I'm having to get used to early mornings here on the ranch. It seems everything is done in the hours before 11am and after 1pm. This is pretty understandable considering the heat here in the country. After breakfast I made my way down to the stables for some morning riding, and yes of course I had my boots on. Breaking them in riding a horse in Texas was the right thing to do. I got to the stables and the horses were all lined up. I walked my way along the line and stopped when I came to a horse that looked odd. It took me a moment to realise that the reason it looked odd was because it only had one eye! I just knew that me and this disabled horse would end up being paired together so I stopped and had a quick chat to it, just to let it know that if it just followed the other horses, didn't try to run off or anything like that, I would mind my own business and just get on with enjoying the scenery and my boots. And yes, low and behold who should get the disabled, one-eyed horse? That's right me! I was glad we had had our chat and reminded it about it once I was saddled up.
It was a slow and ambling ride and we snaked around the hills. Believe it or not I was actually quite accomplished as a horseman in my youth and this was really no test whatsoever. There was a moment when my horse thought about bolting. Clearly it had forgotten our deal, so it got a huge yank of the reins. It didn't play up again, but it was too late, one eye or not, I was going to be bossing it around. By the time I got back my boots had been worn in and Iwas ready for lunch!
I was pretty much free in the afternoon so took myself into Bandera to check out the town and the only way I can ask you to picture it is to think of any western film you've seen and you will roughly have the image that I've been looking at. I think Texas is great, as I've said it's my favourite State so far, but it is very difficult to explore anywhere soon after lunch because of the intense heat. It was actually because of this that I made my way back to the river where I had been yesterday. I spent a good hour just lying back, swimming and paddling around in the cool water. I made a concious effort to remember that moment just being free of any pressures or responsibilities. I haven't said yet, but I passed all my exams, which means I will definitely be starting work in October - so I'm sure that at some point in the future I will be calling on that moment in the river to bring the blood pressure down.
This evening's activity was the main reason I had come to the country. That was to enjoy a quintessentially American activity - the rodeo. At about 7pm a made my way down to the rodeo park and a large crowd was gathering. Before things got going I walked about and mingled with the cowboys and the ranch hands, watching them prepare the animals and the riders for the rodeo. Then on 7.30pm sharp the commentator invited the audience to stand and remove hat, "to honour America," with the singing the national anthem. At the anthem struck up over a squeaky PA system, which if you strained hard enough you just about heard, six cowboys rode into the area carrying the Star Spangled Banner and circuited the ring. With spectators and rodeo riders standing with cowboys hats held over their hearts and military veterans saluting the flags, that was just about as American as you could get.
The rodeo started off pretty tough and within a few minutes the bull was out failing and kicking people off its back. Then out came the fifteen year old I had sat with yesterday. I was sat with his Mum and Dad and to say that she was on the edge of her seat would be an understatement. She needn't have worried as within about two seconds he was off and scrabling over the gated fence. Soon after the bulls came the "muton bustin'". Muton Bustin' is small children, aged about four years old, riding quite large sheep around the ring. These children are absolutely fearless. Those who didn't fall off early and were trampled were charged towards the end of the ring and crashed into the barriers. Nearly all though proudly got up triumphantly punched the air and were joined by beaming mothers, I assume beaming gratitude that their sons had survived as well as being courageous enough to get onboard. After quite a considerable time of watching children being smashed into barriers (which is incredibly entertaining I should say!) the barrel racers, lasooers were out and eventually joined by the big bull again. I was pretty pleased with the evening.
So I mentioned before I was sat with the young rodeoer's parents and said yesterday that I spent a lot of time talking to his father, Larry and I did so again this evening. I want to spend a little time just noting our conversations because he gave an interesting perspective into life in America. Larry was a retired member of the Air Force, was from Texas and was also in Bandera on holiday. Talking about politics is not a taboo or sensitive topic of conversation in America and people readily offer their views. Larry had recently required the use of the the American healthcare system and told me that he must pay $400 per month to pay for his family's insurance. He said that that put a great strain on him ad his family. He was interested in understanding the healthcare system in the UK. I offered him the perspectives I had gained from my experiences both at home and in the United States. He had experience of the UK system as well. His eldest son had need a serious operation whilst in the UK and he received his treatment from a NHS specialist in London. What did he think of his care and treatement? It was of an exceptionally high standard. Did he think he would be able to recieve that treatment here in the US? He said almost certainly not; firstly because his insurance was unlikely to cover it and in any event they could not afford it. This point helps demonstrate a profound differenece between those who work in our respective healthcare systems. Here in the United States it is rare for doctors to join their profession with noble alturistic notions of using their skills to help others - here moreoften than not the profession is joined because it pays big bucks. This helps explain the poor bedside manner of so many healthcare professionals here - it is money and the need to maximise margins, not public service which drives them.
From the rocky coast of Maine to the hills of Texas I have had the opportunity to talk to people about healthcare in the United States. No one I have met has advocated the system as it exists (although some are satisfied with the notion that obtaining healthcare rewards hard work I cannot help but find this view unpersuasive and narrow as it neglects to appreciate that it is usually only those with the highest paying and most stable jobs that are in reciept of such a 'reward', and thus it has limited availability). Why then is this system so undesirable? The American healthcare system is a system of prohibitive costs that excludes a significant minority from the necessity of receiving treatment and no one I have met had failed to overlook this. Why are its costs so high? There are a number of reasons that I have observed, which I should mention in passing to help in this process of explanation. Firstly, higher prices are demanded for goods and services (a factor in this is that each party snatches a profit from the patient and the lack of a comparable system of economies of scale as it exists in the UK). Secondly, there are a seemingly endless list of unnecessary diagnostic tests that a patient is put to before they receive their care, which obviously raises premiums. What cannot be escaped from in accountaing for this is the practise of so called 'defensive medicine', where a doctor seeks to limit the extent of their legal liability by ruthless and relentless testing. Thirdly, the system of healthcare here is adminstrative heavy; it has many tiers, exists across a number of jurisdictions and demands high staffing costs. What then are the consequences of this system as it has developed? I have met people who have experienced or who have told me of people they know who have experienced some of the following; simply not purchasing health insurance at all because it cannot be afforded and in the blind hope that they will just not need treatment, some have sold their homes to pay for treatement, some have needed to declare bankruptcy because they cannot meet their medical bills and others decide to get by with their illnesses. You may be wondering whether there are exceptional characteristics of this system that counterweight these features? Unfortunately there is no evidence to show that there are improved medical outcomes or a higher quality of care.
I asked Larry what he thought of a system in which individuals paid a contribution, those on higher incomes more, which could be accessed by people as needed on the basis of their need and which was administered by an organisation with the task of lowering costs. He said he would be in favour of such a system. What if the organisation was the government? He said although perhaps he would not advocate it, he would not oppose it. This answer from a conservative Texas Republican helps demonstrate the pragmatic reality with which most Americans, who will seriously consider fundamental reform not just talk about it, are prepared to bring to the issue of healthcare. They know the system as it exists has failed - that it must be changed - but they cannot agree on or summon a solution. That I suppose is the responsibility of their leaders. Larry echoed what I have said here previously, that this system is socially and economically unsustainable. I now cannot help but conclude that this burden that the United States has imposed on itself, left unsolved, will be a factor upon which its decline as a world power will hinge.
Ok - so on a lighter note! My cousin recommended that I travel to Glacier National Park in Montana, on the Canadian border. I hadn't considered it at all, but I've been having such an enjoyable time exploring the country by car and seeing America's natural beauty, that I've decided I will head north from Colorado for a three week roadtrip to Glacier, via Grand Teton and Yellowstone National Parks. Once I have reached Glacier I will have driven the entire length of the continental United States - from the Gulf of Mexico to the Canadian border, quite an accomplishment I hope you will agree. First though I must complete my time in Texas.