As tax cut-receiving Tea Baggers and town hall hecklers continue their tirades over health care reform, their kin in the Obama birth certificate denial crowd perpetuate their mass delusion. But lost in the fury is what might be deemed the Iron Law of Birtherism. That is, the birther movement is strongest in precisely those states where Republicans poll best and health care is worst. And as it turns out, there is a Birther Corollary: education, working conditions and myriad other indicators of social failure are generally most dismal in the most red of states.

In the staggering DailyKos/Research 2000 poll released 10 days ago, 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. (Nationally, only 11% of Americans denied Obama's natural citizenship, with another 12% in doubt.) This is a uniquely Southern pathology, a region home to 69% of all birthers and the only part of the country to increase its Republican presidential vote in 2008. And to be sure, the old times there are not forgotten. As Dave Weigel of the Washington Independent concluded, "as many as three-quarters of Southern whites told pollsters that they didn't know where Obama was born."

That the birther movement would take hold in the states of the old Confederacy should come as little surprise. While Americans rejected George W. Bush's Republican Party on Election Day in November, in counties across much of the South voters actually increased their support for the GOP candidate John McCain over Bush four years earlier. The interactive New York Times map above tells the tale of November's losers still fighting their failed 2008 campaign by other means:

That helps explains why when it comes to the delusion over Obama's citizenship, as Steve Benen observed, one of these things is not like the other:

"Outside the South, this madness is gaining very little traction, and remains a fringe conspiracy theory. Within the South, it's practically mainstream."

But that brand of racial flat-earthism is not all that's practically mainstream in the South.

Consider, for example, abysmal health care.

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 were Hawaii, Iowa, New Hampshire, Vermont and Maine. Bringing up the rear were the Bush bastions of Kentucky, Louisiana, Nevada, Arkansas, Texas, with Mississippi and Oklahoma. The 10 worst performing states were all solidly Republican in 2004; 8 voted for McCain in 2008. (In a sad irony, despite Oklahoma being ranked the worst of the worst, its congressional delegation led by James Inhofe, Tom Coburn and John Sullivan has been waging an all-out war to prevent the health care reforms their constituents of all Americans need most.)

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.)

Then there's working conditions. A December 2005 study by the Political Economy Research Institute at the University of Massachusetts showed that Americans' working conditions generally follow the 2004 electoral map. The report's Work Environment Index (WEI) rated the quality of Americans' working lives by a weighting of three factors: job opportunities, job quality, and job fairness. The top five states were Delaware, New Hampshire, Minnesota, Vermont and Iowa, the bottom five were South Carolina, Utah, Arkansas Texas and Louisiana. Unsurprisingly, all five of the cellar-dwellers are so-called "Right-to-Work" states featuring outright hostility towards union organizing. (Click the following links for maps of WEI by state and right-to-work states.)

(It is worth noting that since the Work Environment Index was published, the new federal minimum wage was boosted to $7.25 an hour, well above the $5.15 level previously in place in most Southern states at the time. It is also worth noting that since the recession began in December 2007, decidedly blue states like Michigan, Rhode Island, Oregon and California have been among those hit hardest by unemployment.)

When it comes to education, faithfully Republican red states do a little (but not much) better. In 2007, the U.S. Chamber of Commerce released a study titled "Leaders and Laggards: A State-by-State Report Card on Educational Effectiveness." The report looked at seven different performance categories, including return on education investment, workforce readiness, teacher skills, and academic achievement of low-income and minority students. Again, the top five states (Massachusetts, Minnesota, New Hampshire, Vermont and New Jersey) backed Democrat Obama in 2008. Only two of the bottom 15 states similarly supported John Kerry; five voted for Obama four years later.

The same disturbing pattern applies to a wide array of measures of social dysfunction and pathology. In 2007, 7 of the top 10 states with the highest murder rates were squarely in Red America; conversely, 7 of the 10 states with the lowest murder rates were in the Obama column. (Interestingly, six of those states have no death penalty statute.) The 10 states with the highest divorce rates in 2002 went for Bush two years later. (More recent data suggests an improvement in the Bible Belt.) In January 2009, a new report from the CDC showed teen birth rates increased for the first time in 15 years. Topping the list was Mississippi; again, 8 of the other 9 states in the top 10 went Republican in 2008. By almost any measure of societal breakdown that so-called Republican "values voters" decry, it is Red State America where moral failure is greatest.

Perhaps greatest among those moral failures is the simple unwillingness to accept the empirical truth. Like it or not, Barack Hussein Obama was born in Hawaii and was legitimately elected President of the United States. This objective fact is not merely a case of Colbert's Law, in which "reality has a well-known liberal bias." The paranoia and not so thinly veiled racism of partisans from the underachieving red states, aided and abetted by their feckless Republican representatives, is the Iron Law of Birtherism.

Note: None of the above is to equate correlation with causation, or to ignore the central roles of economic development, demography and history in impacting the social indicators described here. While a state with an overall political preference may exhibit high rates of a given social dysfunction, that does not mean the supporters of that political viewpoint endorse or engage in the behavior in question. That said, when it comes to living standards, culture, politics and public policy matter.

(An earlier version of this piece appeared at Perrspectives.)