Blabber: Pop Consumerist Middle Class...to SAVE WORLD.

Vali Nasr and John Stewart were discussing on the Daily Show the rise of the Middle East’s Middle Class. In doing so they focused on the role the middle classes have on stability and sustainability of communities. Nasr alluded to the formation of a middle class being the foundational element in creation of the United States. Stewart questioned that if we had helped bolster the middle class and then introduce democracy would we have had better results . This idea of the stabilizing powers of the middle class are not new or elite. An issue finds it legs when it is agreed upon by the middle class. Plans are broadly implemented once it is affordable to the middle class. Social contracts are enacted into law when the middle class embraces it.

It has always been difficult for me to embrace extremes. I have had an uneasy feeling about some of the rhetoric I grew up with in a liberal culture. I realized I had taken for granite much in my upbringing when I moved to a more conservative community and certain sentiments made me bristle. Clearly, efforts on the fringe can pull a culture in alignment. As an growing minority (Atheist) I am pulling for liberal extremes. As fiscal conservatives, I hart blue dogs. But in truth I live in an increasingly middle class reality and I hope to keep it that way.

The further the American middle classes embraces the ideals of a greener social and economic model and the more we expect affordable, efficient, caring healthcare, the more our chances of destroying our planet or suffer while trying will diminish. As China has cultivated a middle class, they have been confronted with facing their human rights and environmental responsibilities. The USSR’s fabricated equality fell like a house of cards and without a stable middle class the vacuum was filled with corruption, but perhaps over time a stable middle class will emerge. India’s class system is the only thing standing in the way of progress lead by their middle class. Pakistan’s stability relies in the expectations of its middle class. We will never be successful in Afghanistan until their poverty is changed to a middle class upbringing. Hope in Iraq and Iran lies in the hands of its growing middle class. Egypt, Saudi Arabia, Jordan, UAE all struggle with understanding how to transition to a middle class, but know it must be done. With the voices and success of the middle class in Palestine and Israel so goes the region. In Africa, stability only exists in nations that have a middle class. As the middle class grows in many East Asian nations, the tragedies will diminish. In Europe the middle class has created new levels of stability in just decades, despite the issues in the Baltic States and the social intolerance in Italy. The failure in Iceland after the financial collapse has had an upswing in social issues in the small Island nation. World wide and through history we know success exists in the hands of the Middle Class.

Our modern success was built on pre WWII plans, WWII actions and post WWII transitions centered on the growth of the middle class. Despite the efforts of McCarthyism to embed extremist perspective into our middle class envisions established, success was driven by less ideological realities. McCarthyism only bread extremes embedded in the anti-was and social justice movements. The practical elements of both measures, patriotism and equality have held on, but are there less colorful elements that helped keep the middle class going through daunting times and still help us today?

While my family has a long tradition of secular Jewish culture, I do not believe the Jewish rise in the middle class would have been so rapid without the role my people played in American pop culture. I also come from a Christian family and I do not believe their shedding of Christian traditions would have come without the rise of the middle class and the consumptions that were driven by the rise of the golden era of American advertisements and McCarthy Era iconic imagery of a middle class life and home.

Could our guilt of pop culture and consumerism be misguided? Could it be that not just public education, freedom of speech, a judicial/legislative/execu

tive system, patriotism, the pioneer spirit, civil rights, the separation of church and state, walking softly and carrying a big stick have lead to our middle class and our stability (as fragile as it seems at this moment, that seems far to similar the end of the Roman Empire and speaks to accurately to the prognostications of the end of days)? What is it that seems to accompany modern developments of middle class? Could it be that addictive consumerism and delusions of traditions enabled by appetite for media arts have helped sustain and develop the middle class?

As a graduate from a Media Arts School, I do wonder if my interests are not misguided after all. Now if only we could get our businesses and politicians to take a more moderate perspective and our environment, health, and bank accounts into serious consideration, perhaps we could be Regan’s shining city on a hill and inspire stability and not just jealousy and sometimes-righteous mistrust.

Have the Guts to Save the Globe: Make us Paint our Roofs

I am clear on the issues we are facing these days and the global, national and personal consequences they have on all of us. I also understand the unprecedented steps we have taken in these extraordinary times and the potential for more. I understand clearly that while we continue to add more to our plate we have no way to pay for it without great sacrifice and smarter spending across the board. One issue that is currently dominating I have pleaded for here is a revision of Health Care. But in that same note I mentioned an issue that is of higher concern. One that is at a critical stage currently and always. One that is as close to the risk of failure as any we have faced in the past year. One that simply put if not solved will make all others obsolete. I speak of our Environmental Policy and the Global Warming Crisis. So why is there rumor of stalled action on the part of our congress, our nation, our world?

Congresspersons, have the GUTS to do something, or pay the price we all face...

When the world community meets at the end of this year, we American's will either have contributed to potential successes or granted failure. Earlier this year Fareed Zakaria hit the nail on the head, "America's Fatal Flaw: If it's not a crisis, we can't fix it." I would only ask, what does that mean for slow moving tipping points?

There is speculation that China (who have surpassed us as the worst emitters...and ironically we are indebted to on historic levels) is waiting for the rest of the world to make the first move. Gone are the days when we can act un-American and not lead with our Ethical Foundation. We can no longer be selfish, petty and bring action with hubris. We must lead with honor and ethical obligation that is founded in the ideals this nation was built on and developed my in its greatest moments. We must lead!

Much of the actions that most efficiently give us a chance also help greatly to solve our nations other most crucial issues. We have been speaking of this for months if not years or decades. Investment in renewable resources will lead to job opportunities, new exports, independence from foreign energy sources, decrease our contributions to corrupt governments over seas, increase our national security, decrease our citizens health issues helping decrease health care costs. It will also require investments in areas that have long dogged down by local and Washington politics. Success will require new infrastructure, an increase of quality education in the areas of science, math and art (YES ART...how do you think we learn to think outside the box, problem solve and innovate most effectively...in art class), we will need to correct our personal ethics returning to civil maturity, discipline, work ethic, historical perspective, honesty, volunteerism, sacrifice, neighborly behavior, survival techniques, basic agricultural knowledge, being prepared, freedom of thought and speech. There is much to be done and we look for leadership. We have it in our president, but we are being failed by virtually everyone else.

We simply can not wait any longer. We need solutions on the ground. We need resources to help take action in our homes and communities. We do not need you to bail out Wall Street or car manufacturers....we need more practical localized solutions.

Transportation:

The idea of rail transit is wonderful. I would travel to my folks in California from Vermont instead of flying if I could get there by rail. The best idea I have heard late is the Ion battery. If I had a diesel car or truck I would be converting it to Bio. I still don't get why if Brazil can run on ethanol why we can't help the farmers across America and do that. I guess what I am saying is I don't want to drive my SUV, but it is how I survive the harsh New England winter roads. I would love if my Jetta was even more fuel efficient or even better had zero imitations. I would love to travel by public transport, but I live in a rural environment. I would love to get to my Urban friends and family quickly and with reduced imitations. But non of this is happening, because I don't have the resources and they simply are not being handed to me.

Nuclear:

While at time this seems like a viable option. The efficiency is substantial. The potential for clean energy is there, if we proceed the way they do in France; this would be close to a silver bullet. Particularly if we had 100% electrical heating and power, as well as ion battery cars. Given the issues with Yuka Mountain you can see why we must have a smart reprocessing system minimally.

However, you don't have to look far to see the risks. Here in Vermont there have many risks that have come with a privately run nuclear power plant. That coupled with the considerably growing lack of discipline we have in our work force and education systems, I fear for an environment that could produce a Homer Simpson at the local plant.

Wind/Hydro:

There is still great debate here in Vermont over this...not in my back yard. Regardless I know there are plenty of areas in the country that could and should take even more advantage of the wind and water as an energy resource. I personally wouldn't mind one in my back yard.

Homes:

Despite having Energy Star appliances and theoretically being up to date with instillation, because we are a new townhouse, our home is clearly the biggest cultrate of our imitations foot print. I do not understand why every home and building in America does not have plans for solar panels and has painted their roofs white. If we did that alone, we might have a chance. Of course we can't afforded the solar panels. And I would have to get the condo association to agree to white roves...unless you made everyone do it (this one thing should be mandatory today).

Plant:

We need to plant more trees. Everyone…every ware…all the time.

Businesses:

Newsweek ranked the top environmental businesses and it was surprising (well it was surprising how low Apple was and how high McDonalds and Wal-Mart were). Nevertheless, after reading it I began to wonder, why can’t you mandate that business take some of these policies into all of their operations? It will create a level playing field that will still fuel competitions and the survival of the fittest. I am sure there are plenty of small business that are doing these sorts of things were they can. Sure, some businesses will leave the US. However, at the summit you could argue that all countries should be taking these steps to save the globe. In addition, who wants un-American companies anyway? So we should have all companies offer to recycle their products and provide the most efficient way to transport and process the materials with the lowest environmental impact. We should be requiring limited packaging. We should be stopping computers from ending up in Chinese illegal salvage cities. We should be creating products that last again. We should be learning how to fix things, not just, tossing them and getting a new one. We should be consuming sustainable clean organic agriculture. We should be composting and recycling so there is zero waste. We should be operating and producing locally, not globally. These are sustainable business models that help the bottom line and save the planet. Why do I get this the people in charge don’t?

Bottom line, pass something effective, mandate we do something, give us resources to help with the other things. Make us save ourselves. That is what leadership is about sometimes. Forcing the people to improve their lives. It may not be politically expedient. But you, your kids and your grandkids will not mined if you did not get reelected, as long as you all live. If we are teetering on the edge of extinction, because you were gutless…well lets hope you and your ancestors don’t regret it for eternity. Lets hope me and mine don’t either. The prospect makes me glad I am an atheist.

Health Care Bills: Rambaling Perspective from the Wild West

Disclosure: I work in a small family run, nationally respected, innovative, trail blazing, conservative, effective, essential, medical/dental, chronic pain practice, with one doctor/dentist. We serve our entire state and plus parts of our surrounding states. We are the only game in town and this is not by choice. Our doctor will be the president of a national academy concerned with TMD. Primarily we treat TMD (TMJ) and secondarily Sleep Apnea. We are innovators in quality of care, conservative treatment, treatment coverage, patient advocacy, narcotics prescribing, dealing with narcotics abuse and TMJ care under a medical model. We have many patients with private insurance, such as, BCBS, MVP, Cigna, UHC. We have many patients with government run programs, such as, Medicaid, Medicare, V-Hap and Tricare. We have been closely involved in the development of policy that has opened up coverage opportunities for patients and improved the lives of thousands. We are unique in our experience, perspective and success, mostly because of the reality that only one other state has the TMJ law we have.

I am a patient. I am the son-in-law of the doctor. My wife and I are the clinic directors: we are involved in running the clinic, the business, solving technical issues, training staff and we see patients. I have virtually no medical training or perspective out side the context of this office. I did grow up in a household that provided a perspective on Mental Health Care, which I do value, as much as chronic pain care. I know something about both of these areas, do to my father and my father-in-law. I grew up with great healthcare coverage because my father worked for Kaiser and I did not want for anything medical. This lead me to be stereotypically concerned with healthcare in America and for myself…I did not see it as a huge issue until I worked for my father-in-law and I did not take care of myself to any great degree until more recently. I am relatively healthy luckily. I have a masters in fine art and am a licensed art teacher. I am part of a trailblazing generation of cartoonist with an education in cartooning. I am one of a handful of cartoonist with a BFA and MFA in our field. There for I am expert on the unique role comics in American culture and in its role in the essential value of art education (there is a need for more public and governmental support in these areas). But I am not an expert in Health Care. If you want to actually call on someone for advice I would recommend my father-in-law, Dr. Jeffrey Crandall. Who is a Republican. I am a Democrat; emotionally libertarian, intellectually socialist. This brings me to my perspective, which surprises even me.

Partisanship:

This is a Bipartisan issue that does not need Bipartisan support. It is too important to be bogged down in politics. The regrettable manipulation of this issue by Washington insiders has lead to a furry that on some levels speaks to real concerns, but truly has distracted from effective communication.

Co-Ops

On the surface this seems like a great idea, as long as it is divided into small manageable numbers of participants. In other words a national Co-op would be to bureaucratic and take to much away from advocacy. But to small of a Co-Op will be insufficient in negotiating appropriate rates with hospitals. There would have to be mandatory requirements to provide availability to all who want to participate regardless of income level, a member run board with truly transparent process for claims and clear requirements for coverage that approach true concerns of efficiency and effectiveness of treatment that is not discriminatory to body parts or preexisting conditions. If done intelligently I would prefer this option to any public plan.

Public Option

If I did not work in the medical field, I would blindly be in support of this option. However, I must underscore that the three public plans we currently accept in our office are truly not what I consider an acceptable model. They are not good programs. They are broken programs. Tricare is the worsted of the three, in the fact that they treat our veterans and military to a bureaucracy that fails to support their care and hinders our ability to care for patients. I can’t tell you how many staff meetings we have had where we have discussed the option of dropping Tricare and we know the essential need and duty we have to serve our military. At times, Tricare makes it impossible and our patients just woefully agree and accept their fate. Medicaid pays, sometimes late, but at a rate that relies heavily on our charity, which we have in abundance. Medicare is not as bad, but their reimbursement rate governs our rates and we are not seeing the rises in revenue reported in other areas of Medicine. We just raised our rates for the first time in over a decade and it was by less then 10%. I am worried that another public option will be another broken program, made more expensive and inefficient by bureaucracy. By the way, the low payouts are passed onto other patient’s insurance premiums and out of pocket expenses.

Universal Health Care

A single payer system does work for many countries, much more efficiently then ours. And the longevity of life is greater, in part do to this. But the care for chronic illness is poor in these systems, complex issues are miss handled and miss treated. There are benefits in our chaotic, but independent system that meets needs for some patients more effectively then these other systems, unfortunately the numbers of patients that are benefiting in our country is shrinking.

Private Insurance

Don’t by their hype. While some do have well intentioned professionals in their midst. The vast majority of these companies in our experience pay 20% less then they should to doctors. They are just as bureaucratically inept as government programs. They stand in the way of efficient care for patients despite logic. They are just as big a part of government games as any other. They are the corrupt corporation conspiracy they are accused of being. Only government reform can keep them in line, and yet they are in the room making the reform.

Diagnosis v. Procedure v. Results

Our Doctor out of necessity takes more time to collect data and patient information then any other Doctor I am aware off. This results in the correct diagnosis, in what is a very complex issue. If all my doctors did this I would never get in, but on the other hand in our office we are efficient and we are providing a quality of care that is appreciated and has helped reduce redundant expense and avoided misdiagnosis. It is not unusual because of the nature of the complexity of TMD that we are the 7th Doctor in 20 years that has tried to help a particular patient. Yet there are doctors we know of who use this method of note taking to abuse their patients, because of a lack of research and understanding and the nature of victimization in our patient pool. That being said all you have to do is turn on Discovery Health to realize that there is little incentive for Dr. to take the time to discover what the problem is, before treatment. My wife went through this type of experience and we hear it in our practice every day. Dr. need to be reimbursed primarily for their Diagnosis and the validation of this diagnosis. Results are a great incentive, as long as they are not applied in a black and white manner that discriminates against chronic pain and terminal disease. Procedures should be the least important measure of expense. The system as it stands promotes redundancy and unnecessary procedures and has lead to the over payment of surgeons and dentist and the underpayment of PCP’s and TMJ “specialists.” As it stands if you want to make money, become a plumber.

Chronic Pain

While there is plenty of discussion about dealing with life threatening issues and preventative medicine there is virtually no mention of managing chronic pain. This is shocking because of the level of cost it ways on the system and how it affects our economic productivity, let alone our pursuit of life liberty and happiness. Many of the solutions to other problems efficiency effectively lead to discrimination and the care for chronic pain patients. These are problems that deserve efficient and accurate diagnosis, but leave a reality of long-term care that does not always result in fixing the problem, simply managing it and reducing progression of the problem.

TMD (TMJ Dysfunction)

It is time that patients with TMD are no longer discriminated against. The TMJ has always been cared for by dentists, but finally two states require medical insurance coverage for a problem that involves bone, nerves, muscles, tendons, joints, soft tissues, the mind, posture, breathing and yes teeth. I have heard that 25% of our population experiences some sort of jaw pain in their lifetime. We know from anecdotal and empirical evidence that TMD is a complex condition subject to miss diagnosis and requires sometimes coordination between Dentists, ENTs, Neurologists, Physical Therapists, Psychologists, Pharmacists, Orthodontists, Oral Surgeons, PCPs, Sleep Specialists and TMJ specialists (technically there is no such specialty, which is why we are not likely at any table in the room helping form the government healthcare proposal). And yet, only 16 states cover surgery and only 2 cover conservative treatment. Which in our office means that 95% of TMD patients are either paying out of pocket or not getting treated at all. There is a huge correlation between, domestic abuse, poverty, chronic head ache pain, TMD, drug abuse and borderline personality disorder. Yet, there is little communications between practitioners who deal with these issues that affect our communities nation wide. In Vermont, once we started offering effective care and there was insurance coverage we became a practice that helped solve virtually all the problems the health care bill is concerned with. We have a waiting list of 250 people all the time. We have serviced 1% of our states population to date. That is one Doctor for the entire state.

Dental Care

Should be covered under Medical. It is time the Dental Community start being respectably included in the care for the human body and at the same time not be able to get away with price gouging and elitism.

Malpractice

This is such a small issue. Important, but small in the context of inefficiency.

Narcotic Prescriptions

Our practice is particularly skilled and experienced at appropriate effect prescribing of narcotics for chronic pain. When other means are insufficient, it is appropriate to prescribe opioids, if they are effective in reducing (not necessarily elimination) pain. But you must have what we have in place a well written Opioid Contract, an effective Prescription Monitoring System, clear communication between law enforcement, Doctors, pharmacists, substance abuse programs and patients. With out this we have over prescribing, under prescribing, fear and abuse.

Staffing Shortage and Training

We know there is a staffing shortage first hand. Our state has been trying to recruit PCP’s, Dentists, Nurses and PA’s for a long time. Our office has searched far and wide to find a competent dentist to join us, and we had one of the worlds best ready to, but he decided to stay closer to home and stay at the Military hospital in Bethesda. We need another TMJ “specialist.” But we have exhausted most hope. It could be very likely that my father-in-law will be forced to retire or die before we find a replacement. Where will our state be then? We need more trained professionals. The problem being that the best Dr. are working with patients, not students. There are not enough schools and not enough teachers. There needs to be an effort to fix this issues. Canada is having the same issue, so it does not matter if it is universal or not, if you don’t have the doc you don’t have a shot.

Staffing

I am reasonably compensated for my work. When and if I am lucky enough to get a teaching positions (another subject) I will get a pay cut. We need hardworking, empathic, professional, intelligent staff…there’s your job growth…oh wait you can’t hire teachers of my caliber, because of the ones that are already there so there for our educational system cannot produce the type of staff we need to run the system.

Research

The elephant in the room ir research. I cost us a lot, but brings us untold benefit. It should the included in the cost and the costs should be shared in a system that is efficient.

Pharmaceutical Companies

The amount they pay on research is substantial and relates directly to the amount American’s pay for prescriptions. But it is marketing that is the most expensive part of their operation. Marketing prescriptions is ethically immoral and should be stopped. Then prices should be lowered. But there should be some effort on our part to support increasing prices over seas for our pharmaceutical products sold to those nations that can afford it, why should we have to pay. At the same time we need to increase the availability of cheep prescriptions for nations that cannot afford it, particularly African nations.

Electronic Medical Records

There should be a universal system, that is made affordable for both hospitals and small individual practices like our. We would benefit greatly from Electronic Medical Records that could be manipulated easily to serve our clinical, scheduling and insurance needs. It would increase efficiency and quality of care greatly. We have tried to convert our self, but the expense and effort is to costly on our own.

Administrative Cost

I have heard that administrative cost accounts for 30% of health Care costs. This speaks to the problem with both government run and privately run insurance.

Supplies

Supply cost are just as bad as Rx. I can get the same quality tool from a jewelry catalogue as from a dental supply catalogue for 20% of the price.

Conclusion:

I am sure I am forgetting points I would like to make, but this is certainly enough to chew on. Some of this is already being considered and some may be new to you, but old in the on going discussions of healthcare. This is a major issue, above the importance of Art education and education in general, and certainly a developed respect for comics as America’s visual/literary cultural art form. But all of this is interconnected. And in my mind honestly is secondary to the more prudent necessities regarding the intertwined issues of global warming, energy independence, our security and our economy…oh wait there we have it healthcare and education again. All I know is if we can solve global warming we can save more lives and more money then we would solving healthcare. But I have little faith in either, because as Fereed Zacaria recently pointed out if it isn’t a Crisis, America can’t fix it. Still I show up every day and try to solve issues on my end, it would be nice to have better help. More TMJ docs, better insurance coverage, electronic medical records, better training and communication, a full time Art Ed job for me, more funds to reduce my carbon foot print, a health insurance plan with no deductible (I didn’t even get into that, but I do have personal story there too), and some pay for all my cartooning work. But I know you are facing impossible odds and constant bickering. Makes you whish our for fathers dreams of a Republic had come to fruition sometimes. That’s coming from someone who wants government to leave me alone and stop embarrassing me, but paradoxily provide all the help I need to pursue my potential, life, liberty, happiness and a future for my daughter and her kids.