Berlin

I just returned from a trip to Berlin and I wanted to mention a few things on the blog. The reason I went was last summer my Dad said he wanted to see Berlin so we decided to go for several days over Memorial Day weekend. It is a beautifully diverse city with much history to explore, both recent history and earlier. My Dad was most interested in the Jewish sites such as the holocaust memorial and the Jewish Museum which were both very well done.

The Berliners we contacted were very pleasant and elicited mixed emotions from me. On the one hand these are the decendents of perpetrators of the worst crime ever commited in the history of humanity yet on the other hand I had empathy that they had to suffer the stigma of sins commited by others. What should be the realtionship between son of perpetrator and son of victim? I do not think there is a resolution to this conflict.

The next to last day we took a walking tour of Sachsenhausen, a concentration camp, located twenty minutes outside of Berlin. It was a very emotional visit especially since my wife's grandfather had been a victim of the Nazis in that particular camp. The tour guide was excellent as he tried to bring the site to life. He tried to have us picture in our minds the sufferring of the victims as individuals and the evil of the Nazis also as individual monsters.

I asked the guide if many Muslims come to visit the site as Berlin has a sizeable Muslim/Turkish population. I was curious because of the holocaust denial that seems prevalent amongst the Muslims as spearheaded by the modern day Hitler, Ahmadinejad. He said not many Muslims come but tried to put a spin on my question by relating a story that there was one Muslim victim of the camp during WWII. Not a satisfactory response. Although he did say that school children, including the Muslim school children come to the site as part of their curriulum.

Of course, holocaust denial is not a purely Muslim phenomenon. But my sense is if you polled Americans or Europeans the percentage of deniers would be under 5% while the same poll amongst Middle Eastern Muslims would be 20% at the minimum. I do not have hard data to support thiese numbers, just my suspicion. The horriffic fact is that the current response by Muslims is not the denial of holocaust but the desire to recreate it in the name of "the prophet". Check out the link below.

The one thought I kept coming back to was the importance of the State of Israel to the Jewish people. It is absolutely critical for our ability to defend ourselves and we must only depend on ourselves for our future. Next time we are not going down without a fight. AM YISROEL CHAI!!

http://www.youtube.com/watch?v=h0qkUB_SHQE&feature=player_embedded

Failure of USA Health Care

I saw a patient this week that exemplifies one of the many problems we are facing in the health care delivery system. The patient was a 30ish year old obese female with medicaid insurance who was told she has cancer of the thyroid and was referred for surgery to remove her thyroid. I was the fourth surgeon she was consulting because all the other doctors declined to operate on her. I like the others also declined to operate on her. Let me explain.

Removing the thyroid for thyroid cancer takes at least a few hours at the minimum. It involves extremely delicate structures of the neck putting at risk nerves that course beneath the thyroid gland that enable the vocal cords to move. It is physically demanding for the surgeon, requires great expertise and skill, and is still associated with potential complications even in the best of hands. It involves postoperative care in the hospital which require serial visits as well as follow up in the office. By the way, postoperative visits in the hospital and in the office are not reimbursed as they are considered included in the fee for the surgery. For all this the surgeon may get paid about 500 dollars. And to top it off, if there are any complications the patient can sue you, which will increase your malpractice insurance whether you win or lose.

So you can see why there are no surgeons willing to take on this case. This represents a systemic failure of our health care system and i believe is just the tip of the iceberg. I see patients all the time who cannot find a doctor to take on their cases and it is just going to get worse as reimbursements continue to fall and expenses go up. Doctors will only take on the safest of cases which have minimal risk.

Government bureaucrats think they are doing the population a favor by swelling the medicaid ranks. What use is it to have insurance if nobody accepts it? Medicare is only slightly better and soon I think the same will happen to medicare beneficiaries. They will not find the surgeons to assume their cases for pennies. When I see a patient who I want to refer out I will typically send them to the local teaching hospital. This is an ideal solution for these patient as they get treated for their problems but at the same time they are educating future doctors. Both sides win. The problem is when I send a patient to them they say we have a waiting list of six months. So here again is a failure of the system and similar to other countries with socialized care there are waiting lists to see specialists. The portion of the USA health care that is socialized has waiting lists at best and no care at its worst.

Bottom line: you get what you pay for. If you don't pay up for surgeons who endure long periods of training to attain the expertise to perform delicate operations. If you subject them to lawyers waiting to pounce on them for any negative result regardless of fault. If you treat us like the plumber that fixes your stuffed toilet but pays us less you can say GOODBYE! You will suffer the consequences.

Never Again Rings Hollow

We just celebrated Passover where a main theme is to remember what happened to the Jews thousands of years ago. It extends a transgenerational chain to teach our children and grand children about the exodus of the Jews from slavery into freedom. We also recite at the Seder that it is not just one nation a long time ago that rose up to destroy us but in every generation there will be an entity bent on our destruction. We relive our past to teach us and awaken us to our future.

We also just passed Yom Hashoah, Holocaust remembrance day where the main slogan is Never Again. We teach our children and the world about our experiences in Nazi Germany. We have ceremonies to pay tribute to those who perished and listen to survivors who give us testimonial to the shocking atrocities they lived through. We remember what man can do to his neighbors given the circumstances. We learn of the few righteous gentiles but also of the many complicit gentiles as well as the majority that remained silent.

After these two important holidays have passed and as powerful as these remembrances are, I feel a certain lacking in our (Jewish) response to these historical events.

We talk, we teach, we sing, we remember, but the glaring deficiency is what are we doing in the area of prevention. Words and memories are important but where is the action taking place to defend against the certain next attack against on the Jews. And I am referring to diaspora Jews, not Israelis. We cannot rely on words alone to prevent the next attack and we Jews should know better than anyone that when the time comes there will be NO ONE to protect us. We only have ourselves to protect us yet we do almost nothing.

How many times do we need to learn the same lessons until we understand that we must prepare ourselves better. Can we rely on the government? our local police? our courts? our non-Jewish neighbors? the constitution? How will the Jews defend themselves? Which Jews will be there when the time comes to defend us? Will the words of Jewish lawyers and Jewish politicians mean anything? The answer is maybe. In any case we must learn to defend ourselves.

We are extremely complacent living in this country (USA). These words seem radical to most Jewish Americans who can never envision attacks against us in the land of liberty. We must learn from our Israeli brothers and sisters that words are important but actions and preparedness are critical parts of the equation.