While it is tragic to see the loss of life and destruction in yesterday's
bridge collapse, this is another symbol of growing problems. These can be
organized into a number of categories. More than a few will calculate how
to spin this to their advantage. Basically the people died yesterday
because of the decisions made by Americans, at least the Americans who vote
and shape political leaders and the nation.

Although the investigations will eventually come up with reasons and people
to blame, we have only ourselves to blame. Two slogans sum up growing
problems in America -  No New Taxes and No Child Left Behind

Now those who are poor in America already have figured out the myth of No
New Taxes since they have faced the widest range of creative taxation in
the nation's history in the form of lotteries, gambling, alcohol taxes,
tobacco taxes, co-pays for Medicaid and out of pocket costs, taxation for
child support, lack of health insurance coverage, etc. Most Americans have
already figured out the myth of No Child Left Behind, especially compared
to nation's such as Finland that really do implement the program. But we
allow the names to continue and even support the hypocrisy.

One can also point to another myth related to this area. The myth that we
have been sold that government programs do not work. Ribbons of
transportation and communication that connect Americans and the world are a
testament to the flaws in this myth. However there is a catch. Government
programs do not work when they are funding insufficiently, just like when
they are managed poorly, or when the funding intended for those most in
need is diverted to the uses of those best organized, and usually in less
need of the funding.

It is actually rather tragic that the bridge collapse was in Minnesota, a
state that does tax more, invest more in children and leaves fewer behind,
however all of the "United States" are vulnerable to the current policies
of the nation. California is a leader with the eighth largest economy in
the world and the most federal aid, but it cannot come close to supplying
the teachers, nurses, and public servants that it needs, not when Los
Angeles County cannot graduate much more than 50% from high school.
California is not alone. Most of the electoral votes are tied to states
that fail to create their own costly infrastructure, so they take what they
need from the rest of the nation and the rest of the world. Politics that
uses polls and numbers will not change this onslought nor restore a damaged
Constitution from the Preamble to the most recent events in Congress, the
Presidency, and the Supreme Court.

The tragedy of lack of infrastructure today is presented in real and
visible images, but it is really about the lack of investment of Americans
in America.

America has learned tragically in the past. Last week I was in Kansas City
and had no fear walking across the revised structure that once collapsed 26
years ago http://en.wikipedia.org/wiki/Hyatt_Regency_walkway_collapse and
killed 114, a result of engineering errors and a wakeup to needed
improvements in many areas. My brother lost a friend in this collapse. All
of his education and future income derived from the settlement, but I
suspect that he would rather have his mother back.

American progress has always been about efficiency and effectiveness and we
are losing this edge. We can go no farther than we can see and
infrastructure is what lets us see the future, not just a future for an
elite few, but for all Americans. Beyond the steel and metal framework is
the people infrastructure of America, the stressed to the max teachers, the
neglected child developers, the poorly supported nurses, the public
servants asked to do more and more, facing more and more challenges, and
getting less and less to do their jobs, and the fewer family physicians.
The inclusion of family medicine in this group may be a surprise to many,
but graduating family physicians is about investments in the 65% in lower
and middle income America, medical school admission of this group most
likely to choose family medicine, training relevant for primary care for
the 65% of Americans left out of mainstream health care, and health policy
that shifts funding to provide care for the 65% of Americans outside of
major medical centers, largely the lower and middle income peoples of
America. All are involved in basic access to basic services. All receive
less and less support yet are asked to do more and more. It is not a
surprise that more and more shortages exist in all of the areas.

Most dramatically our streets are filled with the litter of human debris
and chaos, those left behind. These are not dramatic collapses of buildings
or bridges, but they are subtle collapses of our infrastructure. Each of
these changes makes life more difficult for those left behind and the
service oriented professionals that attempt to provide infrastructure even
with increasing difficulties. There are efficient states, cities, and
nations and they work to prevent this devastation. They have learned to
work forward from age 0 - age 8 rather than backward. They invest 2 - 4
times more for age 0 - 6 compared to the United States and they finish at
the top of developed nations while we hug the cellar.

American progress has been about public investments from the Panama Canal
to the great transportation and communication systems to public health and
education. But most of all it has been about improvements in the status of
children, especially the nurturing earliest years that give security, hope,
and a future.

American regression has been about poor understanding, insulation, and
isolation of those most different, in geographic or socio-cultural terms.
Of course our policies of privatization, insulation, and isolation are no
longer possible in a world where those excluded become the primary weapons
of those with violent agendas, in this and in other nations. Our neglect
only brings us more and greater challenges.

We have a window of opportunity to shift resources back to the youngest
generations and to the investments needed to restore efficiency and
effectiveness, or we can continue to concentrate wealth and opportunity
into the hands of a few. The changes needed are across all dimensions
involving speculative finance and economics, corporate agriculture, the
medical-industrial complexes, the new education-industrial complexes, and
many other areas. The window is closing. American leaders arise from a more
and more narrow range of origins. Each new generation of leaders is raised
more and more exclusively and has less and less opportunity to understand
the true conditions in America - the conditions seen by those seeking a
real education or a worthwhile job or those seen by those who spend time
looking up underneath a bridge.

Robert C. Bowman, M.D.
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