It’s Been an Hour and We’re Still in Kansas, Toto
This article was originally published by the New York University chapter, in Edition 001.
In May, I packed my favorite cloth tote bag with my laptop, a water bottle, and some essentials. I boarded an hour-long train that took me from my starting point in Paris, at Gare du Nord, to the train station located in the city center of Brussels, Belgium. A Wednesday free of classes during my study abroad semester allowed me to immerse myself in Belgian culture, indulging in gaufres from street vendors, exploring antique shops, visiting chocolate museums, and savoring Belgian frites. Fast forward to today, a Sunday, where I repeated the ritual in New Jersey, boarding a train from Metuchen Station to Penn Station in New York City. In Paris, a one hour train took me to a brand new country. Here in New York, a one hour train takes me to New Jersey. Huzzah.
Although the concept is embedded in the name of our country, we tend to forget the implications of being the “United States,” as in a group of states that function as a country. A bit like a European Union, no? Except those are all different countries, with different values and populations and political viewpoints. When it comes to drug usage in the United States, the rules that apply in Georgia more or less apply to North Dakota, as long as they are imposed by the federal government. When it comes to drug usage in the European Union, you better not have drugs on you in France, but you can go smoke weed at any corner cafe in The Netherlands. Drawing parallels to the European Union, our diverse states, each with distinct values and perspectives, operate under federal rules, resembling a collection of mini-countries. This is evident in healthcare, where a one-size-fits-all approach fails to acknowledge the diverse needs of each state. The importance of states’ rights is unmatched; it plays an immense role in just about every policy our government imposes, including most healthcare policies, such as those of the Affordable Care Act. We do not beget states’ rights when it comes to making policies, but we do quite often when it comes to innovation.
The idea of Cabin Fever came together within my first few weeks at New York University, which were synonymous with my first few weeks in Paris, as that was the campus where I completed my first ever semester of college. There was a lot to learn just by observing the culture around me, and by learning the ways of this new society in order to integrate myself into it for the remainder of my four months in France. There was a lot to learn about how I could do better as an individual in taking care of myself and my community, but there was particularly a lot to learn about how we, as a country, could do better and follow the examples of our international allies. Innovation is the driving force of change, and the necessity of change is unwavering regardless of how far society progresses, because how could progress ever be enough when there are countless Americans holding themselves back from calling 911 in fear of the ambulance costs, or forgoing essential treatment due to poor or no insurance coverage? We have set ourselves up for a system that will continue to fail the American people unless we think creatively. There are a lot of examples in the world we could look at, but my favorite is Japan.
In Japan, every individual has a card that is inserted into a chip reader, much like a credit card, at the physician’s office [1]. The card contains the individual’s entire health record, which decreases administrative costs significantly [1]. Is this something the United States could benefit from? Undoubtedly. Administrative costs make up one-third of this country’s overall healthcare costs, which drain about 18% of the nation’s gross domestic product in total [2]. However, something as simple as a card could not be integrated into the United States healthcare system as easily as it can be done in Japan, considering Japan’s healthcare runs off of a single-payer system while we continue to chug along with our free market model. With tons of different insurance companies, prices for treatments and procedures, and electronic health record systems, the system of using a single card would not suffice across fifty states.
But what about in just New Jersey? What if we started with an innovative system in one state, perhaps even one county of the state, and gave it a go? Oregon tried it with a system where healthcare was rationed amongst the public for the sake of conserving costs [3], and while it proved to be ultimately unsuccessful, the moral of the story is that states’ rights can be exercised in many forms. We often forget the value of creativity. We do it often in healthcare, a problem that makes up the backbone of this magazine: to reintroduce the significance of creative and innovative thinking into a field that has been rubbed down into a topic that makes politicians uncomfortable on camera. We forget that we can make attempts to implement fresh solutions in small quantities, over small geographic regions. We can start small, because it is infeasible to start big in a country larger than the entire conglomeration that is the European Union. In the way that we can learn from our international neighbors, we can learn from our neighbors within the country as well. A change made in New Jersey can make the same journey that I did this morning, and it can find itself making a home in New York, and it can take a few more trains out to Washington, D.C. and Boston and Cleveland.
I acknowledge that the idea I present is vague, but that is the point. By telling you exactly the solution to a math problem will take away from you trying to solve it yourself. Cabin Fever aims to inspire aspiring healthcare professionals to learn to appreciate the nuances of our global culture. There is beauty in how much we do not know, and how much we have yet to learn from the countries that border us and those on the other side of the world. There is beauty because there is hope, that although we have an enormous line up of problems that we face as citizens of a democracy and a country concerned with the health of its people, there are many places to look for inspiration to craft the right solution.
I often sit on the NJ Transit and think to myself: you are making no progress. An hour just to make it across the river, when an hour in Paris brought you to the world of caramel gaufres. Perhaps it’d be faster if you swam. Perhaps this is an opportunity to rethink how we can implement change. The ticket to success may be to reinvent the way we see ourselves as a country, and start seeing ourselves as a bunch of tiny countries who just want to be good role models for each other. Perhaps New Jersey to New York is just as much progress as Paris to Brussels. There may not be Belgian frites waiting on the other side (that is an arguable statement considering Pommes Frites exists on MacDougal Street), but there may be a better way of life waiting there instead.
Works Cited
- Brabantstraat. (2017, Sep. 20). PBS Frontline: Sick Around the World [Video]. YouTube. https://www.youtube.com/watch?v=h4rg-DJBd34.
- Rosenthal, E. (2013, Jun. 1). The $2.7 Trillion Medical Bill. New York Times. https://www.nytimes.com/2013/06/02/health/colonoscopies-explain-why-us-leads-the-world-in-health-expenditures.html
- Schneider, M. (2021). Rationing. Introduction to Public Health: Sixth Edition (pp. 1104–1107). Jones & Bartlett Learning.
