A few days ago, the distraction of actual governance in Washington was the report on Employment, the economy, and the effect of the Affordable Care Act published by the Congressional Budget Office (CBO). As usual, the talking head of Washington, Republicans and the Democratic White House included, missed the point.
“It confirms what we’ve known all along: The health care law is having a tremendously negative impact on economic growth,” said Sen. Bob Corker (R – Tenn).
“At the beginning of this year, we noted that as part of this new day in health care, Americans would no longer be trapped in a job just to provide coverage for their families, and would have the opportunity to pursue their dreams. This CBO report bears that out, and the Republican plan to repeal the ACA would strip those hard-working Americans of that opportunity.” – White House Press Secretary.
The point missed by both sides, and it happens all the time, so often that many of us have become numb to it, is that they are talking exclusively in numbers of a system which is just as well, if not better, described by the lives of the people they serve.
I had cause to take my friend Sharon to a dermatologist she had never visited before. It was an emergency visit. Sharon had been in and out of the hospital for a few months, and one day, at home, her arm blew up. Her slender arm, where she had a pic-line for IV fluids she had to take at home, suddenly, within hours, inflated almost beyond recognition. She called her nurse, and she called me. What I saw was a Thanksgiving’s Day Parade version of her left arm. We took a picture and sent it to her doctor – anything to avoid going to the hospital, which she had already seen too much of. The doctor called ahead to this dermatologist to take a closer look.
I took Sharon there. She filled out the paperwork. Along with Benadryl, ice, and then heat, the doctor diagnosed her with an allergy to the adhesive of her bandages. After two hours, Sharon was all better; tired, but better. We stopped at the office counter on the way out, so that Sharon could make whatever co-pay was needed. The office accountant happily announced, “Your insurance said that you’ve already met your deductible; isn’t that great!”
I’m sure that the woman meant to say something positive at the end of the long visit. She probably didn’t realize that a fulfilled deductible also meant an exhausting road of illness. How could she know all that Sharon had already endured, and that this was just one more stop in pursuit of better health?
Sharon set her straight, “Do you know how sick I’ve been before I reached the deductible? It’s not worth the savings.”
The Washington Post points out that the CBO was less partisan in its actual findings:
“In its assessment of the law’s impact on the job market, the agency had bad news for both political parties. In an implicit rebuke of GOP talking points, the CBO said that there was little evidence the health-care law is affecting employment and that businesses are not expected to significantly reduce head count or hours as a result of the law.
But the report also contained a setback for the White House. The CBO predicts that the economy will have the equivalent of 2.3 million fewer full-time workers by 2021 as a result of the law — nearly three times previous estimates.
After obtaining coverage under the health-care law, some workers will choose to forgo employment, the report said, while others will voluntarily reduce their hours. That is because insurance subsidies under the law become less generous as income rises, so workers will have less incentive to work more or at all.”
Just as the secretary at the dermatologist’s office spoke to Sharon with only an eye to dollars spent or saved (which really required high expenditures first), so it is when politicians speak about Health Care, as if the care we are speaking about is not about people at all.
I take for granted that both sides, liberals and conservatives, are arguing not about whether or not health care is important. They (ultimately, at least) are arguing about how we should go about providing it. Either because of the political climate and the need to score-or-punish, or, the abstraction of talking about the systems underling funding, both sides have lost the language of human value which underlies the necessity of a government caring for people – real people, such as Sharon.
A parallel exists between the health care debate and the Tower of Babel story.
What did God see at the Tower of Babel that was so infuriating? The Torah never tells us, but it was so bad that God could not allow this first Biblical community to continue. Our sages suggest that it was not the building of tower itself, but rather HOW the people went about building the tower that drew God’s ire. The people were so focused on building the tower, they forgot their humanity.
“The tower was built with steps on the east side and on the west. Single-file, each person would climb up on the east side, place the brick, and descend on the west side. When a person would fall from the great height, they people of Babel would lament, “How long will it be until someone can bring up a brick to replace the one that was just dropped?”
As we continue to discuss the affordability of healthcare, I suggest that we, and the leaders we elect into office, have in mind real people in our lives who have been in need of great care. My hunch is that over the next decade or so, we will indeed develop better cost structures in health care. What we can’t afford is losing our humanity along the way.
“This,” Witherly said, “is one of the most marvelously constructed foods on the planet, in terms of pure pleasure.” He ticked off a dozen attributes of the Cheetos that make the brain say more. But the one he focused on most was the puff’s uncanny ability to melt in the mouth. “It’s called vanishing caloric density,” Witherly said. “If something melts down quickly, your brain thinks that there’s no calories in it…you can just keep eating it forever.” -The Extraordinary Science of Addictive Junk Food, by Michael Moss (NY Times Magazine).
Is it a surprise to hear that food companies painstakingly, scientifically manufacture the taste and textures of our foods and drinks to make them addictive? No. Moss quotes Bob Drane, the brains behind Kraft’s Lunchables, who explains how the food industry got to where it is today: “Our limbic brains love sugar, fat, salt… So formulate products to deliver these. Perhaps add low-cost ingredients to boost profit margins. Then ‘supersize’ to sell more…And advertise/promote to lock in ‘heavy users’.”
“When you sell property to your neighbor, or buy any from your neighbor, you shall not wrong one another” – Lev. 25:14.
From the Torah verse above our sages learn the prohibition of Ona’ah, overreaching – “the act of wronging another by selling him an article for more than its real worth.”
Are food companies withholding what they know about our tastes and therefore making a profit from our lack of knowledge about food science? We like to think that America was built on Judeo-Christian morals, but that is not the case. The reason that there are no warning labels on bags of chips or cans of soda is because our moral code, when it comes to business anyway, is the moral code of Rome not of Jerusalem (an analogy often made by one of my mentors, Dr. Bruce Powell):
Rome teaches: Caveat Emptor – “Let the buyer beware.”
From the perspective of the food company it is the business of the consumer to find out about a product and make her own decision.
Is such a business plan criminal? No. Is it moral? Again, no.
Jerusalem teaches: “It is forbidden to cheat people in buying or selling or to deceive them.” – Mishnah Torah, Laws of Sales. Judaism teaches that buyer has the obligation of full disclosure to seller.
“So,the food and drink around me, that is cheaper and tastier than healthy food and water, is killing me?” Buyer beware, indeed!
I will admit that some will say that ona’ah, overreaching, on the part of Big Food is a stretch. Nonetheless, I stand my ground, but that ona’ah is taking place in hospitable bills is paramount to anyone who has bothered to ask for an itemized bill from their last hospital visit.
This week’s Time Magazine cover article by Steven Brill is a must read for every American. Hospitals, even non-profit hospitals, have such complex guides for deciding payment, which can seem so arbitrary. How do they decide? Hospitals have different pay rates for cash, insurance, and Medicare. Brill give the example of a chest x-ray. A patient might be charged $333, but if it’s billed through Medicare, that same x-ray would pay the hospital $23.83.
Of course, the hospital should be allowed to make a profit, make up for non-payment, or low payment, but it seems that the mark-up something controlled by the secretive “chargemaster- the mysterious internal price list for products and services that every hospital in the U.S. keeps.”
Why are Americans paying so much more for healthcare than other well-off nations without the results? We value the right of hospitals to make money without us fully knowing what we are being charged for. Alas, such is life in Rome. Healthcare costs would not be so bloated if true Judeo-Christian values ruled. Consider this teaching:
“One who has medications, and another person is sick and needs them, it is forbidden to raise their prices beyond what is appropriate.” - SHULCHAN ARUCH, YOREH DE’AH 336:3.
In choosing Rome as our ethical compass, we have led ourselves to a crisis point. Protecting the right of companies to profit at the knowing expense, in dollars and in health, of our citizens is a sure sign that America no longer lives by Judeo-Christian values.