Status Quo in Healthcare

Status Quo in Healthcare

How can we really make change to the United States healthcare system? Dave Chase, in his book The Opioid Crisis Wake-Up Call argues that changes to the system need to come from private businesses, because private businesses are responsible for the health insurance coverage for over 50% of American’s. If business don’t take action and demand changes, Chase argues, then the system will not have enough strength to push against the status quo of rising costs and stagnant productivity within healthcare.

 

A quote from Chase about changing the American healthcare system reveals something larger about public opinion and the status quo in American public policy in general. Chase writes, “This book focuses on non-legislative strategies since the politics of health care are fraught with pitfalls. As we know, the best way to perpetuate the status quo is to politicize a topic – and nothing is easier to politicize than health care.”

 

I think Chase is correct about politicization and the status quo in the United States. Our country has deeply internalized ideas of liberal and conservative and wedded those ideas to the Democratic and Republican parties. This means that if an idea is taken up by a party, if it is politicized and adopted by a party, then it instantly becomes an identity marker, and people who might not have had a strong reason to care about an issue, suddenly find it to be a maker of who they are and what groups they belong to. Politicizing an issue in this system virtually guarantees gridlock, preventing any legislative action on the issue.

 

Private businesses, however, can make changes without relying on a 50% majority vote (or 2/3rds majority vote in congress). Throughout the book Chase presents economic and moral arguments for businesses to take the nation’s opioid crisis seriously, and uses it as a wake-up call to show businesses how our healthcare system is failing individuals, and ultimately failing the companies that hire those individuals and provide for much of the healthcare that individuals receive (or fail to receive). Public action is hard, so in many arenas, private action is the best chance for making the changes we want to see in the world.

More on Temporal Landmarks

According to Daniel Pink in his book When, temporal landmarks can come in two varieties, social and personal. Social temporal landmarks are the dates that everyone shares in common while personal landmarks are the significant dates in our own lives such as birthdays, anniversaries, and dates of significant life events. Studies presented in Pink’s book show that both types of landmarks can serve as helpful anchors for jumping off points. Students are more likely to go to the gym on a Monday, at the start of a semester, or on the day after their birthday than on other random days.

 

Pink describes the anchoring effect this way, “This new period offers a chance to start again by relegating our old selves to the past. It disconnects us from that past self’s mistakes and imperfections, and leaves us confident about our new, superior selves. Fortified by that confidence, we behave better than we have in the past and strive with enhanced fervor to achieve our aspirations.”

 

In the physical world, we can make changes that literally do shut a door on one aspect of our lives. We can move to a new city, we can sell all of our TVs and gaming consoles, we chop down a tree and pave over the place where it used to be. These changes can have physical manifestations that designate something new, something different, and prevent us from continuing on as we always have. Temporal landmarks are not physical and permanent in the same way, but can still serve a similar function for us. They break apart a continuous stream of time and allow us to make distinctions between ourselves now and who we have been in the past.

 

Pink also argues that part of the strength of temporal landmarks is in the way they allow us to reflect and think about who we are, what we have historically been or done, and what our aspirations are for our futures. He writes, “Temporal landmarks slow our thinking, allowing us to deliberate at a higher level and make better decisions.”

 

My example of making a physical world change to change our behaviors is an example of taking a deliberate step to help us make better decisions. Temporal changes don’t necessarily create a physical barrier which changes our behavior, but they do give us a mental stopping point at which we can pause and consider how and why we do something. Rather than continuing on auto-pilot these landmarks make us pause and consider whether we are going in the right direction, whether we are regressing back toward a place we don’t want to be, or whether we can change course and achieve what we want. In many ways, without actually being a physical barrier, these temporal landmarks operate in the same way. Simply because they are not tangible doesn’t make them any more real in the ways we think about our lives, the changes we experience throughout life, and how we make decisions.

Making Global Local

The first time I heard about globalism was in an English class as a freshman in college. Since that time, globalization has gotten a lot more attention and has come to represent people’s fears about automation and job loss, but also people’s ambitions as new markets across the world become more accessible to trade and innovation. Whether we like globalization or not, we must acknowledge the way that markets and societies are changing so that in our own minds globalization doesn’t remain the mysterious boogeyman that it so often is today.

 

In The New Localism, Bruce Katz and Jeremy Nowak discuss globalization and how our cities and metropolitan regions, as opposed to our states or federal institutions, are the most well poised to adapt to an increasingly globalized market and supply chain. The also ask what it means for civil institutions to adapt and change to globalization writing, “The connection between globalization and localism as an arena of enhanced civic action has not been as well explored as the general theme of global economic change and populism.”

 

Since 2016, we have been asking ourselves why a global wave of populism seems to have overtaken normal political processes in the US and UK. Why authoritarian leaders have seemingly become so well entrenched in Turkey and Russia, and why so many people across the globe are willing to protest traditional and seemingly rational governments. What we have not looked at as closely, is how local level leaders can make a huge difference on a global scale and how cities and metropolitan areas can shape policy that influences people’s lives at a greater scale than what we see with movements by populists and authoritarians.

 

Individual states in the US are reversing marijuana policy against the will of the Federal Government. Individual cities are designing their own immigration policy contrary to the demands of the Federal Government. And industries clustered in metropolitan areas are not waiting for new laws and regulations to make decisions that will impact people living within the US and across the globe. The scale of action is local, and that means that cities are the ones who set the agenda for globalization, rather than the larger state governments or federal institutions. How this will ultimately change those larger civil institutions is still a mystery, but in my opinion, local action can dismantle the energy and grievances of populists and authoritarians. Local action can drive economic performance and growth, pacifying the unrest we see at national levels. Globalization might be a phenomenon that connects networks and places all over the Earth, but its effects are felt locally, and good local management and innovation can help make globalization a positive and constructive force.

The Disruptiveness of Political Amateurs

Our society is all about disruption. I am writing this from Reno, Nevada, a city heavily influenced by San Francisco and Silicon Valley tech culture. Today number of Silicon Valley firms are spilling into Northern Nevada to take advantage of our great weather, beautiful outdoors, and minimal traffic. Along with theses firms comes the mindset of disruption. New technology and companies upending the way we drive, the way we access healthcare, and the way we communicate. Even our current president, and the Democrats main primary challenger in 2016, was cry for disruption, and opportunity to shake up politics and bring about a new way of doing business from the Oval Office.

 

Brookings Senior Fellow Jonathan Rauch is skeptical of this disruption, at least in the world of politics, and looks at why government exists and how good governance can be promoted in his book Political Realism. What Rauch finds is that the spirit of disruption in politics is actually nothing new. We have always had candidates who focused on a single issue that they wanted to change. We have always had activists who fought for a particular idea of what was good, often excluding concerns of other issues and areas. And ultimately, we have always had a political establishment to rail against and charge with fraud, corruption, lack of interest, and complain about as a out of touch with the will of the people.

 

What Rauch describes in his book however, is that politics is a long-term game. It extends beyond the current moment and exists in the future and in the past. Our decisions are shaped by what is politically possible and we use compromises as a tool to help us make decisions now that can be adjusted, rescinded, or strengthened in the future. What is important is not necessarily winning right now or introducing entirely new programs to completely tackle a problem today, but rather the importance lies in stability and positioning ourselves to constantly be able to improve and move forward. Our traditional system has done this with professional politicians who must please large and diverse groups of constituents. We have done this with compromise and a willingness to bend on principles to allow legislation to move through. As Charles Lindblom would describe it, we opt for incrementalism, slowly changing existing programs and policies because they already exist and have already been debated and implemented rather than spend all our time debating and fighting over new programs.

 

Contrasting this stable yet slow, lumbering, and apparently corrupting system is today’s vision of disruption. We want ideologically strong candidates who represent something greater than their own self-interest who will not bend on principles and will push for a great new society. This is a terrific vision, but it focuses on short term wins for the here and now at the expense of stability and long-term functionality. The system is composed of political amateurs, “Activists,” described by Rauch in his book as, “very different animals. They are less interested in extrinsic rewards than in advancing a public purpose, fighting for justice, experiencing the intrinsic satisfactions of participation. For them, issues are the essence of politics.” When the system is overwhelmed by the amateurs and activists, activity stops. Compromise is not possible and we cannot move forward with anything because we are all fighting for different ends. From time to time it may be necessary to flood a legislature with activists who represent a shift in the zeitgeist and will fight for things like racial justice, or a reduction in unnecessarily high taxes coupled with inefficient spending, or for a better healthcare system, but when this activist mindset becomes the norm, when every representative must be willing to die for their cause on every vote, the system cannot function and we cannot govern ourselves.

 

Sometimes the boring, the candidates who want office for the glory and not for the issue, and sometimes the flexible compromises are what we need for good governance. I would argue, and I think Rauch would agree, that most of the time these are the political leaders we need. They do not inspire great visions of a world where our political tribe dominates and where everything is about us and our priorities, but  they do work with others who are not like us and position the government to slowly move forward perhaps interrupted on occasion by groups that arise with strong preferences for a noble cause. Too many of these boring officials and we fail to meet the will of the people, but too few, and the system breaks and is open for demagoguery and encourages between-group meanness rather than between-group compromise.

A Close Look at Individuals

In The New Jim Crow, Michelle Alexander finds a common ground between Republicans and Democrats when looking at who we consider change agents in our system. Both groups look at the power of the individual as the driving force of America and see the individual as the mechanism through which change and a better future are possible. The two camps may see the actions of the individual a bit differently, but nevertheless both focus on the individual.

 

Throughout her book however, Alexander is critical of the idea that the individual is capable of creating and instigating the changes in America that are necessary to overcome enormous challenges. There are too many structural barriers for individuals to overcome, and even if the individual does rise to the top, the idea that they can lift an entire group is unrealistic. The individual may play an incredible role, and in America the strength of the individual may be fantasized by popular culture, but the individual exists in a complex society that can only truly change and advance through the mobilization of entire social groups. I agree with Alexander that the structural barriers are too great for us to address on our own, and I want to look at how we think about the individual versus the collective, and examine the ways that Alexander believes this plays out in our criminal justice system.

 

Since our founding, the idea of the individual has been a palpable force in shaping our democracy. Protestant settlers tended to believe that their hard work would be rewarded with great riches from above, and success was (and still is) viewed as an individual’s divine blessing, given by a greater power to those who are hard working, virtuous, and special. If one was successful it was because a divine being had recognized and rewarded them, and through this same view, those who were not successful were in their position due to individual moral failures. On this foundation we built a nation and a constitution that centered around the strength and responsibility of the individual for personal gain. Our primary responsibility was to be a good Christian so that God would bestow great bounty upon us, and if we all focused on this goal as individuals, collectively we would all find an everlasting success. Failure was a result of individuals not living up to the contract from above, and within this lens we developed the idea of the deserving and undeserving.

 

From this foundation our nation has developed to where we are today. Describing the role of the individual in The New Jim Crow, Alexander writes, “Here we see both liberals and conservatives endorsing the same meta-narrative of American individualism: When individuals get ahead, the group triumphs. When individuals succeed, American democracy prevails.” Alexander is critical of this theory and I think she is right to criticize the focus on individualism. I do not believe there is a liberal and a conservative America, because when we use those terms we mean different things in different contexts, so I will drop her terms and simply use Republican and Democrat because party identification is more consistent and to me seems to be more causal than liberal or conservative ideology.

 

Alexander describes the Republican Party as being focused on individuals changing the system through entrepreneurship and insight. The individual can create great innovations if they are not constrained and limited by the system within which they operate. The Democratic party sees the individual as the flagship leader, raising up and pulling the status of the group and the fortunes of others up with them. Both of these views see power as resting with great individuals and leaders, and see exceptional leaders as the key to growth, progress, development, and a better future. Alexander finds this narrative lacking and dangerous, and I agree with her that it is an incomplete view.

 

To me, this focus on individuals is misplaced. What we get from our focus on individualism is instability, delays, and stagnation as often than we get flashes of brilliance, advancement, and progress. An incredible leader and voice may come along to lift up an entire group, as Dr. King Jr. did during the Civil Rights movement, but expecting a great leader to instigate meaningful change causes delays in achieving justice, making scientific advances, and solving substantial problems that impact people’s every day lives. This focus also creates instability since people change and die, and pinning all of our hopes on an individual leaves movements of change and advancement  vulnerable, as the assassination of Dr. King Jr. demonstrated.

 

The real power of the individual is not in change and progress as both Democrats and Republicans would hope. The true power of the individual is in the status quo. It is the power to defend the injustices that exist, the power to delay advancement and equality, and the power to be a barrier that limits other individuals. The reason why an individual has greater power to be a pest and not a hero is because we live in a society that requires collective action. The Republican Party has demonstrated that a few high minded individuals with great influence can derail the ideas of societal responsiveness and democratic representation. As an example, Grover Norquest’s anti-tax pledge is a commitment to abandon the collective more than it is a commitment to improve society. The Koch brother’s campaign against moderate candidates (candidates who more accurately reflect the majority of the country) is a demonstration that a few individuals can block progress and block the strength of our social groups while upholding structural barriers. President Donald Trump clearly shows us that a single individual can reverse and hold up equality and group advancement, while President Barack Obama showed us that even the best among us can only make so much of a dent without the support of broader communities.

 

In America we love our superheroes that pull the world back from the brink of destruction and manage to triumph in the face of adversity. We focus on what the individual can achieve and use material and financial success to demonstrate our value as individuals. What hides below the surface of our love for the individual is the fact that no one can be a superhero without some form of support from a larger group. What we hide in our past is that those who became incredibly wealthy in the early days of our society did so by exploiting the black body, justifying their actions as divinely ordained and rightful by biology and manifest white destiny. This attitude continued and the white individual was able to achieve their own success while holding the entirety of black society back. If we focus on individualism we allow such evils to persist. We must find a new way to be individuals and be successful on our own, but with the understanding that our individual success in terms of wealth, possessions, jobs, and family has as much  to do with with us as individuals as it has to do with the stability and protection offered by the larger society in which we live.

You Are Not Just Yourself

“Much harm is done by a single case of indulgence or greed,” Seneca wrote in a letter saved in the book Letters From a Stoic, “the familiar friend, if he be luxurious, weakens and softens us imperceptibly; the neighbor, if he be rich, rouses our covetousness; the companion, if he be slanderous, rubs off some of his rust upon us, even though we be spotless and sincere. What then do you think the effect will be on character when the world at large assaults it!”

The way we think about ourselves is that we are conscious actors in control of our behaviors, beliefs, worldviews, and actions. Who we are and what we do is under our control. We decide if we want to engage with people, shut ourselves in our room and read all day, be nice to strangers, gossip about our co-workers, and eat at Taco Bell. The reality however, is that much of who we are and what we do is influenced by the people and situations around us. I was recently listening to Rob Reid’s podcast, After On, and his guest described a study looking at the neighbors of people who win new cars as prizes. The number of people who purchase a new car within a short time period after their neighbor wins a car is larger than you would expect just by chance. People seem to be changing their car buying habits when their neighbor gets lucky and wins a new car.

We are never the version of ourselves that is in control of our decisions and behaviors. How we think about the world and what we see when we look at ourselves, the people around us, and the situations we find ourselves in is influenced by the people around us. As Seneca describes, our friends and neighbors can make us feel certain ways, even if we never wanted to feel the way they make us feel. Situations that seem meaningless, like a neighbor buying a new car, can change the way we feel about ourselves.

This idea can be liberating in the sense that we don’t have to believe that we are fully in control of everything. We don’t have to believe that we operate as a completely independent and objective CEO, rationally making perfect decisions about everything. We can take some pressure off of ourselves.

At the same time, this idea can be frustrating. It says that no matter how much you try, things are going to influence you whether you want them to or not. It means that you may be out of luck if you try to change your behavior or try to see the world in a new way. You may have too many forces pushing on you for you to really get outside of the situation that you find yourself in.

Seneca continues, “You should not copy the bad simply because they are many, nor should you hate the many because they are unlike you. Withdraw into yourself, as far as you can. Associate with those who will make a better man of you. Welcome those whom you yourself can improve. The process is mutual; for men learn while they teach.” The advice Seneca gives as a reaction to our susceptibility to be influenced so heavily by the people and world around ourselves is to build to our self-awareness. Reflect deeply on how we act and behave and think about the ways we wish to act and behave. Find people who can be mentors and guides in living the life you think is meaningful, and then turn around and do what you can to help others, because you will learn more by helping others than just by doing. Recognize that you don’t have it all figured out on your own, and that you won’t always see everything happening around you, but try to build your awareness and try to focus on continual improvement. Not in a flashy way, but in a confident way that is always available for those wish to tap into it.

Recognizing the Status Quo

I am not great at recognizing when the status quo is working well for me, but might not be working well for others. Sometimes, I am really not at all good at even recognizing what the status quo is or being aware of the status quo. What I can usually recognize, however, is when someone or some force is working to change the status quo in a way that is unfamiliar or even scary to me. Especially when the possible change in the status quo might require that I lose something that I benefit from, I notice the status quo and have an instant reaction to entrench myself against the change.

 

The status quo never actually needs to be the status quo. If we try to be more aware of what is the status quo for us, we can start to look for ways to change the status quo that won’t hurt us or cause us to lose something, but might move things in a new direction that might be better. We can almost always return to the status quo if we find that our change doesn’t really make the difference we hoped it would make. In his book Becoming Who We Need To Be Colin Wright writes, “the status quo remains the status quo because it’s been our status quo.”

 

It is worth remembering that oftentimes our status quo is totally random. We have a drawer in our kitchen full of utensils simply because when we first moved in we happened to toss the spoons and forks in that drawer. We never sat down to really think about where we would like our utensils and what drawer would be the best for them. It just happened and became the status quo, and changing it seems like more effort than letting it stay.

 

A lot of our lives is driven by a status quo that we haven’t really thought much about. When we try to change it, people who benefit from the status quo, or people who think that it is working and therefore doesn’t need to be changed will entrench themselves. We see this with things like the electoral college, a company changing a logo, or a friend suddenly changing a hairstyle. I think that on an individual level, being more cognizant of the status quo and remembering that often times the status quo is random or the result of a compromise that worked 200 years ago can help us adjust to change more easily. We can think through why things are the way they are, and if they don’t seem to make much of a difference, we can be more open to letting things change. There is no reason our lives should be constrained simply because the status quo happens to be the way it is.

Cognitive Dissonance

I recent changed my mind about vaping. I have asthma and cigarette smoke really gives me terrible breathing problems so I have never smoked either traditional cigarettes or any type of vaping product. I have hated traditional cigarettes my whole life and as vaping has become a new hit, I have hated it as well. Since vaping really popped onto the scene, I considered it to be basically as evil as traditional cigarettes and didn’t make much of a distinction in my head between the two.

 

A recent podcast interview with Dr. David Abrahms on the Healthcare Policy Podcast changed my mind. Vaping products may be far less deadly than traditional burnt cigarettes. The addictive potential of nicotine is still there and there are certainly plenty of things in vaping products that we should not be putting into our lungs, but vaping products may have far fewer carcinogens than traditional cigarettes and appear as though they are far less deadly than traditional cigarettes. For the first time in history, we have a product which could completely displace traditional cigarettes and tobacco, and most importantly, save millions of lives. I still don’t like vaping and won’t ever do it myself, but I the new information has forced me to change the way I think about and respond to vaping.

 

As humans, we really are not very good at changing our mind. We are not very good at being receptive to information that conflicts with what we already think we believe or with what we want to believe. We become really good at rationalizing the beliefs we already hold or that we want to hold, and we discount any information that doesn’t fit the world view we would like to hold. Any argument or debate is basically meaningless because our beliefs often become part of who we are and become unchangeable as part of our identity.

 

Colin Wright addresses this in his book Becoming Who We Need to Be, “First, we seldom experience cognitive dissonance, which is the feeling of discomfort associated with being exposed to information that contradicts our existing beliefs. This dissonance is a vital component of changing our mind and adjusting our views, and without it, without feeling that we might be wrong about something and therefore it’s probably important to check our math and learn more about the subject we’ve been armchair-philosophizing about on Facebook, we stand little chance of ever tempering our extreme, unjustifiable views.”

 

My example of changing my views on vaping is a short version of experiencing cognitive dissonance and being able to adjust opinions in the face of data, even when it is data that doesn’t align with what I want to see in the world (which is no one ever smoking anything). My example is less profound than changing beliefs about economic systems, about political parties, or about favorite super heroes. At some point I’m not sure we ever really will change those beliefs, but I think it is important to be aware of the small times when we change our beliefs so that we can better monitor the beliefs we do hold and be more aware of the times when we may experience cognitive dissonance. Rather than hiding behind a rationalization of our beliefs and pretending that everything within our belief structure is perfectly coherent, we can accept that there are some parts we don’t have figured out or don’t have perfect scientific evidence to support. For some questions, like what religious belief do you hold or what would be the perfect super power if you could only pick one, you will never have the perfect answer that solves all of life’s mysteries. It is ok to accept that people have been debating these questions forever and to not expect that you will suddenly find the perfect answer that no one else could. Cognitive dissonance may be uncomfortable, but it is a necessary part of our lives today and we should embrace it rather than try to hide from or ignore it.

Jefferson on the Constitution

Joseph Ellis, in his book The Quartet argues that many of our founding fathers who actively participated in bringing us our constitution were not focused on creating an ever binding document that would hold in place the nation’s laws forever. They sought, Ellis argues, to build a constitution that would serve as a guiding document for the political thought and ideals of the time. They understood that the Constitution would have to change, and while thy hoped that it would be endearing enough to be well respected and to not be scrapped within ten years, they did not believe the Constitution to be beyond the scope of political discussion and change.

 

This sentiment is capture by Thomas Jefferson, who was not active in the process of writing the constitution and developing its ideas since he was in France during the Constitutional Convention of 1787:

 

“Some men look at constitutions with sanctimonious reverence, and deem them like the ark of the covenant, too sacred to be touched. They ascribe to the preceding age a wisdom more than human, and suppose what they did to be beyond amendment. I knew that age well; I belonged to it and labored with it. It deserved well of its country…. But I know also, that laws and institutions must go hand in hand with the progress of the human mind. As that becomes more developed, more enlightened, as new discoveries are made, new truths discovered…institutions must advance also, and keep pace with the times. We might as well require a man to wear still the coat which fitted him as a boy as civilized society to remain ever under the regime of their barbarous ancestors.”

 

In my mind, the most clear modern example of what Jefferson described in the quote above is the debate in our country over the Second Amendment. In 1787 our founding fathers found it important enough for the nation to be able to be build a militia when needed and for citizens to be able to bear arms to for their protection from tyrannical governments both internal and external to the United States. But the firearms of the Revolution were unlike the weapons of today’s world. The original intent doctrine suggests that we should not limit people’s ability to own and use firearms. This seems very clear with the inclusion of the the Second Amendment, but it also feels to me, that we are forcing the nation to wear its boyhood jacket when we force the modern problems with guns into the framework of the Second Amendment. It is clear that the founding fathers did not write the Second Amendment with handguns in mind. The guns of the time were bulky, slow to reload, and inaccurate. A modern handgun is easily concealable, can be fired rapidly, and is deadly accurate.

 

Jefferson, it appears based on this quote from the end of his life, would argue that the Second Amendment needed to change, that there was not a superhuman view of firearms and democratic preservation written into the Constitution to which we should affix ourselves today. The technology of the world has advanced in unpredictable ways since 1787, and Jefferson would argue that our institutions for governing the nation should change as well.

Growth from Friction

I’m very good at traveling, but I am terrible at planning and setting up trips. I wish I was better at scheduling, coordinating, and getting out on trips, but I am not very good at thinking long ahead and planning out a vacation with another person. On my own, I can travel easily and I am comfortable almost anywhere with almost anything, but traveling with others is never quite so easy.

 

In his book Come Back Frayed, author Colin Wright talks about travel and how traveling pushes and influences us. Wright has spent a lot of time traveling and moving about the world at the suggestion of his fans and readers. He has been in many different places where he did not know the customs, traditions, or cuisines, and has had to learn things quickly in unfamiliar places in order to get by. When it comes to travel he writes, “Travel Frays. not just our stuff, but us. It pushes us, rubs us against uncomfortable realities, the friction creating gaps in our self-identity, loosening and then tightening our structure over and over again.”

 

When we are at home in the routine of everyday life, things is stable and clear. We organize our day, our home, and our actions to be predictable, comfortable, and desirable. We become what we do and what our life is organized around. Our identity is clearly tied to the things we do and the places we go. When we travel, however, curve balls are thrown at us and we are placing our trust, our time, and our physical location in the hands of strangers. Where we are, what we are doing, and how we interact with the world is influenced by forces beyond our control, and this, according to Wright, is what frays us.

 

I am good at traveling on my own because when I have no agenda, no demands, no expectations on myself, and no deep desires for a certain outcome, I can adjust to these fraying experiences and let go of my routine and plans. When I travel with other people however, I must be dependable and consistent through the changes. Traveling on my own I am content to simply walk and experience a new place. To try a new restaurant, to see something different, and to just be in an unfamiliar place. But traveling with others pushes me to do these same things and have these same experiences while also accommodating people who may not be as open and flexible as myself. This is the greater challenge for me, pushing me to give in some areas while remaining firm and foresighted in others. Independent travel reminds me of the variety of the world and human experience, travel with others pushes me to be more thoughtful about who I move through the world with. Ultimately, traveling with others is a changing experience because it drives me to be more mindful of time, my position in the world, and how my actions and the actions of those around me impact the person I travel with. It is a great shifting puzzle in which I must not only think about my own reaction to the world, but also how the person next to me will react to the world. This great challenge is fraying and sometimes a bit painful, but ultimately builds our relationships with other people and with an often unpredictable world.