I favor government-paid equal health care for all Americans. Full-tilt socialized medicine — that's what I want -- completely free at the point of service — and that includes all dental work and vision care. I believe that every useless bum in the country should receive health care as good as you or I get.

I'm a nursing aide at a local hospital — I don't discriminate between "worthy" and "unworthy" people when it comes to health care. We get some real losers here, with medical problems that are almost entirely their own fault — and yet we give them the same quality of care that we give to your grandmother. And, if you have insurance, part of your insurance fee is the money we use to pay for the health care of some of these useless bums. It's a weird system we have now.

I also believe that people should be fully accountable for their behavior -- I believe there is a time and place for judgment, but not at the hospital, and not at the doctor's office.

It is appalling to me, to drive by a doctor's office and realize that I would be turned away from that same office if I did not have money or insurance. The receptionist would hem and haw and make apologies, but it still comes down to, "If you don't have the money, you ain't gettin' in to see the doctor."

Now, many doctors deplore this situation, but they are also good at shielding themselves from it -- which is why the receptionist, not the doctor, tells you to go away -- if you were to be so bold as to ask for treatment.

However, most of us are well-trained and we do not make those demands on individual medical practitioners. But maybe we should?

In the Skagit Valley, if you don't have money, you will be directed to the SeaMar clinic in Mount Vernon, and you can get in to see the doctor for $20, if you have $20.If you don't have $20, you can go to the emergency room at the hospital.

WHAT TO EXPECT. The dreadful economic climate effects hospitals just like every place else. More people will be coming to the emergency room this winter with ailments that could be easily treated in a doctor's office, and the treatment of these ailments will take up the valuable time of emergency physicians and nurses who are trained to handle far more serious problems.

So, demand on hospital services will increase, but income from paying customers will decline. Insurance companies will pay off more slowly, co-payments from individuals will be bargained downward. State medicaid payments will be reduced. Hospitals will be in a squeeze. Expansions plans will delayed. Purchases of new and better equipment will be postponed. Non-essential services will be pared back.

How would you like it, if you worked at a hospital, and some administrator deemed your job to be non-essential? Man, that hurts.

But we'll get through it.

HIGH EXPECTATIONS. I had a wonderful Thanksgiving. I went to work Thursday night and the nursing staff brought all kinds of delicious food to the break room, where a banquet was spread on the table. Good food and overtime pay -- we were all thankful for that.

On Friday, I went to a friend's house for a leftover feast. They had such a big gang at their house for Thanksgiving, that the party was will going on Friday night. And the food was fabulous -- like a white cake with lemon/coconut frosting.

One of the guests was a Lutheran minister, for 32 years he has been a pastor at a church on Beacon Hill in Seattle.

He introduced himself as Victor, but his pastoral vocation came out in the conversation later.

He was wearing a Barack Obama T-shirt, and we talked about that with a shared enthusiasm. He said to me, "Do you have high expectations?"

I was taken aback by that difficult question, and I stumbled before I answered, in this way, "Yes, I have high expectation for Barack Obama as President. But if I have high expectations for him, I must also have high expectation for myself."

Did I get that right? Do we all have high expectations? Don't answer too quickly.