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)