What Obama has[n’t] learned

The New Neo Posted on by

Peter Baker’s interview with President Obama in the NY Times Sunday magazine is entitled “Education of a President.”

It is a curious document. It purports to tell what the president and his advisers have learned from their first two years in office. The short answer seems to be: nothing, except perhaps that they aren’t the miracle workers they thought they were. Duh.

For instance, after Baker reads back to Obama his famous “the rise of the oceans will begin to slow and the planet heal yada yada yada” excerpt, and then asks him how that high-flying rhetoric sounds now, he replies: “It sounds ambitious. Buy you know what? We’ve made progress on each of those fronts.”

I suppose it should not be a surprise that Obama refuses to say the truth, which is that his rhetoric was ridiculously overblown and phenomenally narcissistic. Presidents in general are loathe to own up to mistakes, and Obama is no different.

What is different is Obama’s stubborn refusal—shot through the entire interview—to admit to any real problem other than not selling himself enough. His policies are fine, rock solid. The fact that people don’t accept them is a mere public relations and communication oversight, which would have been rectified by better spin.

Does Obama truly believe that? And if so, is it because he believes his policies are correct? Or is it because he believes he could sell ice to the Eskimos? And if the latter, does he believe it because he thinks people are just that stupid, or because he’s so powerfully persuasive, or both?

And how can he still believe it at this point? Hasn’t he at least been shown that his persuasive powers are not all that strong? Is it just that it’s easier to believe he hasn’t tried hard enough to convince? Easier than to believe that one of his greatest gifts has somehow deserted him, or that the Peter principle has triumphed?

If all he hears are statements like this one from his staff (or former staff), I suppose it wouldn’t be so hard for him to hold onto his old ideas of himself. These people are enablers:

“There is an anti-establishment mood,” Rahm Emanuel, the former Clinton aide who served as Obama’s first White House chief of staff, told me before he stepped down this month. “We just happen to be here when the music is stopping.”

It’s true that correlation doesn’t prove causation. But c’mon guys, this is big-time denial.

Here is the prevailing wisdom that Obama hears:

The view from inside the administration starts with a basic mantra: Obama inherited the worst problems of any president in years. Or in generations. Or in American history. He prevented another Great Depression while putting in place the foundation for a more stable future. But it required him to do unpopular things that would inevitably cost him.

If this is believed, it isn’t just arrogance. It’s delusion. And that’s never good for a president. And then there’s this:

“He’s opaque even to us,” an aide told me. “Except maybe for a few people in the inner circle, he’s a closed book.”

Not a good sign at all, and said by too many people to not be true. In addition, there’s this:

One prominent Democratic lawmaker told me Obama’s problem is that he is not insecure ”” he always believes he is the smartest person in any room and never feels the sense of panic that makes a good politician run scared all the time, frenetically wooing lawmakers, power brokers, adversaries and voters as if the next election were a week away.

Okay, I’ll go on record here: anyone who believes that he or she is always the smartest person in the room is both arrogant and a fool, and that’s not too smart at all.

The lost art of the physical exam

The New Neo Posted on by

The NY Times has an article about how the latest crop of doctors has forgotten—or really, never learned—how to perform a physical exam.

Oh, they can take measurements, and they can order tests. But they have come to rely on those things to diagnose a patient, rather than their eyes and ears and hands. Traditionally, those were doctors’ primary tools, and their skills in using them needed to be sharply honed. Now much of the skill seems to belong to the MRI machine and the sonogram, which give doctors a false sense of security and protection from lawsuits.

I’m not knocking those diagnostic tests; they’re important. But they should be adjuncts to a proper examination, which can tell a doctor a great deal about health rather than body parts. With an MRI and other exquisitely sensitive imaging, you can get into the trap of Too Much Information. For example, the back MRI of a person over forty without back pain often looks almost as abnormal as an MRI of one who does. What does it all mean?

One of the most impressive bits of hands-on diagnosis I’ve ever seen was performed by a man I consider a medical genius, the shoulder and elbow orthopedist Dr. Frank Jobe. The patient was my seventeen-year-old son. He had experienced multiple and repetitive shoulder dislocations, and all the doctors he’d seen on the east coast had agreed that he needed shoulder surgery of the anterior (in the front of the shoulder) type.

Dr. Jobe is the famous surgeon who invented the Tommy John elbow surgery in 1974. He’s elderly and doesn’t operate any more, but back when he saw my son he still did. He’s a genial, low-key guy, despite his fame, and he laid his hands gently on my son’s shoulder and wiggled it a little.

“Oh, my,” he said in surprise. “He’s got anterior and posterior dislocations. That’s highly unusual.”

Almost all shoulder dislocations are anterior. A few are posterior. Only a tiny percentage of shoulder dislocation patients have both, and they usually are people who have hyper-flexible connective tissue, which does not describe my son. All the doctors had missed this, except Jobe.

He went on. “And it’s the posterior dislocation that’s done the most damage.” He explained that he would do two surgeries at once, an arthroscopic one for the anterior problem, and an open surgery for the posterior. And that’s what happened (successful so far; knock wood).

But at that appointment another thing impressed me. There was a younger doctor in the room at the same time, watching. He had done the initial workup of my son and had only felt the anterior dislocation. Jobe called him over and asked him to touch my son’s shoulder again, while he showed him what he had found, “Feel this?” he asked. “Feel that little movement underneath there when I go like that?” he said, jiggling the shoulder ever so slightly. “That’s it.”

The younger doctor tried and tried, but he shook his head. He couldn’t feel it.

I had my own experience with Dr. Jobe. By the time I had my elbow surgery for an ulnar nerve problem, about a decade ago, Dr. Jobe was phasing out the surgical part of his life. I had been to countless doctors, almost all of whom had pronounced my case impossible to diagnose, because the EMG findings (that’s an electrical test for nerve conduction) were ambiguous. So I went back to Los Angeles and Dr. Jobe.

He studied all the findings; I had about eight sets of EMGs to show him. He did his own exam. And in the end he said he thought I was a candidate for surgery. “I can’t give you a guarantee,” he said. “But despite what the EMGs say, I think that, from your symptoms and my examination, this surgery will help you.”

And so it did, rather dramatically, although it took a few years for me to recover. Jobe assisted at my surgery, and I was very glad he did, because it turned out that my case was unusually complex.

I still remember what Dr. Jobe said to me in the recovery room, “We were surprised at how much damage we saw when we opened you up. Your ulnar nerve was very inflamed, and it was pinned down by a large amount of scar tissue that we had to dissect off the nerve. Other nerves had been recruited into the mess, and we had to sever them. Then we moved the ulnar nerve the way we usually do. I can’t guarantee what will happen or how long it will take to heal, because your case is unusual, but I will tell you this: you needed this surgery. Without it, you were never going to get better.”

Without Jobe and his skills, I probably would never have been able to have had that surgery, and I wonder what would have happened to me. And I wonder whether he’s been able to pass those skills on to a significant number of doctors. And I wonder whether they are able to take the time and trouble to use them. I certainly hope so.

Voting

The New Neo Posted on by

I voted by absentee ballot yesterday.

I’m not one to do that, ordinarily. I like going to the polls on voting day. I like the atmosphere of civic duty. I like the people standing around (even in the rain) with posters, hoping vainly to influence somebody at the last minute, or just drinking in the attention. I like the fact that I often meet people I know there from the community, since it’s one of the few things we do as a group any more.

I like the solemnity of going into the booth and drawing the curtain to maintain my privacy. I like to stand there for a moment and savor what I’m about to do, and the fact that I have the right to do it. I’m such a sentimental sap that sometimes there are even tears in my eyes, and not just if my candidate is likely to lose.

I remember noticing as a young child that school was closed on election day because our building was used as a polling place. This gave me a warm feeling about elections right from the start, since I disliked school rather intensely. They’d haul the machines in the day before, with their arcane levers and apparatus that looked a bit like the insides of a piano. It all seemed very adult to me, and I looked forward to the day when I, too, would be a grownup and voting.

But this year I’m going to be out of town on Tuesday, November 2. So yesterday I got an absentee ballot. I felt a grim satisfaction in marking that long row of Republican names, although a couple of the Democrats running are my friends. Straight Republican ticket this year, for obvious reasons.

I’m hoping for a Republican landslide. And then I’m hoping the winners do right by the hope we have invested in them. I say “hope,” because it’s certainly not trust.

Judge says multi-state anti-HRC lawsuit can proceed

The New Neo Posted on by

Federal Judge Roger Vinson has just announced that the anti-HRC lawsuit mounted by 20 states will be allowed to proceed.

An excellent decision, IMHO:

The judge questioned whether the administration was correct in arguing that all Americans are active participants in the health care system regardless of whether they choose to have health insurance and are therefore subject to penalties under the government’s authority to regulate commerce.

This case is potentially huge, and whatever the verdict is, it will almost undoubtedly end up in the Supreme Court, where it rightly belongs.

James Fallows: O’Donnell more dangerous than Palin

The New Neo Posted on by

Two-thirds of the way into O’Donnell’s debate with Coons last night, it occurred to James Fallows that she could be more dangerous than Sarah Palin. Why? Because:

…she has the idiot bravado of the talk show regular.

To echo Bob Schieffer in another context, is that the best Fallows can do to critique her performance? If so, she must have been pretty articulate.

The holidays are coming: click through neo-neocon to Amazon

The New Neo Posted on by

Remember those Amazon widgets on the ride sidebar (four—count ’em, four)? Please use any of them to click through and buy your holiday gifts. Or use them any time you want to purchase books or any of the other gazillion things Amazon now sells.

I believe that I may be performing a real public service (other than obvious and shameless self-promotion) by reminding you in mid-October that it’s only a little over two months until Christmas and about six weeks till Chanukah, which begins extremely early this year on the evening of December 1.

I have always been a procrastinator, the sort of person who remembers a mere week before the holidays that, oh yes, it’s all almost here, and I need to buy some gifts pronto. I then race out and scramble madly. So if I can save you from a similar fate, I will have done some good in this cold cruel world.

[WARNING: I may run this again at least once more before the holidays.]

So sorry, the doctor isn’t in

The New Neo Posted on by

There’s a doctor shortage, in case you hadn’t noticed. And it’s likely to get worse as a result of Obamacare:

This disease can be traced back to 1997, when Congress, anticipating a doctor surplus, included a section in its budget-balancing law that froze the number of Medicare-sponsored residency positions.

But instead of a surplus, a shortage soon developed, and has worsened over the years, now reaching epidemic proportions. The Association of American Medical Colleges Center for Workforce Studies just reported an anticipated shortage of 90,000 doctors of all kinds over the next decade, with half of them being primary care physicians and the other half surgeons and specialists…[What’s more,] the new health care law, known ironically as the Affordable Care Act, is promoting and extending the kind of low co-pay and low deductible insurance that is easy to overuse, overwhelming doctors further and leading to an upward spiral of health care costs.

I recently had the need to change my primary care doctor, and let me tell you it wasn’t easy to find a new one. Helpful friends gave me names of doctors they knew and liked, but when I called the offices, I got the repetitive answer: not taking new patients, and no idea if or when they ever will.

And I’m not even a Medicare recipient. I hear that for them it’s worse, and getting lousier all the time.

It reminds me a bit of the old Soviet system, where a person could go to a restaurant and see a menu that was largely delusional. That’s the stuff we would be serving, the stuff we’d like to serve—if we had it, which we don’t. What’s actually on the menu? Well, there are the potatoes. And then there’s the potatoes. And oh, have we told you we have potatoes?

My doctor problem was solved, for now, by the intervention of a friend who knew a certain doctor well, and who pleaded with him to make a kind exception and take me on as a new patient, which he did. When I arrived at the office, the receptionist was stunned when I told her I was here as a new patient, “Wow, you’re very lucky. He’s a wonderful doctor, but he’s generally not taking any new…”

This particular doctor is in his early 60s, and I’m starting to hope he doesn’t want to retire any too soon. I’m not eager to enter the doctor fray again in a few years. By then, who knows how tough it might be? I got a foretaste today because I’ve also been dealing (unsuccessfully so far, I might add) with trying to phone the DMV to ask a simple question.

Good luck, I know. Fifteen phone numbers and an hour or two later, I’m still waiting for an answer.

Stop the presses: Joe Biden blames Republicans

The New Neo Posted on by

It’s getting almost amusing. Should Republicans say, “I’m rubber, you’re glue, bounces off me and sticks to you”?

Take a look:

We have seen this movie before,” Biden told an enthusiastic crowd of about 200 people during a luncheon at the Hotel Fort Des Moines. “It is a horror movie. Putting these people in charge is like making an arsonist the fire marshal.”

One thing I’ll say for Biden: in the past, unfortunately, it’s true that the Republicans have been fiscally irresponsible as well—although not nearly as irresponsible as the Democrats have turned out to be.

In related news, the polls continue to look good for Republicans. Caveat: don’t get cocky. It’s just polls. The only poll that counts is you-know-when. And then afterwards, the Republicans actually have to deliver the fire marshal goods.

Schieffer and Axelrod on the Chamber of Commerce and foreign donations

The New Neo Posted on by

Bob Schieffer (Bob Shieffer!) asks Axelrod whether throwing a heap of excrement against the wall and seeing what will stick is really the best way for the administration to help the Democratic Party in next month’s election.

No, he doesn’t actually say those words. But watch him ask about the unsupported allegations that the Chamber of Commerce is using foreign donations to help fund Republicans, and watch Axelrod’s answer:

Anyone who has followed Obama and Axelrod should be unsurprised at these tactics. The only surprise is that they have become more transparent (and not in a good way), and that some in the MSM are no longer supporting them.

Unfortunately for Obama as leader of his party, in 2010 there are too many hotly contested battles to be able to dig up sufficient salacious divorce papers on opponents, or to disqualify their signatures on petitions and knock them out of the races, as in the past.

And speaking of the past, remember this?:

Sen. Barack Obama’s presidential campaign is allowing donors to use largely untraceable prepaid credit cards that could potentially be used to evade limits on how much an individual is legally allowed to give or to mask a contributor’s identity, campaign officials confirmed.

Faced with a huge influx of donations over the Internet, the campaign has also chosen not to use basic security measures to prevent potentially illegal or anonymous contributions from flowing into its accounts, aides acknowledged…

In recent weeks, questionable contributions have created headaches for Obama’s accounting team as it has tried to explain why campaign finance filings have included itemized donations from individuals using fake names, such as Es Esh or Doodad Pro. Those revelations prompted conservative bloggers to further test Obama’s finance vetting by giving money using the kind of prepaid cards that can be bought at a drugstore and cannot be traced to a donor.

The problem with such cards, campaign finance lawyers said, is that they make it impossible to tell whether foreign nationals, donors who have exceeded the limits, government contractors or others who are barred from giving to a federal campaign are making contributions.

Careful, Axelrod and Obama. You know what they say about people who live in glass houses. This could come back to haunt you.

[NOTE: And in semi-related news, George Soros says, “I don’t have enough money to buy this one.”

No; what he actually said was this: “I’m not in a position to stop it. I don’t believe in standing in the way of an avalanche.”]

Finally, Obama is inspiring me

The New Neo Posted on by

President Obama admonishes us to “keep believing that change is possible.” He adds:

Let’s show Washington one more time, change doesn’t come from the top. Change happens because of you! Change happens because of you! Change happens because of you!

Just watch, Mr. President. On November 2, the American people are poised to vote for a big change. And you probably won’t like it, not one little bit.

Yes, we can.