I’ve realized finally that it’s not that it’s not that I’m not adventurous. Rather, I’m adventurous, but only in bursts—much in the same way that I’m sociable. I can’t do it for long stretches of time. However, I also tend to like adventure when there’s some semblance of order in it. This doesn’t preclude spontaneity. Instead it means that spontaneous actions have to occur within certain boundaries (in order for them to be fun, at least). I like trying out new things, being un-cautious—but only briefly, or in the company of someone else for whom these things are not new. A friend once invited me to go out, late at night, climbing on rooftops in a city I didn’t know. This might be something that made me uncomfortable (except in circumstances we’ll get to later), except that she had done this before, many times—and knew what she was doing. I trusted her. And I can very often be flexible, it’s not that; if you spring plans on me, I’ll adapt to them, if they sound enjoyable. But if you want to do something truly novel, for all of us, I need some control, somehow. I don’t get anything out of being lost and unsure; it doesn’t do it for me. But when I have some guidelines—and don’t think that they need to be terribly concrete—I enjoy my adventures a lot more.

Now, a quick explanatory side-note. What I mean by this about not-for-a-long-time is that, should you ask me to be adventurous—go into a new situation, or do something I’ve never done before, and so on—if it’s going to be stressful in some way, the two ways of making it less stressful for me are as follows: One, make it short. Bring me to a friend’s house where I don’t know anyone just for a little while; take me out but then let’s go back in. If I don’t become more comfortable, I’m not going to enjoy staying long. Two, give me some control. Tell me about what we’re doing. (Obviously, usually it’s me doing the deciding on these things.) Would I like to be slightly better at this? Yeah, sure. But it’s not something that particularly bothers me, because it’s so easy to gain some semblance of control. You take small steps, rather than giant ones—you meet people through friends rather than meeting them in completely novel situations. And then when you go through with the larger steps, it’s more fun—because it’s an occasional thing. Now I should point this out, although I doubt you’ll be surprised: this is pretty normal. Most people are like this. Most people hate being put into new situations, exactly for the reasons I’m describing. And that’s not a bad thing.

But the thing is, I am adventurous. Seriously. For a long while, I had it in my head that my not liking to be completely out of my depth was a sign of my not being adventurous, not being spontaneous, not being independent. But no—perhaps that seems to be true to my friends who like this unsure-state, or like boundless, incalculable possibilities. But I prefer my thrills to come from controlled ascents, rather than free falls; I like looking at my options before I choose. I will never be the sort to take an entirely unplanned vacation. This might make me sound staid, but I think that’s missing the point. (Of course I don’t always deliberate each decision! Sometimes I enjoy jumping without looking! But only when other factors are secure.) The point, then, is that my adventuring comes from a different route: one where questions are asked and advice sought. I would never climb a mountain without a map, and maybe a guidebook. If not that, then at least I would want to be going into my climbing having read about the route, or being with someone who knew the mountain well. In some sense I would enjoy being the leader, discovering it on my own—but my mode of discovery would be to ask people, or park rangers, to get a map, to bring a compass. I’ve been lost in the woods, before (not terribly lost), and it’s not a lot of fun. If I were to be set adrift somewhere, could I figure things out? Sure. But why would that be fun? (If it were a contest, maybe.) My thrill-seeking mind wouldn’t be piqued by the supposed-joy of discovery if I were confused, lost, and anxious. And why shouldn’t that be the case? Such ways are not in my genes.

What does it really mean for me to being a structured adventurer? Not what it might sound like, perhaps. I do not mean “structured” as listed out, described, ordered, organized—although it is true that I love list-making—but rather in a more literal sense. My structure comes in mental arrangement: my mind needs to grasp the factors involved in what I’m doing. Really, I mean that I must have asked relevant questions and gotten answers. A friend once asked me: “If I shouted ‘Duck!’ at you, would you duck immediately, or ask me why first?” For me the answer was, of course, that I would ask why. (As seems obvious, were we in any of the circumstances wherein immediate response would be obvious and expected (e.g., a war, a water-balloon fight, laser-tag), of course I would duck.) I don’t think this is a problem with trust, or with control: if the command was “Look to your left!”, of course I would look. The problem is the more basic one of congruity: when things are incongruous, I am uncomfortable.

We’ve come rather far afield, but I think that in some sense we’ve hit exactly on the root of it. I am not a person who likes disorder. Show me geometry! Show me arrangement! Intentional incongruity or disorder can be intriguing, or even beautiful. But accidental confusion? Why should I ever settle?

I wrote this mostly on the airplane coming here. It’s not bad for a sort of free-flowing sort of thing, I guess? (I mentioned I would post this a few days ago, no?)

Note: This is me trying to sum up what others have written about the health care debate. I’m trying to be somewhat objective.

Note also: This isn’t a research paper. I didn’t take notes, so where I’m drawing ideas from is not always clear. Still, I’ll link outwards as much as I can, when I know where I’m drawing ideas from. David Goldhill’s article in The Atlantic, here, is pretty amazing; I’ll discuss him later, but he changed quite a few of my thoughts, and he provides the statistics I’m not pretending to know.

Over the past few months, I’ve become increasingly interested in, and frustrated by, the debate over health care in the United States. I’ve had the leisure to do some reading while I’ve been home, and all I read made me more and more angry. Because health care seems something that’s nearly as important as basic rights, and here we barely understand what we’re debating.

One of the marvels of the modern world is that we are able to keep ourselves healthy with medicine and technology; the world has advanced to the degree that most mothers do not die in childbirth, most children in the States live to reach adulthood. This does not seem momentous today, but it is extraordinarily different than things were two centuries ago. More notable, of course, are the leaps and bounds of biotechnology that we read about on Tuesdays in the New York Times, or daily in other papers — the doctors who perform a skin graft on a man’s face, or give another man a new hand, or repair a detached retina, or cure diseases formerly thought untreatable. These things are here, and now. This is what health care is. It is also the emergency rooms that treat victims of fires, of car accidents; it is the oral surgeon who re-set my jaw when I broke it, and wired shut my mouth for six weeks so it would heal.

Health care is also the simple, basic levels of care — the doctors’ visits you think nothing of. The doctors who ask you about your life, answer your questions, and recommend simple tests to make sure you’re healthy. It involves the doctors who, should things look bad on a simple blood test, might ask you to come back in. This is health care, too.

And of course this is simple. It’s basic care. It’s not quite on the level of physiological needs from Maslow’s hierarchy, but it’s not much higher up than that; I’d place it in-between physical needs and safety. Most of my friends have access to health insurance, or have had such up until they left home and had to start paying for it themselves. Most people I will know will have had health insurance for all of their lives. And this is excellent. Yet the system by which we fund such care is, to put it bluntly, fucked. Most people have trouble paying for care; many go without. Some die because they don’t have health care, or because their insurance doesn’t cover what they need. People have to choose which segments of care they wish to fund at the moment. I have had friends who have had operations sooner than needed, so their insurance would pay for them since they were in the same calendar year, and friends who’ve split operations into multiple parts, so the insurance would pay for both parts. This is senseless, and in the first case even dangerous. This is not care.

As I see it, there are a few ways that most health care systems work:

1. Health care is paid for entirely by the consumer. This is the primary method for people who don’t have health insurance (duh), who only get free health care if they go to certain hospitals, in certain places, when they really need care. This is also a primary method in countries without organized private insurers and without enough money to provide government-based care. (See: much of the third world; consider other ways of doing it.) I think most people reading this, at least those who are not anarchists or solipsists, will be in agreement with me that this is a lousy method of providing care, at least when the intention is to provide some sort of care to most people.

2. Health care is paid for by the government. Hospitals and doctors work for, and are paid by, the government. Individuals go to hospitals, meet with doctors, and are treated if their problems are covered by the group plan. Ideally, this could be a very effective, streamlined system. Of course there’s buraucracy involved, but this provides a direct circle insofar as financing goes: individuals pay taxes to the government, which pays for the hospitals and doctors, which service those same individuals. This system does work pretty well. Despite what some might have you think, those in Europe who have socialized medicine (that’s what this is) seem to be getting by pretty well. Their systems have their own problems, and ours would be no different. But if this happened, it would actually work pretty well in America. People often criticize such systems for not paying doctors as much and so forth, but instituting it here would not be liable to change things; it’s not that simple.

Medicare is similar to this system, although the people who pay for it are actually not the people receiving its benefits; rather, the current workforce pays for the previous one. Medicare is not very effective, but that’s only partially its own fault. It is top-heavy, and filled with attempts to make it seem to not be socialism, for one thing. Still, Medicare is a part of the problem as much as it is a solution, in other ways.

Of course, nationalized health care won’t come to pass in the US any time soon, because people are terrified of the idea of helping other people. They’re also rightfully concerned about the bureaucracy of it, and I really can’t fault them for that concern.  There’s also the third option:

3. Health care is paid for by private insurers, who are in turn funded by groups of people. This is more or less the way we currently do it. Those who can afford it pay premiums to a private company, and when they need medical services, the insurer pays for part of the service. Many people buy this insurance through their work-place. Most people, in fact. And the companies pay some of the money that would otherwise go to individual salaries into the insurance companies. Thus our insurance depends on our employer’s choices, and our salaries are limited by insurance premiums — you can think of the amount your employer pays to insurance as an amount they’re taking out of your paycheck. This is a somewhat reasonable method of organizing things (most people do work), but beyond that there seems to be no good reason to do it this way.

Besides which, most of the time the amount we pay to the insurer overshadows the amount they pay out for services, but when we need a big operation, or when something catastrophic happens, they pay for that. That’s why it’s called “insurance,” even though most of what it does doesn’t really sound like insurance at all.

Now, as David Goldhill has pointed out in The Atlantic, what we have isn’t really insurance. It’s more like a combination of two things, only the first of which is insurance: catastrophic insurance, importantly, and a stipend for everything else, less importantly. Goldhill suggests that we change the system away from any of the above, providing government-backed catastrophic insurance for all Americans and then allowing individuals access to a health funds account for their doctor’s visists, basic health services, and so on. This system seems pretty reasonable. It also won’t happen, in part because the private insurance companies are very good at lobbying. It’s also a very drastic change, and the US government is too cumbersome to work with drastic change, most of the time.

To be fair, Goldhill’s system also runs some risks in that there’s an increased incentive for individuals to not use their health insurance fund, saving it up instead. (NPR, among others, have pointed this out.) That said, I must ask: increased as compared to what? Report after report has come through the news about adults on heart medicine who don’t buy their medicine because they can’t afford the co-pays, or those who are uninsured who don’t see a doctor so they can buy their children food. Is this any different than individuals choosing not to see a doctor that they can afford? I would say not at all; a choice between now and later is much better than a choice between your life and your childrens’. And yet this system probably isn’t going to change.

The current suggestions for reform are weak, but they may be positive. The “public option” that is being discussed is watered-down and facile, and it’s barely an option for increased coverage, but it may provide health care for some who did not already have it, and I am not going to knock that. That said, I think Goldhill is right when he says that passing some new “reform” will simply entrench us deeper in our current system. What we’re liable to get is a system that’s marginally better, but not by much. And how will this affect me? Perhaps not at all, especially if no attention is paid to increasing hospital’s working with technology, improving hospital and patient records, and connecting doctors with one another. Will some folks who didn’t have health insurance now have it? Yes, probably. Will life be better for them? I hope so. But the real question is: will the government force a change in the health care system as a whole? And the answer is that it probably won’t. That may happen on its own, but I have no faith in a true reformation.

I haven’t wrapped up anything, which is why I put off publishing this for a while. Still: as a summary, this is something. So shall it be.