[Larger version of image intent on ignoring. The first is the plague that is the "birther movement," the apparently contagious delusion primarily afflicting Southern Republicans that President Obama was not born in the United States. The second is dismal health care. As it turns out, health care performance is worst in precisely those reddest of states which voted for George W. Bush and John McCain.

While even Karl Rove ridiculed the latest bogus Kenyan birth certificate as "likely a forgery," his red state acolytes remain unconvinced. In a jaw-dropping DailyKos/Research 2000 poll released last week, a stunning 58% of Republicans did not believe (28%) or were unsure (30%) that President Barack Obama was in fact born in the United States. And to be sure, this is a uniquely Southern pathology, a region home to 69% of all birthers and not coincidentally the only part of the country to increase its Republican presidential vote in 2008.

But this disturbing denial of the indisputable truth of Obama's U.S. citizenship is far from the only sign of trouble in red state America. There, the health care systems are in critical condition.

A 2007 Commonwealth Fund report, "Aiming Higher: Results from a State Scorecard on Health System Performance," examined states' performance across 32 indicators of health care access, quality, outcomes and hospital use. Topping the list in the chart above were Hawaii, Iowa, New Hampshire, Vermont and Maine. Bringing up the rear were the Bush bastions of Kentucky, Louisiana, Nevada, Arkansas, Texas, Mississippi and Oklahoma. The 10 worst performing states were all solidly Republican in 2004. (8 voted for McCain in 2008.)

The extremes in health care performance are startling.

For example, 30% of adults and 20% of children in Texas lacked health insurance, compared to 11% in Minnesota and 5% in Vermont, respectively. Premature death rates from preventable conditions were almost double (141.7 per 100,000 people) in Tennessee, Arkansas, Louisiana and Mississippi compared to the top performing states (74.1 per 100,000). Adults over 50 receiving preventative care topped 50% in Minnesota compared to only 33% in Idaho. Childhood immunizations reached 94% in Massachusetts, compared to just 75% in the bottom five states. As the report details, federal and state policies such as insurance requirements and Medicaid incentives clearly impact health care outcomes.

In May, the Washington Post rightly noted it would be blue state residents funding health care reform for their red state brethren in an article titled, "A Red State Booster Shot." (The grandstanding of Sarah Palin, Bobby Jindal et al notwithstanding, the same one-way flow of taxpayer dollars from Washington to red states, of course, is a permanent feature of federal spending in general.) And yet a 2008 survey predictably showed 68% of Republicans believe the U.S. has the best health system in the world, compared to only three in 10 Democrats.

For his part, Senator James Inhofe, whose home state of Oklahoma ranked dead last in the Commonwealth Fund scorecard, boasted his party would "stall" President Obama's health care initiative to ensure a "huge gain" in the 2010 election. Meanwhile, Senate Minority Leader Mitch McConnell claims that Americans don't want health care reform that "denies, delays, or rations health care."

Of course, de facto rationing is precisely what their constituents face today. But first things first: let's see that birth certificate.

UPDATE: In the New York Times, Bill Kristol's shoe-filler Ross Douthat argues that Texas should serve as an economic model for the nation. While Ezra Klein demolishes that claim in the Washington Post, other data on working conditions, education performance and other social indicators suggest that things are generally worst in the reddest of the red states.