The Wild and the Woolly

Back when I was a young thing, still in college, a marginally older friend and I had a conversation about aging.  I was reflecting that I didn't want to grow old and unloved, and his response was, "the only way you can ensure that you will be loved when you're old is to become extremely lovable."  Which makes perfect sense in one way and is also a nonsensical passive construction.   Love is in the eye of the beholder after all -- not something we do to or for ourselves.  But, looking a little more deeply, maybe the important question is this: do we actually find ourselves lovable?

I inherited a tendency from my mother to scan for the worst possible outcomes and prepare accordingly.  This risk- averse tendency keeps me flossing and getting check ups, and probably has prevented me from being either very rich or very poor.  I'm the ant in the grasshopper and ant fable -- trying hard to get ready for winter, not singing the summer away.  (Those of you who know me well will point to some rather large leaps of faith I have taken with my life, quite grasshopper like, but let's not let the disconfirming evidence distract us from the narrative at hand.)

Ant

Anyway, my father is rather more the model grasshopper.  He really does live in the moment -- definitely not in a state of high preparedness.  He's had his highs and some pretty dramatic lows, but seems to keep ending up on his feet in improbable ways.  Recently they found a suspicious mass in his lung and all but assured him it was cancer.  Today he went in for the biopsy and poof, no more mass in his lung.  The doctors compared the xrays and couldn't believe what was before their eyes.  I'm sure there's a lesson in there somewhere for us anxious ants.

green grasshopper

Mr Salamander and I just returned from a week of sailing around the Gulf Islands on a 40-foot sailing vessel we rented with another couple, Monike and Paul.  Although we didn't venture very far, we did discover some wonderful little communities in the various marinas and bays we sailed into.  My favorite was Genoa Bay, a sheltered little spot north of Cowichan Bay, with charming houseboats and some really fabulous art.  

Genoa Bay Houseboat

Mr Salamander Heeling

I've been thinking a lot lately about how we define our social distance with other people in our lives.  That barrel-of- laughs philosopher Schopenhauer described the "hedgehog dilemma."  When hedgehogs get cold and lonely they cling to each other for support.  But when they get too close they prick each other and move further away.  Being a somewhat misanthropic guy, Schopenhauer concluded that it's preferable to be a person who generates a lot of his/her own internal warmth so as to be in a position to generate fewer pricks from others.  

Porcupine[1]

Even living in Canada, with its quite sensible health care system, is not protecting me from episodes of sputtering rage regarding the insane debate about health reform going on south of the border.  The latest flap about "euthanasia" is so horribly misinformed I want to cry.  I have been a hospice worker for nearly 10 years, both in the U.S. and in Canada.  In the U.S. hospice is a federally funded program that encourages terminally ill people to maximize the quality of life of their last months of earth.  They are supported to be at home and free of pain.  There is spiritual and psychological support for the dying person and the patient.  

When I used to give talks, I would sometimes lead with the observation that as a healthcare writer and consultant I've learned very little about health and a lot about economics.  The best way to understand how the economics of healthcare differ from the economics of other goods and services is to read Robert Kuttner Everything for Sale: The Virtues and Limits of Markets.  He makes a persuasive case that while capitalism is an excellent mechanism 

Everything for Sale: The Virtues and Limits of Markets

Robert Kuttner

Overreliance on market mechanisms is ruining the health care system, contends Kuttner, a contributing columnist to Business Week, because of enormous hidden costs engendered by opportunism, fragmentation, underinvestment in public health and prevention, and inefficient use of home care and nursing care. In a humane society, whole realms of activity necessarily depart from pure market principles because market norms drive out nonmarket norms, i.e. civility, commitment to the public good, personal economic security and liberty. 

I knew (and respected) the theory, but in moving to Canada I've had the opportunity to live the reality of socialized medicine.  Canada has perhaps the most socialized of all healthcare systems since there are no alternatives at all to the public system.  Your money simply will not buy you more health care in Canada.  I also had the opportunity to consult within the Vancouver regional health care system, so I got to see a bit of it from the inside.  

Let me first say that no system devised by humans is without fault. No health care system will give everyone everything in the optimal time and quantity.  That having been said, the Canadian system is quite impressive.  One thing you notice right away is that the investment in public health and primary care is enormous.  Everyone knows that dollars spent on prevention are the most effective of health care dollars.  The primary care access is simply unbelievable.  There are free walk-in clinics everywhere, and plenty of private primary care physicians (at least in this city -- probably not in all parts of Canada).  My own personal physician spends over an hour with me annually, and employs a level of testing and referral that I am reasonably certain would not be covered in most HMO settings. The breast imaging center is state-of-the-art -- the technology is a big step up from the one I was going to in Port Angeles Washington before I was eligible Canadian coverage.

Primary care physicians here are in private practice (although they are paid by the government).  Specialists are largely employed by the healthcare system.  My subjective impression is that they are not as cranky as U.S. physicians, and definitely not as harassed with regard to paperwork, malpractice insurance and limits on their decision-making.

Like the U.S., Canada also does its fair share of spending on "futile" care, (something like 80 percent of health care dollars are spent in the last 6 months of life).  But, as a volunteer hospice worker I do see many patients who have been helped to understand that major invasive surgery for cancer that has already spread is probably not in their overall best interest.  

Where Canada does fall short is in the waiting lists for elective surgery -- particularly orthopedic surgery.  Although they have made some progress in shortening the queue and managing it openly and fairly, it could be years before you get that hip or knee fixed.  The reasons for these delays are complex, but one of the reasons is staffing.  There just aren't enough orthopedists who are willing to stay in Canada when they can make a fortune south of the border.  Orthopedics is big money in the U.S. and the demand is virtually unlimited.  

There's more to say, but in a nutshell, by and large Canadians love their healthcare system. I read somewhere that British Colombia males are the longest lived on the planet.  Premiums are very low for everyone and zero for those in need. Standards of care are high, even if waiting rooms are shabby.   Public health is taken seriously and is not the orphan child it is in the U.S.  I have more confidence in Canada's ability to manage an epidemic than I do in that of the U.S.  And, the icing on the cake, the costs are dramatically lower:  In 2006, per-capita spending for health care in the U.S. was US$6,714; in Canada, US$3,678.^[5] The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%. 

Reading the debate about health care reform in the U.S. makes me really feel my years.  I was a health care reporter under both the Carter and Reagan administrations, and after moving to California in 1986, spent the ensuing 20 years as a consultant to various health care organizations.  So I hereby offer a bit of history and perspective:

I now know for certain that if I'm stranded on a desert island with only a sheep for company, I could probably keep warm. Note quite sure how that's important, but there you go. I once had the opportunity to spend some time with an individual who had spent some hard time in prison, solitary confinement.  His solemn instructions should I ever be in the same predicament have similar survival value for me, I imagine.  But you never know.

More than a year ago, I decided to undertake the project of creating a garment from raw local wool.  For being free, the wool was quite lovely, but also quite dirty.  Anyway, bit by laborious bit, the sweater emerged -- first clean carded fleece, then spun and plied yarn and then an aran sweater I patched together from many free designs I discovered here and there. I even figured out how do it all in the round and integrate the raglan sleeves on my way up. The miracle is that it actually does fit, despite playing quite fast and loose with the gauge, coupled with the fact that the wool itself is quite imperfectly spun and can range from a lace weight to a worsted.  I'm hoping that the welter of cables will distract from the thin spots.  It does seem to have fulled a bit when I washed it, which helps.  Anyway, I'm quite pleased, both at the result and to be done with it.  I might even enter it into the Saanich fair.  

sweater

We have an unfortunate tendency towards apocalyptic themes in this house.  Mostly I blame Mr. Salamander, but this time I have no one but myself to blame.  An article in the New Yorker  matter of factly describing the signs and symptoms of the accelerating process of human extinction, caught my attention.  At the time I thought extinction would be a pretty bad thing and I was upset.  Mr. Salamander, by contrast, in his outrage about the clumsy and unnecessary damage to living systems done by far too many self-centered homo sapiens on the planet,  was willing to contemplate the notion with a fair amount of complacency, if not satisfaction.