2012: Who Will It Be For The GOP

Here we are at the beginning of 2012 which is the start of 2012 presidential campaign. I guess we know who the democratic nominee will be. I don't think anyone has a chance of competing with BO. Hillary doesn't have a chance since BO will get 98% of the black vote in any challenge and this is too much of a head start for Hillary to overcome. She does not want to be seen as the anti-black candidate and will have to wait for BO to leave office for her to give it another go. No one else could give a serious challenge.

The republicans though, provide an interesting picture. Palin is an automatic loser and a guarantee of four more years of BO. She is not presidential material and I really hope she knows it. She is great at rallying the people on the right and is terrific for the party. She will get out the vote, raise lots of money for republican candidates, and help in many state and local elections. She should be the cheerleader in chief for the republicans not try to be the commander in chief.

Romney is difficult because of Romney care. No matter how much he tries to separate Romey care from Obama care it is an impossible feat. Health care is one of the most important issues of the election and he will not be able to provide a vision that is significantly different from Obama care. This sinks his candidacy.

Newt is the smartest idea man of the republican party and if I had my choice I would want him as my president. But unfortunately I think he is unelectable. There is a certain staleness that I feel a politician gets after he has been around for a while. People lose their excitement after a while and I think he would suffer from that.

Huckabee, I have never been to thrilled about as a candidate. I don't think he generates much connection with the voter and I don't think he would create significant turnout.

So who is it going to be for the GOP? I think it is going to be someone who is not yet on the radar screen. The best person would be a governor over a senator or congressman. Governors are natural precursors to presidents as they run a state government with responsibility for budgets. Contrarily, congressmen fight over bills without the individual onus of the success of the country.

The nominee should be from a state which has shown that republican ideals have improved the financial outlook of the state. They should have been in office for a minimum of three to four years. They should have made inroads into cutting government size and intrusion as well as government spending. They should be seen as being able to stand up to unions and special interest for the benefit of the taxpayer. These policies are exactly what the American people want and having demonstrated they could implement them in there states, the electorate will want them implemented nationally.

I am sure such an individual exists but right now they have not taken to the stage. In the next few months we will see who enters the race.

Rationing Health Care Part II

My daughter texted me last week that she didn't quite get the last blog entry, so I wanted to expand a little on that topic. I also wanted to mention that I am not opposed to industry discovering and profiting on new health care modalities. Free market forces promote the development of new techniques and drugs and the profit that follows is the reward for taking the chance on such a development.

People in the pharma industry would defend the high cost of new drugs in the following way. They note that the cost to bring the drug to market is very expensive. Only one in a hundred molecules that go through expensive trials actually make it to market so they have to recoup the cost of not only the marketable drug but also the molecules that were developed and tested that never made it. They also would mention that by keeping people with chronic diseases healthy with newer technology, other costs such as long term hospitalization or institutionalization have abated. Lastly, they would stress the enormous impact that new drugs and technology have had both by lengthening people's lives and improving the quality of those lives. Is there any price to be placed on those factors?


Sometimes by looking at an extreme example you can clarify the problem and possible solutions. Lets say that an imaginary drug company named Eternity Therapeutics develops two drugs. Drug A can cure cancer but you must take it for the rest of your life. Drug B can stop you from aging but must also be taken daily or the aging process will resume.(Btw, these are not fantasies but research is now taking place to achieve both of these). The cost of each drug is one million dollars per year. Why is it so expensive? Maybe it has ingredients that are extremely rare and thus is in limited supply. Maybe Eternity Therapeutics knows they can get their price so they price it at whatever the market will bear.

So who should pay for drugs A and B? Private insurance companies will not include these drugs in their benefits. Their premiums would have to be too high to include these drugs. If government included these drugs in their benefit packages, the country would go broke (I should say, even more broke than they are currently). Ultimately , it is unaffordable and only the rich will be able to get them. At some point the cost of extending peoples lives will just cost too much for society. The only question is where is that point. Will we be able to have the discussion without the opposition declaring death squads or throwing granny under the bus.

My point in the previous blog was not to demonize private industry regarding the cost of new drugs/techniques. Hopefully, they can continue to develop drugs and profit without charging exorbitant fees. Their profit should be generated from all countries not just the USA which pays higher fees than other countries. The point was only to raise the notion that the costs of new technology have outpaced the ability of society to pay for them. What's the use of developing new drugs if society cannot afford them. Eventually, industry will conclude that if there is no profit to be had further innovation will cease. Everyone loses.

Rationing Health Care, A Must

I was talking to a friend of mine who works in the pharmaceutical industry last week. He was on a trip trying to market the use of a drug for multiple sclerosis. He was circulating amongst neurologists in my area trying to encourage these doctors to use his drug. Out of curiosity, I asked him how much the medicine costs and he responded $48,000 per year. I told him that I thought that was a ridiculous price and he responded by asking if I knew how much it costs to investigate new drugs and bring them to market.

So here is the problem. We are discovering drugs and new medical devices that can extend the duration and quality of people's lives. That is wonderful but the problem is we cannot afford it. The advances in the medical and pharmaceutical industries have outpaced our ability to pay for it. There is no way government can afford to pay 48K for one drug per year to extend peoples lives with MS. Insurance companies would have to charge such high premiums if this drug was included in their benefits that it would be unaffordable. That is a sad statement but indicates ultimately the requirement at some level to ration care. At some level there must be a limit to an individuals medical consumption and the population of this country needs to understand that and establish the limits.

In Europe the governments decide which medications and technologies are allowed in the country. Part of their determinations are guided by a cost/benefit analysis. Can we afford to pay for this procedure or this medication? Is it worth the benefit received by the individual and society as a whole? In fact, I asked my pharmaceutical friend if the MS drug is being used in Europe and he said it was rejected. Likely due to cost as its efficacy has been proven. We in the US need to have this conversation and set limits. As technology continues to advance we will surely bankrupt ourselves using more and more expensive modalities.

People should be able to choose an insurance policy that would cover these extremely costly medications and they would be required to pay the fair premiums. People should also be allowed to buy a bare bones or catastrophic policy in which case they would not be covered for expensive drugs and would either not get it or have to pay out of pocket. In both cases, with private insurance the individual sets the limits by purchasing the appropriate policy/benefits. The problem is if you are on government insurance. What are the limits that should be set? Who should set it? Very difficult questions that we have to confront, but we absolutely must and soon.

Barney the Dinosaur

Barney the purple dinosaur sings never talk to strangers that's very good advice cuz you just can't tell if they're good or bad even though they may seem nice. After traveling to Israel over Thanksgiving I experienced a glaring difference between life here in the states and life in Israel. It is so embedded in our culture to be wary of strangers. Barney the dinosaur is indoctrinating our three and four year old kids to avoid any interaction with strangers as they are not to be trusted. Of course, this is necessary in our society as we are so disconnected with each other and bombarded with criminal activity every night on the news. It is a survival tactic that we learn at a young age. Contrarily in Israel, where people are interconnected by their religion, heritage, and nationalism there is much less wariness of strangers.

While traveling in Israel, for the most part, I traveled as a tourist. Stayed in a touristy hotel, went to touristy restaurants and went to historical sites visited by tourists. But I traveled by buses to get around, not by cabs, and this gave me a feel for life in Israel. Conversations take place on the buses between strangers all the time and sometimes get pretty heated. What struck me was when women with strollers would get on or off the bus there was always some stranger helping her with the stroller. My daughter who is studying in Israel tells me she would fall asleep on the shoulder of a stranger sitting next to her on the bus. She would wake up suddenly and apologize but the stranger would encourage her to put her back down and go back to sleep. Little children go on buses by themselves, something one would never see here.

Contrast that with public travel in New York. When I go on a subway everybody has their heads buried in a book being careful not to look up and actually look a stranger in the face. We become expressionless and dare not eyeball anyone in the subway car lest this lead towards an acknowledgment of another's presence. I do not recall ever seeing strangers helping each other as we are all too suspicious of each other's motives.

Life in Israel is tough but the interconnection between complete strangers is a benefit of living in a more uniform society. Life is easier here but we live in our little cocoons detached from each other. We live with constant suspicion of everyone and trust only our inner circle. They live with the threat of a bomb coming from an external enemy and we live with the threat of crime by our fellow American. Both locations have positives and negatives and I don't suggest that one is better than the other, just different.

Last week after I came home I saw a 3 year old black girl in the office who sang to me the Hebrew alphabet. She learned it from Barney the dinosaur and anyone with little kids knows that tune. By this little girl learning my culture Barney is creating connections between people but at the same time he is disconnecting people by warning about strangers. Seemingly a contradictory message.
Who knew the purple dinosaur was so deep and complex?

No Scan, No Fly

I just returned from a week abroad and I was prepared for a scan to be performed by security at the airport. For whatever reason, there was only the usual metal detector and conveyor belt for carry-on items. No scan or pat down. I must say I was a little disappointed by the lack of the most up to date security system present at my flight. I want to fly with the knowledge that my fellow air travellers on board have been subjected to the greatest scrutiny possible.

People complain about the imposition on their privacy rights by being forced into these scans. I say if it improves security and lessens the chance of a bomb being smuggled onto the plane then I am all for it. I don't even want the option of a pat down. If you fly you must be scanned, period. A pat down, I believe, is more susceptible to human error and I do not want to take the risk that an error was was made on my fellow passenger resulting in a tragedy. If you refuse the scan then you do not fly. No exceptions.

People complain about the radiation risk. I saw a statistic that the amount of radiation exposure from a security scan is equivalent to the exposure while flying at 30,000 feet for 30 minutes. The risk of terrorism is greater than the risk of cancer from the radiation exposure of a security scan. A trivial argument.

People complain that the TSA person will be able to see you essentially naked and object to the scan on that basis. It is not as if the person who is watching the scan is the one at the security counter looking at the image of your naked body while looking up at your face. The image is piped to another location where the agent/computer evaluate the image without a facial image. No connection at all between the body images and the individual.

I can tell you as a doctor that after seeing complete bodies hour after hour and day after day, it is not an erotic experience. In fact, the constant exposure diminishes the experience when it should be stimulative, as in marital relations. Furthermore, if you see the average person travelling in the airport most of them you would not want to see naked. With obesity rates over 50% and morbid obesity rates at 15-20% you couldn't pay me enough to sit behind a monitor and look at fat bodies all day.

So lets drop all the modesty nonsense and lets make the safety of the flying public the major goal. Lets also drop the claim of the reach of government going too far. Air safety is a good role for government as it can be combined with intelligence to maximize our safety and not be motivated by profit. They should try to hire ex-military and ex-police as they have the experience to ensure security.

Scans should be mandatory. If you refuse to be scanned you do not fly, end of conversation. Flying is a privilege, not a right. Remember, there's always Amtrak.

Reasons for Optimism

I apologize if I have been too pessimistic in my entries. Specifically last week, writing about the race to the bottom was definitely a downer. But I think there is a lot to be hopeful about. Most of the hope lies in situations where people have bucked the usual trends and have achieved success in spite of being labeled as bad students or disabled or poor. They succeed not because of government assistance but in spite of it. They all use their particular skill sets to advance and not follow the accepted formula as dictated by society.

I was watching 60 Minutes last week and two of the three segments portrayed men who have succeeded in life despite early challenges. The first was a man who was a troubled youth and eventually landed in jail but changed his life to become a well known actor and director. The other was a man who was a terrible student but turned himself around to become a geneticist who unraveled the human genome. Finally, I refer to the person who responded to last week’s blog who was labeled as ADHD but overcame his label to be a successful automobile developer. The common thread amongst these men is their exploitation of their specific talents to succeed. They didn’t rely on government but succeeded by plowing a pathway themselves.

Everyone is born with certain skills and talents. The goal is to identify and encourage a person’s array of skills that will enable him/her to excel maximally. Since we are all different a specific pathway does not exist which could apply to all. Government attempts to treat everybody the same and pigeon holes people to fit into a specific mold/pathway (square peg in round hole). Government dulls a person’s sense of individualism and promotes conformity and uniformity. Ultimately this is detrimental for the individual and in an effort to help people government is really hurting them. A bureaucracy in Washington or at the state house is too removed from the individual to have the ability to explore and encourage an individual’s particular situation.

Each person has to be seen as an individual and allowed to find the pathway that best uses his/her particular skill set. For example, not everyone should go to college. Some peoples’ skill set are not conducive to college and would be better advanced by pursuing a different route. Teachers and parents need to recognize what makes their children/students unique and help them pursue those goals which optimize their talents.

This country at its core was built on principles to encourage the individualistic spirit and for government to get out of the way while its people succeed or fail based on their own ability. Its greatness lies in the fact that it encourages individuals to compete on a leveled playing field regardless of labels and the best man/woman wins while the loser learns from the failure and tries again. This micro-battle which occurs every day, everywhere and at all levels raises the entire nation as a whole. We are an excellent nation because we are made up of excellent individuals. Our national success is due only to the cumulative effect of our smaller individual successes. We should be optimistic since this country is the best place on Earth that allows each individual to exploit his/her innate and learned skill set to achieve success.

Extra Time, The Race to the Bottom

I saw a patient last week, a young lady, who demonstrated a very mild hearing loss on her hearing test. She was going to take the SAT and her mother wanted me to write a note saying she needs special attention because she would have a difficult time taking the test due to her VERY mild haring loss. I told the mom I didn't understand since the SAT is a test where hearing is not required. She said she wouldn't be able to hear the instructions or hear when time was up. I didn't continue my questioning but thought to myself if she cannot figure out how to take the exam without hearing the instructions and use a watch to gauge her time she has a lot more problems than a mild hearing loss. But this just demonstrates the desirability to be seen as handicapped or as a victim. These labels are used to receive special dispensations. As an attempt to level the playing field for people with true disabilities, gamers of the system will try to receive a leg up on the competition by claiming a handicap.

This is similar to the situation that goes on regarding granting of extra time on exams to certain kids who are diagnosed with attention disorders. Now all mothers want their kids to be labeled with an attention deficis since they receive extra time on exams. Some parents pay therapists to purposely label their kids in order to obtain a leg up on the competition regardless if they have an actual disorder. It wouldn't be so bad if grades on tests would be designated as having been obtained with or without extra time, but in our p.c. world we cannot place labels. So there is no downside in getting extra time because no one ever knows about it. So the college who is seeing the SAT score or the medical school who is evaluating GPAs have no idea which transcripts include extra time and which did not.

Extra time is granted in high school, on the SAT, in college and beyond. Isn't the point of examinations to let competition determine who is at the top versus the bottom. Isn't the point to select out those kids who can work under pressure within a certain time frame. The point is specifically not to level the playing field but to stratify it. The pc nonsense has us believing everybody is equal, that any poor performance is not due to inherent inabilities but due to a disorder that needs to be compensated for. It is the same nonsense that proposes that poor people are victims of outside forces not of their own inabilities. And the same nonsense that proposes that there are no evil people just victims of bad upbringings or psychological disorders, or impoverished childhoods.

In real life there is no extra time. When I am in surgery performing a difficult case on a sick patient every extra moment under anesthesia carries increased risk to the patient. I cannot turn to the nurse or the anesthesiologist and explain that I need extra time since I am having difficulty concentrating. I certainly cannot go out to the patient's family and explain to them that the surgery took twice as long because i needed extra time due to inability to focus. Do we really want our doctors/surgeons to be the ones who required extra time due to difficulty with paying attention to the task at hand?

It used to be that the kids who couldn't concentrate were considered slower. They either improved with practice and time and caught up to the rest or they performed poorer and chose professions not as intense. Nothing wrong with that. By perpetuating extra time these kids are placed into situations requiring too much intensity and eventually fail. Were they truly served well by extra time or propped up to eventually fail when real life approaches.

Everybody wants to be labeled as being disadvantaged. It may be claiming to have minority status or being handicapped or even to have a learning disability. In our upside down pc world this is somehow seen as advantageous. We are in a race to the bottom as more people claim victimization to receive special treatment. Don't be surprised when we end up there.