THE BUS TO OZ

(Originally published at EisenhowersLastSmoke.org on 7/15/2013)

The summer after I turned 12, I went to camp somewhere in upstate New York. My mom took me to stay with my grandparents in Brooklyn , and then my grandfather (remember Ike) drove us to the city to meet up with the bus to camp. I had spent a lot of holidays and long weekends in Brooklyn, and had hardly been to any other part of New York, city or otherwise.

I remember the car ride to that bus clearly. I remember literally wishing it would go on forever. Not that riding around with my mom and grandparents was my tween ideal of a good time, but I was terrified of getting out of the car, and starting the new adventure I was about to have. Sleep away camp. For eight weeks. On my own – no sister with me, no school friends, no friends of friends. I wanted to go to camp, but I dreaded getting on that bus.

That 7th-grade feeling returned this past weekend, as I packed and repacked for my Eisenhower Fellowship to Australia, New Zealand, and Singapore. I’ll hit about 10 different places in at least three climates over about five weeks. I’ll meet dozens of new people, and I’ll probably spend a lot of time alone.

Don’t get me wrong, I want to go on the fellowship. In fact, I cannot believe how lucky I am that I was chosen to have this experience or that I have such a supportive family and employer to enable me to do it.  But traveling across the world, to a place I’ve never been, on my own, is frankly, as terrifying as it is exhilarating.  Actually, more terrifying.

The plane ride to L.A. is like the car ride to the bus. I’m packed. I’m going. It’s really here and this is really happening. And now, all I can do is put one foot in front of the other. Follow my itinerary. Get to my hotel. And start exploring Australia and its health care system in search of ideas and insights to bring back home.

One of the best things my mother taught me was that I could always come home. Whenever I left on any trip or adventure, of which there have been many, my mom has always assured me that I could come home if it was terrible. And I’ve always believed her, that if I needed to bail, there’d be no judgment, and maybe even plane fare or a ride. But of course, I’ve never taken her up on it.

So Oz, here I come. One foot in front of the other. A laptop, a camera, a notebook, (yes, like with paper inside), and way too many outfits.  But did I bring enough shoes?

EISENHOWER'S LAST SMOKE - THE NEW ZEALAND EDITION

(Originally published at EisenhowersLastSmoke.org on 7/11/2013)

Credit: Jennifer Hill http://www.jhilldesign.com/collections/new-zealand

“How can I convince you to come visit New Zealand when you’re in Australia?” asked Eisenhower Fellow and a member of the New Zealand parliament, David Clark (@DavidClarkNZ). I have to admit it didn’t take much. Having been to New Zealand once before, I remember the lush scenery, delicious seafood, and collective obsession about the national rugby team. I also remember someone telling me that New Zealand has more sheep than people. (It turns out that is true: http://datamarket.com/featured/man-vs-sheep-new-zealand-myth/)

The New Zealand health care system is a primarily public system, with about 1/3 of the population buying private insurance to have a broader choice of clinicians [or treatment sites] and shorter wait times. The population – just about four million people (with nine times as many sheep) – is two-thirds of European descent and 15% Maori, the indigenous people of New Zealand. Notably, the Maori people are reported to have greater challenges accessing health care, with almost a quarter of Maori adults reporting that cost prevented them from seeking primary care.

So it’s not a perfect system. However, in a Commonwealth Fund exploration of seven industrialized nations, New Zealand ranked #1 in patient-centered care, with Australia at #2 and the US, not surprisingly, bringing up the rear at #7. And, they have the lowest per capita expenditure in this set, spending about 1/3 the amount of the US per capita.

As health care leaders in the U.S. talk a lot about “patient-centered” care without always, you know, involving the patient, I am keen to find out what puts New Zealand in the top spot.

It’s also pretty cool to spend time with a member of parliament, particularly one who is committed to addressing issues of social mobility and reducing the wealth gap. Social and economic inequalities are fundamental contributors to the U.S. health system’s dysfunction, and New Zealand may have things to teach us here too.

BANISHING INSULARITY, PATRIOTICALLY

(Originally published at EisenhowersLastSmoke.com on 7/4/2013)

On this Fourth of July holiday, while Americans celebrate our nation’s independence and an excuse to eat juicy hamburgers with minimal guilt, I am packing for a trip that will take me pretty much as far from the U.S. as possible.  In just a week, I’ll be setting off on my five-week journey to Australia, New Zealand, and Singapore to study their health care systems and what role consumer empowerment has in the effectiveness of these systems.

Why go anywhere else? Don’t we have the “best health care in the world?” While I hear this notion quite a bit, most often from elected officials in political debates, data abounds to the contrary. The U.S. ranks #37 on the World Health Organization’s World Health Report, two slots above Cuba and 32 slots below Malta, a set of islands south of Sicily, and a member of the European Union.

Need more to go on? Well, the U.S. spends 18% of our GDP on health care , which is almost double the average spent in Organisation for Economic Co-operation and Development (OECD) countries and a third more than the next most spendy country, the Netherlands. Yet, in the U.S. we have 45 million people without health insurance. We rank 33rd in the world for life expectancy. And we rank 34th in the world in infant mortality: we have almost 7 deaths per 1000 live births per year[1] . (We’re just behind Cuba on this one.)  If you’re not a data wonk, then I invite you to think about your own experiences at the doctor’s office, hospital, or on the phone with an insurance company. Tell me your experience feels “best in class”. (Seriously, tell me: I’d love to know where that is). According to Gallup, 67% of Americans rate their health care coverage as excellent or very good[2]. That's not too bad, but we could do better. If that were a test score, it'd be a C- at best.

The chest-thumping patriotism espoused by politicians – “We’re the best in the world” – strikes me as a funny expression of love for country. If we’re truly invested in our country and our kids, a more nuanced approached might involve recognizing our weaknesses and taking examples anywhere we can. So,  I am going to see what’s happening in a few of these countries that are beating us on these lists. And patriotism aside, I’m wicked competitive. I take our wholly mediocre health performance personally.

I’m certainly not the first one to get this idea. In search of a health care system that works better than ours in the U.S., author T.R. Reid set out on a similar journey, which he chronicled in The Healing of America.  He quickly realizes “better than ours” does not sufficiently narrow down his choice of destinations! Reid actually dedicates his book to President Dwight D. Eisenhower, citing Eisenhower's willingness to use the best ideas, wherever they may have come from, as his own inspiration. Eisenhower reportedly demanded bigger thinking and better ideas for the U.S. interstate highway system based on what he had seen of the German autobahn. No matter that Germany had been an American enemy or that he observed the superior German highway system while at war. Their way worked better, and we ought not settle for less.

Many of us curse the number of cars that fit on these superhighways as we travel to our July 4th destinations. But the fact is, we have a better highway system because someone had the vision and pragmatism to look abroad for ideas and then to do the most patriotic thing possible: insist on the best for America.

To that end, I’ll go back to packing for a trip looking for ways to engage Americans in their health care. Over the next week I’ll post more about where I’m going and why, and in the meantime, you can get a preview here.

I’m also looking forward to grabbing a burger. Happy 4th, everyone!

[1] "CIA – The World Factbook: Infant Mortality Rate". Archived from the original on December 18, 2012 (Older data). Retrieved May 15, 2013.

[2] http://www.gallup.com/poll/159455/americans-satisfaction-health-coverage-slips-slightly.aspx