I have never had a cavity. At least, not as far as I know. The last time I darkened a dentist’s door the world wide web had not yet been invented (though the NeXT computer, which hosted it, had). I’ve had a few health scares in the past few years, but nothing that has required a visit to the doctor. And by required, I do mean required. If I had health insurance, I would have gotten myself checked out before now. I have never quite kicked the smoking habit I acquired just before I turned 30, but the wooziness and heart palpitations of this spring served to reduce my intake from a pack a day to bumming 4 or 5 cigarettes off my sister 1 or 2 days a week. I even started running again, but that’s only slightly less sporadic than my smoking. Or possibly slightly more. Anyway, the point is, I’m one of millions of Americans without health insurance, and I’m reaching the age where I’m going to start to need some health care, and the longer I wait, the more expensive it will be when I finally get it.

The latest health drama occurred soon after my first attempt to sharpen a lawn-mower blade. I was reinstalling the blade, applying pressure to a wrench, when I decided to test the quality of my work by allowing my hand to slip off the wrench’s handle and dash against the blade. Well, you can see the result, albeit some two days later. I honestly don’t remember if I swore. In my flashbacks, I alternately remember three different cuss words and/or phrases. It’s possible all I actually said was, “Ow!” followed by a grunt and/or a growl (I am not a particularly verbal person). It was probably the most blood I’ve lost accidentally. It just didn’t want to stop. My dad suggested stitches, but I balked at the cost of a trip to the emergency room. “Get a grip,” I told myself (though not in so many words). People deal with much worse without rushing to the hospital, which is true enough.

Only now, several days later, I’m starting to worry. Shouldn’t there be a scab by now? Are the edges going to heal up without rejoining? Am I going to have to get a doctor to recut the skin and stitch it together in order to cover up the layer of subcutaneous fat that’s visible, along with the ends of two or three blood vessels? Shit, I don’t know. I keep it clean, apply antibiotics, alternate between keeping it covered and giving it air. The skin on the back of my finger between the cut and the nail is swollen and largely numb, but my fingertip retains its feeling and its color. Most importantly, I can still type with it.

But here’s the thing. Ten years ago or so I was complaining to my writers’ group about a pain in my abdomen. My fellow writers regaled me with stories of their friends and loved ones who had waited to get such pain looked at, only to come close to death as a result, mainly from burst appendices. Well, they succeeded in scaring me to the hospital, where the doctor’s first comment was, “Well, we know it’s not appendicitis–your appendix is on the other side.” I was working only sporadically back then, so the $500 they charged me (for x-rays and blood tests and whatever else) hurt worse than my abdomen, especially given the final diagnosis of “probably just a pulled muscle.”

But here’s the other thing. I read an article recently about a 24-year-old guy who died of a tooth infection because he didn’t have health insurance. He went to the hospital before he died, and the doctor prescribed a pain-killer and an antibiotic. He could only afford one of them, and you can guess which one he chose. The thing is, people in debilitating pain are not necessarily adept at making good choices. Hell, my pain wasn’t even that debilitating, but what are the criteria for deciding when to go to the hospital? The web is the first place to go to find out, and after several days I looked up some articles on suturing yourself. It was very helpful, but I thought perhaps I had waited too long, so I searched some more and dug up an old scouting page, which seemed to suggest that my wound was right in the middle between “definitely” and “maybe” as a candidate for stitches, but that it was probably far too late to get them.

I realized that what I wanted was a family doctor, a general practitioner like I had as a child (man, I’m old, and/or man, this is a small, New England town). Someone whose office I could have gone to and had my wound looked at with a trained eye and maybe stitched up with a practiced hand for maybe the price of a half-grown pullet. We all know that doctors these days are contractually obligated to test for every possible complication so as not to get sued for malpractice if they misdiagnose. It makes it impractical for those of us without insurance to seek medical attention unless we’re dying and/or have stacks of cash sitting around with nothing else to do.

There may be alternatives, free clinics, etc. Were I a good and responsible blogger, I would doubtless research such things for your edification, but my point is merely that I, a reasonably well-informed (averagely informed? Not atypically clueless?) citizen, have no idea where to turn for a routine medical issue that won’t cost me an arm and a leg. Typically, my proposed solution is to do away with all of it. Fuck hospitals. Let’s go back to shamans and witch doctors and endless, fever-hazed nights of torment and eventual death from creatures so small we don’t even know they exist, but we know where that kind of primitivist anarchy leads—go visit an Indian Reservation if you want to see for yourself.

Most of the world survives without advanced medical care, and many suffer needlessly for the lack of it, but our advancements have come at a cost. We (by which I mean I) just don’t know how to deal with the more extreme bumps and scrapes that the world sometimes has to offer, and for the most part the people who have the information I need will expect me to pay them rather exorbitantly for the privelege of having them impart the pertinent data to me.

And I guess that’s okay. It means that when the economy finally collapses, along with our health care system, it will be we the wealthy who die off most quickly, leaving the world to the poor and the meek, to whom Jesus once promised it.

UPDATE: My scab fell off today (September 23). It’s still a bit swollen and numb between scar and knuckle, but there’s no sign of infection. It appears that my gamble paid off! (This time.)