Dagny Loved Coda. The Saudis, Our Adversaries and Redefining The American Dreamer.

;
Dagny was having a melt down at dinner, she hasn't done this in a while, and we couldn't get her to say what was wrong so I asked her to draw what was bothering her. She writes "I love you Coda - Dagny" then she broke down in tears.

(Dagny's Coda had to be put to sleep because she had incurable cancer and was in pain and suffering.)
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
This from a dear friend and fellow memo reader who lives in Atlanta. (See 1 below.)
===
I have received this from several friends and fellow memo readers and I question whether it is the right conclusion but decided to post in anyway.  Time will tell. 

 Perhaps the truth will conquer in the end and, if not set us free, at least set us on a better path. (See 2 below.)
+++
Have The Saudi's finally gotten their act together? (See 3 below.)
+++
Victor Davis Hanson gives evidence why America's adversaries believe we are vulnerable and are acting accordingly.  (See 4 below.)
===
The redefinition of the American Dreamer is a sign of disaster according to my friend, Allen West. (See 5 below.)
===
Dick
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++1)Obamacare and the Private Practitioner: 2016

By Keith Jackson

Keith Jackson is a otolaryngology, head, and neck surgeon in Atlanta, Georgia.

Private practice medicine in the United States is rapidly going away.  In the past few years, the percentage of doctors who own their own businesses has plummeted.  The middle class, the supposed beneficiaries of Obamacare, can't afford their deductibles and are avoiding necessary treatments and tests because of costs, leading doctors to have to care for them at more advanced stages of disease.  Doctors (and nurses), the highest trained and most knowledgeable providers of patient care, are mostly data input vehicles for the massive electronic medical records systems.  And the amount of money that has been shoveled into the great abyss of the new government bureaucracy is enough to have bought all of us excellent private care, yet our care and our coverage for that care is worse.

Before Obamacare, the percentage of physicians owning their own businesses was around 70%.  It is now hovering around 30%.  The reason for the shift is not widely reported.  As costs to run their businesses have been going up, reimbursements to doctors are going down, making the margin for being able to stay open smaller and smaller.  Meanwhile, hospitals are doing comparatively better.  Why?  Because they can charge more for a service than doctors can charge.  Hospitals can do this because they have traditionally taken care of the uninsured, and states have written into their books a differential in the reimbursement to make things "fair."  This differential allows hospital corporations the ability to afford to buy doctors' practices.

This affects costs adversely.  (Get ready for a lesson in medical billing "transparency").  As an example, if Dr. Jones charges $535 for a C.T. scan of the sinuses as a private practitioner and submits the bill to an insurer, he may receive as payment $235.  If a hospital owns the practice, and the billing is done through the hospital's auspices, they can charge $895 and may get $695.  If the doctor then looks down your throat through your nose with a fiber-optic endoscope, he charges $180 and receives $60 in payment from the insurers, while the hospital can charge $365 and get $285.

Because of these differentials, the hospital can negotiate with the doctors to buy their medical and surgical practices with the ability to stabilize their drop in take-home income and allow their offices to remain open.  Doctors who used to be staunch advocates of private practice health care have little choice and join "the Borg."  Your costs go up.  Private practice goes away.

(Interestingly, hospital corporations still don't get what they pay for, as doctors often work less diligently as a part of a conglomerate, and even when they do, the costs of running the practices are frequently higher than hospitals predict.  They make up for this by restricting that surgeries be done only at their facilities, as surgeries can make up the profit differential, as anyone who has gotten a surgery bill will attest.)

The middle classes and upper middle classes are bearing the brunt of Obamacare, and it negatively impacts physicians and their ability to care for them.  In order to afford insurance, people often choose very high deductible plans, usually with no health care savings account to assist them with unexpected costs.  And as every American knows, we tend to live right on the edge of what our paychecks allow.  As a result, because it is essentially a cash proposition to go to the doctor until that deductible is met, and since billing for health care is done with the knowledge that most bills are negotiated down by insurers and are inflated as a result, affording a visit to the doctor is financially untenable.  Because we don't have cash stashed away for this contingency, we tend to allow disease to progress farther before it is addressed.

A typical example of the plight of the middle and upper middle class with high insurance deductibles is seen in hospital infusion centers.  When checking in, these groups frequently are counseled that they need to see the financial department to go over their situation.  Americans with a good income may buy a house that is just around the maximum allowed by the banks.  They may choose to send their kid to a private school.  They know that if they work hard, they can eventually pay the bill, because that formula has worked for them in the past.  Then they get cancer.  An $8,000.00 deductible and owing 20% of the bill has them staring bankruptcy right in the face.  This negatively effects care and makes the job of the private practitioner nearly impossible, with "can I do something less expensive?" a chronic refrain.  Many choose no care at all.

Surgeons who used to do frequent semi-elective procedures in communities with relative above average wealth have seen their number of surgery cases plummet, as people will live with their "bum knee" or "sinus" rather than pay to have the problem improved.  (As a result, it would probably not be all that surprising if health care costs are going down, as people are not doing things for their health that used to be commonplace.  After all, a surgeon doing less surgery saves a bunch of money.)

If you have been to a hospital in the past few years, you have probably noticed that nurses and doctors are not in patient's rooms like in the past.  They are camped out at portable computer stations, inputting data so that proper billing is justified.  They are the only people in the system who truly know what care has been delivered and how it should be coded into the electronic medical record system.  From a bureaucratic point of view, this would seem optimal.  Reasonably and practically, however, it is a nightmare.

To adequately fill in all of the checked boxes to justify levels of care for billing purposes would take more time than can reasonably be extended to a patient than the practitioner has available.  Then there is the necessary impersonality of having to look at the computer while talking to the patient so that you don't have to catch up later, making the patient think that you are not listening and are not relatable.  When a patient doesn't trust the doctor, the compliance to the recommended care plan is gone.  That doctor's effectiveness in helping the patient suffers, as does the patient.

The impact of the electronic medical records systems (EMRs) is profound.  Doctors see fewer patients.  They end up bringing more work home.  The resulting notes that are sent to the referring physicians are cumbersome and almost unreadable.  Unless editing is done by some provider with a lot of time on their hands, misdiagnoses are forever listed under "patient problems," as are medications that were never received.  Doctors who spend 45 minutes discussing what another provider might take 5 minutes to do frequently miss out on differential reimbursement because they are not up to speed on the latest coding changes.  Cleaning up a chart to reflect all that had been asked and done could take two or three ancillary assistants that the doctors cannot afford to employ.  Doctors incrementally do less health care for their patients and more data entry facilitation, decreasing the joy and accomplishment of the profession and decreasing the quality of the encounter.

In addition, the whole point of EMR is to data-mine.  The reason for data-mining is essentially to help third parties decide what service that they will pay less for in the next billing cycle.  So by checking the interminable boxes in the medical record, the doctor is complicit in his own financial demise.

The instillation and management of Obamacare is so entrenched now as to be almost unassailable.  It has cost us untold monies.  It promised us much more than it delivered.  It has not been worth the investment.  Yet with the number of people dependent on the government-run elements of covered care, such as Medicare, Medicaid, and Tricare, the possibility of reversing the course back to private care delivery from private hands is about zero.

When the BBC came to America before voting on Obamacare, they sought out people to interview who didn't have health coverage and asked about their concerns.  One woman in Georgia with a strong breast cancer family history was afraid to see the doctor because of cost.  The BBC essentially shamed us for the situation, castigating our system as unfair.  At the time, however, the chance of that uninsured American surviving her breast cancer diagnosis was substantially higher than a corresponding "covered by the National Health Service" woman in England.  No one ever mentioned this fact.

Private practice medicine run by doctors who could "adjust the bill," make payment plans more suitable for indigent patients and create "lost leaders" – taking a financial hit on one service knowing that they could make up for it with the better reimbursement from another service – were a much better means to provide care.  The government-initiated efforts to save us money and increase affordability were dumb from the beginning and have taken away from us one of the greatest things about American health care, namely doctors working with patients to provide care that the doctor and patient both deem is best for that individual.  They have skyrocketed costs and impersonalized care.

Who in his right mind would want to "hang up a shingle" in this environment?

Keith Jackson is an otolaryngology, head, and neck surgeon in Atlanta, Georgia

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

2) Consider this:

   

Comey is not a stupid guy.  He may have been directed to "take the fall" with his Hillary announcement (we know that Loretta didn't want this thrown on her desk to preside over, even though the FBI has no authority to make decisions whether or not to prosecute crimes; they only investigate and Justice Dept decides that).  However, he decided to do something out of the ordinary -- lay out and disclose all of his evidence during his Press Conference.  He knew what he was doing and he knew that it would create a "firestorm" of controversy.  If he had just sent everything he had to AG Lynch, it might have all gotten buried or, at least, not disclosed until long after the election.  Instead, he threw it all out for the public to know.

   He also knew that it would cause Congress to call for an investigation so, now, he will not just be able to go and answer their questions; he made himself available almost instantly (tomorrow at 10 AM) full well knowing that they will want to dig even deeper, hear about more evidence and have an open-ended Q&A for the entire day if they want to.  If he wanted to, he could have stalled this for a month just by saying "he's busy; send me a Subpoena or let's schedule it for a convenient time.  I think Comey knew that this way the FBI's entire case will get a full public airing (and, since there isn't a prosecution pending, he can be candid and open about anything and everything).  If it went to the Justice Dept's hands, it would die a slow death there.  Nothing will be kept secret now; we'll learn about things (such as Hillary having 12 private servers) that no one even suspected existed.  Comey can, literally, try this case before the public, just as he started to do laying out the key evidence just before "dropping the case", when everyone thought he was heading toward a recommendation of prosecution.

The Public and Media will now get to know EVERYTHING that would or could have been presented in court if there was a prosecution (in fact, even more than what could be presented in court because there will be no rules of evidence holding him back).  This hearing could be extremely eye-opening.  Like I said, Comey isn't a stupid guy and he might have just outsmarted Lynch and Obama when they told him to "kill this case".  A Grand Jury might have taken 6 months or longer to accomplish, if playing "according to Hoyle", plus it is secret, except for leaks.  Now nothing will be secret.  Again, Comey is not stupid and he might also prove that he is no one's lacky; however, he will just "play it straight"; answer all of the questions and not have to volunteer anything.  After all, Obama and Lynch can't tell him to lie to Congress.  He might look foolish laying out this case when not recommending prosecution but he might be wiser beyond our thinking because now he will just be responding to questions "under oath.

    That's my take on this scenario.  This could come out to be the biggest fake-out in American history and, possibly, the only way to take down a liar and dishonest government official who is being "protected".  It might, actually, be worse than anything Hillary and Bill ever imagined.

   Who knows; maybe this will also carry into the Foundation crap as well.  We will see. 

"Look, the average Democrat voter is just plain stupid.  They're easy to manipulate.  That's the easy part." - Hillary Clinton, 2005

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
3)Prince Turki bin Faisal Al-Saud Drops Bombshell at Iranian Opposition Rally

by Clare M. Lopez
 

At the annual gathering of Iranians outside of Paris, France on 9 July 2016, where some 100,000 showed up to express support for regime change in Tehran, one of the guest speakers dropped a bombshell announcement. Even before he took the podium, Prince Turki bin Faisal Al-Saud, appearing in the distinctive gold-edged dark cloak and white keffiyeh headdress of the Saudi royal family, of which he is a senior member, drew commentary and lots of second looks. The Prince is the founder of the King Faisal Foundation, and chairman of the King Faisal Center for Research and Islamic Studies, and served from 1977-2001 as director general of Al-Mukhabarat Al-A’amah, Saudi Arabia’s intelligence agency, resigning the position on 1 September 2001, some ten days before the attacks of 9/11.

He took the podium late in the afternoon program on 9 July and, after a discourse on the shared Islamic history of the Middle East, launched into an attack on Ayatollah Ruhollah Khomeini, whose 1979 revolution changed the course of history not just in Iran, but throughout the world. His next statement sent a shock wave through the assembly: Bin Faisal pledged support to the Iranian NCRI opposition and to its President-elect Maryam Rajavi personally. Given bin Faisal’s senior position in the Saudi royal family and his long career in positions of key responsibility in the Kingdom, it can only be understood that he spoke for the Riyadh government. The hall erupted in cheers and thunderous applause.

Iranians and others who packed the convention center in Bourget, Paris came for a day-long program attended by representatives from around the world. Organized by the National Council of Resistance of Iran (NCRI), the event featured a day filled with speeches and musical performances. A senior-level U.S. delegation included Linda Chavez, Chairwoman of the U.S. Center for Equal Opportunity; former Speaker of the House Newt Gingrich; former Governor of Pennsylvania and Secretary of Homeland Security Tom Ridge; Judge Michael Mukasey; former Governor of Vermont and Presidential candidate Howard Dean; and former national security advisor to President George W. Bush, Fran Townsend.

The NCRI and its key affiliate, the Mujahedeen-e Kahlq (MEK), were on the U.S. Foreign Terrorist Organizations (FTO) list until 2012, having been placed there at the express request of Iranian president Khatami. Iranian university students formed the MEK in the 1960s to oppose the Shah’s rule. The MEK participated in the Khomeini Revolution but then was forced into exile when Khomeini turned on his own allies and obliterated any hopes for democratic reform. Granted protection by the U.S. under the 4th Geneva Convention in 2004, remnants of the MEK opposition have been stranded in Iraq, first at Camp Ashraf and now in Camp Liberty near Baghdad since U.S. forces left Iraq. Completely disarmed and defenseless, the 2,000 or so remaining residents of Camp Liberty, who are desperately seeking resettlement, come under periodic deadly attack by Iraqi forces under Iranian Qods Force direction. The most recent rocket attack on July 4th, 2016 set much of the camp ablaze and devastated the Iranians’ unprotected mobile homes. The MEK/NCRI fought their terrorist designations in the courts in both Europe and the U.S., finally winning removal in 2012. The NCRI’s national headquarters are now located in downtown Washington, DC, from where they work intensively with Congress, the media, and U.S. society to urge regime change and a genuinely liberal democratic platform for Iran.

Given the Obama administration’s close alignment with the Tehran regime, it is perhaps not surprising that the NCRI and Riyadh (both feeling marginalized by the U.S.) should find common cause to oppose the mullahs’ unceasing quest for deliverable nuclear weapons, aggressively expansionist regional agenda, and destabilizing involvement in multiple area conflicts, especially its extensive support for the murderous rule of Bashar al-Assad. Nevertheless, the implications of official Riyadh government support for the largest, most dedicated, and best-organized Iranian opposition movement will reverberate through the Middle East.

Although not openly stated by bin Faisal, the new NCRI-Riyadh alliance may be expected to involve funding, intelligence sharing, and possible collaboration in operations aimed at the shared goal of overthrowing the current Tehran regime. The alignment doubtless will change the course of events in the Middle East, and while Saudi Arabia can hardly be counted among the liberal democracies of the world, the woman-led NCRI movement declares a 10-point plan for Iran that does embrace the ideals of Western Civilization. The impact of the Saudi initiative will not be limited to Iran or the surrounding region but at least as importantly, surely will be felt internally as well, among a young and restless Saudi population that looks hopefully to the rule of King Salman and his 30-something son, Deputy Crown Prince Mohammad bin Salman al-Saud.

Clare M. Lopez is the Vice President for Research and Analysis at the Center for Security Policy

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
4) Enemies see America as vulnerable prey

By Victor Davis Hanson

Here is a sampling of some recent news abroad:

A Russian guard attacked a U.S. diplomatic official at the door to the American Embassy in Moscow, even as NATO leaders met to galvanize against the next act of Russian aggression.

The Islamic State continued its global terrorist rampage with horrific attacks in Baghdad and Istanbul.

Iran rebuffed United Nations warnings and defiantly boasted that it will continue testing ballistic missiles. German intelligence believes that Iran, empowered by the release of $100 billion in impounded cash, is violating its recent American-led nonproliferation deal in an effort to import nuclear bomb-making technology.

North Korea conducted a test (unsuccessful, apparently) of a submarine-based guided missile.

There are various ways of interpreting these ominous events.

They could represent just more empty chest-thumping by our enemies.

Or, because this is an election year in the U.S., enemies are posturing in order to advance their agendas, as they often do in times of uncertainty about who will be the next president.

Or, Obama is perceived as an exceptionally lame-duck president who is hoping to wind down his tenure in passivity, without a major incident abroad that might imperil his presidential legacy.

Or, after the explosive rise of ISIS, the disaster in Benghazi, the failed reset with Russia, the unchecked Chinese aggression in the South China Sea, the concessions in the Iran deal, the veritable implosion of theMiddle East, and the president's counterproductive sermonizing about Brexit, enemies sense that the U.S. is directionless. These enemies may be unsure whether America still wishes to -- or even can -- exercise its traditional leadership of the free world and remain the custodian of the postwar international order.

But perhaps there is yet another catalyst prompting such events.

The United States appears to be entering another era of dangerous internal instability similar to the one it endured in the 1960s-1970s.

After the attacks by radical Islamists in San Bernardino and Orlando, Americans did not rally together as they had after 9/11. Instead, almost immediately, the country was torn further apart. About half the nation saw the terrorist killings as a reason for stricter gun control rather than a reason to fear the continuing spread of radical Islamic terrorism. The other half worried that political correctness and the president's refusal to even mention radical Islamic terrorism are eroding the ability to deter it.

America's enemies draw their own conclusions.

After the Orlando attack, al-Qaida urged lone-wolf terrorists in the U.S. to focus exclusively on white targets. The organization's leaders apparently worry that if terrorists again hit minority communities, it will prompt a bickering America to blame itself rather than give full credit to the attackers.After the recent deaths of two black men in confrontations with police (in Minnesota and Louisiana), followed by national Black Lives Matter protests and the killing of five law-enforcement officers in Dallas, it might appear to our enemies abroad that the American superpower is internally unwinding into tribalism in the fashion of the Balkans, Iraq or Lebanon.

As in the case of Islamic terrorism, America seems to have no answers to racial tensions. Half the country believes African-Americans are inordinately targeted by police and that inner-city violence can be attributed to a long history of racism, national neglect and economic stagnation. The other half blame disastrous social-welfare and big-government policies for creating dangerous dependencies and a dearth of jobs in America's inner cities, as well as a popular culture that glorifies rather than discourages the excesses of many young black males.

One America believes that the Obama administration genuinely tried, but so far has failed, to resolve the tensions between inner-city residents and police. The other America thinks Obama sought to leverage those tensions for political reasons.

Either way, most of America privately thinks that Islamic terrorist acts and racial tensions are going to get far worse -- a perception that is probably shared overseas as well.

Our enemies increasingly may gamble that provocations won't elicit a U.S. reaction. Or that even if America did respond, the resulting domestic divisions and turmoil would diminish the effectiveness of the response.

Add to the equation record debt and vast cuts in the defense budget, and our enemies may conclude that we are Rome of AD 500, Britain of the late 1940s, or Russia of the 1980s.

To be blunt, America's vulnerable postwar global order may already seem to those abroad to be bloated carrion ready to be picked apart by opportunistic vultures.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

5)

The Future for the Real American Dreamers

By Allen West

(Editors’ note: This column was co-authored by Luke Twombly)

“Tolerance is a tremendous virtue, but the immediate neighbors of tolerance are apathy and weakness” – Sir James Goldsmith

“When tolerance becomes a one way street, it leads to cultural suicide” – LTC Allen B. West (USA, Ret)

The song by Neil Diamond, “America” is one that expresses the true essence of the attainment of that which we refer to as the American dream. It is here upon these shores where one is rewarded for an indomitable, individual drive…that singular thing we call work ethic. Those are the ingredients which go into that “melting pot,” producing entrepreneurs and those seeking “the “pursuit of happiness.” They come to America, to experience and achieve the American dream.

However, what happens when a political ideology perverts language and redefines the word “dream” into a policy that is not consistent with our fundamental values and principles? Such has occurred with the term “dreamer,” as if there is only a specific, politically designated group that is searching for a dream.

All of a sudden there has been an almost Orwellian, political redefinition of a “dreamer.” Dreamers are now, as defined by the Obama administration, any illegal immigrant who claims to have come into the country before the age of 16, whom has also been here continuously for five years, and is currently under age 35. The federal government estimates that there are 1.4 million “dreamers” in the United States. Of that number, 68% are from Mexico, 13% are from Latin America or the Caribbean, and 8% are Asian.

When huge political capital is being expended to secure a desired outcome, who suffers the most?

It is our native born American children and grandchildren, and those who have come to our land legally. For some odd reason, they are not defined as “dreamers,” and even legislation signed into law dismisses their aspirations. While on the other hand, there is a group being politically elevated upon their backs -- hence the Dream Act. Fortunately, we have recently witnessed the U.S. Supreme Court ruling against President Obama’s executive amnesty and this ideologically imposed agenda.

But, is this contest over? What are the ramifications for the real American dreamers, our own sons and daughters? Half of this rising Millennial generation has adopted the bleak outlook that the American dream is dead. While the other half remains steadfast in a hope for America and its economic future. Perhaps not all is lost.

For today’s American Millennial the economic outlook is bleak. Unemployment for these real American dreamers is almost 13%. Furthermore, to exacerbate the situation, 51% of this generation are underemployed to the point of being Baristas with Bachelor degrees, certainly not the ideal circumstance for the generation taking us into the highly technical 21st century. Since 2000, 100% of net gain job creation has gone to immigrants, both legal and illegal, while the native born population accounts for 66% of population growth.

In examining the workforce participation rate, we are at a dreadful all-time low of 62.4% which translates to 94.7 million Americans not actively in the workforce. The deceptive tool of declaring the unemployment rate at 4.7% is a reflection of not counting these millions of Americans in the calculation. The denominator changes for political expediency.

For the homegrown, minority American dreamers, the statistics are dire. The millennial Hispanic unemployment rate is 13.9% and for the black community it is at an alarming 15.2%. One must ask, why would anyone place a higher value on illegal, foreign-born millennials than those who are part of the legacy representing the American ideal? It can only be explained by the fact that perhaps there are those who do not believe there is a legacy, a lineage, which has been passed down through generations in America. Or, perhaps there are those who see little value in our national sovereignty and therefore, no value in America’s cultural history and identity?

The best means by which our real American dreamers achieve their hopes is with a quality education. But, it appears the resources needed for them are being allocated elsewhere for the politically defined foreign born dreamers. Case in point: in America, English learner programs are costing between $20-$25K for each Obama administration-defined “dreamer.” Instead of these investments going toward after school education, music, arts, and vocational training programs for our children, our tax revenues are being redistributed from American dreamers to the foreign millennials.

When all is said and done, the total annual education cost for those here illegally is $52 billion. But, this does not take into account the oversized classes, over-extended teachers, and the other adverse effects on our education system.

Some will certainly deem this commentary as lacking compassion. However, what can be more dispassionate than to politically deny the dreams of our own children and grandchildren? We must ask ourselves, for what purpose?

There are those who would actually attack anyone stating these figures as xenophobic and racist. This has become a means to an end preventing anyone from bringing this topic to the discussion table. They would leverage the catch all phrase of “multiculturalism” to promote ideological uniformity -- and silence.

It is time to break the silence of apathy and weakness to secure the future for the real American dreamers.

Allen West is the Executive Director and Vice Chairman of the Board for the National Center for Policy Analysis, where Luke Twombly is a research associate.

+++++++++++++++++++++++++++++++++++++++++++++++++++++