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.