Only one person was killed in a shooting at a synagogue in Poway, California on Saturday and merely three other people were shot and that is a miracle isn’t it. It counts as a miracle that a total of only four bodies were struck by bullets at one of these things. Thank god there was only one dead.

That we can think something like that is the opposite of a miracle I don’t know what the term for that is or if there is one. A curse?

Of course for the people there and their families and the people injured it is a nightmare come to life they may never recover from and for Jewish people it is a yet another reminder of the country’s ascendant anti-semitism but for many of us who experienced it through the news it’s different because we weren’t there and people are very good at pretending things they weren’t there for never happened and will never happen. In a week or so we will stop thinking about it and at some point we will be closer to the next mass shooting than the last one but we won’t know it yet until it happens and then we’ll go How many dead? Fifty? Holy shit. Or else we’ll say Only two? Ah well that’s very bad too we’ll say but still. Thank god it wasn’t worse we’ll say.

Someone will reference Poway, California some day down the line when they’re reading off a list of shootings and you might be like which one was that again?

We read and see stories on TV about what it’s like to be at one of these regularly scheduled killing ceremonies but we can’t really understand it because we haven’t been to our own specific mass shooting event yet although I’m sure that time will come for a lot of us at this rate and maybe by then once every single person living in the country has been shot at we might start to make some headway on confronting the American death cult of gun worship. Probably not but maybe!

Sometimes people say shit like I can’t wait for this generation of racist old hateful right wingers to die off and they’ll give an example of some young kids doing something kind and inclusionary and they’ll say those kids will live in a better world but I’m not sure I would bet on that. This shooter was nineteen years old and the one at the church in Charleston was twenty one and the shooter in Parkland was nineteen so I don’t know it seems like they already have their own freshman class of terrible people coming up and they’ll probably be worse than the older ones because they also know how to use the internet.

A lot of us reading this might not end up ever being shot by an anti-semitic internet Nazi we might instead be shot by the police which is worse in a way because then at least half the population will conspire to come up with ways in which we had it coming.

There are a couple of different ways you can run a news story when the police shoot someone like they did on Friday in Oklahoma when there was a let’s say it all together now class officer-involved shooting. One way to do it is to describe the events as they happened to the best of your knowledge at the time using a combination of “official” events which means what the police say happened as well as witness accounts. For the most part that’s what the Washington Post does here.

On Friday police near the Oklahoma Texas border were looking for a man suspected of the armed robbery of a Pizza Hut the week before. Believing they had found him they attempted to talk to the man who was driving a pickup truck. Being confronted by the police perhaps panicked the man and he backed up the truck and struck one of the officers somewhat they said and you know what that means it’s shooting time now baby.

The two officers “feared for their life” so they had no alternative but to light up the truck with bullets perhaps not knowing or perhaps not caring that there was a woman and four tiny little baby children all under five years old in the truck with the man they merely suspected of robbery at the time. The bullets went ahead and somehow ending up working their way into the bodies of three of those babies.

“My 4-year-old daughter was shot in the head, and she has a bullet in her brain,” Hill said through tears as she prepared to visit her injured kids at a children’s hospital in Tulsa. “My 5-year-old has a skull fracture. My 1-year-old baby has gunshot wounds on her face, and my 2-year-old wasn’t touched with any bullets.”

The headline for that piece is “Police shot at the vehicle of a robbery suspect — and hit 3 children inside” which is almost refreshing because at least it gives agency to the police and doesn’t attribute the appearance of bullets in the children’s bodies to some unnamed magical trick of happenstance.

The other way you can report on a story like this is the way ABC News did in a piece headlined “3 children shot as Oklahoma police open fire on alleged robbery suspect.” The children in this framing were coincidentally shot at the same time police opened fire which is a much more confusing way of saying what happened.

The video report along with the piece includes our favorite passive description of state violence of course and then the rest of the piece goes on to include security camera footage of the Pizza Hut robbery with a man who I guess is the one who was driving the truck I’m not sure and I’m not sure if they are sure either. But he looks angry and menacing in the photos and well you know how else he looks so maybe readers might start to think this guy and the three babies he knows deserved to be shot by the police. What else could the police have done? The man reversed his car after all.

The babies apparently are expected to survive which is a miracle of its own kind.

Here’s a comment I just read about the story:

“I can't judge what the police did on the basis of the reports so far, but I can form an opinion of this woman who decided to hang out with a felon who tried to run over a couple of cops. What could possibly go wrong?”

When I posted about it on Twitter some genius replied that he shouldn’t have broken the law if he didn’t want to get shot and sometimes I wonder what it’s like to have a brain like that that automatically defers to the armed state forces’ versions of events when they shoot people. It’s still very weird to me that the people who always fall in line when it comes to backing the blue or whatever sports chant they have about cops are always 2nd Amendment supporters and probably have guns of their own they keep on hand for when they fantasize about rebelling against government some day. I wonder who the gun kissers think it is they’re going to be shooting at when their rebellion happens because it’s not going to be Nancy Pelosi and AOC out there with the helicopters and tanks it’s going to be the cops and the troops that they respect and love.

There is already an occupying force operating with near carte blanch within our borders and they are called ICE and most of the people who stockpile guns to fight Obama and Hillary in mecha suits don’t seem to be bothered by what they’re up to due to the people ICE are terrorizing tend to have skin that is moderately darker then their own.

Some people don’t like what ICE is up to all that much on the other hand like the Massachusetts judge I wrote about the other day who was charged with obstruction of justice by the feds for refusing to allow them to set up shop in her court to snatch up an undocumented immigrant. That’s a pretty big story right because I feel like arresting a judge for not collaborating with the deportation troops is a big story but I haven’t really seen too much about it in the national news.

Here in Massachusetts it’s a pretty big deal though and one good thing that has come after it is that the Boston area Middlesex and Suffolk county District Attorneys have said they are filing a lawsuit today that will block ICE from courthouses according to CommonWealth Magazine. The two DAs have been expressing their frustration with ICE for some time now so it’s not new but the timing is interesting.

Marian Ryan the Middlesex DA released a statement today explaining the reasoning behind it which is that ICE poking their snouts around is making it harder for them to actually do their jobs and actively making the community less safe.

“ICE’s policy is undermining the work of the justice system as a whole.  Prosecutors are forced to abandon cases because many victims and witnesses are deterred from appearing in court. The policy also makes it more difficult to obtain defendants’ appearance in court,” she said.

Ah what the fuck they are showing on CNN right now that a young man named Corey Ballantine who was just drafted by the New York Giants was shot. They have a video of him talking to the coach this weekend hold on let me see what it says.

“Yes sir I’m glad to be a part of the franchise. I’ve been waiting on this opportunity for a lifetime really. I’m glad to even be part of the conversation. I’m definitely ready to start learning,” he said to his new coach on the phone and then a couple hours later he and a teammate at Washburn University in Topeka, Kansas were at a party likely celebrating his being drafted into the NFL which is a miracle of a kind and then a car pulled up and shot Ballantine and his friend Dwane Simmons. Ballantine is going to recover they said by which they mean physically but Simmons will not recover from anything anymore.

Every day one hundred people in America are killed with guns and hundreds more are merely shot according to Everytown for Gun Safety and we don’t talk about each one when they happen because how could we keep up. We could spend every hour of every day talking about each person who is killed by a gun and never have time to finish never mind get to the ones that are only wounded. You could spend your entire life thinking about each death for fifteen minutes and still fall short. It would be impossible to do and so we don’t do it and besides the vast majority of those shootings we don’t even hear about because there are usually only one or two people involved and that barely counts as news. There needs to be a hook for us to pay attention like if the guy was going to play in the NFL.

I lose my fucking mind every time there is a mass shooting like the one in California this weekend and I guess what I am saying is why don’t I lose my mind over all the other ones? None of which is to say that an attack on a place of worship isn’t objectively terrifying or that it doesn’t perfectly and succinctly symbolize the existential plague confronting this uniquely violent and racist country but it is strange that we spend so much time on shootings like these and not on the run of the mill every day gun massacres. It is worse that it happened in a place that we think of as being a safe refuge but shouldn’t that also apply to our homes and on the streets of our neighborhoods and everywhere else? Everywhere should be a place where it is surprising to get shot.

Terrorism and religious terrorism in particular are certainly horrible complicating factors but the prevalence of guns in this country is its own kind of daily mundane terrorism and what else would you call people who refuse to do anything about it and in fact actively promote it but terrorists?

A significant portion of those gun deaths are suicides which is an even harder aspect of the gun plague to talk about and around one thousand of those deaths are people being shot by police but that number is likely low since there still is not uniform reporting of police shootings on a national level. We make it very hard to study gun violence on account of the money the gun fuckers give to our amoral leaders who then go ahead and take that money and do things like make it illegal for our doctors to ask us if there is a gun in the home.

Another way to die besides gun violence in America is from cancer. Here’s a grim chart you can look at incidentally. Which is the most depressing square do you think? My two picks are the one on the top left and the one on the bottom right.

Unlike gun violence it seems like cancer is a thing that is being studied right like you think of cancer and you sort of trust that someone is working on that in the background. Cancer is in good hands you imagine and that is sort of true there are lots of people studying cancer but it’s not as unified an effort as we might like I recently learned.

I spoke with someone who works on studying cancer at a prestigious research hospital and they pointed out something which had never occurred to me which is that one of the things holding them back from accessing all the data that they need is that private insurers and even the government charge significant amounts of money for it. This person who asked to be anonymous because they aren’t allowed to speak on behalf of the hospital works for a non-profit that is often underfunded and getting data from one specific insurer for one small group of cancer patients can be many tens of thousands of dollars they said.

One added bonus of Medicare for All the person said is that it would likely make it much more seamless and efficient having all of the data brought together under one umbrella. Think about what they might learn if there weren’t dozens of interested for-profit groups asking for their cut before letting scientists and doctors do the work that might save many of our lives?

We talked about it a little more.

What is it that you do?

I’m a statistician and I do a lot of observational research using things like administrative claims and insurance claims data at a research hospital known for cancer studies.

So it’s hard to find comprehensive data on cancer?

Yeah. There are two different types of research. You could do a clinical trial but a lot of stuff like real world evidence and how things are being used comes from observational data. Insurance claims come with their own set of challenges. Whether or not you have access to them is one question. There’s private insurance and then there’s government insurance. Some private insurance companies, like United for example, I don’t know if they still do it, but they used to make their data available, but it was very expensive. The Center for Medicare and Medicaid Services make some of their data available but not all of it. Medicaid data is not available, it’s possibly coming out this year. Medicare data has two different parts and data from one of the parts is available. It’s still expensive but not nearly as expensive as private insurance.

What kind of numbers are you talking about when you say expensive?

We have three years of data from Medicare for a subset of patients, not all, just a couple hundred thousand patients, and it costs eighty thousand dollars. I work for a non-profit, so that’s expensive.

What is it that you study?

A lot of stuff with patterns of use, so if there’s a new surgery introduced you can look at if patients are getting that surgery versus a previously existing surgery. You could look at cost of care. You could look at the number of health care encounters, what type of treatment, chemotherapy or radiation. The limitations of using the insurance claims is that it’s all observational. So you might know someone had a blood test, but you won’t know the results of their blood tests. It’s just not included on the bill you get from an insurance company.

But the big thing is across all the different kinds of insurance, only a small subset is available. And we can’t track people across insurance. So if someone’s on Medicare then all of a sudden they’re on another insurance we don’t know what happens to them. So it’s very limiting in that sense.

What is your goal though? To improve health care or make it more efficient from a cost perspective?

All of the above. It depends on the principle investigator leading a project. A lot of times the end result is to write a paper in an academic journal to describe trends or costs. Sometimes it’s to make a point about costs, that it’s too high or this or that. Or to compare costs across treatments, or see what’s helping survival the most. The broad overarching goal though is to improve public health.

Why do you think the insurance companies charge so much for this data? Is it just a little way to make some extra change for them? It doesn’t seem like that much money for an insurance company.

I think there’s some work that goes into aggregating the data and making it readily available for someone who wants to use it. There’s also a whole process involved, figuring out the cohort you want. CMS has a whole system of people that process these requests. I don’t know if private insurance companies have that infrastructure. I have heard that they’re moving even further away from sharing data as insurance companies merge. They’re like, nope, no one is getting access to our data anymore.

When people think about having their medical data shared it’s usually in a bad sense. But this is anonymized right?

Yeah it’s completely anonymized. You couldn’t trace anyone back if you wanted to. And there are all these privacy protections in place about how we share the data, where it’s saved. When we publish something we can never say something like ‘there was one patient aged sixteen who went to a hospital in New York state with kidney disease’ because theoretically you could trace that back.

The other thing about private insurance not sharing their data is Medicare is only sixty five and older, so a lot of research that happens is only based on [older people]. So it’s not even necessarily representative of what’s happening with everybody.

The idea that we’re talking about is that if there was Medicare for all, in theory, this would all be under the same umbrella and would be more usable.

That’s the idea. You’d be able to track people over time, you wouldn’t have people going in and out because their employer changed insurers. It would be all ages which would be really nice. Things like that would be a big deal. They might sound small but it’s a big limitation on a lot of the work we do.

I think it’s an interesting point. This is yet another argument, not the main one mind you, for Medicare for all, that this could contribute to the greater public health in your opinion?

Oh yeah. Yeah definitely. I think if data availability were improved for more patients and more locations and more demographics and you could track people over time, the opportunity to study what’s happening, and improve what’s happening is really there and it would be worth exploring.

Is this something you talk about with your colleagues? Is this a widely complained about thing in your field?

Not really. A lot of the talk about Medicare for all at the hospital, at the cost level, is about the costs to the hospital. I don’t know that embarrassing is the word, but from a public health perspective… I think the focus is misplaced. But this perspective that we’d be able to do all this research isn’t like the hot topic in health research.

So this isn’t some obvious thing that lots of people are talking about that I’ve just never heard of and I’m going to seem stupid for bringing it up?

No not that I know of. I haven’t talked about it with any colleagues.

You said the word embarrassing. Do you mean you hear from people talking about how Medicare for all might be a burden on the hospital in terms of operations or for people there being able to make money?

I think a little bit of both.

Are the people by and large at your hospital good or evil?

I think they’re mostly good.

What about insurance companies?

More evil than good.