America Alone, The End of the World as We Know It, by Mark Steyn. Regnery Publishing, Inc., Washington, D.C., 224 pages, $27.95.

When people see a strong horse and a weak horse, by nature they will like the strong horse. --Osama Bin Laden, Kandahar, November 2001.

If we know anything, it is that weakness is provocative. --Donald Rumsfeld, Washington D.C., 1998.

Steyn begins:

Do you worry? You look like you do. Worrying is the way the responsible citizen of an advanced society demonstrates his virtue: he feels good about feeling bad. But what to worry about? Iranian nukes? . . . worrying about nukes is so eighties.

So what should we be cowering in terror over? Steyn feels the harrowing nightmares of doom didn't start with Chicken Little and won't end with Al Gore. So, should we forget about the end of the world and head for the hills? Steyn says: Don't head for the hills-they're full of Islamist terrorist camps. He describes a much bigger nutshell. The Western world will not survive the 21st century. Many, if not most European countries will effectively disappear in our lifetime. Just as in Istanbul there's still a building known as St. Sophia's Cathedral, but it's not a cathedral: It's merely a designation for a piece of real estate. Likewise, Italy and the Netherlands will merely be designations for real estate. Forget the ecochondriacs's obsessions with rising sea levels that might hypothetically threaten the Maldive Islands circa 2500; contrary to Francis Fukuyama, it's not the end of history; it's the end of the world as we know it. Whether we like what replaces it depends on whether America can summon the will to shape at least part of the emerging world. If not, then it's the dawn of the new Dark Ages (if darkness can dawn): A planet on which much of the map is re-primitized.

Before you think that Steyn is as nuts as the ecodoom set, he reminds us of Chicken Little's successors in this field.

* Distinguished Scientist Paul Ehrlich declared in his 1968 best-selling book, The Population Bomb, "In the 1970s the world will undergo famines-hundreds of millions of people are going to starve to death."

* In 1976, Lowell Ponte published a huge bestseller called The Cooling: Has the New Ice Age Already Begun? Can We Survive?

* In 1997, Jimmy Carter, President of the United States (incredible as it may seem), confidently predicted that "we could use up all of the proven reserves of oil in the entire world by the end of the next decade."

None of these things occurred. But according to Steyn, here's what did happen between 1970 and 2000: in that period, the developed world declined from just under 30 percent of the global population to just over 20 percent, and the Muslim nations increased from about 15 percent to 20 percent. Is that fact less significant than the fate of some tree or endangered sloth? In 1970, very few non-Muslims outside the Indian subcontinent gave much though to Islam. Even the Palestinian situation was seen within the framework of a more or less conventional ethnic nationalist problem. Yet today it's Islam a-go-go: Almost every geopolitical crises takes place on what Sam Huntington, in The Clash of Civilizations, calls "the boundary looping across Eurasia and Africa that separates Muslims from non-Muslims." That boundary loops from Bali, to southern Thailand, to an obscure resource-rich Muslim republic in the Russian Federation to Madrid, and London before penetrating into the very heart of the West in a little more than a generation. September 11, 2001 was not "the day everything changed," but the day that revealed how much had already changed. That Tuesday morning the top of the iceberg bobbed up and toppled the Twin Towers.

Steyn says that his book is about the seven-eighths of the iceberg below the surface-the larger forces at play in the developed world that have left Europe too enfeebled to resist its remorseless transformation into Eurabia and that call into question the future of much of the rest of the world, including the United States, Canada and beyond.

He cites three key factors:

* Demographic decline: People Power.

* The unsustainability of the Advanced Western social-democratic state: Welfare and Warfare.

* Civilizational exhaustion: Fighting vainly the old ennui.

1. People Power

Steyn starts with demography, because everything does. He wonders how many pontificators on the Middle East peace process ever run this number: the median age in the Gaza Strip is 15.8 years. Once you know that, all the rest is details. If you were a "moderate Palestinian" leader, would you want to try to persuade a nation-or pseudo-nation of unemployed poorly educated teenage boys raised in a UN-supervised European-funded death cult to see sense? Any analysis of the "Palestinian problem" that doesn't take into account the most important determinant on the ground is a waste of time.

In a similar fashion, the salient feature of Europe, Canada, Japan and Russia is that they're running out of babies. What's happening in the developed world is one of the fastest demographic evolutions in history. The heart-warming ethnic comedies, where a WASPy type dates a gal from a vast, loving, fecund Mediterranean family, so abundantly endowed with sisters and cousins and uncles that you can barely get in the room, are an inversion of the truth. Greece has a fertility rate hovering just below 1.3 births per couple, which is what demographers call the point of "lowest-low" fertility from which no human society has ever recovered. And Greece's fertility rate is the healthiest in Mediterranean Europe: Italy has a fertility rate of 1.2, Spain, 1.1. Insofar as any citizens of the developed world are having "big" families these days, it's the Anglo democracies: America's fertility rate is 2.1, New Zealand's a little below. Hollywood should be making a movie on a sad, Greek, only child marrying into a big-heartwarming New Zealand family where the spouse actually has a sibling.

Steyn says this isn't a projection-it's actually happening now. But if you do extrapolate, here goes: by 2050, 60 percent of Italians will have no brothers, no sisters, no cousins, no aunts, and no uncles. The big Italian family with papa pouring vino and mama spooning out pasta on an endless table will be gone, no more, dead as the dinosaurs.

Experts talk about root causes. But demography is the most basic root of all. Many of the developed world's citizens gave no conscious thought to Islam before September 11. Now when we watch the evening news, there are many trouble spots around the world. As a general rule it's easy to make an educated guess at one of the participants: Muslims vs. Jews in "Palestine," Muslims vs. Hindus in Kashmir, Muslims vs. Christians in Africa, Muslims vs. Buddhists in Thailand, Muslims vs. Russians in the Caucasus, Muslims vs. backpacking tourists in Bali, Muslims vs. Danish cartoonists in Scandinavia. The environmentalist may claim to think globally but act locally; these guys live it. They open up a new front some where on the planet with nary a thought.

Why? Because they've got the manpower. Because in the seventies and eighties, Muslims had children (those self-detonating Islamists in London and Gaza are literal baby boomers) while Westerners took all those silly doomsday tomes about "overpopulation" seriously. We still do In 2005. Jared Diamond published a best-selling book called Collapse: How Societies Choose to Fail or Succeed. A timely subject, so Steyn bought a copy. It's all about Easter Island going belly up because they chopped down all their trees. The author sees his curious choices of "societies" collapsing because they chopped down their trees.

Steyn surmises: Poor old Diamond can't see the forest because of his obsession with the trees. Russia's collapsing and it's nothing to do with deforestation. It's not the tree, it's the family tree. It's the babes in the wood. A people that won't multiply can't go forth or go anywhere. Those who do will shape the age we live in. Because, when history comes a-calling, it starts with the most basic question of all:

* Knock-knock.

* Who's there?

2. Welfare and Warfare

In this section, Steyn gives us valuable insight into our welfare system. Demographic decline and the unsustainabilty of the social-democratic state are closely related. In America, politicians upset about the federal deficit like to complain that we're piling up debts our children and grandchildren will have to pay off. But in Europe the unaffordable entitlements are in even worse shape: there are no kids or grandkids to stick it to.

Steyn gives several examples of peaks and valleys of populations without any harm. In the post-Gold Rush Yukon, one minute the saloons are bustling and the garters of the hoochie-koochie dancers are stuffed with dollar bills; the next they're all shuttered up and everyone's skedaddled out on the last south-bound dogsled. But the territory isn't stuck trying to figure who's going to pay for the hoochie-koochie gals' retirement complex. Unlike the emptying saloons of White Horse and Dawson City, demography is an existential crisis for the developed world, because the 20th-century social-democratic state was built on a careless model that requires a constantly growing population to sustain it.

Steyn formulates it like this:

* Age + Welfare = Disaster for you

* Youth + Will = Disaster for whoever gets in your way.

By "Will" Steyn means the metaphorical spine of a culture. Africa has plenty of young people, but it's riddled with AIDS and, for the most part, Africans don't think of themselves as Africans; as seen in Rwanda, their primary identity is tribal, and most tribes have no global ambitions. Islam, however, has serious global ambitions, and it forms the primal, core identity of most of its adherents in the Middle East, South Asia, and elsewhere. Islam has youth and will. Europe has age and welfare.

Steyn feels we are witnessing the end of the late 20th-century's progressive welfare democracy. Its fiscal bankruptcy is merely a symptom of a more fundamental bankruptcy: Its insufficiency as an animating principle for society. For states in demographic decline with ever more lavish social programs, the question is a simple one: Can they get real? Can they grow up before they grow old? If not, then they'll end their days in societies dominated by people with a very different worldview.

3. Fighting Vainly the Old Ennui

Steyn then proceeds into the third factor-the enervated state of the Western world, the sense of Civilizational ennui, of nations too mired in cultural relativism to understand what's at stake. To Americans, it doesn't always seem obvious that there's any connection between the "war on terror" and the so-called "pocketbook issues" of domestic politics. But there is a correlation between the structural weaknesses of the social-democratic state and the rise of a globalized Islam. The state has gradually annexed all the responsibilities of adulthood-health care, child care, care of the elderly to the point where it's effectively severed its citizens from humanity's primal instincts, not least the survival instinct. These programs corrode the citizen's sense of self-reliance to a potentially fatal degree. Big government is a national security threat: It increases your vulnerability to threats like Islamism, and makes it less likely you'll be able to summon the will to rebuff it. We should have learned that lesson on September 11, 2001, when big government flopped big-time and the only good news of the day came from the ad hoc citizen militia of Flight 93.

There were two forces at play in the late 20th century: In the eastern bloc, the collapse of Communism; in the West, the collapse of confidence. The collapse of Communism is seen by Americans or at least non-Democratic, voting Americans-as "winning" the Cold War. But the French and the Belgians and the Germans and the Canadians don't. Very few British do. These are all formal NATO allies-they were technically on the winning side against a horrible tyranny few would wish to live under themselves. There was no sense on the Continent that our Big Idea had beaten their Big Idea. With the best will in the world, it's hard to credit the citizens of France or Italy as having made any serious contribution to the defeat of Communism. Au contraire, millions of them voted for Communism year in, year out.

The enemies we face in the future will look a lot like al Qaeda: transnational, globalized, locally franchised, extensively outsourced but tied together through a powerful identity that leaps frontiers and continents. They won't be nation states and they'll have no interest in becoming nation states though they might use the husks thereof, as they did in Afghanistan and then in Somalia. September 10 institutions like the UN and the EU will be unlikely to provide effective responses.

When Osama bin Laden made his observation about people being attracted to the strong horse rather than the weak horse, it was partly a perception issue. You can be, technically, the strong horse-plenty of tanks and bombs and nukes and whatnot-but if you're seen as too feeble ever to deploy them, you'll be kitted out for the weak-horse suit. He wasn't thinking of Europe, whose reabsorption within the caliphate Islamists see as all but complete. Rather, he was considering the hyperpower.

America is the most benign hegemon in history: it's the world's first non-imperial superpower and, at the dawn of the American moment, it chose to set itself up as a kind of geopolitical sugar daddy. By picking up the tab for Europe's defense, it hoped to prevent those countries lapsing into traditional power rivalries. Nice idea. But it also absolved them of the traditional responsibilities of nationhood, turning the alliance into a dysfunctional sitcom family, with one grown-up presiding over a brood of whiny teenagers. American's preference for diluting its power within the UN and other organs of an embryo world government has not won it friends. All dominant powers are hated-Britain was, and Rome-but they're usually hated for the right reasons. America is hated for every reason. The fanatical Muslims despise America because it's all lap-dancing and gay porn; the secular Europeans despise America because there are all these born-again Christians hung up on abortion; the anti-Semites despise America because it's controlled by Jews. Too Jewish, too Christian, too godless, America is George Orwell's Room 101: whatever your bugbear you will find it therein; whatever you're against, America is the prime example of it.

If Washington were a conventional great power, the intellectual class would be arguing that the United States is a threat to France or India or Gabon or some such. But because it's so obviously not that kind of power the world has had to concoct a thesis that the hyper-power is a threat not merely to this or that rinky-dink nation state but to the entire planet, if not the entire galaxy. "We are," warns Al Gore portentously, "altering the balance of energy between our planet and the rest of the universe." Steyn lists a number of so called alleged strains on the earth in ways that genocidal conquerors like Hitler and Stalin could only have dreamed of. The construct of this fantasy is very revealing about how unthreatening America is.

Consider those nations who regard themselves well-disposed toward America and share the view that Islamism represents a critical global security threat, yet have concluded that the United States lacks the will to get the job done. You hear such worries routinely expressed by the political class in India, Singapore and other emerging nations. The British historian Niall Ferguson talks about "the clay feet of the colossus." Admiral Yamamoto's "sleeping giant" has become hard to rouse. In Vietnam, it took 50,000 deaths to drive the giant away; maybe in the Middle East, it will only take 5,000. And maybe in the next war the giant will give up after 500, or 50, or not bother at all. America has the advantage of the most powerful army on the face of the planet, but she doesn't have the stomach for war, so it's no advantage at all. The minute you send it anywhere hysterical congressmen are shrieking that we need an "exit strategy." The corpulent snorer in the La-Z-Boy recliner may have a beautifully waxed Ferrari in the garage, but hates having to take it out on the potholed roads. Still, it looks mighty nice parked in the driveway when he washes it.

So why is a book concerning America's future so relevant and timely for physicians and health care? Steyn writes about the future of heatlh care as part of all government entitlements. He puts government heatlh care into a perspective that few who are still pushing for making it an entitlement understand. He has given up on Europe, calling it Eurabia. He predicts their cradle-to-grave welfare system will totally collapse before 2050, when there won't be enough children to pay for the beneficiaries. Then all heatlh care, social security, childcare and government programs will simply disappear; those that believed in entitlements will wonder why they are without benefits.

Suffused with Steyn's trademark wit and piercing insights, America Alone calls on us to summon the will to fight this great struggle for Western civilization. He provides an enlightening basis on just how bad things are currently, and how they likely will get worse. We should take his insight seriously so as to ensure that our children and grandchildren will live in the bright light of freedom our forefathers fought so hard to win. Let's not turn our backs on our heritage.

There is a message on how detrimental state heatlh care is for our future. He places it in context that even the most arched advocate of government medicine should be able to understand. It is critical for the leaders of our physicians' professional organizations (who are supporting single payer initiatives) to understand. This book has important messages for all physicians, nurses and health administrators. It is urgent, not only for our patients, but for all Americans to comprehend.

--Del Meyer