Market Psychology Under BO

One of the benefits of working as a doctor is coming across a wide selection of the workforce. This allows me to me to get a decent read of the economic activity of the local and national economy. I see realtors, factory workers, small business owners, Wall Street bankers, UPS workers, local bankers, day workers etc. I often ask them how business is going to get a feel of the general business climate.

This past week I saw a man who works for a fund that invests in real estate. He told me that they are not buying anything now and not expecting to in the foreseeable future. When I asked him why, he explained to me that his investors have been turned off by the current administration’s attitude towards the financial industry. I am sure if there was money to be made these people would find a way to invest but it is interesting how these psychological factors have affected their investment decisions and thus the economy.

The most critical group of people responsible for economic expansion are the entrepreneurs, the risk takers. They are the ones who establish new businesses and create jobs. For multiple reasons they are inactive including fear of federal regulations and taxes, fear of continued economic malaise, and fear of inflation due to overprinting of money by the fed. But most importantly they feel vilified by the current administration. They have been portrayed by the left as the source of all that is wrong and this had led them to respond by inactivity. This is their weapon by which they can respond to such attacks. The irony is that the administration needs these entrepreneurs to become active, to grow the economy, to produce jobs and generate tax revenues to support government expansion.

Market psychology is perhaps the most important factor when it comes to economic trends. As long as the sentiment remains that government is anti-business, the economy will continue to stagnate. The entrepreneurs must feel that the potential reward gained is worth the risk taken. BO thinks the government can replace the private market in expanding the economy. He also believes he can continue to drain private business to support his government expansion while vilifying the golden goose at the same time. Sadly this is only a recipe for further deterioration of the economy which then leads to more safety net expansion of the government. And the cycle continues downward.

BO Surfing TV

I was wondering when BO was at the end of his day, sitting on the couch in some room of the white house with a remote control flipping through the channels what he watches. I have a strange suspicion he lands on Fox news and watches Beck, O’Reilly and Hannity. One might think he would select NBC, CBS or MSNBC, which are outright supporters of his, but I do not think he goes there and I will explain why.

BO is a narcissist. He truly believes he has the answer to all of our problems and given time he can solve them all. This is why government will expand dramatically under his watch as he views it as the solution to our woes not the problem itself. He also believes he is smarter than all the presidents before him which is why he travels around the world apologizing for previous administration’s actions and decisions. Of course, he has the benefit of hindsight. By apologizing for previous policies he elevates himself personally at the expense of the previous decision makers and the historical record of the country. The apology confers the idea that if only he had been the president at that time, a better decision would have been made. It’s all about him.

As a narcissist BO cannot understand how people exist that do not agree with his policies. This probably eats him up inside and is eager to understand why there are dissenting opinions if he already has all the answers. This is why I think he is obsessed with Fox news, the main TV outlet for opposing opinions. He doesn’t care about MSNBC where they are all Kool Aid drinkers and cheerlead for him regardless. He dwells on those “crazies” who can actually disagree with him and he tries to comprehend why.

Fox news can thank BO for his loyal viewership. But he should not feel alone because as the ratings would indicate millions are tuning in to Fox over NBC, CBS, and MSNBC. He wishes it were for the same reasons.

Timing is Everything

It is now clear why it took so long for BO to come forward with his Afghan plan. Call me conspiratorial but I think he was waiting to use the issue as a way to deflect attention away from the health care argument. This administration is extremely calculating and as Rahm says never let a major issue go to waste, but use it to advance your agenda even if it involves a failing economy or sending kids to war.

The popularity of the health care plan was dropping on a weekly basis. The more people knew about it, the more they disliked it. They had to get this issue off the front pages and talk shows. They successfully deflected the attention of the media and the American public away from health care and onto the Afghan war.

The GOP has to be just as calculating and prepare for the Dems maneuvering. For example, the Dems are waiting to bring up the immigration issue to coincide with the next election cycle. They are well aware of the polarizing nature of this matter and the power of this issue to bring out the all important Hispanic vote. They are using immigration reform as a tool to manipulate the electorate and extend their power. The GOP must prepare the counter argument that will not alienate the Hispanic vote but attract the vote to the Republican side. They have plenty of time to come up with a platform that would appeal to the Hispanic voter.

They have to send a positive message to the Hispanics that they add a great deal to our nation and are critical to our future. Stay away from the often negative statements of illegality, deportations, and draining society’s resources. The vast majority of the Hispanics want their chance at the American dream not a replay of the socialist state that they escaped from and which the Dems are creating. This along with their high percentage of religious devotion should make them natural allies of the GOP.

The Republicans need to be just as cunning and manipulative as the Dems. They have to predict the timing of issues and plan their counterarguments. Most importantly they need to keep their messages positive. Negativity is not a recipe for success.

BO's Afghanistan Poilcy

BO is stuck in a corner regarding Afghanistan and this is why it has taken him so long to arrive at a decision. He campaigned on the idea that Iraq was the bad war whereas Afghanistan was the right war, the war of necessity. I don’t think he actually believed that but took that position to be the non-Bush. Instead of campaigning on his true beliefs he said whatever it took to be elected even in the case of war.

Now he actually has to be the commander in chief of a war that he likely does not believe in but is forced to fight. Everything points to the fact that he is a pacifist and likely believes there is never a case for war. He believes in talking as the sole instrument in resolving issues as we can see in his comments and actions in regards to other conflicts.He also has to please the far left, to which he is indebted, who is anti-war.

Afghanistan is very different than Iraq and what worked in Iraq will likely not work in Afghanistan. Perhaps a more limited force would be better with greater emphasis on intelligence and surgical strikes. The idea of adding additional troops there as sitting ducks waiting for the Afghan army and government to evolve is a mistake. I fear major troop losses. We need leaders who can think outside the box. A surge won’t work everyplace just because it worked in one place.

BO is incapable of fighting this war that he is not dedicated to and this will be detrimental to the troops in the field. For this reason he should not approve any more troops to be sent over and should plan for withdrawal. This is most likely what he would like to do but he would need to backtrack on his previous words. This would be difficult for him but isn’t that admission better than sending our boys and girls into a war that he does not back 100%. If he feels cornered into making the choice between two bad decisions I hope he selects the side that preserves the troops versus what is politically convenient.

Government vs. Health Insurance Company

Although the majority of the implementation of the health care proposal will go into effect in 2013, two changes are planned to start immediately. Those are the prevention of insurance company’s denial based on pre-existing conditions and the elimination of lifetime caps on benefits. It is obvious that if insurance companies are forced to comply with these regulations then the cost of insurance will need to go up and perhaps significantly. This will result in a decrease in employers offering insurance, more out of pocket expenses, more people uninsured, and ultimately greater unemployment. Exactly the opposite of what the goals of the government should be.

What needs to be understood is that the insurance company is just a middle man that takes in premiums and then doles out payments and takes a cut as their profit. They create insurance products with pre-existing clauses and lifetime caps to keep the premiums down for the purchaser. Then when an individual’s care is rejected due to the details of the health plan they selected, the insurance company is viewed as evil. The insurance company becomes an easy target for policy makers but in truth is implementing the plan that was paid for.

The insurance company keeps premiums down by rationing care. They attempt to screen out costs that are deemed to be unnecessary and are vigilant against fraud and abuse. This may seem cruel at times, especially when dealing with the sick but it is necessary to maximize the value of the premium dollar. Critics will say the insurance company denies care to improve their profits not to keep premiums low and there is likely some truth to that. But that is where competition and the free market step in. The company must keep their insured satisfied and their premiums competitive. This is why maximizing competition is critical. The more competition that exists, the better the product at the lowest cost. This is why purchasing plans over state lines which would enhance competition is such an important change.

The government has demonstrated its inability to limit costs and instead ends up overpaying for unnecessary and fraudulent claims. They are able to do this because they are not limited by the premiums they collect and by shareholders seeking earnings. They are funded by the taxpayer, the printing press, and by borrowing from China.

As the government puts more restrictions on insurance companies they are essentially limiting the options for us to choose from. This will result in more expensive policies and fewer people insured. More people will then rely on government for health care which is their underlying goal. Vilifying the insurance companies by the government is a populist scheme to garner more federal control and less individual liberty.

Israel vs. Iran Coming to a Head

Last week in Iran there was a state sanctioned rally to mark the 30th anniversary of the US embassy takeover. Instead of the expected anti-Americanism, the Anti-government reformist took over demonstrating once again against the current regime. Another indication that the Iranian public is not supportive of the current leaders but has little opportunity to achieve change. The government is trying its utmost to suppress this opposition and will do anything to maintain their control. As an American this may seem to be a favorable trend but I think it actually creates a very unstable and dangerous situation.

As per the usual middle Eastern playbook, the regimes attempt to divert the attention of their populous by diverting their attention away from their corrupt despotic government. What this usually means is to instigate a confrontation with Israel. When Israel responds the blame for the incident is placed on Israel and the Arab/Persian media gang up on Israel hoping to divert the attention of their street. Unfortunately, the European and American media are right behind lining up to blame Israel first. If the Israelis only treated the Palestinians better this would never have happened. What B.S. We have seen this play out in Gaza and Lebanon.

I have great concern that Iran is going to draw Israel into a confrontation either in Gaza or Lebanon. The Iranian regime is feeling much pressure from their citizens and they will take desperate measures to remain in power. It will not take much to instigate Israel as we saw a few years ago it only took the kidnapping of two soldiers. The Iranians use Gaza and Lebanon as pawns to achieve their own goals at the expense of Arabs whom they view as expendable. The Persians are building up the weapons in Gaza and Southern Lebanon as demonstrated by the vessel the Israelis intercepted recently with massive weaponry destined for these areas.

I fear the next 6-18 months as Iran sees that Obama is a weak leader and is distancing the US from Israel. Iran is banking that US support for Israel is waning and sees this as an opportunity to achieve its goals of distracting the street and eliminating Israel. I suspect Israel is well aware of the scenario, is taking the appropriate steps and sees this as its own opportunity to remove Iran as its main threat. Israel needs to strike at the heart of the beast and it needs to act before Iran obtains nukes.

Fort Hood, Who's to Blame

What bothers me most about the massacre at Ft.Hood is the revelation that there were several indications that the shooter, Nidal Malik Hasan, was a problem waiting to happen. Apparently, he made numerous comments regarding his opposition to the war which alone isn’t a problem as I suspect many in the armed forces feel similarly. He also made comments to the effect that he felt suicide bombers were justifiable in their actions. He had colleagues that were aware of his radical views that were never acted upon by authorities. It is now coming out that he attended the same mosque as two of the 9/11 hijackers. Lastly, I just heard the government was aware for months that Hasan was trying to contact Al Qaeda.

There is plenty of blame to go around but I put the majority of the blame upon those that have crippled us with political correctness. The lawyers such as those on the ACLU have caused everybody to walk on egg shells when it comes to treatment of certain protected groups. We are all so scared of getting sued that we are unable to protect ourselves when a true threat arises. I am sure that nothing was done to Hasan because of his religion as the authorities were concerned about being called racists and possibly indicted for discrimination,

These lawyers have the blood of the thirteen murdered victims on their hands. We as a nation have allowed the lawyers to bring us to a point that we can no longer protect ourselves. I do not know how, but this must change for the nation to survive.. The notion that by just giving everybody a chance, treating them as equals, and availing all people of opportunities that they will reciprocate with gratitude is false. There is a segment of the population that is overtly anti- American and this group must be identified and dealt with regardless of their color, race, sex or religion.

I hope this tragic episode causes a redirection of our legal system, our mainstream media and our liberal politicians. But I am sure that instead of blaming radical Islam, somehow Hasan will be viewed as a victim. This country is in truly bad shape and there doesn't appear to be anything to be hopeful for in the near future.

Pre-existing Clause Tactic

This week I had an interesting situation with a patient and his insurance company. A young man with a mass in his nose that clearly needed surgery. As usual we called the insurance company first to get pre-certification. This informs them of my plan and whether I can proceed with the proposed treatment. Since they are paying they require us to obtain their permission and that’s fine. One would think that if they approved the surgery that would mean I would get paid, but that is not the case. They approve the surgery and then decide afterwards whether his benefits apply. For this patient I was told by the insurance company that his condition is pre-existing and so I can proceed with the surgery and then afterwards they will decide if they will pay. It’s not like if they don’t pay me I can take the surgery back.

Thereafter, I spoke with the patient and told him if he wants to proceed he would have to pay us in advance for the surgery. If his insurance company paid us we would refund his money. I they denied our claim we would keep the deposit. As of now he has refused to agree to those terms and is looking for another doctor to operate on him and will do so knowing he or she may not get paid, but will only know that after the fact.

As a doctor why do I have to deal with these insurance company tactics? I wasn’t trained to negotiate with a bunch of bean counter suits whose only goal is to find ways not to pay valid claims. This is another example of a patient being failed by his insurance company. It also demonstrates the shortcomings of the current proposals as well as the problems with for profit private health insurance.

The administration is putting forward the notion that an insurance company cannot deny coverage to anyone, an obligation that already exists in New Jersey. The opponents argue that a person will just wait until they are sick to obtain coverage. But as is evident in this case, coverage does not translate into treatment. If there is a gap in coverage (a period of time where the individual was uninsured) the insurance can use a pre-existing clause to deny treatment.

The solution is to mandate coverage for everyone at all times so there will never be a gap in coverage that can result in denial of services. This makes sense because often illness comes on unexpectedly so one should always carry health coverage. But logistically how can you force the small business owner or the fellow who just lost his job to pony up thousands of dollars that he/she may not have for a private plan? The only answer I can come up with is for government to step in. As much as it bothers me, I agree with the need for a public plan as a safety net for those who need to fill in their gaps in coverage. This coverage must be bare bones in order to minimize cost to the taxpayer and to incentivize the individual to obtain a better private plan.

BO vs. Fox

The White House is making some serious blunders as it tries to vilify Fox News Channel. Perhaps they are trying to use Chicago style tactics against those that do not line up behind their agenda. In reality, all they are doing is demonstrating their lack of confidence in their own ideas and their own staff. It appears that they cannot defend their agenda or appointments but instead must resort to political ploys to quiet their opponents.

What better way to demonstrate the benefits of your agenda than to debate them with others of differing opinions? Why not have a representative from the White House go on Fox to debate and defend their proposal? They should go on O’Reilly, Beck, and Hannity which gives them the perfect audience. Those that do not agree will perhaps be convinced to support their proposals. This should be desirable for the administration unless they feel that their agenda does not hold up to debate.

More and more I see the administration hiding from their own proposals. It seems the less they let the public know about the details the better for them. In fact, it is exactly their strategy to minimize the dissemination of the details of their plans for us. We are supposed to be like sheep lining up and not asking any questions. The problem with Fox is that they are asking the questions and this threatens BO. They are unveiling the details to the public and this frustrates the White House. As the specifics come out BO’s popularity declines.

What’s worse for BO is that Fox is attracting record number of viewers, thanks to him. As he tries to silence his opposition he is in fact doing the exact opposite. People wonder what they are saying on Fox that has BO so riled up so they tune in to find out. BO would have done much better never singling out Fox but now that he has, he must face them directly. He has to confront the opposition or his popularity will continue to fade as people lose their confidence in him. People will assume he has something to hide.

The truth is BO and Rahm cannot defend their positions. Upon close scrutiny their ideas will be unpopular and will not pass. Their only chance is to keep us in the dark. Thank heavens for Fox which shines a bright light on their schemes.

I Just Don't Get It

I went into this hotel last week and got into the elevator along with several others. The door shut and the elevator started rising. Suddenly the lights went off and the elevator continued to rise. All you could see was the digital display of the floor you were up to and the people in the elevator became very nervous. People were screaming. It reached the top floor and all of a sudden something snapped and the elevator went into free fall. The weird thing is I waited one hour to get on the elevator and I even paid to get on knowing what was going to happen. Naturally, I was at Disneyworld at the Tower of Terror.

Can someone please explain to me the attraction of this ride? I just do not get it. And while you are at it you can also explain why people get enjoyment from riding on a roller coaster that makes you feel like you are in free fall. I experience total fear and the sensation that my private parts are transplanted into my throat. I assume I am not unusual with these feelings but the fact that some enjoy them escapes me.

Putting that experience aside, Disney does a terrific job with their customers. Their staff is wonderful, including the greeters at the airport, the drivers of the buses, the hotel staff and the employees at the theme parks. They interact with thousands of people yet are kind and patient and are wonderful with the children. Any company that wants to learn about customer service should send their employees to Disneyworld. As I also deal with the public on a daily basis I know how difficult it can be. I certainly learned from my experience at Disney and will try to be more patient with my clients.

There were many foreigners at the parks which is a testament to the global attraction that is Disney. It is a great asset to this country and generates many jobs, tax revenue, and infrastructure to that region of Florida. Walt was a remarkable man with great foresight.

My four days at Disney with my seven year old son were unforgettable. Watching his smiles as we went through the parks is something I will always remember. I thank Disney for giving me the opportunity.

Next time we go to an amusement park, though, I’ll be watching him from sidelines.

The On Call Nightmare

This week I have the distinct honor of being on call. Let me explain to you what that entails. For one, my patients and the patients of other doctors I am covering for can call me for any problems they may have during hours when the office is closed. I think the public watches too much Grey’s Anatomy because people honestly believe that I live in the hospital and my entire life is exclusively geared towards their every desire. People are surprised to hear that I actually have a life outside of medicine. Because of this, people have no problem calling me at any of hour of the night with their non-emergent issues. It is not unusual to get the call at 3 am from the patient with ear pain that has been going on for a week. The chutzpah of some people who call me in the middle of the night is not to be believed.

As bad as that part is, it is not the worst part of being on call. The worst part is the requirement to take emergency room call. As part of my privileges at the hospital I belong to, I am required to share in taking care of people that show up in the emergency room with problems within my specialty. Now this may sound like a reasonable system but the truth is the system is broken. Many times the people who show up in the ER have no medical insurance. I am required to travel to the ER, take care of the patient, travel back home, all for free (yes, I can bill the patient but I never get paid). And worse, this patient can sue me if things, for whatever reason, go wrong. A high percentage of lawsuits are generated by emergency room visits. I essentially have legal exposure and must pay exorbitant malpractice premiums without the possibility of generating compensation. Now you tell me what other profession is enslaved like this.

Taking it a step further, if I am up in the middle of the night taking care of the nonpaying patient I may have a full day the next day with multiple surgical cases and a full schedule of office visits. So here I am operating and consulting on my insured patients with little or no sleep. There is no way anyone can be at their best having been deprived of sleep. The emergency room effects the care of those who are not even there, but just unfortunate enough to have picked their appointment on the day after a bad night for the doctor.

One will ask why then would I maintain privileges in the hospital and I would answer that I really do not want to. But, I am forced to have privileges by whom else but the insurance company. To be on their panels you must maintain privileges in a hospital.

There is no doubt that the system of emergency care is completely broken. More and more doctors are electing not to take emergency call unless they are compensated for it. This will affect care for people who truly require emergent care. Ultimately, it is always the public that suffers.

Well I’ll end it there. I just heard my beeper going off.

9.8% and Counting

Week after week we see more and more jobs being lost. At least 200k jobs almost every week for months. We are up to 9.8% unemployment and that figure probably understates the actual number. The harsh reality is that these many of these jobs are not just temporarily lost but are gone forever. This trend is neither BO’s fault nor GW Bush’s as some analysts would have you believe.

Many of the lost jobs were in industries that were based on bad business models such as the auto industry where a high school graduate could get a job on the assembly line for 60 dollars per hour with unheard of benefits. This is obviously unsustainable and ultimately makes the business noncompetitive in the world market. These jobs are not returning.

Many of the jobs were in industries that were being overinflated due to bubbles. This includes the real estate business with jobs ranging from construction workers to real estate brokers to mortgage companies. Many jobs were lost here after the bubble popped and are certainly not coming back.

Many jobs were lost in the financial industry which was both a flawed business model as well as a business overinflated by the creation of debt instruments. Nothing was actually created by these companies, just the repackaging of debt and selling to the next guy. Then that guy would sell it to another guy. A huge pyramid scheme. These jobs are not coming back.

So where does that leave us? More jobs will be lost as these industries consolidate. That is why we are seeing improvement in earnings as company’s expenses are being reduced due to lower personnel cost, not by greater sales (top line growth). The economy is stabilizing but will only expand once top line growth improves which will only happen when employment improves.

A no-brainer would be to immediately encourage the production and usage of our own sources of energy. This creates new business and enlarges existing businesses in that industry. Instead of shipping billions of dollars to import energy/oil, that money could be staying here creating good paying jobs. The plan to convert all 18 wheelers to natural gas should start immediately. We have lots of natural gas and reduces our funding of despotic regimes.

The key to job growth is in new industries and small business which is being ignored by the current administration. In fact, they are being targeted for more regulation and tax increases. Small business is the generator of jobs in this country and everything should be done to facilitate and encourage their development. It is the only way to create prosperity for all of us. Energy jobs are the way to go, NOW.

College Selection Process

This past week I went with my daughter to visit a college campus that she is interested in applying to. She is a senior in high school and is going through he process of college selection. I think the competition to get into the top universities is much more intense than when I applied almost 30 years ago. I do not envy her as she goes through this process. If you look at the numbers, there are so many kids with perfect SAT scores, top grades and excellent extra-curriculars it seems a very daunting task to go through this process. So many kids go through intense tutoring and spending their summers in educational pursuits that the bar has been risen to unobtainable heights. These kids are prepped to the exclusion of having a "normal" teenage lives just to be able to get into a particular college. Many of these kids lack adequate and critical social skills which are so important in almost all professions and businesses.

I keep telling her that it is not the most important thing where she goes to school and that she will be happy wherever she attends. I encourage her not to fall in love with a particular school that she can attain her goals regardless of the school she attends. I tell her that ultimately it is the qualities that she possesses, not the university from which she graduates that will dictate her success. Nevertheless, her desire to excel generates pressure on herself to go to a top school and I fear her disappointment if this doesn't occur.

After listening to the admissions officer discuss what the school looks for when making their selections, I think that they get it. They do not only look at the numbers but at the entire package. I don't know how they do it and I think it is a very difficult task to weed through thousands of applications and make intelligent selections. Somehow they are able to determine from an application who is the best fit for their university. They understand that the goal is a well rounded child who can excel in their schoolwork yet can also be a good communicator, a leader not just a human computer with perfect numbers.

Say what you want about the average high school graduate in this country, but the upper echelon of graduates that are generated are extraordinary. There always seem to be a group of kids that excel and will be able to successfully compete with piers from anywhere in the world. This is created by their own innate ambition and their desire to excel, not by an external force. I very much hope my daughter gets into the college of her choice but I have no doubt she and other graduates ultimately achieve based on their own assets and liabilities not by the words on their diplomas.

Race Relations under BO

This week I was on call and was called into the hospital in the middle of the night to consult on a patient who was having an emergent problem breathing. He bit his tongue and the entire tongue swelled to the point where it was blocking his ability to breath. When I arrived at the bedside in the intensive care unit there was a Filipino nurse an Indian hospitalist, an Arabic respiratory therapist, an African American anesthesiologist and me, a white Jewish guy. This is truly a remarkable collection of disparate ethnicities that were brought together that night. Almost every corner of the globe was represented that night, assembled to save the life of this man. The truth is nobody in that room cared about the sex, color, religion, or age of the other people. Especially the patient didn't care, he just wanted us to do our best to help him.

When I arrived there I saw the anesthesiologist who was trying to help this man. I have known him for several years and is one of the best anesthesiologists I have ever worked with. I was incredibly relieved knowing that he, in particular, was there as we worked together to save this man. His skin color never was or is a factor in our working relationship. We respect each others ability to do our jobs as we aim to help our patients. We look at each other and we look past the superficial. When I look at him I do not see a black anesthesiologist, I see an extremely competent professional, an excellent anesthesiologist. This patient was very lucky to have had this anesthesiologist on call that night. The two of us live in a post-racial world where we judge each other not by color but by our abilities.

This episode stands in contrast to what I am reading in the newspaper and seeing on the television. The comments by Jimmy Carter that opposition to BO's health care is racially motivated. The questions of Barbara Boxer to Harry Alford about his taking a position not in line with the black caucus. The recent discovery that BO's czar Van Jones believed white people were intentionally polluting black communities. All these are making race relations worse. BO was supposed to be healing racial tensions but I believe instead things are getting worse. Certain people in both parties cannot get past the color thing. One might expect more from the dems as they are the party that supposedly represents most African Americans. But every time they bring up the race card they show they are just as fixated by color and cannot see past peoples skin.

We will never live in a post racial world as long as every time someone opposes a position by BO they are called racists. How are we supposed to have a democratic system if your motives are questioned whenever you disagree with a position held by someone of the opposite sex, different color, or another religion. Fortunately for that patient the other night, many of us do live in a post racial world and see each other as colleagues and partners. We work together as equals to perform for our patients. We see past the amount of melanin in our skin. We in the real world have made great progress in this regard while the government and politicians cannot and may in fact be contributing to undermining this progress.

We all thought that having an African American president would be great for the country. Even if we didn't believe in his policies it would demonstrate that we are past the whole race thing that we could elect a black president. Unfortunately, I believe the legacy will be that race relations will worsen under his administration. There are just too many people white AND black that just cannot see past skin color.

Perspective

As much as I rant about the issues related to health care I must say that the practice of medicine is a very sobering one. This past week I had the unfortunate opportunity to diagnose two women in their twenties with cancer. They both came with masses in their necks and after biopsy were both positive for lymphoma. They were living completely normal lives until one day they felt something abnormal in their bodies. It is unimaginable that in the course of days we can go from our normal routine to our lives being turned completely upside down with our lives in jeopardy. I am left with something very important and that is perspective as my "problems" seem very small after having to tell these women their diagnoses.

I think we tend to lose our perspective as we focus on the details of our lives. This is likely our natural tendencies to concentrate on our own sheltered lives until we are exposed to another's tragedy or perhaps one of our own which then give us perspective. It is unfortunate that it takes a shock to regain our sense of what is truly important. On the other hand, is it preferable to go through life with the attitude that things can always be worse, that every problem that arises is negligible compared to what these women are faced with. This approach tends to minimize any conflict that is not tragic which can also be problematic.

Clearly, the balance lies somewhere in between where we deal with our problems but always keep them in perspective. This is easy to say but difficult to live. We tend to drift back into our own worlds as it is too difficult and painful to live our lives thinking that tomorrow or the next day we will feel a lump somewhere in our bodies that shouldn't be there. I think as doctors we are faced with people's tragedies and are reminded often about perspective which tends to minimize other problems that may arise. This doesn't necessarily work well if our spouses do not share our perspective and feel that we too easily dismiss what they consider problematic. I suppose this is an occupational hazard.

These next few weeks are the period in the Jewish calendar where we are judged and our fates are determined for the coming year. Who will live and who will die. Whether one believes that his/her future is determined in the next couple of weeks is a personal issue but it certainly demands that one put their life into perspective. We never know whether we will wake up one day with a lump somewhere and our lives will forever be turned upside down.

Something for Nothing

This week a 47 year old female came to see me in the office. She weighs 275 pounds and she came to see me for a minor problem. I looked at her insurance information and was surprised to see she had medicare. For those of you who don't know medicare is not only for the elderly but it also is given to people who qualify for permanent disability. Aside from her weight she did not appear to be someone who is completely disabled so I asked her the nature of her disability. She explained she tore something in her knee which was repaired and thus she was placed on permanent disability. As a result she receives medicare and disability payments from the government forever. She then proceeded to leave the office walking without difficulty.

There is no reason why this lady should qualify for disability especially because her knee problem was likely caused by her own self inflicted obesity. There is no doubt in my mind this woman is completely capable of some type of employment but it is much better for her to collect disability than to get a job. I wouldn't even be surprised if she does have a job that pays her under the table and thus does not get reported and effect her eligibility for disability. Basically she is gaming the system at the expense of the taxpayer.

This is what tends to happen when government takes control and offers free services. What I call the something for nothing crowd finds ways of gaming the system to get freebies and benefits that they are not truly entitled to. So even though the government may be well intentioned in trying to assist the poor and disabled when people see the government giving out money, they line up. The government does not do a good job at policing who gets the benefits and is truly qualified or if they are just cheating. They just keep doling out freebies and continue doing what they are good at which is taxing and borrowing. It is government's duty that if they are going to confiscate my money and my kids and grandchildren's future earnings through taxation and borrowing to give to someone else they better be darn sure that person is truly deserving of it.

In general, the government is not good at policing fraud and abuse in their welfare programs and this is seen in the medicare program where estimates are as high as 10%. It is not surprising since government believes it has no limit on its spending and little incentive to cut the fraud. They'll just keep sucking the blood from the taxpayer. The truth is, the present government probably couldn't care less whether there is fraud because ultimately there goal is to redistribute wealth from the taxpayer to the non taxpayer. Whether this is done honestly or through fraud doesn't matter as long as the ultimate goal is achieved.

There is a segment of the population in this country who try to live off the benevolent nature of the government. They justify in their minds that they are somehow entitled to these benefits and do not see themselves as cheaters, thieves, and parasites. They don't see that they are in effect taking money from someone else unfairly because government is in the middle taking the money through taxes and then giving it to them. I do not know if this exists in other countries but my feeling is this is much more prevalent in this country. As government expands expect the something for nothing crowd to be lining up.

If You Like Your Health Plan You Can Keep It But....

If you like your health care plan you can keep it and if you like your doctor you can continue to see him. This is the BO mantra. He starts out every health care speech with this statement as he thinks the more he says it the more it will be believed as the truth. But let me tell you the real deal. BO is absolutely telling the truth, however, he is leaving out a critical part and only revealing half the statement. He is right in that in Obamacare you can keep your health paln/doctor but what he fails to mention is that is going to cost you more and possibly a lot more to do so. You see, these lawyers such as BO are trained to use the English language to deceive. They purposely make comments that are half truths and incomplete so that they cannot be accused of lying in the future. They are experts in the field of verbal deception. He purposely leaves out the second sentence that the cost to keep your plan/doctor may be prohibitively expensive because he knows this would be unpopular and kill the plan. By creating a system of government health care, private care would be comparatively more expensive and this will de facto force more people into the public plan on an economic basis. BO can later claim he was telling the truth, that you can keep your plan. Bur he fails to mention only if you can afford it.

As an employee either your employer will provide health care or he will have to pay a penalty to the government so the government can supply you with health care. Lets take the first situation. Your employer give you an amount of money to spend on health care. You go the market place and find that your employer has given you enough money to pay for the public plan (what incentive is there for him to provide more?). In order to keep your existing plan you will have to pay the difference which may be thousands of dollars. So you will have to decide whether you want to spend the difference to stay in your existing plan or opt for the public plan.

The second situation is very similar but instead of getting the subsidy from the employer, it is coming from the government, The subsidy from the government will also likely cover the public plan and you will have to decide whether you want to pay the difference to stay in your existing plan. Again, BO says you can keep your plan but what he fails to mention is that it’s going to cost you.

The other factor is how the cost of the public plan will be determined. The politicians can easily keep it artificially low which will make private health insurance comparatively more expensive requiring greater out of pocket expense to pay the difference. This will make private insurance more out of reach for most people dumping more of the population into the public system.

Truthfully, I have no problem with a competing public plan that is accurately priced. The private health insurance is also broken as too much money goes towards overhead ( CEO salary, advertising, stockholder profits) and too little for medical care. The public plan would force private companies to compete by lowering overhead and premiums. The only caveats are that the public plan must be priced at an accurate level base on its payment of services and overhead. It cannot be subsidized with taxpayer dollars. It must allow providers to participate and drop from the plan based on their reimbursements.

People in their gut know the future of their health care lies in the balance and that is why we are seeing such an enormous backlash. Do not believe you will be able to keep your own plan without great expense. If it sound too good to be true it likely is. Beware the experts of verbal deception.

End of Days

Of the several venues that I frequent in my practice I began to consider a nursing home that I visit on occasion. On this unit the residents are all hooked up to ventilators or breathing machines. They are all incapable of breathing on their own so a trachesotomy is placed which is a hole in the front of the neck and a tube is placed into their windpipe which then gets attached to a breathing machine. Periodically the tube wears down and that is where I come in to change it. These patients are fed through a tube that goes through their abdomen into their stomachs, are completely unaware of their surroundings and are essentially kept alive through artificial means. They have absolutely no quality of live and in fact are likely suffering. I suspect if they had the chance to express their views they would elect to have the machines removed and allowed to pass.

The problem is that the majority of these patients experienced a sudden, unexpected and significant brain injury. Whether a large stroke, traumatic brain injury or an aneurysm that ruptured they succumbed to an event that placed them in this unit without the ability to have planned for their desires. Some live for years in this situation with absolutely no chance of recovery and the costs to maintain these individuals is enormous. Only the families can elect to withdraw treatment and their families for whatever reason demand that they be kept alive on machines. I cannot understand why the families cannot make the most humane decision for their loved ones which is to allow them to pass. Maybe there are religious reasons or feeling of guilt, and I am not saying these are easy decisions, but to maintain a body with no cognition for years and years is wrong. Unfortunately for these patients, they did not have an advanced directive which would have expressed their desires prior to their injuries.

I agree with the Obama administration that end of life planning should be a critical part of the reformation of healthcare. Everyone should be required to have an advanced directive to clearly state what their wishes are. The document should express the desires of the individual not to be maintained indefinitely by artificial means and to be allowed to die. It is clear that many families cannot make the appropriate decision and that is why the document lets the family off the hook, so to speak. Not only will this allow for the more humane treatment of these patients but another benefit is the savings of an enormous quantity of money that is currently being wasted.

The attack by the right on this part of the health care reform is not fair. People have the option of expressing their desires precisely on the advance directive and the government cannot mandate specific language. It is very important for everyone as part of their individual and civic responsibility to have these forms completed. There should be no barrier for individuals to fill out these forms and there should be no cost to the individuals. This will ultimately save a tremendous amount of money in health care costs. But more importantly, it will allow all of us to express our desires to die in a dignified manner with minimal suffering and with the least burden to our families and to our country. It will release our families from the responsibility of making end of life decisions for us that seem so difficult.

Dustin the River Guide

I was on vacation this past week so I missed an entry on to the blog. Anyway, I went to Idaho for a week where I spent four days on the Salmon and Snake Rivers white water rafting and camping on the banks of the river. I must say this was an extraordinary experience. The natural beauty of this country is beyond what words can describe. Experiencing man-made beauty such as art, architecture, theater and cuisine can be impressive but they don't nearly approach the majesty of the natural world.

On the river we had guides who led our party. One of them was a twenty something guy from Montana named Dustin. A very bright young man who was planning to attend law school in the fall. Obviously he was a democrat (young, prelaw, tree hugger) and me being on the opposite side of the political spectrum led to several contentious conversations. I asked him if it was possible to be conservative politically as well as pro-environment to which he responded no. Naturally, I asked to explain why and he could not come up with a reasonable answer. It is unfortunate for the right/conservative/republican side to be associated with an anti-environmental position. I cannot reconcile the fact that views of less government, more individual responsibility, and greater emphasis on religion is somehow connected with being less environmentally friendly. And contrarily, more government involvement in our lives, less stress on religion, and more reliance on the state are positions that somehow are connected with the pro-environmentalist position. The left should not have exclusivity when it comes to being pro-environmental.

The only connection I can see is that the right has historically placed greater emphasis on business and profits and sometimes this may have come at the expense of the environment. The extreme environmentalists would have us sacrifice any profit generated at the expense of the environment regardless of its benefit to humanity. Obviously, a middle ground has to be reached that is sensitive to both the preservation of the environment and the use of its abundant natural resources for commerce.

The environmental issue should not be a right/left issue at all. There is no reason why the right cannot be as green or more green than the left. In fact, I can make the argument that one's heightened sense of individual responsibility and liberty would lead to a greater feeling of one's responsibility to the land. Much more so than can be controlled or legislated by the government. Yes, it is important for the government to set aside land for preservation but who is going to pick up the wrapper, clean the campsite as if no one had been there or be obsessively careful with campfires? the government? Only the individual can micromanage his actions.

The democrats use environmental issues for political gain They create or exaggerate environmental issues to polarize the electorate and claim they are the only truly green party. It's time for a conservatives to boldly claim that they will not concede this issue to the left. Their slogan should be "conservatives for conservation" and should claim to advance the position of using the environment in a responsible manner.

The platform of the right should include limited government, greater personal responsibility for their lives and their land, and the preservation and care of the environment. Natural resources must be used in the most efficient and minimally destructive manner. So to my friend Dustin, the river guide, I hope you can reconsider your political affiliation and feel comfortable being green in the red party. The right needs young people such as yourself to lead us into the future.

A Great Press Conference

I can't believe I ever thought i would have a difficult time coming up with material to write on this blog. I contemplated several topics this week but I felt I had to write about the most successful press conference I have ever seen. By that I mean, what is the purpose of a press conference? To inform the press and public as to what is going on in the administration and what the president is thinking and planning. Well BO certainly informed the public on two issues that are very enlightening. Unfortunately for him, these two topics were not in his planned comments but he brought them up anyway in an unscripted manner. It certainly demonstrated his true feelings as to where the problem lies both in the escalation of health care costs as well as in race relations. A disaster for BO but a truly informative and eye opening conference.

I also felt obligated to write about this press conference since I learned during this conference that I am personally responsible for the dramatic escalation of health care costs in the United States. Not only that, but I am unethical, I decide treatment based on reimbursement, and I border on criminal activity by performing unnecessary surgery on children. Yes, I admit it, I perform tonsillectomies. Just put the handcuffs on me already and ship me off to Alcatraz. BO is really smarter than I thought. He is fully knowledgeable in the field of Otolaryngology and understands all the criteria that go into the decision as to when a tonsillectomy is appropriate. He knows exactly what goes through my mind when I decide to operate and he has determined that I am performing unnecessary surgery on children just for the money.

This knucklehead with a law degree doesn't consider the amount of training I went through to be qualified to perform tonsillectomies and to understand when it is indicated and when it is not. He doesn't consider the thousands of children that benefit from the surgery as many studies have concluded and he has no clue as to the indications to perform such surgery. He has concluded that the parents of the children undergoing tonsillectomies are complicit with the surgeon and are not smart enough to ask the doctor whether the surgery would help their child so they allow their children to undergo unnecessary surgery (don't you worry the government will come to your rescue). He hasn't considered that the risk of doing unnecessary surgery carries with it the risk a lawsuit which is always in the back of any surgeon's mind. He also hasn't considered that in cases where the indication for tonsillectomy is recurrent tonsillitis that in fact health care costs are reduced by the surgery as the patient's need for doctor visits and antibiotics are greatly reduced.

It is sobering to know that BO considers the doctors as the source for the nation's healthcare problem. He clearly said as much at the news conference and he will likely bring this opinion to the restructuring of our healthcare system. Doctor beware, you are the problem. The only doctor that is safe in the restructuring is the abortionist. The only surgery that BO approves of and promotes is an abortion. I, who try to improve the lives of children through medical and surgical treatment, am the problem but the doctor who destroys life is revered. Truly a bizzaro world.

Briefly, the other revelation during the press conference was his determination that it was the fault of the police officer in the Gates arrest. BO is a genius. He admits he doesn't know the details but is smart enough to know that it was the police officer who acted stupidly, according to BO, who was at fault. In fact, this clearly demonstrates his view that police officer, you are the problem. The facts do not matter, your training doesn't matter, your years on the job do not matter, and your previous behavior regarding race relations do not matter. The knucklehead with a law degree (BO) has predetermined that you are a racist just like he has determined that I am a unethical, money hungry, deceiving physician.

So lets add two more sets of people to the list of groups who should definitely regret their votes for BO (See entry 5/25/09). Doctors and the law enforcement community. The fact is any doctor that voted for BO should have his head examined. There were plenty of indications during the campaign he was going to reform health care on the backs of doctors since it is them who are problem. Now we know the full extent of his feelings towards doctors. And anybody who makes their living in law enforcement you should know you will never get the benefit of the doubt. You are predetermined to be racist and will be judged as such.

I would like to thank BO for expressing his heart felt opinions on these matters and really detailing his true beliefs. We need to have more press conferences with BO so we can learn more about his honest opinions in all matters. Biden has got nothing on BO when it comes to public missteps.

Job Creation (?Job Saving) Obama Style

It has certainly become a lot more clear what Obama meant when he said he was going to create or save thousands of jobs. It turns out the jobs he is saving are jobs that are funded by the taxpayer and not private sector jobs. With his massive "stimulus" bill he is pumping money into state and municipal governments to help balance their budgets without any conditions. Instead of these local governments making the hard and necessary choices of cutting back their payroll and unsustainable benefits they are just continuing to suck the taxpayer dry by taking federal funds which will be payed for by higher federal taxes as well as by repaying debt by our children and grandchildren.

The other job that Obama has decreed as worth saving is the union employee. He is bailing out the car companies which are clearly not based on a profitable business model. But nevertheless the taxpayer will be burdened by the perpetuation of these union jobs. Instead of the car companies making the tough choices and the government forcing the companies to make those choices the union is able to protect their jobs at the expense of the taxpayer. It is unfair that with unemployment at 9.5% and with millions of people having lost their jobs that these auto workers are supported by tax dollars and artificially maintained in their positions. The administration is bought and paid for by the unions. Of course this is a payback by Obama for the union support during the campaign.

The jobs that BO has decided are okay to lose are those of small businesses, the true generator of the majority of jobs in this country. In fact he is contributing to the loss of jobs by small business. By increasing taxes and mandating employee health care coverage or a fine, any bozo can see this will lead to further unemployment. He fails to appreciate the critical role small business plays in the economy. What small business owner will hire in this environment? The small business owner will cut back on payroll to maintain profitability.

So union jobs and municipal jobs are in and small business jobs are out. BO has decided that preserving these jobs are more important than stealing from future generations. And on the flip side losing the small business jobs is okay even if it tanks the economy. This is a very bad trend for our economic future. Although we are seeing a slight bounce back from the lows in the economy I cannot see a scenario that would lead to a significant expansion of the economy. We will likely see a jobless recovery and a protracted period of economic stagnation.

Where's Hillary?

I don't know if you've noticed but Hillary is nowhere to be found. I haven't seen her on the news, on any news shows, or quoted in the newspaper as far back as I can remember. One would expect in light of the recent uprising in Iran, a major and historic moment, the secretary of state would have weighed in with her opinion on the matter. There are two possibilities, either the administration is controlling the situation and limiting her exposure so she doesn't outshine Obama. I think this is unlikely as I doubt she would be quieted by her previous foe. More likely she is purposely remaining under the radar screen. But why?

I have no doubt that Hillary is still seething from the primary battle and feels she should have been the nominee. She must be second guessing her campaign constantly since she knows she was the more qualified candidate. She was given the position of secretary of state but then all these special envoys were appointed to deal with specific regions. An envoy to the middle east (Mitchell), an envoy to Pakistan and Afghanistan (Holbrooke), an envoy to Sudan (Gration), an envoy to Iraq (Hill), etc. All the hot spots were taken by appointed envoys. So what's left for Hill? Not much, just a very sore, frustrated, vengeful woman.

I think she has every intention to run against Obama in the 2012 primary. If she appeared on the news she would have to follow the party line and back up all of Obama's decisions and policies. She doesn't want to be seen doing this as this would negate her ability to criticize his policies in the next primary. She is waiting for the perfect time to resign her position and this will likely be in some response to an Obama position that she will say she cannot support. This recent episode was perfect since Obama did not immediately support the uprising in Iran. Hillary could have stepped in and said I support the freedom fighters and stood against Obama. This makes her look to be the candidate who supports democracy in a theocratic regime while Obama looks to be the guy who wants to schmooze with the Mullahs and Ahmadinejad.

The problem was it was too early. She has to wait for about another year until she makes her move. His approval numbers will continue to deteriorate over the next year while she is in the background with a low profile quietly building support. As his numbers go down there will be splintering within the democratic party. He will be on the liberal side and she will dominate the moderate wing. The liberal agenda will be seen as an absolute failure both domestically and with regards to foreign policy. There will be major defections from Obama supporters to the moderate wing of the party ie. Hillary. Her approval numbers will soar as the dems look for a less liberal representative. She is a very intelligent, calculating woman. I have no doubt we have not seen the end of the Clinton machine.

Lessons From MJ

The king of pop, Michael Jackson, was a highly talented entertainer who was blessed with many skills that propelled him into an extremely privileged life. He attained worldwide fame, his music was recognized around the globe, he earned a large fortune but despite all that, the evidence points to the fact that he was an extremely unhappy individual. It seems clear that he was conflicted about his heritage, his blackness. His desire was to reject being black. By reshaping his nose through repeated surgeries, chemically altering the color of his skin, and straightening his hair it appears his goal was to remove his negroid features. It seems unusual that the black community has embraced MJ to such a great extent posthumously even as he appeared to reject that community during his life.

This is no way a slight on people of color but rather a manifestation of someone who is unhappy with who he or she is and is searching for a path to happiness. He likely thought if he could just lose certain ethnic features he would achieve fulfillment through a new appearance. He bought into the notion that it was his blackness that was preventing his ultimate desire of self-fulfillment.

He also demonstrates that regardless of endless possessions it was not enough or able to satiate his quest for self fulfillment. Regardless of an enormous mansion, endless furnishings and anything that his heart desired he remained unfulfilled.

Finally, he demonstrated that a life of fame does not necessarily correlate with a life of happiness. I recently heard a survey conducted amongst college aged kids as to what is there greatest desire. It wasn't wealth or health but the desire to become famous. As demonstrated by MJ and numerous other celebrities, fame is no guaranteed pathway to a content life. We live in a society where celebrities are placed on a pedestal and are adored, and kids want to attain that adoration to the exclusion of everything. Maybe that is why we have so much depression in this country as people buy into the idea that if they were better looking or richer or had more stuff or famous then only then would they be happy. And since this not attainable to most it becomes a source of dissatisfaction that leads to depression.

So MJ has shown us that fame, wealth and appearance are not necessarily a pathway to a fulfilled life. Despite his many gifts he lacked the one gift that would allow him to be content. The greatest gift one can receive is to be happy with what one has, what one looks like, and with one's lot in life. This is not to say that one should not strive for greater things but to be content with one's station in life is truly the greatest gift.

GP Versus Specialist

In the recent discussion about reforming health care much has been discussed about the lack of primary care physicians and the plethora of specialists. It seems that the specialist is being demonized as the source of waste and overspending in medicine while the GP is praised as the saviour. I would like to dispel this myth by describing two recent cases.

The first case is that of a 54 year old male who came to see me complaining of a sore throat. He had been to his primary doctor several times over the previous 4 months complaining of a sore throat and was given an antibiotic each time. This time he decided to see a specialist. His examination revealed a large advanced malignant tumor in his throat.

The second case is a 33 year old female who came to see me for a wax buildup in her ears. I asked her if she had seen her primary care physician to deal with this problem. She answered that her doctor told her he doesn't clean out people's ears and anyway she preferred to see the specialist.

These cases demonstrate the critical and indispensable role of the specialist in today's health care and three forces that ensure this trend continues. The first is simply patient preference. A significant portion of the population want to see a specialist who has greater expertise in a specific disease or region of the body than a GP. The public believes they will receive better and more up to date care from a specialist who deals specifically with their problem. The woman preferred to see me to clean her ears because this is a regular part of my practice and the assumption is that leads to greater skill.

The second force is that in this era of major advancement in medicine the GP is unable to be fully knowledgeable in all disciplines of medicine. He or she will have a cursory knowledge in many subjects areas but cannot attain the depth of knowledge a specialist would have who just deals with one specific area. Therefore, the GP refers his/her patients to the specialist because they are unable to deal satisfactorily with all their patients complaints and ailments.

Thirdly, the GP refers his/her patients to the specialist because they do not want to take the risk of missing a diagnosis as was done in the gentleman I described. They are covering their behinds because they know if they miss a diagnosis they will be sued for a delay in diagnosis.

So what should be the role of the GP? He/she should coordinate the care for the patients by referring them to the appropriate specialist and then oversee and integrate the recommendations of the varied specialists. The other main role of the GP is to be the disease preventer. Instead of being called a GP he should be the DP (disease preventer). All preventive care (obesity, cigarette cessation, immunizations, etc.) and screenings (mammograms, blood pressure, blood test screening, etc.) should be the responsibility of the DP. The role of the specialist is to treat disease as they have greater expertise in the treatment of ailments effecting their specialty than the DP. And this is often preferred by the patient.

So specialty care often translates into better care and this is likely to continue as the patients and the primary care doctor demand it. Yes it is more expensive care but higher quality often comes at a cost. It is similar to the situation where a transmission breaks. Who would be the preferred person to repair it. A general repair shop or a shop that exclusively fixes transmissions. Or a situation where a pipe bursts. Do you call a general handyman or a plumber. The plumber may be more expensive but the outcome is likely more reliable.

Instead of demonizing the specialists they should be recognized as a product of the incredible complexity of modern medicine. They serve a critical role in delivering state of the art care. Both the primary care and specialist need to work together, in their appropriate roles, for the benefit of their patients. The patient must be seen as a series of complex parts (treated by the appropriate specialists) and also as a whole unit (managed by the DP). Specialty care without the oversight of the DP or primary care without the expertise of specialists is substandard care.

Self Definition

So my mother has been reading this blog and I recently asked her what she thought. She answered, somewhat critically, that she was hoping I would write something more from the heart. To which my wife responded that I have no heart. She was kidding. I think. Well, I thought I would try to write about something less dry than politics.

I was watching 60 minutes last week and there was a segment about the repercussions of the Madoff scandal. They interviewed an elderly man who supposedly lost his entire fortune, which was reported to be in the seven figures. Surprisingly, he didn't appear despondent. His main disappointment wasn't about the money he had lost but the money which friends and relatives had lost who invested with Madoff based on his recommendation. The impact of the potential loss of his relationships with others were more important than his own actual financial loss.

Naturally, it made me think how I would feel if I were to lose everything and then started pondering what defines a person. Or better yet how do we define ourselves. Do we define ourselves based on how others define us or how we think others are defining us. Is a person defined by his/her wealth, by the car they drive or by the house they live in. Do we define ourselves based on the clothes we wear or other external manifestations of materialism.

Or do we define ourselves based on our relationships with others. How we relate to our spouses and children. How we relate to our friends and coworkers. Some defined themselves by their relationship with god. Does one define themselves by the amount of money they have or by how good they are as a son/daughter or mother/father. I suspect that most of us get caught up in the rat race and the pursuit of more and more stuff but the truth is that like the old man it is the relationships we build that has a greater impact on us than the stuff we accumulate. And at the end of the day if we were to all lose our stuff it wouldn't matter nearly as much as losing the relationships we build with others. For some reason it is difficult to live our lives with this knowledge as we concern ourselves with accumulating more and more.

All of us are imperfect and have flaws but we should always try to find the positive attributes of those around us and acknowledge their impact on our lives. It is especially appropriate on this father's day weekend to appreciate the sacrifices our parents have made for us. This day gives us an opportunity to give gratitude to our fathers and we should all tell our fathers thank you.
So Dad thanks a lot for all you have done for me and I hope my kids appreciate what I do for them. Okay Mom?

Upside Down World

I once asked a friend of mine who is Korean how many Jews he thought existed in this world. I prefaced my question by telling him there were 1.3 billion Chinese and 1.2 billion Muslims. I don't remember the exact number he guessed but it was much higher than the actual number which is approximately 12 million. He was astonished by that fact, and I am astonished by the impact this minuscule percentage of mankind has had, is having, and likely will have on human events. If you look at where Judaism ranks in terms of population, it is behind Juche (19 million), Spiritism (15 million), and Sikhism (23 million). When was the last time you saw these religions and there adherents referenced in the media?
The disproportionate impact of the Jews is demonstrated by the countless contributions made in so many areas. Not the least of which is the basis of all monotheistic religions ie. the belief in a single god. There is a hardly a field in the arts, sciences or any other human endeavor that hasn't been advanced by contributions from Jews. They have improved the lives of so many Jews and non-Jews alike, but this advancement has come at a great cost. It has engendered tremendous hatred and suffering towards the Jews throughout history and continues today. The world is truly upside down when you contrast the positive contributions of the Jews to the entire world versus the suffering inflicted upon them and the hatred and blame directed at them by the same world.
Just look at three examples that are occurring currently, the holocaust museum shooting, the Wright statements, and the Iranian situation. The shooter was an old man who probably never even met a Jew who blamed his shortcomings and the country's ills on the Jews. Wright blames the Jews/Zionists for controlling what the president does and who he talks to. Ahmadinejad consistently blames the Jews and Israel and would like nothing more than their destruction. The common theme that underlies all three is that the Jews are responsible for all the ills of society. It is the age old scapegoating against the Jews, when things go bad blame the Jews.
It seems that this is as bad as it has been in a long while. Any positive feeling that the Jews had garnered from the holocaust, which was actually just pity for what they experienced, has ended. It is now back in fashion to openly express one's hatred towards the Jews. The hatred was never gone, it just became politically incorrect, but now that veil has been lifted and the truth revealed. That this tiny percentage of the world population, the Jews, is the recipient of so much hatred amongst so many people and disparate cultures ( Middle America, Black Americans, Muslims) is a stain on humanity.
What have these 12 million people (0.2% of the world population) done to generate such hatred? Discovered medical treatments to prolong and enhance people's lives? Won more than 130 nobel prizes (out of approx 720 awarded)? Advocated for the persecuted, the poor, and the discriminated? All they want is to live peacefully, to practice their religion, to contribute to society, and to live in their ancestral homeland. It is precisely their disproportionately positive impact that has created such jealousy amongst the nations. For only a truly chosen people could accomplish what they have accomplished and this is too much for some non-Jews to bear.
We really live in an upside down world and we should all fear how it is trending.

Rich Kid Poor Kid

Regarding the Sotomayor nomination, a lot is being made of her story being compelling. I suppose this is the typical rags to riches story and how we are supposed to be so impressed by her ability to have achieved from such humble beginnings to where she is today, a nominee to the supreme court. Yes, this is impressive, but is it any more impressive than someone who came from a more privileged upbringing. I believe that in some ways it is equally or more difficult for the child who has it all to grow up to be successful.

When I was a surgical resident I had the opportunity to be involved in the selection process for applicants in my field. The chairman of the department was very impressed by an applicant who had come from humble beginnings and was given an edge over other equally or more qualified applicants. Although this is anecdotal, I believe that if you come from an advantaged background you are penalized at best or at worst discriminated against. Hard to believe I am proposing bias against the children of the wealthy but I believe the thinking is that since you're parents are rich you don't really need the position. Thus the position is given to the one who supposedly scraped and struggled to get to the same level.

The truth is the poor kid may have received significant advantages along the way to have reached the same level as the rich kid. Affirmative action by definition helps a certain group but this is always at the expense of another group. As fair and noble as it may seem to help a disadvantaged child/person it must always be remembered that it comes at the cost of discriminating against the person who has equal or better credentials but the wrong parents. Yes it is true that the wealthy have connections/money that can and do open doors but this is only reserved for the super wealthy. Most moderately wealthy people do not have this advantage.

The poor child who strives for a better life knows the difficulty and hardship of living with limited means . He/She has a hunger to achieve to attain a better life and rid themselves of that poor lifestyle. The rich kid, on the other hand, has been given everything his entire life and lacks the fire in his stomach. The drive is greater for the poor child.

Similarly, the expectations are lower for the poor child and failing in his/her achievement will result in no change in their standard of living. The pressure on them is low. For the rich kid the pressure is much greater to achieve just to maintain the same living standard. The poor kid hasn't much to lose but the rich kid has alot more pressure on him just to stay even with his parents. Thus the rich kid starts out with less drive and more pressure while the poor kid has a strong driving force with little pressure. In other words, the poor kid has nothing to lose as compared to the rich kid who has much to lose.

Ultimately, a persons upbringing should have no effect on whether he/she is selected for a certain position or job. It is not in one's control to effect this genetic fact. Similarly, selecting someone on the basis of his/her race, sex, religion, age etc. is not fair as it is based on factors that a person cannot control. Proponents of selection based on genes or upbringing will say it provides diversity which is advantageous, but lets be honest about what it really is. It is by definition discriminating against someone or a group that does not possess the correct physical appearance or background.

Somewhere out there is an equally qualified or more qualified white middle aged male judge that was passed over for this nomination because he was neither a Hispanic nor a female. The supreme court has filled its quota for middle aged white men. He was discriminated against due to his genetic makeup and his qualifications were secondary. The country ultimately suffers when it is not the most qualified person who gets the job but the individual who wins the genetic jackpot.

Obama Regrets

A few months into the Obama/Pelosi reign there are two demographic groups that should have significant regrets about their votes. The first group is the 18-30 year old voters. Obama won the under 30 vote by 34 points. The young voters that I spoke to during the campaign were completely enamored by Barrack and were totally brainwashed by the media that Bush was a failed president. The vast majority had no clue about his policies and fewer about how his policies would negatively effect their futures.
It is clear that with Obama/Pelosi administration spending is reaching a level never before seen. Trillions of dollars are being spent and commitments being made. This is even before including health care reform which is guaranteed to be a major source of spending. The money to pay for this spending spree can only come from two sources, either raising taxes or borrowing the funds. By borrowing , bonds are being sold predominantly to the Chinese which will have to be paid back over decades. By spending now what will need to be paid for by future generations is basically robbing from our children and grandchildren. The 18-30 crowd will be paying off Obama's debts for almost their entire working career. I wonder if they knew or now know that Obama/Pelosi are spending their future earnings.
Otherwise, taxes can be raised to pay for this historic spending spree. Obama has already indicated his intention to raise taxes on those making over 200k. He says he will only raise taxes to the level they were during the Clinton years but to pay for this degree of spending, taxes will have to be raised substantially more. This degree of confiscatory taxation will significantly inhibit people from trying to exceed 200k of income. Why would someone take unnecessary risks, endure long periods of training, or work extra hard if the government will penalize you by excessive taxation over 200k of income. Young people will be facing a future where their upside is limited. They will be essentially capped at a certain level and any dream to reach above that level will be deemed not to be worth the effort. A very sad prognostication for our youth and for the future of this country. But regretfully, this is what they voted for.
The other demographic group that should be or will be regretting their support of Obama is the Jews. It is astonishing to me that after the Bush administration was such an unwavering backer of Israel, that the Jews overwhelmingly backed Obama. 78% went to Obama versus 21% for Mccain. This is not understandable to me. Why will my coreligionists, the Jews, not support the republicans who have demonstrated such tremendous loyalty. Instead they support the dems who fail to use the words Islamic terrorism. The leftists dems are filled with the blame Israel first crowd. They believe Israel is the obstacle and the Pals just want their independence and are willing to live in peace and harmony. Truly enigmatic.
As time passes, it seems clearer that Obama is going to try to pressure Israel into unilateral concessions. He views Israel as the obstacle to peace and makes no demands on the Pals. He demands a halt to all Jewish construction in the West bank, including natural growth, in the naive opinion that this is what is preventing peace. Obama and Netanyahu do not share the same vision of the middle east and this will continue to fray the relationship between the U.S. and Israel. Regretfully, support of Israel will diminish.
Hopefully, these two demographic groups realize they made some serious mistakes. Hopefully, they will try to correct these mistakes in the midterm elections. Hopefully, these corrections will happen before its too late.

Hooray for California!

They say that California is ungovernable. The blame is falsely placed on the people due to the referenda which the people voted down as they did this past week when they voted no on five measures. The truth is that there hasn't been a government in place which can effectively govern the state and govern in a way that the people want. It is a problem of the government, not of the people. They just don't get it.
Sitting here across the country, I see two main issues which would frustrate me to no end if I lived in California. I see the identical issues here in New Jersey. The people want the budgetary issue solved with smaller government, not tax increases. We are enraged that as private sector jobs are being eliminated due to the economy, the public sector only shows signs of expanding. As we apply for unemployment benefits, you with your government job and your gold plated benefits package are immune to downsizing. What makes this most unfair is we in the private sector are paying for your salary and package. You work for us but you have better job security, salary, and benefits than we do. We the tax payer want this to end.
The people know what we want. We just need the right person to campaign on this platform and implement it . Politicians are desperately needed that will stand up to the unions that twist their arms and renegotiate these ridiculous contracts (that includes the teachers union). We need to be able to vote on a referendum that would correct this imbalance between the public and private sector. And by the way, don't try and scare us that this will reduce services. Get by with less like we are forced to.
The second issue that is infuriating is the illegal immigration issue. California is being buried underneath the weight of the services being given to illegals. Health care, education, costs of incarceration are too much for any state to endure. It is bankrupting the state and needs to change. I strongly believe in the benefits of legal immigration and the its contribution to our economy but California's share of illegal immigration is contributing to its current crisis.
So kudos to the California voter for rejecting these recent referenda and not settling for bad policy. Keep the politicians feet to the fire until they deliver what is needed. California is not ungovernable, it just requires the right government to make the right choices and the people will line up behind it.

Pelosi and/is Torture

First Nancy Pelosi never knew about waterboarding. Then she admitted she was briefed but that it wasn't used and then it came out that she was briefed about the use of the technique that had already been used. It sounds like a Jackie Mason routine. If it weren't so sad it would be comical. As she digs a deeper and deeper hole for herself hopefully the sides will start caving in.
Her behavior and comments are all too typical of modern day politicians. They try to finesse their language in a way that doesn't commit them to a specific viewpoint. Just in case they want to backtrack in the future they have an out. We never know what they truly believe in as they change their opinion based on the current prevailing winds and polls. Pelosi should have said that in 2002 the situation was such that those techniques were appropriate and now in retrospect it was either a good or bad decision. Stick with what you believe in and tell us the truth. If you made a mistake own up to it. Don't treat us like idiots.
In any event, the decision of whether waterboarding is torture is essentially someones opinion. There is no black and white concerning what constitutes torture. Some may feel that yelling loudly at a prisoner is torture. On the other hand, some may feel that the end justifies the means. That is, if life saving information is obtained, that would justify any method to obtain it. So to ask a judge or lawyer or politician whether enhanced interrogation techniques was legal or illegal makes no sense because it depends who is asked. It could be legal during Bush's administration (his legal opinions supported the use of those techniques) and then when a new administration takes over could be deemed illegal.
To look to prosecute individuals based on a new legal opinion is ridiculous. This is a gray area of law that is best left to the discretion of the commander in chief not to a group of politically appointed lawyers. The president has the responsibility to keep the country safe and should not be second guessed by these Monday morning quarterbacks with law degrees.
As much as I despise Nancy Pelosi, I must say she was right in not objecting to the use of these techniques in 2002. This was the right decision at the time and likely saved many American lives. She should be seeking accolades for her decision and not be trying to weasel her way out of it. By trying to rewrite history she demonstrates that she has no ability to stand up for her decisions, no core beliefs, and will change her position based on the prevailing polls. We should demand more from our elected officials.

Enemy? What Enemy?

As usual, on Saturday, I was in synagogue and the Rabbi delivered a very informative sermon. He had attended the AIPAC (American Israel Public Affairs Committee) conference during the preceding week and was relaying highlights of his trip. He first spoke about the speech given by Newt Gingrich and then discussed the speech given by Eric Cantor. He selected these two because he clearly felt they described the situation in the middle east most accurately and realistically.
The two speakers described the situation as a dire threat to the existence of the Jewish nation. They felt we are on the verge of catastrophic times and it is similar to the years preceding world war two. They pondered whether we are too late to stop the catastrophe which is looming. Newt went on to discuss the possibility of an electromagnetic pulse which would effectively halt the function of this country and could be caused by a rogue nation or a terrorist setting off nuclear bombs in the atmosphere. He mentioned the possibility of a nuclear bomb going off in Israel, Europe, or the US. All very scary scenarios.
What was upsetting about the sermon was that there were people in the audience who clearly rejected what the Rabbi was saying. They were mocking the information and were turning their heads in a dismissive manner. I can understand that as democrats they were not happy that two republican figures were quoted but regardless they seem unable to see an enemy before us. It distresses me that there is a group of people, mostly dems, who are just not willing to see the evidence in front of them that there is an enemy at war with us whose goal is to eliminate Israel and then go after the US. Furthermore for Jews, especially with our recent history, to not accept the facts that there are existential dangers before us is a distorted view of reality (definition of psychosis).
I think these people suffer from an inability to accept that there are people who are just evil. That it is just a function of a bad upbringing or inadequate opportunities. They feel if they just were placed in the right environment or spoken to in a certain way then they would no longer be threatening. The enormous pressure to close Guantanamo Bay by the dems, the elimination of advanced interrogation techniques, and the ceasing of phone tapping are not measures taken by a people at war. These measures are not necessary because they feel there is no enemy. In fact they believe it is the US and Israel that are causing all the problems.
If we could just get Barack Obama to talk to Ahmadinejad, Chavez and Jong-Il it is their belief that all will be fixed. Not only is this ridiculous but we are opening ourselves to additional risks. By not recognizing and addressing the threats we are enabling the terrorists. They want to live in a 9/10 world when all the facts say they cannot. I am not sure if it is fear, stupidity, psychosis or a combination but I think it will take another attack to convince the doubters that we are at war and should be fighting as such. God help us.

Childhood Obesity, Whose Fault?

This week an eight year old patient came to see me who weighed 180 pounds. The complaint was that he was having difficulty breathing at night and whether removing his tonsils and adenoids would improve his breathing. Clearly, the source of his breathing problem was related to his weight. The extra fat in his neck and throat would cause his airway to collapse during deep sleep and the extra fat in his chest made it difficult for him to expand his lungs.
The problem of obesity in children is an immense problem that effects the individual as well as places a lifelong burden on society. I see a huge amount of children who are overweight and it disproportionately effects the African-American and Hispanic communities. These kids are looking forward to the development of diabetes, heart disease and a shortened life span. They are unlikely to find long lasting employment and find themselves occupied with frequent doctor visits and hospital stays. They contribute little but consume a large amount of public resources.
I may be wrong but many of the parents do not see this as a significant problem. I don't know if it is a cultural issue but I am amazed how flippant the parents seem to be regarding this life altering issue. To keep feeding your child in an unhealthy way seems ignorant and foolish at best and at worse seems akin to child abuse. The question is why are parents allowing and contributing to this?
I think these communities are so used to being taken care of by government that the ideas of self reliance are completely stripped from their thoughts. This leads to a complete inability to take control of their own lives and by default the lives of their children. They have lost a sense of personal responsibility. These feeling of dependence are actually caused by the overpresence of government since it is similar to a child who is constantly spoiled by his parents and thus never gains his independence. Yes we need a safety net but it is counterproductive if that net doesn't allow or require a person to try to become self-reliant.
I think this a perfect issue for Obama to target and to use his popularity. To try and convince the public that the goal is not for government to micromanage and be heavily involved in their lives but for them to be self-reliant. As an African-American I think he can have an honest dialogue with the public that it their responsibility to make sure their kids are fed responsibly, that their homework is done, that they read with their children, that they encourage exercise, and that they grow up with good behavior. The Obamas are excellent role models and they should exploit that for the benefit of the country. Instead of useless press conferences where nothing is learned he should use this exposure as an opportunity to demonstrate how people can improve their lives.
As a modification of JFK's call, Obama should demand of the public "ask not what your country can do for you but what you can do for yourself". If he shows how he and Michelle have done it and are doing it for their kids, the public will follow.