Wednesday, November 10, 2010

Are Europeans Better Equipped to Face the Next Decade?


It was breakfast time in Munich, Germany and I found myself again in a Marriott Hotel, debating whether or not to spend the 30 Euros for the breakfast buffet or not.  But I do have to say, the European breakfast buffets (which, ironically, are only served in Europe at American chain hotels) are usually great.  They are the equivalent to Sunday brunch in the USA, only with breads and pastries which are truly worth blowing your diet on--and omelets to make you cry.  Well, not exactly cry, but they do make me a bit misty.  The mushrooms, the cheese, the freshly snipped chives....I digress.

On this particular day the breakfast room in the Marriott Hotel was full.  Not every seat was taken, but certainly almost every table was occupied.  After some weaving around the dining room with suitcase in tow, I finally found a spot (my VERY OWN spot) behind a square column in the center of the room.  Happy to have found a place, I put my things down and proceeded to get, you guessed it, an omelet.  After getting that and a few other tasty things, I ordered my coffee and sat down.  Not two seconds later a man, presumably in his 50s, came up to me and asked me, in German, if the seat across from me was free.

Several versions of "NO" crossed my mind at once.  I wanted to say NO, that seat is taken!  But my poor German and even slower reflexes produced a "Ja" and the next thing I knew he planted himself in front of me with a smile.

It wasn't an overture.  It wasn't about getting to know me.  He wore a gold wedding ring which was no longer shiny, covered in soft wear from at least 25 years.  He ate quietly, making the occasional small talk about how much food there was, or how he was going to get maybe just one more thing off the buffet, or how he always eats too much for breakfast when he is here.  And I finally got it.

This guy--someone's son, presumably someone's father, and someone's beloved husband--had probably eaten breakfast in someone's company his whole life.  He didn't want to eat his omelet alone.

Contrast that to my immediate reaction upon seeing the full dining room--I actually bristled at the thought of having to share my private space with a stranger, and I know that if you're American, you would have felt the same way.

Which leads me to my point--Europeans share.  They have grown up sharing.  Attached homes are more the norm than the exception.  In fact, a single family detached home is incredibly unusual--or is way out in the country and usually associated with a farm!  Attached homes are energy efficient, relatively less expensive to purchase and not at all associated with the stigma that seems to be irrevocably attached, excuse the pun, to the ones in the USA.

Living in closer quarters forces you to be a better neighbor.  Anything you do can affect your neighbor--hammering a nail into the wall to hang a picture at 11 pm is probably not a good idea, mowing your lawn at 7 am on a Saturday is likewise, not such a thoughtful thing to do.  You begin to think in terms of those around you a LOT more, and I must admit, your mindset begins to change.  And  you suddenly realize that the very people you watch out for are actually watching out for you.  These are people who volunteer to help you.  For the first time in my life, I'm finally getting the whole concept--no, living the concept--of community.

Instead of seeing it as a hassle and invasion of my rights and my privacy, I look at my actions and behaviors as an investment into my future security and happiness.  Those who I help also help me.  And I don't lose by sharing a wall with the neighbor--I win.  We all win.

Contrast that with the American dream--to have your own house, your own land, to answer to no one and to be responsible for only yourself.  To only think of yourself, and not your neighbor--because, after all, it's every man for himself, right?  I work hard, I earn money, I take care of my family, I don't take "handouts" and I don't give 'em.  To a certain extent I can definitely see the nobility in that mindset.  It's based on responsibility and a strong work ethic.  But it's also based on being born into fortunate circumstances, building up your own network as a safety net, and then being graced with the kind of life where nothing catastrophic happens.  It works out for many people, but for some it does not.  But let's take that concept a bit further--if I have the money, then I can have it, right?

This is where the subtle differences between Americans and Europeans begin to become black and white.

Let's take as an example:  the trash.  I could probably write an entire column just on Swiss trash handling, but suffice to say--if you wanna play, you gotta pay.  You make trash, you pay to have it carted away.  You pay a LOT.  If, however, you choose to recycle and carefully separate your trash, you pay a lot LESS.  There is no such thing as weekly collection where you stuff as much as you can into your two 100 gallon trash cans, and leave the overflow on the side.  Oh no.  It's the equivalent to $5 a very small bag.  It's expensive to produce trash in Switzerland, and therefore, I look for every possible way NOT to produce trash.  No such thing as volume discounts here.  On anything.

It's one of the ways that residents of this country are treated equally, irrespective of bank account size (not that you can really tell who has what, but I'll save the conspicuous consumption theme for another post).  We are all ultimately responsible for the resources we use and the trash we create--because what we do individually affects the whole.  And we are made very aware of that through a tidy set of rules.

Recycling in the US is largely optional.  I know people who refuse to recycle because they simply don't feel any remorse whatsoever in creating landfill. They live for today and for themselves.  Who cares about tomorrow--they probably won't be around when it matters.

But times are changing.  Americans simply cannot continue to live as we have in the past.  There are those who would like to block progress, calling it Socialism or whatever other scary name comes to mind.  The mere thought of having rules of how to do something or when to do something goes against the founding principles of the constitution--or so we claim.  Privacy and independence and "freedom", at whatever price are values which are fervently defended--as we watch our country go down the drain. 

Interestingly, Switzerland (a country where zero privacy and HUGE rules abound) has twice as many millionaires per capita as the United States.  Does a rules-based, lower privacy state inhibit one from being successful and independent?  Does the presence of a system which ensures care of its citizens prevent those very citizens from being independent and possibly wealthy?  In my experience a so-called "Social Democracy" has the opposite effect.  I have not seen someone sitting on the sidewalk begging in nearly 6 years (since I've arrived).  I don't hear horror stories of health care gone wrong.  I don't see gross inequities in medical care.  I don't see physicians operating in an environment where not getting sued is their primary goal.

I think it all starts with our willingness to share breakfast with a stranger, to open up our minds to the possibility that resources are  not infinite, and just because we might have the means doesn't mean we have the right.  And to feel happy about sharing space.

Saturday, January 30, 2010

To cut healthcare costs, give U.S. pharmacists more authority

I'm not a pharmacist.

I love reading package inserts (those little white, fine print leaflets which come in the box of your medicine) but that's part of my day job.  I'm supposed to get excited by that kind of stuff.

But because of the business I'm in, I do have pharmacist friends.  And they're smart.  Really smart.  Not just the kind of smart which let's them win Trivial Pursuit (which they usually do anyway).  But the kind of smart which makes you kind of step back with a bit of awe and a whole lot of respect.  These people need to know stuff. 

And they do.  They understand anatomy and physiology.  They have magnificent minds for detail.  They understand the complex enzymatic systems which help us to metabolize and clear all the junk out of our body.  They have to understand diseases and conditions.  They cannot afford to just specialize in one area.

So the million dollar question is this:  Why don't they have more authority?

For those of you living in the United States, you know what I mean.  Pharmacists seem to be overworked pill counters...and they may get called upon to answer the occasional question about which over-the-counter decongestant is best for your kid.  But that's it.  Honestly I don't believe I've ever benefited from the full scope of knowledge these folks bring to the table.  Here's how it always worked for me:  I went to the doctor, the doctor prescribed my medicine, I handed the white prescription paper to the pharmacy clerk, and 2 hours later (if I was very lucky) I could go pick it up.

Living in Switzerland, here's how my routine has changed.  First, many times, I don't even need to start with the doctor.  Today, after a really long cough, sputter, choke, cry, cough cough cough night with my daughter, I simply went directly to the pharmacy this morning.  I walked right up to the counter (no lines) and described my daughter's symptoms, her age, and her weight.  She asked me a couple of clarifying questions (does she have fever, and how long did she have the cough?) and then promptly produced two cough syrups.  These were not your run of the mill do-nothing cough syrups.  They were both highly effective brews (one for day and one for night) that have put an immediate halt to the hacking.

What was saved:  time and money.  I didn't  have to make an appointment with the pediatrician, possibly having to wait until Monday to be seen, I didn't have to stand in a line, and my kid got what she needed immediately.  I didn't pay for an office visit, I didn't jam up an already jammed up winter waiting room--filled with, no doubt, more coughers and hackers.  I payed about $35 for two extremely effective products.  That was it.

Pharmacists in Europe are given quite a bit more authority than their brethren in the United States, which creates a winning situation for everyone.  My health care insurance just avoided having to pay for a needless office visit, and I got what I needed stat.  I even think my insurer may even reimburse me for this--I'll have to find out. 

No matter, because as I peck away at the keyboard, I hear the sweet sound of silence in the background.  She's sleeping like a baby once again. 

Best $35 I've spent in a long time.