Contact Your Congressman

Unfortunately, my house has lost power for the last 3 days and I have been unable to blog. I am writing in the doctors lounge at the hospital and want to copy a letter I just wrote to my congressman, Bill Pascrell. I urge everybody to write, call, email their representative and let them know what they think about this bill. It is our responsibility to let our representatives know how their constituents feel. Please take the time. It only takes a few minutes.

Honorable Representative Pascrell,
As a physician on the front lines,I would like to inform you that I agree the health care system is broken and is in need of significant changes. The changes proposed by the current senate bill will ultimately lead to much higher costs to the taxpayer and likely rationing of care. A yes vote by you will be seen as advocating for big government health care and you will be blamed for peoples future negative experience as they confront the new system as well as its cost. I urge you to consider these issues as you vote. Do you really think the government is the right body to make decisions about a persons health care issues. You know that ultimately government control is the desire of the far left currently in power. Does Pelosi really speak for you? If you fall in line behind her you will be seen as a far left puppet. Be strong and courageous. Do not fall in line behind the far left wing of the democratic party. Demonstrate that you can buck the enormous pressure being put on you to ram this thing through. You will be seen as a free thinker with strong convictions if you vote no for this bill. I strongly recommend you listen to the interview with Warren Buffet when he described the 2000 page bill as nonsense and the real issue is to LOWER COSTS. If that is done the issue of coverage will be easily fixed. Address the cost issue first then coverage not the reverse. This is where the American people are at. If you would care to communicate further regarding these issues please do not hesitate to contact me.
Respectfully, Dr. Mayersquared

When Time Stands Still

It is Monday morning and I am drinking coffee and playing online poker instead of going to work, treating patients, and earning a living. I wish I could say I was on vacation lying on a beach somewhere but actually I am at the court house serving on jury duty. As much as I dislike getting the summons to serve and costs me due to lost wages I realize it is my civic responsibility and I do so begrudgingly (not that I have any choice). Anyway, it give me time to blog.

You know you really enjoy an activity when it seems that time goes by very quickly when you are engaged in such activity. Contrarily, some activities (like jury duty), it seems as though the clock is not moving or worse seems to be moving backwards. This clearly indicates how tedious and unenjoyable certain activities are. Other examples of such activities include sitting in a really boring lecture or sermon, engaging in certain exercise routines, or some employment situations where people are engaged in boring and tedious work.

There are two activities that come to mind when I feel that time just flies by. The first is casino gambling. I realize this is probably not so good but in truth I could sit at a blackjack table or a poker table for hours and it feels like I just sat down, especially if I am winning (a rare event). Of course the casinos promote this by not having any clocks visible or any windows so gamblers will lose their sense of time and continue to enrich the proprietors. I guess it is a good thing that the nearest casino is over two hours away and I refuse to take part in online gambling (only play money).

The second activity where I lose sense of time is in the operating room. I can tell you that there are instances during an operation when I ask the OR nurse for the time and hours have passed when it feels like twenty minutes. In the past I have been involved in surgeries that last for 12-18 hours. Although I no longer perform such operations, those hours were amongst the shortest of my life. I suspect for those who are not surgeons it is difficult to understand how a person can operate for many hours straight without a break or wake up in the middle of the night and operate with little or no sleep. I suppose when a surgeon's concentration is so intense and focused the feel for time is lost. It is this intensity along with the gratification experienced by being a surgeon that creates the phenomenon of timelessness.

In medical school the third year is designed to allow the student to rotate through the various specialties and allow them to experience each discipline. When I first went to the operating room during this year I knew immediately this was where I wanted to be. Even at that early stage I felt time was imperceptible and that was the indication that this is where I need to be. Although I was a student and just assisting the main surgeon I knew I eventually wanted to be the person holding the scalpel.

It is a truly a gift when ones work is so interesting that it seems as though time doesn't exist whereas sitting at a job every day and watching the clock stand still is akin to torture. I realize I whine a lot on this blog about the ills of the health care situation but as I sit here at jury duty (I swear that clock is not moving) I honestly feel fortunate for what I am doing every day at work. And if I have a bad day I can always come home and play online poker.

On Call Dilemma

Once again I had the pleasure of being on call this past weekend and I had an episode which demonstrates the effects of the legal profession on my everyday decisions. A man called me about his 91 year old mother suffering from an ear ache and asked me if I could prescribe medicine for her over the phone. He said it had just snowed heavily and was unable to get his 91 year old mother to the office. I had never seen him or his mother before in the office and was likely a patient of one of the doctors I was covering. Naturally, I felt for his dilemma and would have liked to help his mother but I told him that I could not prescribe any medicines over the phone without first examining her. His options were to go to the emergency room, an urgent center, or wait until the following day when the office would be open and she could be seen. He was not happy with that answer and asked me simply whatever causes ear aches just give her the medicine to treat her to whom I replied it is not that simple and the pain could be due to several causes which are treated differently.

I could have called in an antibiotic or ear drop for her which most likely would have helped but by doing that I have accepted the legal responsibility of treating her which then infers that I know what is wrong with her without ever seeing her. If she had a rarer and more serious cause for the ear pain that went undiagnosed or a delay in diagnosis and I have treated her I am going to get a call from the local lawyer’s office. After he sues me and I show up in court he cross examines me and says “Doctor, you prescribed ear drop A for this 91 year old lady. Can you explain to the jury the results of your physical examination”. Of course, I have no answer and look incompetent. They do not care that it had just snowed and he couldn’t get his elderly mother out, and that I felt badly for their plight. The lawyer continues “Doctor, do you know that because you prescribed ear drop A the patient did not go to the emergency room, the ear pain was actually due to a life threatening infection and she ended up dying after a protracted course of hospitalization and suffering. Obviously, I have no acceptable answer and lose a multi-million award.

Yes, 999 out of 1000 times this would not happen and by calling in the medicine I would have cured her and had a satisfied customer. But because of the one in a thousand where I could have a bad outcome I refuse to prescribe medicines over the phone. I refuse to accept the legal exposure this puts me in. The lawyers, by exploiting the one in a thousand for a jackpot award have made the 999 suffer or be inconvenienced and this is all too often the result of legal actions. One person makes out real big (and the lawyer) while the remaining population ends up suffering for it.

Unfortunately, I have to practice medicine with the fear of being second guessed and a lawsuit around the corner. I am always thinking of the legal repercussions of my actions and with every interaction with a patient my assumption is that their lawyer is in the room or on the phone with us. Not only does this add a tremendous amount of money and stress to the practice, it ultimately gets translated into more inconvenience and expense for the patient. It’s hard to have compassion for this suffering 91 year old lady when no one will show compassion to me for the decisions I make and the factors that led to them.

Buy Low Sell High

Last week I discussed the age old doctrine of buy low and sell high in the realm of politics and I want to expand on that somewhat but in its natural realm of investing. I do not profess to be an expert in economics or investing but I guess I have an interest in the world of money and I do a lot of watching, reading and listening. It seems to me that the best strategy when it comes to investing is to find the class that is most out of favor and buy quality within that class and then wait. I know this sounds very simplistic but in practice is very difficult to implement.

The natural tendency of people is to invest in the class that is running up or that already had its run-up resulting in buying at or near the top or missing a significant segment of the run up. It is inherently difficult to invest in a class that nobody else wants and seems to be decreasing but that is exactly the time to buy it. It amazes me the degree to which herd psychology plays a tremendous force in the world of investing and that is why it is difficult as one has to go against the herd. This scenario plays out over and over again.

So when should one buy into a class that is out of favor as it is impossible to detect the ultimate bottom. Since it is not possible then one should buy the out of favor class with the knowledge that if that class continues to decline then the opportunity presents itself to buy even more at a greater sale price. Thus, one should only invest gradually into this class. If it starts to rise then one could start looking at other investment classes that me be newly out of favor to invest in. The advantage of the individual investor is that he does not have to show an above market return every quarter. He can continue to amass more out of favor investments and sit tight and wait. At some point all investment classes eventually rise. The question of when to sell is also difficult but should also be done gradually as it is not possible to detect the top.

A strategy that would implement these ideas is to have a portfolio with each class comprising a specific percentage. The portfolio is adjusted yearly or quarterly to maintain the pre-determined percentage. In this scenario classes of investments that have declined would be bought to bring them up to the correct level and vice-versa for appreciating classes. This removes the psychological aspects and forces one to buy losing classes and sell winners.

Looking at today’s market then, which assets should be bought and which should be sold. The market which seems to be most overbought and bubble-like is the US treasury market. The upside is highly limited and those that are using these instruments as a hiding place to protect their money are going to experience significant losses when the market turns and interest rates rise (resulting in a depreciation of their principal). Currently, stocks and commodities are somewhere in the middle, neither overbought nor oversold.

The market which seems to be most out of favor is the one related to housing. Which mechanism to use to purchase within this class is difficult to say. Maybe certain REITs, or housing stocks, or buying foreclosed properties. If I could get my hands on certain distressed debt such as collateralized mortgage obligations at significant discounts I think would be a terrific play. Anyway, just to reiterate my disclaimer that I am an armchair investor but if you look historically every class eventually has its day it just takes courage to go against the herd and be patient.

The Biggest Loser

There is no doubt in my mind that the biggest loser of 2009 is the senior senator from Pennsylvania, Arlen Specter. This knucklehead, if you do not remember, switched from the GOP to the Democratic Party soon after the election of BO and the overwhelming victory of the dems against the GOP in the 2008 elections. His conversion gave the dems a filibuster proof majority in the senate. I am sure he thought he was switching to the party that would be in the majority for a long time. But no matter how you look at it and from any perspective the results of this decision have had exactly the opposite effects that were intended.

From a personal point of view, Specter’s switch to the dems will certainly cause the end of his senatorial career. The dems have quickly fallen out of favor as they pursue the Pelosi/Reid far left agenda. The approval rating of the congress is very low and in many congressional races entrenched democrats look to be facing fierce competition from the GOP. Specter thought he would more likely get another senatorial term as a democrat. Although Specter would have had a hard time getting re-elected as republican, his chances of re-election as a democrat in the current political environment is almost zero.

From the point of view of the democratic party, Specter’s handing them a filibuster proof 60th vote was certainly viewed as a victory and a ticket to pursue their agenda without opposition. In actuality, all it gave the dems was the chance to show how incompetent and out of touch they are with the folks. They completely overplayed their hand and ultimately were not able to pass any significant legislation even with this supermajority (except very unpopular, pork laden, deficit exploding and ineffective spending). Without having the GOP as a foil, they exposed their true agenda and demonstrated their true intentions (big nanny government and redistribution of wealth). What was thought to be a conquest (60 votes) for the dems is turning out to be a disaster.

From the GOP point of view, Specter’s defection, completely took them away from the negotiating table. By losing the ability to filibuster they were deemed irrelevant in forming policy and this was seen as a severe blow to the party. What turned out though is that by not having any role in policy formation in actuality worked in their favor. Yes, it allowed the dems to expose themselves as described above. But more so, I think if Specter stayed a republican and they had 41 votes the dems would have had an easier time getting through their agenda. They would have Specter the republican going along with their agenda giving them cover. Additionally, if they were blocked by a filibuster they could blame the GOP for any failure keeping public opinion in their favor. Ultimately, they could not blame the GOP for their failures with a resulting loss of public opinion for the dems and gains for the GOP.

Specter violated the age old doctrine of buy low and sell high. He bought stock in the Democratic Party at its high and has seen his investment plummet. He must be regretting that decision, terribly. What he thought would be beneficial to him and the dems effectively became a detriment and a boon to the GOP. I wonder whether he is pondering if it is too late for him to switch back. I don’t suppose the GOP will welcome him with open arms.

Back to Reality, Part II

Last week I wrote about some fairly scary scenarios. I thought this week I would write about some possible steps that could be taken to enhance security. The steps are geared towards a Jewish audience as I feel that they are likely to be targeted and are probably already the targets of sleeper cells that exist in this country. Last week at a congressional testimony the heads of the FBI, CIA, and homeland security testified that an attack on this country in the next 3- 6 months is CERTAIN. They mentioned that there already exist operatives in this country ready to act.

I am surprised the terrorists have not figured out the following strategy. They blow up a mall in the U.S., blame it on Israel’s oppression of the Pals which will turn American public opinion against Israel. Guaranteed, the American public will throw Israel under the bus if this scenario repeats itself several times. Without American support, Israel will be significantly weakened. Already, BO has distanced the US from Israel and I think he would have no problem further severing the relationship.

We Jews more than any other group should be very concerned and take steps to protect ourselves. With our recent history in the early 20th century we should know that no one will protect us when the time comes. The government, especially this administration, will likely not be there for us and will probably be too busy reading Miranda rights to the terrorist. They will blame Israel for the terrorist’s rage, that his actions are understandable based on how the Palestinians are treated. We have been complacent for far too long and now must take the situation into our hands and prepare ourselves.

Our brothers and sisters in Israel have shown us we can be comfortable defending ourselves. We should learn to be comfortable with guns and teach ourselves and our children the safe use and handling of a firearm. Our Jewish schools should have after school mandatory activities to teach children on self defense, security methods and the use of firearms. Our synagogues should have self protection groups that are in charge of maintaining security. This would include armed guards (trained synagogue members), provisional plans in the event of an attack, and members trained in having concealed weapons and their use. Our summer camps are a perfect place to train children in self defense and the use of weapons. There are already Israelis coming to these camps as counselors. Why not bring a few Israelis to teach our kids how to protect themselves.

I know some will read this and think I am going overboard and maybe I am. But I think the burden is upon us to ensure our own safety. Our history dictates that we are always targeted and blamed. If we think that somehow this time is different, that we live in a country where we are protected, then ultimately we have only ourselves to blame for our complacency. More than any other group, we should know that history keeps repeating itself and we should act accordingly.

Back to Reality

It was nice to be away for a week or so and not hear much in the way of current events. The cruise had no newspaper but you could watch Fox news or CNN. I didn't have much time to watch which was fine. Going through all the security on the plane and ship I started thinking where a terrorist would strike to inflict significant damage. Although I think the plane's and ships's security are penetrable, it is now somewhat more difficult. There are much easier targets to pursue.

If they wanted to target Jews, which seem to be a constant, I think they could easily inflict significant casualties. My synagogue has no security and in this regard we are way behind other countries. When travelling to Vienna a couple of years ago, it was very difficult to enter the synagogue. The street was blocked off and guarded by armed soldiers. Entry was granted only after a brief interview. There is no deterrent from a terrorist entering my synagogue on any Saturday with a bomb or machine gun causing a massacre.

My children's Jewish school is "protected" by a person sitting at a desk asking people to sign in when they arrive. I do not believe they are armed but even if they were they are a minimal deterrent to a determined armed terrorist. Scary thought what could occur.

The scariest scenario, however, would be at a sleep away summer camp. It is very easy to google Jewish camp and determine their locations. They are filled with many children and few adults. They are located in isolated, remote areas. They are in rural towns which are very spread out and with minimal police forces. As far as I know there is no security in these camps and they would be easy targets. It is too painful to imagine what could happen with one crazy terrorist carrying a weapon and lots of ammo.

In typical American/non-Israeli style, security will only be implemented after the first attack. Unfortunately, the best protection I have is that statistically it would be a long shot that my synagogue, school or camp will be the first one hit. Once there is a hit, which is only a matter of time, no cost will be spared to ensure security. It's too bad we can't be proactive, predict their moves and act pre-emptively. Instead we act reponsively, after it is too late. Pretty depressing thoughts.