If Evidence Mattered…

Despite the fact that he has no legal authority to do so, Governor Pence has doubled down on his rejection of Syrian refugees. He continues to insist that he is just concerned for the safety of Indiana residents.

Indiana’s Governor lives in a wholly fact-free zone, of course. Refugees are highly unlikely to pose a threat to Hoosiers. (Unrestricted access to guns, however, which he enthusiastically supports, represents a huge and demonstrable threat…).

Not only have refugees proven to be virtually all law-abiding, but the danger posed even by genuine, avowed jihadists is actually quite low. Per The New York Times:

Despite public anxiety about extremists inspired by Al Qaeda and the Islamic State, the number of violent plots by such individuals has remained very low. Since 9/11, an average of nine American Muslims per year have been involved in an average of six terrorism-related plots against targets in the United States. Most were disrupted, but the 20 plots that were carried out accounted for 50 fatalities over the past 13 and a half years.

In contrast, right-wing extremists averaged 337 attacks per year in the decade after 9/11, causing a total of 254 fatalities, according to a study by Arie Perliger, a professor at the United States Military Academy’s Combating Terrorism Center. The toll has increased since the study was released in 2012.

Other data sets, using different definitions of political violence, tell comparable stories….

Meanwhile, terrorism of all forms has accounted for a tiny proportion of violence in America. There have been more than 215,000 murders in the United States since 9/11. For every person killed by Muslim extremists, there have been 4,300 homicides from other threats.

A colleague with whom I was discussing this data shared an interesting article from Slate about the venues supplying our home-grown terrorists. The article’s sub-head advised “Forget Syria. The most dangerous religious extremists are migrants from North and South Carolina.”

Today, Republican presidential candidates are climbing over one another in a race to block the entry of Syrian refugees. They’re doing this even though, among the nearly 800,000 refugees we’ve accepted since 9/11, not one has been convicted of—or has even been arrested for—plotting a terror attack in this country. (A few have been arrested for links to terrorism elsewhere.) Why do refugees have such a clean record? Because they have to go through an elaborate process: screening by U.N. evaluators, “biometric and biographic checks,” consultations with U.S. counterterrorism agencies, and an in-person interview with the Department of Homeland Security. On average, the process takes about a year and a half—or, in the case of Syrian refugees, about two years.

Terrorists from North Carolina encounter no such scrutiny. They just climb into their cars, cross the border, and proceed to Georgia, Kansas, or Colorado. They’re protected by Article IV of the Constitution, which, as interpreted by the U.S. Supreme Court, guarantees citizens “the right of free ingress into other States.” That’s why, among the 27 fatal terror attacks inflicted in this country since 9/11, 20 were committed by domestic right-wing extremists. (The other seven attacks were committed by domestic jihadists, not by foreign terrorist organizations.) Of the 77 people killed in these 27 incidents, two-thirds died at the hands of anti-abortion fanatics, “Christian Identity” zealots, white anti-Semites, or other right-wing militants.

The writer concluded by wondering “why, as we close our doors to refugees who have done us no harm, we pay so little attention to our enemies within.”

Let’s be candid, even if the Governor isn’t: it’s because we fear those who don’t look like “us.”

Comments

Prescriptions from the Doctor

It’s interesting that most of the public opposition to the Affordable Care Act has come from politicians–not infrequently, from politicians whose most generous donors have a vested interest in the medical status quo–and not from providers of medical care.

Perhaps we should listen to the people on the front lines–the doctors. This is from my cousin, a cardiologist whom I often quote here:

As a physician who had been in practice for many years, I remember the hardships suffered by many of my elderly patients prior to the initiation of Medicare in 1965. During that time, I was forced to sit painfully by as many unfortunate sufferers lamented that, even though they desperately needed to be hospitalized or needed expensive tests and additional services, they had only received small monthly social security payments with or without a small pension that barely sustained them at a subsistence level. In short, that situation afforded not only insufficient medical care, but threatened their financial security during those so-called “golden years.”

Then, in 1965, something abruptly and miraculously changed the landscape—the advent of Medicare. Suddenly our elderly could receive a standard level of medical care, which included, among others, diagnostic tests and hospitalizations. The financial burden was lifted from both the patients and us physicians, because we were no longer confronted with agonizing daily decisions about how we could provide decent medical care on a shoestring budget without threatening our patients’ health or survival.

He writes that two other doctors have recently weighed in via the New England Journal of Medicine (November 20, 2014). In “Civil Disobedience and Physicians—Protesting the Blockade of Medicaid,” C. van der Horst, MD, wrote that, when he anticipated passage of the Affordable Care Act, he thought he would no longer need to worry about patients’ affording necessary medications, preventive care services and hospitalizations.

But then van der Horst’s home State of North Carolina (like Indiana) blocked Medicaid expansion (even though, as it bears repeating, the federal government would pay 100% of the costs for the first 3 years and 90% thereafter). Over the protests of health care workers, teachers, union workers, immigrants, environmentalists, and people of all races and religions, North Carolina lawmakers have stubbornly refused to expand coverage.

The second article–written by Michael Stillman, MD–detailed the very different experience of Kentucky. Kentucky approved Medicaid expansion and “fundamentally altered our medical practice, allowing us to provide data-driven and thorough care without first considering our patients’ ability to pay” and giving 650,000 Kentuckians access to decent, comprehensive medical care. Most had previously lacked health insurance, had avoided routine preventive care—and worried that a medical emergency would leave them bankrupt. Medicaid expansion lightened their financial and emotional burden–and as a bonus, provided better physician education.  (Previously, doctors in training had become accustomed to offering substandard and incomplete care to indigent populations.) Now they are able to provide appropriate, evidence-based care.

As my cousin concludes:

This country will eventually—and inevitably—support decent medical care for all its constituents. Perhaps the process would be enhanced if our politicians were forced to spend time on the “front lines” of medical care in our clinics and hospitals and actually have dialog with those patients who are most vulnerable and under-served.

Listen to the doctor.

Comments

Because If We Ignore It, It Won’t Happen

It’s magic.

Hear no science, see no science, acknowledge no science…

“The North Carolina Coastal Resources Commission has found a solution to the political impasse posed by the conflict between science, which predicts the acceleration of sea level rise as the glaciers of western Antarctica collapse into the Southern Ocean, and Republican, money-driven politics tied to coastal development. The Coastal Commission voted to ignore long-term sea level rise.

The Commission voted, with one lone dissent, to limit the period of consideration of sea level rise to 30 years. Keeping the period to 30 years allowed the Commission to avoid considering the consequences of the collapse of west Antarctic glaciers, the speed up of the melting of Greenland’s ice cap and the slowing of the Gulf Stream. This vote will end the conflict between the Republican dominated state legislature and the Commission that happened in 2010 when the Commission’s panel of experts predicted as much as 5 feet of sea level rise by 2100. The legislature rejected that report and prohibited state and local government offices from considering the possibility that sea level rise would accelerate.”

See–wasn’t that easy?

I know Pat Sajak would approve.

Comments