Transcriber: Ariana Bleau Lugo Reviewer: Ruxandra Taleanu
Today I'd like to talk to you about
the woman in the picture behind me.
Her name is Hosepha.
And she was born in Cuba
several years before the communist revolution.
The late 1970's,
she would then decide to leave
everything she knew behind,
determined to give her family a chance
at a better life in the US.
She also happens to be my grandmother
and one of the most important figures
in my life as I was growing up.
Some of my happiest childhood memories
were simply getting to come home,
every day from school, to be given
a huge big hug from my grandmother.
But that hug would one day turn my life upside down.
You see, as my head brushed up against a side of hers,
I felt a big lump.
When I asked her what it was
she said it was nothing,
but I would later go on to overhear my family
talking about a tumor and cancer.
I can't begin to describe to you
what I felt in that moment.
My grandmother was my whole world
and as I stood in that doorway listening
I was paralyzed with fear.
I begged and pleaded with my grandmother
that she'd go to the doctor,
but the harsh reality was that
my family simply couldn't afford it.
And in my young mind
the concept of my grandmother's life
hanging in the balance over a question of money
didn't make any sense to me.
It was perhaps the first time in my life
I had ever felt powerless.
Powerless over my circumstances,
powerless at my inability to do anything
for someone that meant so much.
And I remember desperately wanting a way out.
Sometime later, that way out would come
thanks to the chanced generosity of a family friend,
to whom I'll forever be thankful
for what he did for my grandmother.
But, are we comfortable with that?
With the notion that a person's life
potentially hinges on the means they have?
That wealth so directly determines
something as basic and fundamental as health?
At the time, I never questioned that reality.
As a kid, I simply internalized my experience
and became intensely focused on the only thing
I felt I had any control over, my education.
It wasn't until many years later,
upon arriving at Stanford,
and taking a health policy course
that I would come to feel empowered
to revisit and question that reality.
For ten weeks I sat in class horrified
and fascinated by what I learned.
Horrified by the scale upon which
I saw my own family's health struggles
writ large across our nation.
But fascinated by the potential of policy
to have such far reaching positive effects
on the lives of so many people.
I began to wonder if the current state
of health care was truly inevitable,
or if a different reality was possible.
And my search for an answer to this question
would lead me to work
over the last four years in five countries,
spanning Europe, Asia and Africa.
And today I'd like to take you on that journey
to three of those places.
First on my list was France,
which I had learned had been ranked as having
the best health care system in the world,
by the World Health Organization in 2000.
And what struck me the most,
working in a Parisian hospital, was not
only how accessible health care was for everyone,
but how universally agreed upon it was
among the French that it should be.
This is something that I would later go on to know
about the Japanese health care system,
while I was living and working in Japan for one year.
Here was a country with some
of the world's best health outcomes,
longest life expectancy,
one of the lowest rates of infant mortality,
had managed to achieve universal coverage
at a time when Japan was still rebuilding itself,
after World War II.
And yet manages to spend half of what
the Unites States spends on health per capita.
As I reflect on these experiences with you,
I don't mean to oversimplify the issue
or lead you to believe that I think that
what has worked in one country is
directly adaptable or transferable to another.
The more countries and systems
I've had the opportunity to study
the more I've come to appreciate just how
truly complex the issue of health care is.
But I've also come to believe that
what's possible in terms of health care access
is largely dependent on what societies choose to value
and make possible for their populations.
The best example I can think of this is Rwanda,
where I recently worked with
the Clinton Health Access Initiative.
A country ravaged by genocide
less than 20 years ago.
10% of its population murdered,
with more than half of its population
still living in poverty.
The house I lived in didn't have running water
or direct access to paved roads.
I was fortunate to have electricity,
the only house in the district to have it.
And yet, even in the absence of
so many resources and basic necessities,
they felt it was so indispensable
that everyone should have a basic
minimum level of health care
that they chose to make it possible.
Now I'm not saying that I think that
Rwanda's health care system is perfect.
Much work still remains to be done.
But considering that they have
an annual health budget of $56 per person
I'd say they are doing pretty well.
And the world is taking notice.
Something that seemed so impossible
just a few years ago,
the notion that developing nations
could achieve universal coverage,
is now not only increasingly being regarded as feasible,
but as the next step in continuing
to make sustainable global health progress.
That perhaps has been the biggest
take home lesson for me.
Where there's a will there's a way!
In the US, this doesn't seem to be a question of resources.
According to the World Health Organization's
2010 World Health Report,
the United States spends over
2 trillion dollars a year on health care,
out of a global 5.3 trillion.
That's approximately 40% of all the money
that is spent all over the world on health.
In one country, in our country.
And yet somehow, 50 million Americans
slip through the cracks, remaining uninsured.
In the words of one of my Rwandan colleague, he said,
"Rayden, if your country can't do it, then who can?"
And when I think about this issue from that perspective,
the question I find myself asking is not
whether we can afford to insure a basic
minimum level of health care for everyone,
but whether we choose to make that possible.
Last year, a man in North Carolina robbed a bank,
demanding one dollar, hoping
to be sent to prison
so that he could receive medical attention
for a growth in his chest
he couldn't afford to treat on his own.
How desperate does a human being need to be,
need to feel,
to be willing to trade his freedom
for his health?
I came to share my story with you today
because despite how divisive the issue
of health care in our country has become,
I believe that we profoundly want
and can aspire to more than the status quo,
that a world where poverty of wealth
does not necessitate the poverty of health is possible.
A world where people like my grandmother
do not need to forgo potentially life saving treatment
because of a lack of resources.
But this doesn't become possible
because a few policy makers, doctors,
health economists, advocates get together
to engineer a perfect solution.
Truly sustainable changes, I believe,
are first dependent on what we all,
as a society, choose to value
and believe to be possible.
What do we value?
What do we choose?
Thank you.
(Applause)