Archive for November, 2014

Student Spotlight: Jacqueline Wilson

Posted on November 24, 2014 in Students

Wilson, Jacqueline 14-15 (2)Here at the Nanovic Institute, we’ve just started going through the materials sent to us by our fall break grant recipients. What exciting and educational trips they have taken! One of those fall break grant recipients is Jacqueline Wilson. Inspired by current healthcare debates in the US, she traveled to Switzerland to research their consumer-driven healthcare system. When she returned, she sent us a report of her experience:

As healthcare reform continues to be a topic of debate in the United States, we should look to the successful healthcare systems throughout the world for options, alternatives, and answers to our healthcare challenges. One such system is the Swiss consumer-driven healthcare system, which consistently achieves universal coverage, widespread access, lower costs, and excellent quality.Over fall break, I completed research and met with residents throughout Switzerland, with the objective of studying Swiss healthcare and the roles that transparency, culture, and inequality play within this system. Through my interesting research and eventful travels, I learned a great deal about Swiss healthcare and culture. This journey shaped the way I see healthcare, its future in the United States, and the role I hope to one day play in it.

After studying US healthcare policy in Washington DC, I was intrigued by the “consumer-driven” and “market-based” policies that some politicians advocated for (or wanted more of) within the Affordable Care Act. In order to examine a more consumer-driven and market oriented system, I looked to Switzerland. Harvard Business School professor and healthcare expert, Regina Herzlinger, defines consumer-driven healthcare as a system that “combines free demand and supply, transparency, and active government over-sight”. Although the Swiss system is not perfectly consumer driven, as it does place constraints on demand and supply, it is a great example of what market influences can do to control costs, increase efficiency, and improve quality.

By examining the Swiss Federal Law on Healthcare Insurance (LaMal for short), I was able learn a great deal about the Swiss healthcare and insurance systems. In Switzerland, all residents are required to have health insurance. Unlike the US healthcare system, all individuals buy their own insurance from a private insurer, rather than their employer or the government (Medicare, Medicaid) providing the insurance. Insurers must have policies that meet a required set of minimum benefits, and they cannot deny participants for age or pre-existing conditions. If basic plan insurance premiums exceed 8% of personal income, the Swiss government will provide a subsidy. Plans vary by the price of the premium, deductible, and copayment. Besides the basic, compulsory insurance that all residents must buy, they also have the option to buy supplementary insurance that covers more services. This system has led to some of the best healthcare outcomes in the world. They achieve this while keeping healthcare costs much lower than those in the US, 11.0% GDP compared to 17.7% GDP (2011). Overall, Swiss healthcare is characterized by using the private market, encouraging individual responsibility, supporting those in need, and obtaining excellent outcomes.

In order to truly understand the benefits and drawbacks of this system, I had to directly speak to consumers, especially with regards to the roles of transparency, culture, and inequality. As an IT management major, I was especially interested in the online resources consumers have to compare prices, insurers, and providers. After speaking with residents, I learned that there are excellent websites for consumers to compare insurance options (http://en.comparis.ch/, http://www.priminfo.ch/praemien/index.php?sprache=d). However, similar to the US, there are few resources for them to decide what provider (doctor, hospital etc.) has the best outcomes and prices. In order for the Swiss system to be truly consumer-driven, it needs to improve transparency measures and resources for both insurers and providers.

Culture is a very important component to healthcare, so traveling throughout Switzerland and meeting with residents was essential to understanding the different influences within the Swiss system. The consumer-driven healthcare system reflects the independent yet supportive nature of Swiss culture. While speaking with a resident on the plane, she described that Swiss culture places a great deal of emphasis on individual responsibility but still recognizes the importance of social securities and safety nets. This reflects the mandate that residents must buy their own insurance but can also receive subsidies and assistance from the government.

Because health inequality is such an important topic in the United States, I had hoped that Switzerland could provide some insights into dealing with this important social justice topic. As long as healthcare systems allow participants to buy supplementary insurance beyond the minimum, there will be inequalities between those that can afford beyond the compulsory plan and those that cannot. However, because Switzerland has an expansive minimum benefits package, a low rate of poverty, and a good subsidy system, they have not had as many problems with healthcare inequality as the United States. This is also due to excellent quality of public services in Switzerland, in which variables that affect health such as education, housing, and food are much more robust, equal, and efficient.  

Through my travels in Switzerland, I also hoped to analyze the applicability of the Swiss healthcare system in the United States. With the new reforms in the US, Americans without insurance can now buy insurance on exchanges that are very similar to the Swiss healthcare experience. But could this system be applied across all US residents? Because of our similar focus on individualism and individual responsibility, it is culturally feasible. However, many people would not support the inconvenience of losing their current Medicaid, Medicare, or employer based insurance in exchange for a plan they select themselves. Due to our large size and polarized views, I hypothesize that the US will continue to have a “glued-together” system that represents many different types of healthcare systems from across the globe.

My experience in Switzerland was absolutely incredible. I thoroughly enjoyed my time there and met with many great people, from Notre Dame Alumni to Swiss citizens. This trip further solidified my passion for healthcare, specifically when it comes to policy and the implementation of policy. I am thrilled to be able to share these new insights with other Notre Dame students whom I will be leading on the healthcare policy seminar in Washington D.C. next spring. I will forever be grateful for the Nanovic Institute’s generosity and support. 

Gen X and 1989 in Poland

Posted on November 20, 2014 in Events, Partners, Social and Political Geographies

On Tuesday, November 11, 2014, Alicja Kusiak-Brownstein (Visiting Faculty) joined A. James McAdams (Director, Nanovic Institute), David Cortright (Kroc Institute), and Sebastian Rosato (Political Science) for a panel discussion commemorating the fall of the Berlin Wall. Her reflections are reprinted here below.

After being invited to the panel “The Berlin Wall 25 Years On: Its Meaning, Then and Now,” I asked my friends in Poland, who in 1989 were in their late teens and early twenties: how do you remember the fall of the wall?

Though from a far distance, their memories resonate with Prof. A. James McAdams’ observation that the Berlin Wall did not fall so much as it opened. They also embody the point made by Prof. David Cortright that civil society had the leading role in the transformations of the late 1980s. Moreover, those memories, though indirectly, reveal one important quality of the political changes epitomized by the fall of the Berlin Wall: its peacefulness. That quality is too often played down. The fall of the Berlin Wall was certainly a spectacular media event seen around the world. Yet the fall of the wall was just one of a series of events that helped to bring down communism in Eastern Europe over a three-year period. This peaceful dismantling of the communist regimes spared us the trauma caused by military violence, one that could have lasted for generations.

One of my immediate observations, however, was how much the place where one stands defines the point of view, or in other words, how different the fall of the Berlin Wall is remembered by the Poles who at the time lived in the West, and those of us who lived in the East. The West was astounded at the collapse of the wall. Justyna, in 1989 an undergraduate student at University of California in San Diego, said she was astonished to see the reports about the Berlin Wall in the newspapers. “I was very surprised that it is happening now… simply, one beautiful day communism collapsed, and that’s that.” Hania, who worked in a photography studio in Suresne, in the western suburbs of Paris, said she was petrified when she first heard the news. While the French radio constantly played the reports from Berlin, her little shop turned into a discussion club, where clients and employees had heated debates about what that event would bring to Germany, Europe, and the world.

The memories from the Polish side show less surprise. Andrzej’s first thoughts were clear and patriotic: “Damn it! It’s gonna be a great symbol of the fall of the communism. Germans took over us, the Poles, again!” Indeed, in 1989 Poland was in the avant-garde of the political changes in Eastern Block. Following the wave of strikes in 1988, communism had been dismantling peacefully, in conference rooms, through open and the closed-door negotiations. In the spring 1989, the Round Table Talks between the communist government, the anti-communist opposition, and with observers from the Catholic and the Lutheran churches, agreed to carry out the first semi-free election. Held in June 1989, the election brought the overwhelming victory of the Solidarity movement. By November 9, when the demolition of the Berlin Wall began, Poland already had its new government, containing the members of the opposition and the communist political establishment, with Tadeusz Mazowiecki, one of the Solidarity leaders, as Prime Minister.

Some young people took the great political changes as a flow of life. When the news reached Małgosia in her hometown, Białystok, she was preparing for finals in high school: “I was buried with books, notebooks, tired, sleepy, beleaguered by my Polish language teacher. Then, my mother entered the room and said: ‘Małgosia, did you hear that? The Berlin Wall just fell.’ I answered: It’s about time, isn’t it? I had a feeling that this fall of the wall is like… after dinner, mustard.” Doszka, then a student at Jagiellonian University in Kraków, remembers a visit of West German Chancellor Helmut Kohl: “While his bus was passing by Planty Park, he waved to ‘the natives’. And then… he suddenly left.” The fall of the Berlin Wall prompted Chancellor Kohl to interrupt his visit in Poland for one day, November 10, yet in the following day he resumed it.

Other youngsters felt euphoria mixed with anxiety. Nearly all of us remember that “Another Brick in the Wall” by Pink Floyd was being played everywhere. Ola recalls: “I thought: It’s wonderful! The world is changing in front of me. Everything is possible!” In 1990 she traveled with friends from Warsaw to Berlin to the concert “The Wall – Live in Berlin” by Roger Waters and guests, a performance of Pink Floyd’s legendary album. They traveled with no restrictions. Kasia remarked: “I was aware that the world around me was changing, but I was also worrying whether its was happening for real, or whether somebody will soon call it off and everything will be as it always was.” Iza, who when I asked, just happened to be going through archives of photographs and short films from 1989 in Poznań, said: “I am struck by one thing in these images – the faces of ordinary people. Happy faces. So uncommon now.”

For most of us, the Fall of the Berlin Wall was just another, though spectacular, TV event in the time that Padraic Kenney has called “the Carnival of the Revolution.” The Velvet Revolution in Czechoslovakia in November-December 1989 was awakening memories of the Warsaw Pact’s invasion during the Prague Spring of 1968. Many of us recall the anxiety around the events in the Baltic States. In August 1989 approximately two million people formed a human chain for a distance of nearly 420 miles, across the territories of Lithuanian, Latvian, and Estonian Soviet Republics. That peaceful demonstration, known as the Baltic Way, followed the Estonian declaration of sovereignty in 1988. The outcome of the events in the Baltic States was the ultimate test of whether the change was for real, or whether the Soviet Union was going to wake us up with kalashnikovs. It did not. The subsequent “parade of sovereignties,” when all other Soviet republics declared their independence, led to a peaceful dissolution of the Soviet Union.

Yet, many of us remember also the bloody collapse of the regime of Nicolae Ceaușescu in Romania, instigated by protests in Timișoara, in December 1989. The images from the execution of the Ceaușescus came as a reminder that there are other ways in which political systems collapse. In the following year the wars in Yugoslavia began, getting news big coverage in Eastern Europe. For eight years, daily footages were pushing in front of our eyes images of the horrors of the civil war: mass murders, mass rapes, ethnic cleansing, waves of refugees, and the destruction of the cultural heritage. When the Berlin Wall was falling and millions of people peacefully called for political change all over Eastern Europe, few of us imagined that soon we would see reports of genocide.

1989 was the year of high spirits. The level of activism among young people was very high. It seemed like we were all involved in something—amateur theater, amateur press, music, politics, religious and self-education groups, free travel without money, fraternization, “the first joint and getting high!” University students, who were still very much radicalized, called for impromptu gatherings, and did not miss any opportunity to protest on the streets, challenging the infamous armed troops of the militia—until then a symbol of the brutality of the communist regime. The armed militia for its part actively tried to avoid clashes with students. In Polish cities “the walls” were falling on every street.

The Berlin Wall outlasted its fall, transformed into gravel, and went on a world tour. In the autumn of 1990, Hania travelled from France to Poland, through Berlin. She went to the wall, chipped off, as she said, “one of the last remnants from the Berlin Wall,” and brought it to Poznań. She said she could not do otherwise: “I remember when my father and I travelled to East Berlin to buy the photography accessories. My father had a little photo-studio in Zbąszyń. Before crossing the border with Poland, we were parking our Syrena [a car] in the woods, disabling the engine of the car, and hiding the photography paper, films, etc., as it was illegal to carry them across the border. While in Berlin, my father was always taking me by the Berlin Wall, saying: ‘Remember my child, behind this wall is freedom.’ Soon after, her piece of the wall reached my hands.

In the spring of 1990 university history students in Poznań began occupying, and eventually took over, the big and hideous residence of the communist party, located in the city center. They did it to chase communists away, and to solve the permanent housing problems of their own department, squeezed in one building with all possible modern languages and literatures. This was the building where I began my history studies.

In 1991 the spirit at the university was still anarchic. After a class on the theory of history, instead of going home, we stayed and talked with our lecturer, and with whoever wished to enter our seminar room. We were smoking like chimneys, drinking beer and strong tea, and discussing our present and our future—that is history in the making. Once, a young artist entered the room, listened for a while, then grabbed something from his pocket and said: “Would you like to hold a piece of the Berlin Wall… for a while?” That piece of wall, Hania’s piece, with smudges of paint, circulated from hand to hand. We did not treat it as a relic. We knew that we could do with it anything we wanted, including throwing it through the window. And that was the Berlin Wall. Now dispersed, circulating in a million fragments throughout the world. The feeling of great opportunities and the open world was overwhelming and palpable. Yet, as history taught us, it did not last long.

Let me put that one piece of the Wall in context: children grow up fast in a time of political or social turmoil. While holding that piece of the wall, I was thinking about the moment Martial Law was declared in Poland, in 1981. It was the response of the communist regime to the Solidarity movement. The night before the declaration of Martial Law, my mother and I stood by the window in a dark room of our apartment house, by the road which connected Poznań—the biggest city in western Poland—with the largest Polish and Soviet military bases. Though all the windows in the apartments around us were dark, we knew that all the residents are up, and were doing the same as we did: counting the tanks and military vehicles passing under our windows. I remember after my mother reached one hundred, she burst in tears. Yet, more important than the number of the tanks, was whether they had the red star on them. If they did, it meant that Poland had been invaded. If not, there was still a chance that we could avoid a civil war by negotiations. So, holding a piece of the Berlin Wall eight years after that traumatic event, which I still can vividly see, it seemed somehow surreal.

That evening, this piece of the wall opened up the memory bag for others as well. My experience appeared to be modest compared with that of my older companions. Gwidon, our teacher, as an undergraduate got involved in printing and distributing dissident flyers. Dragged by the militia from the dorm, he remained in prison for half a year. He was beaten during interrogation, though as he always admitted, “not severely,” and eventually released for lack of evidence. Other friends shared their anecdotes about confrontations with the armed militia, mostly recounting physical and moral wounds, bruises, and proudly explaining how they avoided being raped. The tone was not heroic, but picaresque. After all – we were young. And what stands out most from the memories evoked by the fall of the Berlin Wall was the euphoria of freedom and of youth. From the perspective of personal and collective memory, the grand politics appear as nothing more than a colorful background to those things that my friends and I identify as the most important for us, then: love, friendship, activism, exploring the world, and ourselves in the world.

Why do I think this series of memory postcards is important to remember? Because, no matter how historians, politicians, or social scientists evaluate the Revolution of 1989, its most important characteristic was that, for the most part, it was peaceful. It came as a result of negotiation. Had it been otherwise, the memories I just recalled would be very different. There is great value in a peaceful resolution of political conflicts. In the case of East Europeans in 1989, it saved our youth and many lives. Thanks to the peaceful, though noisy, fall of the Berlin Wall, we do not remember it as clearly, as we remember our own most colorful and noisy years.

I would like to thank Justyna Beinek, Małgorzata Fidelis, Andrzej Kałwa, Dobrochna Kałwa, Marzena Lizurej, Izabella Main, Anna Muller, Aleksandra Sekuła, Izabela Skórzyńska, Katarzyna Stańczak-Wiślicz, Błażej Warkocki, Hanna Zaworonko-Olejniczak, for sharing with me their memories.