Government-Run Health Care in the New-Age Economy: Hand-Outs More Okay; What Elephant?

You know that feeling. Maybe you got laid off. Or your surviving parent needs to move in. Or, hey, let's say your health insurance plan's fine print just kicked in and your out-of-pocket just drained the retirement account. What do you do first? That feeling in your gut, the panic, gets you to cut back instantly, right? You cut coupons, buy generic and in bulk, take a bagged lunch, fill the jar with found coins. If it gets worse, maybe you have to let some bills slide. Depending on your situation, maybe you have to sell stuff; maybe even your house. That's the level of desperation that seems to have hit Americans facing health care reform. When the economy was good, most of us could shut the windows, turn on the AC, and avoid the alarms about rising health care costs. Someone who had constituents affected by the problem would take care of it eventually. But, once the jobless rate neared the 6 percent mark in the Indian summer of our economic turmoil, maybe the electric bill went unpaid, because suddenly everyone was opening the windows.

The problems of health insurance, access to care, and rising out-of-pocket costs used to stay tucked neatly out of public policy sight because, let's face it, it afflicted mostly immigrants right? And people who weren't ambitious enough to get a college degree and a reliable job or who made poor choices that landed them in trouble, right? But now that more and more of us near the proverbial "other side of the tracks" -if we haven't crossed already - suddenly it's about all of us, and the panic about access to and cost of health care seems to render banal other concerns like food on the table and meeting the mortgage payment. A look at today's New York Times poll on government-run health insurance reveals that suddenly almost three-quarters of the country supports a government-backed insurance plan and nearly sixty percent are willing to spread the wealth (and receive less luxurious care) to cover folks who are unable to afford it. Huh. Suddenly, it's okay for those less affected by these problems to make the sacrifices that will cover people now affected or threatened by them.

Let's clarify in terms of numbers: Health care spending in 2007 amounted to 16.2 percent of the gross domestic product (GDP), up from 13 percent in 2000. Between 2006 and 2007, the increase of 6.1 percent in health care spending far outpaced the GDP, which grew by 4.8 percent in that same timeframe, according to the Commerce Department. We spent nearly $7500 per person on health care in 2007. It used to be statistics like these were concealed by stalled legislation and in the shadows of poll results for American Idol or Dancing with the Stars. Now, everyone suddenly seems to be aware that by 2018, nearly one-fifth of the nation's spending will go towards health care.

So today, according to the NYT poll conducted this month, we're more willing to pay higher taxes for a government plan (57%). Half of us -versus 30 percent in 2007 - think the government would better private insurers in providing medical coverage, and 59 percent versus 47 percent in 20007 believe it will hold down health care costs better than private insurers. That's a big change of heart in one year. Like some big ol' wind came blowing through all those open windows.

But in our panic to regroup and restructure to meet our newfound altruistic ideals, no one is acknowledging loudly enough the elephant in the room: The size and weight of a government-run plan could create similarly sizable cost burdens and bloat its bureaucracy, negating intended gains in effectiveness. People who remember when Medicare and Medicaid could produce new illnesses just by participating in the plan know about government-run health care. Veterans who received the 92 botched prostrate cancer treatments out of 116 performed in a span of six years at the Philadelphia Veterans Hospital know about government-run health care.

With most Americans now facing real threats to their ability to afford and receive decent health care, an overhaul of the system is, miraculously, near. But don't be fooled. This isn't going to get us much closer to a good night's sleep. In fact, it's going to throw off our whole circadian rhythm of entitlement. We'll pay, and pay a lot. And we'll have to get used to less. Less choice. Less efficiency. Less of the best. The, um, good news is that more of us will get it.

Let's try to do this without so much panic, though. That's never a good way to make the big decisions.

To Skin a Rattlesnake

Twenty six years ago, I made my first trip to the Fuller family cabin in remote Gravelly Valley, California. East Coast girl's first pioneering adventure in the wild west. There I strolled with my mother in a field of dry grass, where we considered that more than a century earlier on that same plain, hardy ladies in white cotton dresses and bonnets danced to fiddle tunes with gentlemen in black trousers and suspenders. We walked by the swimming pool buried under the silt of the '64 flood waters that washed down the valley a whole compound of rustic cabins, stables, and dining hall along with all the creature comforts of society life delivered from San Francisco. We poked around some broken boards of a washed-out walkway that surrounded the pool when we heard an unsettling sound. We'd been instructed to run if we heard the rattlesnake's warning, so we did. The fellas -- Brian (now my husband), his father George, and brother Kirk -- asked if we might have mistaken a cicadas' pitch there in the June heat, but if there's anything you know better than any other North American if you're from the humid Eastern Seaboard, it's cicadas. We shot them our look, and they grabbed the trident and a shovel. According to the Gravelly rattlesnake code: take no chances where your babies sleep, we had to kill it. The photo above was taken just a moment before the look of horror that came to my face when the field mouse digesting inside that rattler dropped green and slimy out of the beheaded end.

Fast forward to last Saturday; same time of year, damned near same spot where those broken walkway boards lay scattered like bleached bones. This time, the pool is cleaned out, and our son Malcolm and his friend Remington were clearing the old drainage when a big ol' rattler caught their attention. Where Gravelly code trumps animal rights in our little neck of the wilderness, off came its head (but not without second thoughts about passing this legacy onto the kids in front of us). We bury the head to keep animals from chomping onto the venom pouches in its cheeks. As we all stood around marveling at the impulses continuing to make the headless body coil and slither, I suggested we go on in to get a closer look at the decentralized nervous system inside. As soon as the words came out of my mouth, the thrill of biology filled the air, and they knew: a field dissection would be taking place that afternoon. The boys and men gave me a strange look that suggested they were intrigued but had other things suddenly on their agendas.

Remington had a utility knife with a serrated edge on one blade and sharp straight edge on the other. With dramatic ceremony, I removed the rattle and handed the trophy over to him, as my father-in-law had done for my mother and me a quarter century earlier. It's a mistake to think the segments on a rattle indicate age like the rings in a tree trunk. They gain new segments each time they shed their skin, which can occur several times a year.


I carried the body back to the cabin grounds where I nailed it to a tree to drain. A few hours later, I secured it to a board and began the necropsy. The photo to the left shows the first cut, and the ones below show my laboratory, the midsection cut, and the skin drying on the board after I cleaned it in the creek. (Admittedly at that point it had become a badge of honor.)




I spare you the macro-lens close-ups I took of the various stages of dissection (but if you have the stomach for it, click on the links below), during which I learned:

• The skin comes away quite easily from the flesh; only a thin membrane and some white fibers binds them.
• The skin around the tail end is tougher and more tightly bound to the flesh.
• A long silver cord extends from the neck and reminded me of a spinal cord without the vertebrae to protect it. This is the snake's trachea; it ends near the heart.
• The main organs gather about three inches below the head. It's the only place the body bleeds.
• Gas exchanges that occur near the lungs were still functioning after I cut; thin membranes filled up like bubbles.
• Fat collected around the other end, over the kidneys, small intestine and colon.
• You simply can't appreciate the intricate pattern on a snake skin until it lays flat.
• Rattlesnakes have scent glands at their tail; I didn't see them.
  

Removing the skin

Main organs
Gallbladder
Kidney