Left Wing Dilemma

I had a friend growing up who is a kool aid drinking leftist and also a staunch supporter of the State of Israel. Lets call him DF and he must be going through a gut wrenching period trying to maintain his party loyalty. It seems more and more that support for Israel is reflected predominantly amongst the right wing while the pro-Palestinians view is predominantly a left wing phenomenon. Jewish support of the left wing is becoming problematic for many dems as this administration seems to slant towards the Arab states and away from Israel. This causes an inner conflict amongst dems between democratic left wing ideology and the support for the State of Israel.

I wonder which position is stronger for DF. Does Israel policy trump domestic ideology or vice versa. Would he vote against BO due to his Israel policy or stick with his boy in Washington and throw Israel under the bus? In any case, it pleases me to know the inner turmoil he is probably going through as he tries to reconcile his party loyalty. We argued for many years right versus left policies. There were times during the Bush years that I had a very hard time defending the right wing, specifically regarding entry into Iraq and lack of WMDs. But that is nothing compared to the contortions he must be doing trying to defend BO and his Middle East policy.

As I mentioned, anti-Israel and pro-Palestinian policy seems to be overtaking the democratic party. BO certainly has veered democratic foreign policy in this direction. The comparison between W Bush and BO regarding support of Israel couldn't be more stark. Just look at the approval rating of BO in Israel. The support that Palestinians receive by university professors and their views on Israel as an oppressive society bolsters the left's anti-Israel policy. Look at the Americans who are supporting the flotilla, all left wing characters. Also, the anti-Israel and antisemitic diatribes by Black preachers further push large swaths of democrats into the anti-Israel and pro-Palestinian position. It is becoming increasingly clear that the left wing has very little room for supporters of Israel but unlimited tolerance for Muslims and excuses for their misbehavior.

The next year and a half (hopefully, not five and a half) will be very critical for BO vs. Israel. BO can no longer pass his domestic agenda with a GOP congress and the country strongly opposed to a further left wing push by the administration. BO will concentrate on foreign policy as he can push his ideology without congressional or popular support. Nothing would add to his already bloated ego than to try to put Middle East peace as a feather in his cap. He will demand huge concessions from Israel to obtain this goal all to soothe his ego. Further, Israel's enemies and specifically Iran may feel that it is the perfect time to attack Israel while BO is in power. This is their chance while support from the American president is marginal and he may out of office in 18 months when a strong Israel supporter may come in.

The overwhelming majority of Jews are democrats (for some insane reason) and voted for BO. They now have a huge decision to make. Israel or ideology? I sincerely hope that DF and his nutty left wing buddies decide to sit this one out and give Israel a break. It's the least they can do for the State of Israel.

Operating on the Dead

This past week I was on call for the hospital. Without a doubt, the worst part of my job. I was called to evaluate a seventy something year old male for a tracheostomy. He had a major stroke and was hooked up to a ventilator for a couple of weeks. He had major medical problems and the chances of him surviving this episode was nearly zero. However, his family felt they were doing him a favor by insisting that all measures be taken to keep him alive regardless of the fact that he was suffering needlessly. I felt terribly being asked to put this man through a surgical procedure with its associated postoperative pain. But my hands were tied and I could not go against the wishes of the family. The risk of a complication is great because of his medical condition which places me at risk for potential legal action. For all this stress, time spent in family consultation, time spent performing the surgery, and potential liability for any untoward sequelae I will be paid about 200 dollars. Now you know why I hate taking call at the hospital.

I have written before and I will reiterate that we, as a nation, must have the conversation of end of life care. It is bankrupting us as we spent a fortune in the last two weeks of a person's life. We cannot rely on the patient's family to make the difficult decisions. They are not in a position to rationally decide on their parent's or spouses care. There are too many emotional attachments that distort their decision making. Therefore, it is imperative that every person must have an advanced directive so that their wishes are explicitly laid out prior to their eventual illness. Simply, you will decide if you want heroic efforts taken when the time comes and which will be clearly spelled out. If you have an advanced directive your insurance premiums, ie medicare payments, would be reduced. If you fail to have an advance directive or you want heroic measures to be taken you will pay additional premiums during your lifetime. This makes complete sense.

I was reading an article the other day that was very interesting. It is somewhat counterintuitive but makes sense if you think about it. End of life care is significantly more expensive for a 70 old than a 100 year old. The reason is that the 100 year old is likely to die from a sudden event without time to receive medical care and the family is less likely to pursue heroic measures at that age. Additionally their 70 or 80 year old child who is making their medical decisions understands the need for compassionate end of life care better than a 30 year old would. On the other hand, the seventy year old is more likely to have a chronic illness and will sustain a more drawn out end of life process requiring multiple hospital admissions and large costs. This demonstrates that maintaining a healthy lifestyle not only decreases the burden you place on the health system at a younger age but also the costs you incur at death.

A large majority of chronic illness is the result of lifestyle choices. Overeating and obesity, sedentary lifestyle and lack of exercise, cigarette smoking and avoiding preventive care all incur tremendous burdens on our health care system. Right up to the last seconds of life the bad choices that people make drain our resources and stick the rest of us with the bill. It is critical this be addressed and remedied. These are difficult decisions and conversations that require leadership by our elected officials. As I wrote last week about adaptive challenges, there is no imposable solution. Our leaders must challenge us to change our thinking about end of life care. To take responsibility for our own health and to have an advanced directive to dictate what we each would want done when we all reach that final stage of life.

A Leader's Challenge

I was reading an article by Rabbi Jonathan Sacks (Covenant and Conversation, Beha'alotecha 5771) where he was describing types of challenges that Moses encountered during the time of the Exodus (highly recommended, link at bottom). He quoted the work of Prof. Ronald Heifetz at the JFK School of Government at Harvard. In that work he describes two types of challenges encountered by a leader, technical and adaptive. Briefly the technical challenge is simply one that requires a response by the leader to a specific problem. For instance, providing aid in an emergency situation or defending the nation in response to an attack.

The other challenge, the adaptive challenge, requires the leader to respond not necessarily with a unilateral action but by changing the mindset or circumstance of the people effected by the challenge. Only by doing so can the challenge be resolved. The solution to the problem lies within the people not by an externally imposed response.

For instance, in the case of our national girth problem, obesity. There is no governmental action that can fix this regardless of the attempts with the soda tax or the manipulation school lunches. The change must come from within the people. The leader must address this challenge by altering the behavior of the population. In the case of the enormous public debt and massive entitlement spending there is no externally imposable solution. The population must change its mindset from one of government dependency to one of self sufficiency. From one of selfishness and the mindset of entitlement to one of self-sufficiency and not rely on government to take from others so they can give it to me. In the case of white-black relations, there is no imposable solution. The leader must lead by altering the mindset of the "victim" that he/she is "oppressed". He must lead by example demonstrating that we are all individuals in this country with equal opportunities. We can all get as far as we can based on our own talents. That we are not victimized by our color, sex or sexual preference.

This is where true leadership lies. Unfortunately BO is incapable or unwilling to rise to the adaptive challenges. He tries to respond to adaptive challenges with technical government imposed solutions. He believes the central government can fix all of our problems and not put any demands on the population to accept changes to their sense of entitlement. We need a leader who believes in the people that we can rise to the occasion to solve our problems. We need a leader who will tell us the truth that the federal government is NOT the answer to our problems and often is the cause and that the solution lies within us.

I was optimistic after watching the republican debate the other night. These are much stronger candidates than I had believed and I think one will emerge who will be a true leader. One who can respond to our challenges and lead our country by transforming us as a nation. One who will not impose ineffective and expensive technical solutions to problems that actually require adaptive responses that require changes within ourselves.

http://www.chiefrabbi.org/ReadArtical.aspx?id=1767

DSK

I keep thinking about the Dominique Strauss-Kahn (DSK) case, the one where the French IMF guy was hauled off a flight and accused of raping a hotel maid. At the end of the day it is nearly impossible to determine who will be telling the truth. It is his word against her word. He will say it was consensual and she will deny it, that he forced himself on her. How is a jury supposed to determine who is right? There is no physical evidence that can be obtained to confirm either one's story (unless there are significant signs of assault).

In my practice, I examine women in an examination room and at times there is no one else in the room. My examination involves fully clothed males and females and is limited to the region above the shoulders. What prevents a woman from making a claim against me that I touched her inappropriately behind the closed doors. What proof do I have that this did not happen? What if it was some poor woman versus me, the rich doctor? Which side do you think the media would take?

In the DSK case the media is certainly taking the side of the maid as is the usual stance by the media. They always take the side of the underdog, the poor over the rich, the female over the male, or the minority over the Caucasian. I would probably be hauled off in handcuffs and sent to prison. My practice would be finished and my life would be shattered. I would have to pay a fortune to be defended by a lawyer that would likely bankrupt me. Then they would haul me in front of a jury who would have to decide if I was guilty based on my word versus her word. Based on my appearance, my demeanor, my testimony. And then maybe serve jail time for a crime that never happened.

Am I supposed to hire a person to be with me at all times in the office? Should I have video cameras going in my office at all times to protect me from false accusations? Is that even legal? One thing is for sure, if a woman comes to see me above 18 years old and below say 65 by herself I will try to remember to bring a staff member into the examination room with me. But I am not sure if even that completely protects me.

This is really scary stuff.

Berlin

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

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

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

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

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

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

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

Failure of USA Health Care

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

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

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

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

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

Never Again Rings Hollow

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

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

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

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

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

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