love America, but the people in it. Have your Christmas; pray it, sing it, spend it. Fall on your knees and hear the angels' voices. Jingle all the way. But:

In the spirit of the season, wish everyone well. If a merchant wants to make his money by refraining from exclusivity, let him. Go shop somewhere else if you must. Don't scream bloody myrrhder. Use a little common frankincense. You have your church, your home, your friends' homes; you have your Christmas Tree Lanes. Carols are in the elevators, on the radio; Charlie Brown and everyone else has a Christmas special. Twenty four hours a day you even have your own Christian cable. Several of them. Hell, you can even pray online! So when you look at your city hall and don't see a creche, be glad you live in America. Consider it a gift to yourself, from all the rest of us.

Open it any time you want.

And Merry Christmas!

[Update, 12/3: this should make at least one of my commenters happy!]

[Maybe this, too.]