Month: April 2016

The Doctor Shortage revisited.

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33 - Lister

I have previously written posts about a coming doctor shortage.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?

The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.

I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.

I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.

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ISIS Practices “Auftragstaktik”‏ — A Case of Evolutionary Selection in Action

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America’s incompetently planned and led wars in the Middle East have acted as a biological process of evolutionary selection that has been creating nastier and more lethal terrorist organizations. This has happened because of the fecklessness of America’s political leaders. (Bing West covers that political fecklessness and the selective pressures on our Islamist enemies in his article America the Weak.)

Nowhere is this selective pressure seen better than with the evolution of ISIS and its adoption of “Auftragstaktik”‏ in order to execute terrorist operations.

“Auftragstaktik”‏ is a German military term that is loosely translated in English as “Mission Tactics”. According to the UK Daily Mail, the terrorist organization ISIS has adopted “Auftragstaktik”‏ as a central organizing theme because Western signals intelligence destroyed other Islamic terrorist organizations like Al-Qaeda that tried to be more centrally directed.

ISIS figured out that if you give a leader resources, a target, and a time to get it done, then tell him to get it done however he can, you will get big, nasty and above all successful terrorist attacks in western nations, because such methods do not require detectable electronic communications.

See this UK Daily Mail clip:

The bloodthirsty militant group admitted to following the technique in a recent issue of Dar al-Islam, its French-language propaganda magazine.
 
It was this strategy of warfare that led to the November 13 Paris attacks, in which 130 people died, and the Brussels bombings two weeks ago that killed another 32.
 
The doctrine was first developed in the early 19th century in Prussia in response to the state’s crushing defeat against Napoleon.
 
This new theory of war – which gave troops the skills to respond to rapidly changing circumstances in the heat of battle – was then refined by general Carl von Clausewitz.
 
Later fellow Prussian general Moltke the Elder further tweaked his theory, ushering in a new way of commanding modern-day armies.
 
Today, similar tactics form a crucial component of the U.S. and UK armies military training.
 
The February ISIS article, which was devoted almost entirely to the Paris bombings, explained that its jihad in Europe encompasses three types of attacks.
 
This includes ambitious mass slaughter plots carried out by operatives sent from ISIS headquarters in the Middle East, to lone-wolf attacks by people with no connection whatsoever to the group.
 
It even cited a historical German infantry manual from 1908 as its inspiration.
 
The soldiers’ manual stated: ‘There is nothing more important than educating the soldier to think and act for himself.
 
‘Autonomy and his sense of honor push him to do his duty even when it is not in front of his superior.’
 
According to SOFREP.com, this style of warfare – known in the U.S. as mission-type tactics – translates to: ‘Here is your target, here are your assets, go get it done.’
 
This, ISIS claimed, allowed its cells to inflict terror in Europe with ‘complete tactical autonomy’ and leaves little evidence that can link back to their commanders.

This ISIS “Auftragstaktik”‏ model will be replicated and improved upon. This will not end well.

We have sowed the wind, now we reap the whirlwind.

Discuss.

The 1922 Luna Savings & Loan Bank Robbery

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(A diversion for a Friday, from the next Luna City Chronicle, which will be launched late this month … since everyone seemed to find the first Chronicle amusing, and to be wondering about the cliffhanger ending …)

There are three official historical markers in Town Square, much cherished by local citizens. The most noted is the one marking the site where Old Charley Mills was nearly lynched by infuriated citizens, which action was forestalled by the timely intervention of somewhat less-infuriated and more clear-thinking individuals, who included Doc Wyler’s father, Albert Wyler and his younger brother Thomas Wyler, the Reverend Calvin Rowbottom, then senior minister of the Luna City First Methodist Church, and a handful of others whose irreproachable  respectability was of such a degree that they were able with reason and persuasion, to turn their fellow citizens aside from such an irrevocable action. The second official historical marker is set into the wall of the building now housing Luna Café and Coffee and marks the site of the last officially noted personal gunfight on the streets of Luna City in 1919; this being a duel between Don Antonio Gonzales and Eusebio Garcia Maldonado. The only casualties were the radiator of Don Antonio’s Model-A sedan, a city street-light and a mule hitched to a wagon parked farther down the square felled by a wild shot from Eusebio’s revolver.

The third historical marker is set into the red brick and neo-classical style exterior wall of the what was once the Luna City Savings & Loan, but now houses city offices and the Chamber of Commerce.

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