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Dick
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Friday, in typical stolid English Bull Dog fashion, Prime MInister Cameron laid out the case for stopping the Muslim Mudslide in Great Britain. It was a speech that should awaken the Brits to the fact that their nation and culture, along with the rest of Europe, is in imminent danger of losing the very freedoms they have enjoyed over the many centuries they have been in existence.
Words express intent so now the question is will they be implemented?
Time will tell so stay tuned.
Meanwhile, our own president continues to demonstrate he has the capacity to lay the foundation, for blaming others but remains unwilling and/or incapable of making a decision.
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A tale of two funerals. You decide about the message! (See 2 below.)
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Israel won the war, if wreckage is the equation used but lost the battle for justification because Israel can never win since it is strong. The politically correct world favors the weak even when the weak are terrorists. (See3 below.)
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Doctor, heal thyself if you can and Obamacare will permit. If not we all suffer. (See 4 below.)
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Dick
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1) By all accounts, Harold was a bright child. He grew up in America. He went to school and had a bright future ahead of him.
Harold’s full life was cut short in a violent moment.
While few people had ever heard of Harold before his death, many did afterwards.
And in death, something shocking happened.
What was so shocking, especially when it is compared to the death of someone else recently in the news?
Harold is Harold Greene, Major General United States Army.
On August 5th, General Greene was killed by a Taliban terrorist. He was returned to America with full military honors.
It has been a tradition that the President attends the funeral of flag officers killed in the line of duty. Richard Nixon attended the funeral of a Major General killed in Vietnam and George W. Bush attended the funeral of Lieutenant General Timothy Maude, who was killed in the 9/11 attacks.
While Major General Greene was buried, Barack Obama was golfing. The Vice President wasn’t there either. Neither was the Secretary of Defense. Flags were not even lowered to half staff.
Four days after Harold Greene gave his life for America, Michael Brown was killed in Ferguson Missouri.
It is safe to say, Brown was at best a possible bully, maybe even a thug,
The media has repeatedly shown photos of Brown flashing gang signs. Some media outlets have even associated him with a specific gang. In the minutes before his death, Brown committed a robbery at a local convenience store.
According to other reports, Brown struck officer Darren Wilson and shattered his orbital bone.
Obama is sent a three-person White House delegation to Michael Brown’s funeral.
Obama would not attend the funeral of the highest ranking military officer killed in the line of duty since 9/11, yet he will send a delegation to the funeral of Mr. Brown
When Margaret Thatcher, one of America’s staunchest allies and Ronald Reagan’s partner in bringing down Soviet communism died, Obama sent only a small low-level delegation to her funeral. The snub was not missed by the British.
When Chris Kyle, the most lethal American sniper in history was murdered, there was no expression of sympathy from the White House. There was no White House delegation at his funeral.
American heroes die and Obama goes to the golf course.
Mr. Brown dies and he gets a White House delegation.
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2) Blacks Must Confront Reality
Though racial discrimination exists, it is nowhere near the barrier it once was. The relevant question is: How much of what we see today can be explained by racial discrimination? This is an important question because if we conclude that racial discrimination is the major cause of black problems when it isn't, then effective solutions will be elusive forever. To begin to get a handle on the answer, let's pull up a few historical facts about black Americans.
In 1950, female-headed households were 18 percent of the black population. Today it's close to 70 percent. One study of 19th-century slave families found that in up to three-fourths of the families, all the children lived with the biological mother and father. In 1925 New York City, 85 percent of black households were two-parent households. Herbert Gutman, author of "The Black Family in Slavery and Freedom, 1750-1925," reports, "Five in six children under the age of six lived with both parents." Also, both during slavery and as late as 1920, a teenage girl raising a child without a man present was rare among blacks.
A study of 1880 family structure in Philadelphia found that three-quarters of black families were nuclear families (composed of two parents and children). What is significant, given today's arguments that slavery and discrimination decimated the black family structure, is the fact that years ago, there were only slight differences in family structure among racial groups.
Coupled with the dramatic breakdown in the black family structure has been an astonishing growth in the rate of illegitimacy. The black illegitimacy rate in 1940 was about 14 percent; black illegitimacy today is over 70 percent, and in some cities, it is over 80 percent.
The point of bringing up these historical facts is to ask this question, with a bit of sarcasm: Is the reason the black family was far healthier in the late 1800s and 1900s that back then there was far less racial discrimination and there were greater opportunities? Or did what experts call the "legacy of slavery" wait several generations to victimize today's blacks?
The Census Bureau pegs the poverty rate among blacks at 28.1 percent. A statistic that one never hears about is that the poverty rate among intact married black families has been in the single digits for more than two decades, currently at 8.4 percent. Weak family structures not only spell poverty and dependency but also contribute to the social pathology seen in many black communities -- for example, violence and predatory sex. Each year, roughly 7,000 blacks are murdered. Ninety-four percent of the time, the murderer is another black person. Though blacks are 13 percent of the nation's population, they account for more than 50 percent of homicide victims. Nationally, the black homicide victimization rate is six times that of whites, and in some cities, it's 22 times that of whites. According to the Bureau of Justice Statistics, between 1976 and 2011, there were 279,384 black murder victims. Coupled with being most of the nation's homicide victims, blacks are also major victims of violent personal crimes, such as assault, rape and robbery.
To put this violence in perspective, black fatalities during the Korean War (3,075), Vietnam War (7,243) and all wars since 1980 (about 8,200) come to about 18,500, a number that pales in comparison with black loss of life at home. Young black males had a greater chance of reaching maturity on the battlefields of Iraq and Afghanistan than on the streets of Philadelphia, Chicago, Detroit, Oakland, Newark and other cities.
The black academic achievement gap is a disaster. Often, black 12th-graders can read, write and deal with scientific and math problems at only the level of white sixth-graders. This doesn't bode well for success in college or passing civil service exams.
If it is assumed that problems that have a devastating impact on black well-being are a result of racial discrimination and a "legacy of slavery" when they are not, resources spent pursuing a civil rights strategy will yield disappointing results.
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3) The War with Gaza: Let the Recriminations Begin
In a wretched neighborhood called the Middle East where perception usually trumps reality, Israel has lost on both accounts. As Likud Central Committee chairman Danny Danon announced on Wednesday: "The Protective Edge war that began with huge support ended with Israel shamed and confused." Despite the spin of some pundits and people in and out of government, the facts support MK Danon’s assertion.
In addition to Danon, the deal, unilaterally agreed to by Prime Minister Benjamin Netanyahu without consent from his cabinet rattled coalition partners and political rivals such as Naftali Bennett and Avigdor Lieberman. Itamar Shimoni, The mayor of Ashkelon, a beachside city adjacent to Gaza hit incessantly by rocket fire since 2005 had this to say: “Any concession to Hamas is a surrender to terrorism.”
Steven Emerson, writing for the “Investigative Project on Terrorism” seemed to concur with senior Israeli security officials which stated that Hamas has taken a severe military and morale blow, but its military arm is preparing for another round of fighting, believing the price its people are paying is tolerable as long as its goals are achieved. By Netanyahu acquiescing to this latest truce, their assessment seems have been proven correct.
Emerson closes out his article describing the bitterness and hatred felt by some Gazans in the street toward Hamas for firing and placing munitions in hospitals, Mosques, and private residences while senior leadership hid in tunnels leaving residents to fend for themselves. He quotes a Hamas fighter claiming to have received his anti-tank training in a hall under the Alshafi Mosque in Khan Yunis where the Izzadin Al-Kassam Brigades train. All this is probably true. Yet the streets were filled Gazans celebrating what they deemed a great victory over the “Zionist occupation.”
That Gaza has been dealt a heavy blow there can be no question. According to a CBS report; (biased no doubt and dependent upon overinflated U.N. and Hamas estimates) The Gaza war has killed at least 2,133 Palestinians and wounded more than 11,000, according to Palestinian health officials. The U.N. estimates more than 17,000 homes have been destroyed, leaving 100,000 people homeless. Inflated or not, the damage to Gaza is indeed considerable.
But so what? To a rogue “government” of terrorists that ruthlessly uses its people as human shields, death and destruction are water off a duck’s back. It’s actually welcomed for its propaganda value. Throughout the war, biased media constantly harped on the absurd issue of “proportionality.” As if war was a game and Israel was guilty of not suffering sufficient fatalities.
Emerson may be correct: “Many within Gaza are disillusioned with Hamas.” No doubt during the waning days of the World War II many Germans were likewise disillusioned with the Nazis as their cities too laid in ruin and they lacked control of events. Yet the war dragged on until unconditional surrender was effectuated and Germany no longer had the wherewithal to conduct aggression. This is not the case with Hamas, which still retains the capacity after 50 days of fighting to disrupt the lives of not only Israelis living adjacent to Gaza but throughout all of Israel.
To these Israelis, recriminations against Prime Minister Netanyahu have already begun. They correctly view that the failure to unconditionally win this war lies upon his shoulders.
Trying to paint a brighter picture, at a Jerusalem press conference Wednesday alongside Defense Minister Moshe Ya’alon and Chief of Staff Lt.-Gen. Benny Gantz, Netanyahu declared, “Hamas was hit hard, and did not get any of the things it demanded for a cease-fire.” With obfuscation worthy of President Obama, he listed his take on Israel’s achieved goals in the war:
Destruction of Hamas’s attack tunnels; killing some 1,000 terrorists, including top commanders; destroying thousands of rockets, rocket launchers, arms depots, and weapon manufacturing facilities; knocking out “hundreds” of command centers; and preventing Hamas attacks on Israel from the land, sea and air; Hamas’s conditions of a sea and airport were denied; as were their demands to release prisoners placed back under arrest following the murder of the three Israeli boys.
Glaringly, he failed to come to grips with the least common denominator of this war. Issues which politicians and people from all points on Israel’s political spectrum are already taking him to task for, his irresolute military leadership and Hamas’s ability to renew hostilities at any time of its choosing. Many are also accusing him of being more concerned with world opinion than the welfare of the people he was elected to defend.
According to polls conducted by Israel’s Channels 2 and 10: 54% of Israelis oppose the ceasefire, 37% support it. In accordance, 59% are dissatisfied with Netanyahu’s performance. Most notably, the poll also found satisfaction with the prime minister fell to just 32%, down from 38% on Monday, 55% last Thursday, and from 82% since July 23 when ground forces first entered Gaza.
In fairness, when asked who won the war another poll from Channel 10 indicated: 32% said Israel, 25% said Hamas, and 26% called it a tie; 19% did not know. Not exactly a mandate for Netanyahu’s conduct of a war in which he seemed to lack a cogent plan, one that some are accusing him of lacking the moxie to finish. The question is not so much as who won the war as the absurdity to the way it was fought.
From dropping of leaflets warning Hamas of imminent attack to allowing them a respite by tolerating eleven ceasefire violations, from failure to consider sensitive targets due to collateral damage to continued electrical service into Gaza, Netanyahu may go down in Israeli history not as a leader but as its most congenial warrior. Particularly in the Middle East, moral codes of ethics are viewed as cowardice, not strength. Like bad neighborhoods throughout the world, perception of weakness is immediately recognized by bullies and bad guys.
On Wednesday the Iranian Foreign Ministry wasted no time congratulating Hamas: “The heroic Palestinian people have forged a new era with the victory of the resistance which has brought the Zionist regime to its knees.” Hamas senior spokesman, Sami Abu Zuhri proclaimed: “The value of this campaign is not in the opening of this crossing or that crossing, but in paving the way for the next stage, liberating Jerusalem.” It’s this long-term messianic viewpoint spelled out explicitly in its charter of 1988 that makes Hamas so dangerous to Israel. Unwilling to accept the sacrifices necessary to totally eviscerate this sworn enemy, Netanyahu has allowed them the perception of victory, a pause to rearm, and preparation for the next round which is surely to come.
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4) Why Doctors Are Sick of Their Profession
American physicians are increasingly unhappy with their once-vaunted profession, and that malaise is bad for their patients
By Sandeep Jauhar
What happens when doctors are unhappy? They have unhappy patients. A new memoir, 'Doctored,' presents one cardiologist's take on the challenges facing American medicine and the real impact on patient care. Dr. Sandeep Jauhar discusses his book on Lunch Break with Tanya Rivero. Photo: Getty
All too often these days, I find myself fidgeting by the doorway to my exam room, trying to conclude an office visit with one of my patients. When I look at my career at midlife, I realize that in many ways I have become the kind of doctor I never thought I'd be: impatient, occasionally indifferent, at times dismissive or paternalistic. Many of my colleagues are similarly struggling with the loss of their professional ideals.
It could be just a midlife crisis, but it occurs to me that my profession is in a sort of midlife crisis of its own. In the past four decades, American doctors have lost the status they used to enjoy. In the mid-20th century, physicians were the pillars of any community. If you were smart and sincere and ambitious, at the top of your class, there was nothing nobler or more rewarding that you could aspire to become.
Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future. In surveys, a majority of doctors express diminished enthusiasm for medicine and say they would discourage a friend or family member from entering the profession. In a 2008 survey of 12,000 physicians, only 6% described their morale as positive. Eighty-four percent said that their incomes were constant or decreasing. Most said they didn't have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether.
American doctors are suffering from a collective malaise. We strove, made sacrifices—and for what? For many of us, the job has become only that—a job.
That attitude isn't just a problem for doctors. It hurts patients too.
In a survey of 12,000 physicians, only 6% described their morale as positive. Getty Images
Consider what one doctor had to say on Sermo, the online community of more than 270,000 physicians:
"I wouldn't do it again, and it has nothing to do with the money. I get too little respect from patients, physician colleagues, and administrators, despite good clinical judgment, hard work, and compassion for my patients. Working up patients in the ER these days involves shotguning multiple unnecessary tests (everybody gets a CT!) despite the fact that we know they don't need them, and being aware of the wastefulness of it all really sucks the love out of what you do. I feel like a pawn in a moneymaking game for hospital administrators. There are so many other ways I could have made my living and been more fulfilled. The sad part is we chose medicine because we thought it was worthwhile and noble, but from what I have seen in my short career, it is a charade."
The discontent is alarming, but how did we get to this point? To some degree, doctors themselves are at fault.
In the halcyon days of the mid-20th century, American medicine was also in a golden age. Life expectancy increased sharply (from 65 years in 1940 to 71 years in 1970), aided by such triumphs of medical science as polio vaccination and heart-lung bypass. Doctors largely set their own hours and determined their own fees. Popular depictions of physicians ("Marcus Welby," "General Hospital") were overwhelmingly positive, almost heroic.
American doctors at midcentury were generally content with their circumstances. They were prospering under the private fee-for-service model, in which patients were covering costs out of pocket or through fledgling private insurance programs such as Blue Cross/Blue Shield. They could regulate fees based on a patient's ability to pay and look like benefactors. They weren't subordinated to bureaucratic hierarchy.
Read more from The Wall Street Journal: Five Things To Know Today.
After Medicare was introduced in 1965 as a social safety net for the elderly, doctors' salaries actually increased as more people sought medical care. In 1940, in inflation-adjusted 2010 dollars, the mean income for U.S. physicians was about $50,000. By 1970, it was close to $250,000—nearly six times the median household income.
But as doctors profited, they were increasingly perceived as bilking the system. Year after year, health-care spending grew faster than the U.S. economy as a whole. Meanwhile, reports of waste and fraud were rampant. A congressional investigation found that in 1974, surgeons performed 2.4 million unnecessary operations, costing nearly $4 billion and resulting in nearly 12,000 deaths. In 1969, the president of the New Haven County Medical Society warned his colleagues "to quit strangling the goose that can lay those golden eggs."
If doctors were mismanaging their patients' care, someone else would have to manage that care for them. Beginning in 1970, health maintenance organizations, or HMOs, were championed to promote a new kind of health-care delivery built around price controls and fixed payments. Unlike with Medicare or private insurance, doctors themselves would be held responsible for excess spending. Other novel mechanisms were introduced to curtail health outlays, including greater cost-sharing by patients and insurer reviews of the necessity of medical services. That ushered in the era of HMOs.
In 1973, fewer than 15% of physicians reported any doubts that they had made the right career choice. By 1981, half said they would not recommend the practice of medicine as highly as they would have a decade earlier.
Public opinion of doctors shifted distinctly downward too. Doctors were no longer unquestioningly exalted. On television, physicians were portrayed as more human—flawed or vulnerable ("M*A*S*H*," "St. Elsewhere") or professionally and personally fallible ("ER").
As managed care grew (by the early 2000s, 95% of insured workers were in some sort of managed-care plan), physicians' confidence plummeted. In 2001, 58% of about 2,000 physicians questioned said that their enthusiasm for medicine had gone down in the previous five years, and 87% said that their overall morale had declined during that time. More recent surveys have shown that 30% to 40% of practicing physicians wouldn't choose to enter the medical profession if they were deciding on a career again—and an even higher percentage wouldn't encourage their children to pursue a medical career.
There are many reasons for this disillusionment besides managed care. One unintended consequence of progress is that physicians increasingly say they don't have enough time to spend with patients. Medical advances have transformed once-terminal diseases—cancer, AIDS, congestive heart failure—into complex chronic conditions that must be managed over the long term. Physicians also have more diagnostic and treatment options and must provide a growing array of screenings and other preventative services.
At the same time, salaries haven't kept pace with doctors' expectations. In 1970, the average inflation-adjusted income of general practitioners was $185,000. In 2010, it was $161,000, despite a near doubling of the number of patients that doctors see a day.
While patients today are undoubtedly paying more for medical care, less of that money is actually going to the people who provide the care. According to a 2002 article in the journal Academic Medicine, the return on educational investment for primary-care physicians, adjusted for differences in number of hours worked, is just under $6 per hour, as compared with $11 for lawyers. Some doctors are limiting their practices to patients who can pay out of pocket without insurance company discounting.
Other factors in our profession's woes include a labyrinthine payer bureaucracy. U.S. doctors spend almost an hour on average each day, and $83,000 a year—four times their Canadian counterparts—dealing with the paperwork of insurance companies. Their office staffs spend more than seven hours a day. And don't forget the fear of lawsuits; runaway malpractice-liability premiums; and finally the loss of professional autonomy that has led many physicians to view themselves as pawns in a battle between insurers and the government.
The growing discontent has serious consequences for patients. One is a looming shortage of doctors, especially in primary care, which has the lowest reimbursement of all the medical specialties and probably has the most dissatisfied practitioners. Try getting a timely appointment with your family doctor; in some parts of the country, it is next to impossible. Aging baby boomers are starting to require more care just as aging baby boomer physicians are getting ready to retire. The country is going to need new doctors, especially geriatricians and other primary care physicians, to care for these patients. But interest in primary care is at an all-time low.
Perhaps the most serious downside, however, is that unhappy doctors make for unhappy patients. Patients today are increasingly disenchanted with a medical system that is often indifferent to their needs. People used to talk about "my doctor." Now, in a given year, Medicare patients see on average two different primary care physicians and five specialists working in four separate practices. For many of us, it is rare to find a primary physician who can remember us from visit to visit, let alone come to know us in depth or with any meaning or relevancy.
Insensitivity in patient-doctor interactions has become almost normal. I once took care of a patient who developed kidney failure after receiving contrast dye for a CT scan. On rounds, he recalled for me a conversation he'd had with his nephrologist about whether his kidney function was going to get better. "The doctor said, 'What do you mean?' " my patient told me. "I said, 'Are my kidneys going to come back?' He said, 'How long have you been on dialysis?' I said, 'A few days.' And then he thought for a moment and said, 'Nah, I don't think they're going to come back.' "
My patient broke into sobs. " 'Nah, I don't think they're going to come back.' That's what he said to me. Just like that."
Of course, doctors aren't the only professionals who are unhappy today. Many professions, including law and teaching, have become constrained by corporate structures, resulting in loss of autonomy, status, and respect. But as the Princeton sociologist Paul Starr writes, for most of the 20th century, medicine was "the heroic exception that sustained the waning tradition of independent professionalism." It is an exception whose time has expired.
How can we reverse the disillusionment that is so widespread in the medical profession? There are many measures of success in medicine: income, of course, but also creating attachments with patients, making a difference in their lives and providing good care while responsibly managing limited resources.
The challenge in dealing with physician burnout on a practical level is to create new incentive schemes to foster that meaning: publicizing clinical excellence, for example (public reporting of surgeons' mortality rates or physicians' readmission rates is a good first step), or giving rewards for patient satisfaction (physicians at my hospital now receive quarterly reports that tell us how our patients rate us on measures such as communication skills and the amount of time we spend with them).
We also need to replace the current fee-for-service system with payment methods such as bundled payment, in which doctors on a case are paid a lump sum to divide among themselves, or pay for performance, which offers incentives for good health outcomes. We need systems that don't simply reward high-volume care but also help restore the humanism in doctor-patient relationships that have been weakened by business considerations, corporate directives and third-party intrusions.
I believe most doctors continue to want to be like the physician knights of the golden age of medicine. Most of us went into medicine to help people. We want to practice medicine the right way, but too many forces today are propelling us away from the bench or the bedside. No one ever goes into medicine to do unnecessary testing, but this sort of behavior is rampant. The American system too often seems to promote knavery over knighthood.
Fulfillment in medicine, as with any endeavor, is about managing hopes. Probably the group best equipped to deal with the changes wracking the profession today is medical students, who are not so weighed down by great expectations. Doctors ensconced in professional midlife are having the hardest time.
In the end, the problem is one of resilience. American doctors need an internal compass to navigate the changing landscape of our profession. For most doctors, this compass begins and ends with their patients. In surveys, most physicians—even the dissatisfied ones—say the best part of their jobs is taking care of people. I believe this is the key to coping with the stresses of contemporary medicine: identifying what is important to you, what you believe in and what you will fight for. Medical schools and residency programs can help by instilling professionalism early on and assessing it frequently throughout the many years of training. Introducing students to virtuous mentors and alternative career options, such as part-time work, may also help stem some of the burnout.
What's most important to me as a doctor, I've learned, are the human moments. Medicine is about taking care of people in their most vulnerable states and making yourself somewhat vulnerable in the process. Those human moments are what others—the lawyers, the bankers—envy about our profession, and no company, no agency, no entity can take those away. Ultimately, this is the best hope for our professional salvation.
Dr. Jauhar is director of the Heart Failure Program at the Long Island Jewish Medical Center. This essay is adapted from his new book, "Doctored: The Disillusionment of an American Physician," published by Farrar, Straus and Giroux.
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