Curmudgeon Rant: “We don’t have small.”

I went to see a movie yesterday, which is something I don’t often do, and I decided to order a coffee, which is something I do even less frequently. When I got to the counter, the menu said “Cappuccino, $4/$5.” It was refreshing to see that the sizes didn’t have silly names, really.

So, I ordered a small cappuccino, and the cashier told me (I should have predicted it) that they do not have small cappuccinos. I would have to choose either a medium or a large. Of course, I do know that the United States, as a group of people, has become addicted to diabetes-inducing portions of food and drink.  I also happen to think they shouldn’t force us to choose between oversized drinks and super-oversized drinks, but that isn’t what makes it the most annoying.

The most annoying thing for me is the fact that I truly do not believe anyone ever asked for a small without wanting the smallest size available. No one ever said, “Oh, you don’t have small? I will have a large then.” No, it is quite clear that anyone who asks for a small wants the $4 drink and not the $5 drink. Why rub our faces in the fact that we can’t actually order the size drink we want?

We are the 85 percent

Over the years, I have had several people in healthcare tell me that about 85 percent of patients in doctor’s waiting rooms have no medical problem that won’t take care of itself with a little time and patience, but patients have been trained to demand treatment for every ache and pain. I’m sure this made-up statistic does not appear in print or as part of any official statement, but there is a feeling that mildly sick people are a drain on a system that is already overloaded.

 It isn’t a small concern, and doctors are not entirely to blame. Patients do sometimes demand treatments that are counterproductive, which has led to the excessive overuse of antibiotics, for example. Of course, patient perception is that doctors prescribed the antibiotics, leading them to believe they are effective for mild earaches and colds. Doctors say they feel pressure from patients to “do something” about their mild condition. Patients and doctors both feel they are doing what the other is directing them to do. I would guess that about 85 percent of doctors and patients feel this way, if I were to start making up statistics.

 The result is that patients can become pushy and demanding or that doctors can become resentful of needy patients. And both conditions arise, I think, from a misunderstanding of the wishes of the other. I honestly don’t think either side wants to waste time or money on useless treatments. So, “communication is the key” to a better doctor-patient relationship, or so the shibboleth goes.

 But it is more complicated that that, of course. When I was quite a bit younger, a member of my family began having fairly vague complaints and discomfort that prompted her to see her doctor. She was overweight. She smoked. She rarely got exercise at all. The doctor told her to lose weight, stop smoking, and check back in a few months. Each time she went to the doctor, she received the same advice, even if the wording changed a little, but her symptoms became more pronounced and harder to ignore.

 Finally, the doctor ordered a biopsy, which was positive for colon cancer. She was then referred to an oncologist. On their first meeting, he said, “I wish you had come to me sooner before it had spread.” Perhaps he didn’t mean to blame her for her cancer or for her lack of treatment, but that is certainly how she heard it.  Too many of us who have experience with cancer in our families have heard, “I wish you would have come sooner,” even when the patient has been seeing a doctor regularly for months or years.

 So, patients are in a bind. If we go to the doctor at the first sign of a problem, we may be seen as hypochondriacs or as clingy whiners. If we wait till the symptoms manifest themselves more boldly, we may be blamed for neglecting our own health and causing our own deaths. Given this choice, most of us would rather be seen as frivolous. We say things like, “I’m sure it is nothing, but I watched my loved one suffer, and I won’t make the same mistake.”

 This is why healthcare providers need to show a little understanding. With the possible exception of a few individuals with some rare psychological conditions, people don’t go to the doctor for the fun of it. They trust their doctors to tell them whether their symptoms are serious enough to warrant further attention, and they aren’t looking to waste time, money, or resources. To be on the safe side, I try to tell my doctors that I only want treatments that are both necessary and effective. This takes, I hope, the burden off the doctor to “do something, anything” for me.

 

China, England, and the profusion of human emotions

Given his recent meteoric rise to international celebrity, I felt compelled to read something by Mo Yan. As I’m reading from translation, I don’t think I am at all qualified to comment on the literary merit of his work, but his characters capture China as I remember it. Contrary to stereotypes, his characters exhibit a massive profusion of emotions—they scream, break down crying, and are overcome with lust as their libido drives them to distraction. The characters are sometimes admonished that they really should try to keep it together as it is unbecoming to be so overwrought.

Before I went to spend a semester in China, I tried to get advice from books, people from China, and people who had worked in China. I was told that losing control of my emotions would be a terrible thing, as I would lose face. Many who talk about China stress the importance of losing face as if having a mental and emotional breakdown in the rest of the world will be met with complete acceptance or even admiration. So, I was quite surprised to arrive in Beijing and see frequent and extreme departures from the assumed equanimity of Chinese people. Perhaps the emotional nature of the people is why their society has emerged to keep emotions under strict control—or at least save it for private moments.

I had similar experiences confronting British culture. The more British people I meet, the more baffled I am by the stereotype of “British reserve.” Really, if you just look at a crowd shot at any English football game or walk through any pub after hours, you are likely to understand the phrase “spontaneous overflow of emotion” better than the stuff about having a “stiff upper lip.” People in Britain, as far as I can tell, celebrate with gusto, compete with passion, and love with intensity, despite constant reminders to stay calm. When I posed this question, my wife, who is English, postulated that the emotional nature of the English is why they needed all those signs reminding them to “keep calm.” And they did keep calm, when they needed to in order to survive, and the Chinese keep calm if necessary, but humans need full emotional lives to be fully human.

And this is what separates us from machines. Descartes postulated that machines could not ever think. If machines do think, he said, they will be able to express thoughts using language. Much later, Alan Turing developed the Turing Test of artificial intelligence, which claimed that we can test for human intelligence by seeing how well the machine can use language. If it uses language in the manner of a human, it will have human consciousness. Now, many of us walk around with electronic devices that are personal assistants that carry on conversations with us. I am not sure whether Turing would give them the stamp of human consciousness, but Siri is at least approaching conversational levels of language, with limitations, of course.

But Siri doesn’t seem to become exasperated, lovelorn, ecstatic, or depressed. Even if she appears to, we aren’t likely to believe it, at least as first. Robot designers are making impressive improvements in the facial and bodily expressions of emotions in machines.  If machines are able to convincingly display a wide range of human expression, we may not be convinced machines actually feel these things, but we may start to wonder whether our fellow humans actually feel what they are expressing. And in that state of confusion (as some of us already are), we will be truly alone.

Politifact, Obama, and Tax Plans

Mitt Romney has repeatedly said that several studies prove his tax plan is possible without tax increases on the middle class. President Obama claims that even these “studies” show that middle-class tax increases would be required to make the plan work. The studies (or analyses) in question are those by Harvey Rosen and Martin Feldstein. Politifact rated the president’s claim “mostly false.” This is just one more egregious rating from Politifact.

The president has said that making the plan work would require either raising taxes on the middle class or eliminating popular deductions such as the home mortgage deduction. In supporting their “mostly false” rating, Politifact said, “Rosen found that when a wide array of tax breaks are eliminated — from home mortgages to charitable giving to health insurance benefits — and projected economic growth rates are factored in that the increased revenues can balance out the money lost through tax rate cuts for high-income taxpayers.” These are, of course, exactly the middle-class deductions the president was referring to. Eliminating these deductions will, of course, increase the taxes middle-class families pay.

As for the Feldstein claim, Politifact quotes Feldstein as saying he did not separate data on the income earners to which President Obama referred, so it is impossible to say whether Obama’s statement is true or false. But please note, it is possible to say that Romney’s claim that the study proves his plan is possible without increasing taxes on the middle class is possible to evaluate. It is false. Feldstein says his claim was that Romney’s plan was possible without raising taxes on families earning less than $100,000/year. As Josh Barro pointed out, “Feldstein allows for tax increases on people making more than $100,000. But on Sept. 14, Romney told ABC’s George Stephanopoulos that he would hold people making less than $200,000 or $250,000 harmless from tax increases.” Feldstein certainly doesn’t claim that Romney’s plan is viable without eliminating the deductions President Obama says will need to be eliminated, and he does not claim it would not require tax increases on those making $100,000 to $250,000, which is Romney’s definition of middle class.

Wither Education; Whither Education

In his Apology, Socrates boasted that he shared whatever knowledge or skills he had in the agora with no expectation of payment, and he managed to work in a little reminder that he had reduced himself to poverty by refusing payment for his tireless search for truth. By this, of course, he insinuated no small measure of superiority over the Sophists, who choose to offer educational opportunities in exchange for a living wage, something educators are only occasionally lucky enough to achieve today. Socrates shared his information primarily with wealthy young men who had plenty of leisure time to sit around the agora soaking up tidbits of brilliance from an old master. Likewise, it is currently difficult for any but the most affluent to afford the luxury of study for the sake of intellectual stimulation and personal enrichment.

Indeed, it is increasingly painful for most middle-class people to afford even a vocational education that doesn’t leave them deeply in debt. Education is now typically only worth the expense when students go for the quick credential—a certificate or license that will get them in the pool of skilled labor. In the past, students such as myself could afford to pursue intellectual interests without worrying about being reduced to poverty. Study in the arts and humanities has never generated great financial rewards, but it did not always result in a lifetime of crippling debt as many recent graduates are finding awaits them now.

So, unlike students we once had, entering freshmen will forgo anything resembling a liberal education and opt for vocational training instead, leaving them unaccustomed to the expansion of the moral imagination and sharpening of the critical edge. We no longer need visionary writers to describe some hellish dystopia where critical thinking is forbidden and creativity is quashed. We have seen this future, and the future is now. The Texas Republican Party is now officially opposed to the teaching of higher-order thinking skills. They argue that education in critical thinking causes students to challenge the teaching of their parents, but they seem less concerned about parental authority when parents teach their children that global warming and evolution are real but the seven habits of highly effective people are not. Parents have the right to turn off the lights, they believe, but not the right to open the window and invite illumination from the sun.

A few days ago, I read and shared a blog by Jack Rasmus, who warned of the dangers of corporatization and privatization of education (another excellent blog on the subject is here). His blog is insightful and accurate, but I don’t think many in education will need his warning—we have already experienced the move away from education and toward indoctrination. Rasmus says one goal of privatization is to replace educators either with machines or curricula so standardized that teachers are no better than machines. I once had the surreal experience of sitting in a meeting where we were told in no uncertain terms that there was no movement toward developing a standardized curriculum. No, we had it all wrong. In fact, what they were doing, we were told, was developing a few standardized questions for the final exam. They were merely determining the content of our classes; we were free to teach it anyway we saw fit, so long as we used the tools provided in the training we would be required to complete.

Not surprisingly, many teachers have left the schools for other pursuits, but no teacher wants to give up on education. We may not all be willing to die for education as Socrates was, but we aren’t likely to give up without a fight, either. And we do know, of course, that we may very well end up reduced to poverty and may face trouble with the authorities.

As we flee the schools and universities, where will we take our questions, answers, and insights? Socrates lectured in the open market, where he ran into trouble. We can go to the public spaces, but the public spaces are now almost entirely privately owned. We can emigrate away from repressive governments, but we cannot escape the reach of the transnational corporations that own the public spaces, water, and land we occupy. The internet is democratic we thought, until we realized the corporate owners of internet services store and compile the private messages, tweets, and personal information of everyone, and they often do not hesitate to turn over such information of rabble-rousers to authorities.

In an entirely Socratic move, some universities and individuals have decided to offer their instruction for free with open-sourced content. Students thirsty for knowledge can find lectures uploaded to various content sites, syllabi posted for all to see, and bibliographies filled with provocative citations. If the content is difficult to comprehend or organize, many dedicated individuals are willing to provide coaching, tutoring, or lecturing for any and all willing to listen.

As the conservative fear, teaching is a subversive activity (though it can subvert either the left or right), and subversives will not stop teaching. The pursuit of knowledge, even if unattainable, is a worthy endeavor, and the desire to broaden our imaginations and expand our reach is the only path to a brighter future. The next dark ages could, indeed, be the last, but we must strive for a new age of enlightenment or die trying.

 

Update on Saylor White

After public pressure and eliminating all excuses for denial, Aetna has finally approved Saylor’s surgery, so he is at last getting treatment. His wife sent the following message to those who were concerned about him:

“Great news! Aetna APPROVED Saylor White‘s surgery with the original surgical team and hospital. They could not provide the services in-network so had to approve it. His doctors office is working to reschedule ASAP. Thank you to everyone who has been comfort and support to us during this trying time. Bless you all!”

While we are all relieved and thrilled he is getting treatment, there is no excuse for subjecting sick people to so much stress and indignity.

Notes on European Socialized Healthcare

Yesterday, I posted a blog about three people who must rely on contributions from friends, admirers, and strangers to maintain the healthcare they need, and these three individuals are not unusual cases in the US. It is the argument of conservatives that universal healthcare coverage (or anything socialized) will deprive workers of their dignity. It is the pride of ownership and rewards for hard work that gives people self-respect and a feeling of accomplishment. Providing for yourself makes you a better person.

The majority of Europeans, where it is generally inconceivable that anyone would be forced to hold a fundraiser to pay medical bills, seem to disagree. Just as most Americans do not consider Social Security or public education to be a demeaning form of charity, most Europeans do not consider healthcare to be a demeaning government handout. Rather, healthcare is a burden shared by all to protect their common interests. The costs of advanced medical technologies and surgeries are out of range for all but the richest Americans. Medical emergencies can quickly run to the hundreds of thousands of dollars. A six-figure salary will not offset the costs.

Having to ask friends, family, admirers, and strangers to help pay your bills is demeaning, demoralizing, and degrading. The conservative vision of letting everyone pay their own way or debase themselves in their dying months, weeks, or days is appalling and unconscionable. I have my own objections to the Affordable Care Act, but trying to fix the problem is more honorable than ignoring the problem or, worse, declaring that the current crisis in healthcare is acceptable. We must demand solutions. If you are opposed to the solution on the table, bring your idea to the table.

Ignoring the problem is killing us. Unfortunately, we must also be humiliated before we can die penniless and ashamed.