I’d like to draw your attention to an excellent presentation on Ebola in YouTube video form:

ably summarized in text form at the blog Raconteur Report. There’s no panic, no partisan posturing, no temporizing, no embroidering. Just a basic presentation from Michael Osterholm, Director of the Center for Infectious Disease Research and Policy. It also challenges the “nothing to see here, move along” posture we’re getting so much of these days.

This presentation was brought to my presentation by the commenter Piercello. In my view this exemplifies one of the very best aspects of the World Wide Web, generally, and social media in particular. A link to the video was left by an anonymous commenter at Raconteur Report who promoted it into a post. I am now, in turn, promoting a comment left here to a post (giving credit to all sources) in the hope that it might be helpful to someone else.

I’ve mentioned Michael Powell’s masterpiece, The Red Shoes, before. If you haven’t seen it, I recommend it. It’s foundational cinema, filmed in that glorious, saturated, surreal, old British Technicolor. I don’t think my revealing the end will spoil it for you. At the end of the movie, the production of the ballet goes on. A pair of red pointe shoes are carried around the stage. The ballerina who was to have worn them has committed suicide.

That’s what I think of when I read about the challenges to the subsidies for states that did not implement their own healthcare exchanges that are making their way through the courts and which I think the Supreme Court should hear with all due haste. The production is the PPACA. The subsidies are the red shoes. The ballerina is Jonathan Gruber, a prime architect of the PPACA, and his explanation of the subsidies as incentives to the states to create their own exchanges. Without recognizing there once was a ballerina it all becomes surreal and imcomprehensible.

According to the Mayo Clinic’s helpful website the symptoms of a panic attack are:

• Sense of impending doom or danger
• Fear of loss of control or death
• Rapid heart rate
• Sweating
• Trembling
• Shortness of breath
• Hyperventilation
• Chills
• Hot flashes
• Nausea
• Abdominal cramping
• Chest pain
• Headache
• Dizziness
• Faintness
• Tightness in your throat
• Trouble swallowing

I don’t feel any of those symptoms other than, possibly, nausea but that’s clearly because I listen to the political discourse in the United States too closely. Indeed, when I look around the clearest signs of panic are among Democratic politicians rather than the public at large. It’s just like in the movies. The most panic-stricken guy on the boat is the one who’s rushing around frantically telling everyone else to remain calm.

In this post I’d like to suggest that we not remain calm.

In every crisis over the period of the last century or more the only things that have motivated Americans to action have been strong emotions: pity, fear, most commonly anger. Those are what motivated us to enter World War I, to act during the Great Depression of the 1930s (whether you think we acted prudently is another question entirely), to respond to the Japanese attack on Pearl Harbor, to become the primary healthcare provider in Pakistan for a year following a massive earthquake there, or even to send a man to the moon. Calm motivates us to watch the World Series or check out the antics on The Big Bang Theory.

The reality is that the Ebola epidemic that has struck Guinea, Liberia, and Sierra Leone is beyond those countries’ ability to manage. Not only are they among the poorest countries in the world but they have among the least competent and most corrupt governments, not unrelated things. Since healthcare workers are highly at risk from Ebola the epidemic has depleted their already weak healthcare systems.

The number of deaths from Ebola in those countries is already approaching 5,000. There are projections that within a month or so it will rise into the tens of thousands and if unchecked it could rise into the millions by early next year.

Each new case is accompanied by the possibility that the virus could go airborne, a prospect that would be a disaster of global proportions, or that it could become endemic in that region of Africa or even beyond. Those are things we don’t want to happen.

The time-honored approach to dealing with the disease and the approach that has been successful in Nigeria and Senegal already has been to isolate the active cases and track down and quarantine those most at risk from the disease due to their contacts with people with active cases. That still is not impossible, as Nigeria and Senegal have demonstrated, but it soon may become so and Guinea, Liberia, and Sierra Leone are incapable of managing the problem on their own. I also think that our own greatest safety lies in treating the epidemic successfully in West Africa.

We need to intervene with all due speed and I don’t see calm as motivating us to do that. It’s the last thing we need. A few hundred soldiers erecting tent hospitals, our present commitment, isn’t enough to do the job.

When I was an undergraduate my alma mater’s football team’s biggest yard-gaining play was the quick kick. You read that right. It’s a play of desperation, one that’s rarely seen in modern football. Another play of desperation is the “Hail Mary pass”, a long forward pass with little likelihood of successful execution.

That’s pretty much analogous to what Scott Gottlieb and Tevi Troy propose as our response to the Ebola epidemic in West Africa:

Mr. Obama has stated repeatedly that the U.S. has helped to snuff out every other outbreak of Ebola and that the country will do the same with this one. However, past outbreaks occurred almost exclusively in remote villages, and entire locales would be cordoned off while the virus burned itself out. Liberia, a country of 4.4 million people, can’t be encircled. Nor can Dallas be quarantined.

Instead, medical countermeasures are critical. Despite early swagger by public-health officials at the National Institutes of Health and CDC that this crisis will be solved with public-health tools alone, and that a vaccine or treatment won’t be available in time, smart medical experts are recognizing the need for a therapeutic drug or vaccine.

One leading plan is for a 30,000-person clinical trial to begin as early as December with two experimental vaccines. Two groups of 10,000 West Africans will each receive one of the two novel vaccines. A third group of 10,000 West Africans will serve as a control group and receive a hepatitis B vaccine. The plan is dependent on completing early-stage trials under way now and having vaccine supply on schedule.

While a vaccine is needed to help stop the epidemic in West Africa, it is equally important to develop a drug to treat the disease in those who have been infected. This is especially so for the U.S., where a drug or drugs can combat containable outbreaks.

The problem with this strategy is that it ignores downside risk. It could take two years or twenty years to develop an effective vaccine. Or it may prove impossible to develop one. We just don’t know. Meanwhile, the number of cases in West Africa will continue to grow, people will continue to die, and, in all likelihood, the probability that Ebola will become endemic in West Africa or even in sub-Saharan Africa more generally will grow.

The only way we can avoid the worst case scenarios of the Ebola epidemic is by serious attention now, not merely from the United States but from the entire developed world. There’s a lot riding on it.

The editors of the Chicago Tribune pronounce cost control under the PPACA dead:

In year one, spending increased at 14 sites and only 13 of the 32 qualified for a bonus. In year two, spending increased at six of the remaining 23 and 11 received a bonus. Spending did fall somewhat overall, driven by a few high-performance successes. After netting out the bonuses and penalties, the Pioneer ACOs saved taxpayers a grand total of $17.89 million in 2012 and $43.36 million in 2013. All in, per capita spending was a mere 0.45% lower compared to ordinary fee for service Medicare.

Yet the upfront start-up investments for the pioneers (in administration, compliance and information technology) ran to $64 million, so at best the program is a wash. More to the point, the Medicare budget for 2013 was about $583 billion and these are supposed to be the most experienced providers. If most of them can’t succeed, what about the community hospitals that need the most improvement?

HHS runs a second ACO pilot for everybody else, with rewards but no penalties, called the Shared Savings program. Among those 114 ACOs, only 29 hit HHS’s financial targets in 2012. They saved $128 million and were paid $126 million in bonuses. In 2013, only 64 of 243 participants hit the targets.

The WSJ editors continue to cling bitterly to the illusion that market forces can bring down healthcare costs in the U. S.:

A better alternative would give patients the incentive and usable information about prices and value a la Paul Ryan’s defined-contribution Medicare reform. Doctors and hospitals will quickly adapt to compete for their business. That might mean ACOs or something else.

That might be true except that providers control both the supply and demand for healthcare. Revenues can be increased either by increasing the prices of individual services or by increasing the number of services prescribed. That’s no market.

The reality is that the fee-for-services model has fallen and it can’t get up. Under the model as it exists now almost all of the economic surplus is captured by producers while far too many patients can’t afford care. The PPACA with its healthcare exchanges has not improved on this. It has merely provided an illusion of improvement. For many people deductibles are unaffordably high.

Reform can no longer just nibble around the edges. It’s got to be a lot more basic than that.

The editors of the Chicago Tribune explain how they had to struggle with their consciences to endorse the re-election of Dick Durbin to the Senate:

We often disagree with Durbin on issues. But we would rather have Illinois represented by a highly capable partisan than by a less capable partisan.

My misgivings about Durbin extend farther than those of the Trib editors. I don’t think that he’s been a particularly effective senator for Illinois. Even when they’ve risen to leadership roles in the Senate, senators aren’t elected to represent the whole country. They’re elected to represent their states and I do not see that Illinois has prospered through Sen. Durbin’s tenure or Senate leadership. Just look around you at the statistics. We lead the country in lost jobs, lost companies, and net outmigration. Although Illinois didn’t share in the huge run-up in home prices seen in California or Nevada, we haven’t shared in the housing price recovery, either.

In the final analysis a candidate for the Senate does not need to be the best of all possible candidates. Merely better than his or her opponent. This epitomizes the problem with the Republican Party ion Illinois:

In their primary, Republicans did have a promising candidate, political newcomer Doug Truax: West Point grad, former Army Ranger, owner of an Oak Brook firm helping employers address the costs of health care and retirement benefits. He had smart ideas for rescuing entitlement programs and reforming the tax code.

Republicans instead nominated Jim Oberweis, a business executive who in 2012 won an Illinois Senate seat after five unsuccessful runs for higher offices.

During that candidate debate with Durbin, Oberweis was every bit as partisan, but more evasive and not as prepared to delve into difficult issues such as immigration and federal finances. Oberweis’ campaign rests on stock GOP themes — less government, lower taxation — and that’s fine. But we have no faith he’d be a change agent in the Senate. When he finally got elected to something — the state Senate — he could have served a term and built a record. Instead, he quickly jumped into the next campaign, for the U.S. Senate.

They have an unerring instinct for snatching defeat from the jaws of victory. In a year in which events are breaking in favor of the Republicans they fail to nominate a decent candidate. I am thoroughly unimpressed with Jim Oberweis. Love his milk but hate his politics.

At this stage in what may be a series of events of worldwide importance, I think it’s appropriate to consider a few alternative scenarios dispassionately. Before I begin it might be helpful to define a few terms: epidemic, endemic, and pandemic. If you know Greek, their meanings are obvious but classical educations have become rare.

We characterize a disease as “epidemic”, literally “among the people”, when there is a outbreak of an infectious disease in a large number of people over a short period of time. A disease is “endemic”, literally “in the people”, when it is maintained within a population at a more or less stable rate permanently. For example, chickenpox is endemic in the United States. A disease is said to be “pandemic”, literally “all of the people”, when there is global outbreak of a disease affecting a significant number of people.

Here are some scenarios I think are worth thinking about:

• Worldwide Ebola pandemic
• Ebola becomes endemic outside Africa
• Ebola becomes endemic in sub-Saharan Africa
• Ebola becomes endemic in West Africa
• Ebola epidemic outside West Africa
• Ebola epidemic in West Africa
• Ebola outbreak outside West Africa

There are other possibilities that could be considered but that list hits the high spots. Now let’s put a little flesh on these scenarios and do a bit of speculating about their likelihoods.

Worldwide Ebola pandemic

I think this is extremely unlikely. I have no way of calculating the costs of this taking place but they would be vast. Half of the world’s population would die.

Ebola becomes endemic outside Africa

I think this is unlikely.

Ebola becomes endemic in sub-Saharan Africa

I think this is somewhat unlikely. If it takes place it will be a consequence of inaction in stemming the epidemic in West Africa, the weak economies and institutions in sub-Saharan Africa, and indifference on the part of the developed world. The costs of this scenario both in human and economic terms would be large.

Ebola becomes endemic in West Africa

This is a substantial and significant fear and the longer the epidemic in West Africa continues the more likely it becoming endemic will become. I think this is slightly likely.

Ebola epidemic outside West Africa

I think this is somewhat unlikely. If it does take place, it will be a consequence of allowing the epidemic in West Africa to continue and is most likely to take place in countries with weak economies and institutions.

Ebola epidemic in West Africa

Since there is already an ongoing epidemic in Guinea, Liberia, and Sierra Leone, this is now a certainty.

Ebola outbreak outside West Africa

Sadly, since there are has already been a small outbreak in the United States, this, too, is now a certainty. It should debunk the notion that an outbreak in the United States is impossible but interested parties are already trying to spin the truth away, a practice that I think increases the likelihood of future outbreaks rather than reducing their likelihood. IMO the outbreak was caused by reckless behavior on the part of professionals. We can only hope that the professionals will be chastened by the experience but I see no signs of that yet.

Note that these scenarios operate along several different planes, i.e. geographic extent, duration, number of cases, and cost. Also note that as the last-mentioned scenarios increase in likelihood the scenarios mentioned earlier become more likely, too. So, for example, if Ebola becomes endemic in West Africa, it will become harder (and more expensive) to prevent it from becoming endemic in sub-Saharan Africa more generally.

That’s why I think that we need to undertake a somewhat more muscular effort in Guinea, Liberia, and Sierra Leone that we presently have. As of this writing we have fewer than 1,000 troops there and they are insufficiently trained to deal with Ebola cases themselves.

They are better prepared to build hospitals but hospitals won’t staff and equip themselves. Not only the United States but France, the United Kingdom, Germany, and China should be making significant commitments of money, materiel, and people in West Africa.

The United States Navy has two hospital ships capable of treating 1,000 patients each and eight Wasp class amphibious assault vehicles capable of treating 600 patients each. These are, in effect, large mobile modern hospitals, fully staffed and equipt. Should some of these existing resources be deployed there? That’s a question. I’m not in the Navy and I don’t know the complications or issues involved.

The Watcher’s Council has announced its winners for last week.

Council Winners

• *First place with 2 1/3 votes!– The Noisy Room – The Brookings Institution and Qatar – The Money, Power and Influence Behind Global Terror
• Second place *t* with 2 votes –VA Right! – 2014 US Senate Race – Analyzing the Polls in Close Races Plus My Prediction!
• Second place *t* with 2 votes –Joshuapundit–The Left’s Latest Big Lie : “Ebola Outbreak Is Due To GOP Cuts”
• Third place *t* with 1 vote –Bookworm Room – This American life lovingly focuses on Jewish wrongs, while ignoring Muslim depredations
• Third place *t* with 1 vote –Rhymes With Right – Wendy Davis Desperately Attacks Abbott’s Disability
• Fourth place *t* with 2/3 vote –Ask Marion – Famous Ultra-Liberal Claims Obama’s Only Accomplishment is Being Black
• Fourth place *t* with 2/3 vote – GrEaT sAtAn”S gIrLfRiEnD – Columbus Day!
• Fourth place *t* with 2/3 vote –Simply Jews – Naomi Wolf and her two sources system
• Fourth place *t* with 2/3 vote – The Independent Sentinel – Rest Assured Your Government Has ISIS Under Control
• Fifth place with 1/3 vote – Nice Deb – Kurdish Female Fighters Holding the Line in Kobani

Non-Council Winners

• First place with 2 1/3 votes! – Michael Totten – From Havana to Hanoi submitted by Joshuapundit
• Second place *t* with 2 votes–Stephen F. Hayes/The Weekly Standard –Failure Upon Failure, The Disintegration of the Obama Presidency submitted by The Independent Sentinel
• Second place *t* with 2 votes– Paul Rahe/Ricochet –The Centers for Disease Control Loses Its Grip submitted by Nice Deb
• Third place with 1 vote –Sultan Knish –The Progressive Missionaries of Unhappiness submitted by The Noisy Room
• Third place with 1 vote –Roger L. Simon/PJ Media –What Happens if Republicans Win? submitted by The Watcher
• Fourth place *t* with 2/3 vote –Point Of No Return – When Granny had dinner with the Mufti submitted by Simply Jews
• Fourth place *t* with 2/3 vote – Victor Davis Hansen/NRO–Ruins Of The Middle East submitted by Bookworm Room
• Fourth place *t* with 2/3 vote – Clash Daily – 15 B.S. Research Projects That NIH Wasted $10 Million of Your Money On Instead of Studying Ebola submitted by VA Right!
• Fourth place *t* with 2/3 vote – Judith Shulevitz/The New Republic – Accused College Rapists Have Rights, Too submitted by The Watcher
• Fifth place with 1/3 vote – Jeff Nyquist – Opening Moscow’s Bag of Political and Strategic Tricks submitted by The Right Planet

The link at the Watcher’s site is here.

Have you ever wondered about how a French aristocrat lived 70 years ago? Voici!

The auctioneer who walked into that was one lucky chap.