Health Care/Joan Retsinas

Cruelty Cloaked in Morality

Cruelty often cloaks itself in morality. Bertrand Russell noted, “The infliction of cruelty with a good conscience is a delight to moralists.”

So here is a Thanksgiving wish. Please let us drop the cloak of morality. Let kindness prevail. The action will bolster our health, physical if not moral. If we have any“better angels,” unleash them.

To start, let’s stop making a hospital a way-station to the poorhouse. The cruelty evokes Charles Dickens at his darkest: a sick person gets treated. The good news: that person recovers. The corollary: that person bears crippling debt. The problem of medical debt has awakened the souls of Democrats and Republicans. Some stop-gap measures help.

About 20 states have ruled against exorbitant interest ranges, against overly aggressive bill collection, against collectors placing liens on homes. Some states have barred hospital debt from consumer credit reports, President Joe Biden introduced measures to bar medical debt from consumer credit agencies (a measure not universally supported by conservatives.)

But those are marginal efforts. The reality is that sick people without insurance incur impossible debt: the hospital even charges more than the rates negotiated with insurers. People with inadequate insurance — think Medicare Advantage plans with gaps, or the faith-based quasi-insurance, or the barebones policies advanced by the Trump Administration — face debt. Even people with “good insurance” may find the co-pays, premiums, and deductibles crushing. The solution is to revamp how we pay for healthcare. We acknowledge that consumers accept responsibility for living beyond their means; but surely we don’t hold sick people to that standard, equating chemotherapy with a spa weekend.

Next, let hospitals dispense life-saving healthcare, not moral precepts. Discard the anti-abortion strictures that keep hospitals from helping pregnant women. Sometimes fetuses are not viable; and rules that preclude abortion can hurt women, even kill them. In Eureka, California, a woman pregnant with twins feared that she would not survive childbirth. She arrived at a Catholic hospital’s emergency room. The recommended treatment for premature rupture of the membrane of the amniotic sac: an abortion. But the hospital held firm: abortion, whatever the reason, is immoral.

So no abortion, even though a federal law required hospitals to treat pregnant women who come to emergency rooms needing treatment to save either their lives or their health. The hospital sent the woman off with a bucket and towels. She made her way to a hospital 12 miles away, where a physician aborted the pregnancy. (The state is suing the hospital.) But that hospital is poised to close its maternity ward. Throughout the country we have “obstetrical deserts” (thank you, Supreme Court) without obstetrics departments. And the hospitals that do treat pregnant women, and do offer abortions, face not only patients within their region, but the women who travel from a “no abortion” to a “permitted abortion” state. ProPublica reported two instances, in Georgia, where a woman rejected from a hospital died.

Finally, we end up sick, disabled, sometimes dead not just from viruses but also from gunfire. The Wild West ethos of lax gun regulation is cruel. Let’s Inject compassion into the discussion. Yes, the Second Amendment guarantees people the right to bear arms. Yes, guns represent a thriving industry, with scads of lobbyists. Yes, people have a right to defend themselves. But that ethos has killed thousands of Americans, from children who play with an unlocked gun to high school students or mall shoppers unlucky enough to be in the range of somebody brandishing a machine gun. Ironically, legislators who are most intent on saving the unborn are willing to let people be shot. In 2024, Mississippi had the highest gun violence rate per thousand (29.7%), followed by Louisiana (28.2%). Rhode Island came in lowest (3.1%). Access to abortion varies inversely. The legislators who invoke the Constitution to block stringent regulations are rarely the people who will suffer. The hypocrisy is blatant. So is the cruelty.

We have pharmaceutical wonders that ease depression, lower blood pressure, raise libido. Sadly, Big Pharma has not devised a drug to make us kinder. The onus falls on us: somehow we must unearth the humanity behind the precepts that cloak our cruelty.

Joan Retsinas is a sociologist in Providence, R.I., who writes about health care Email joan.retsinas@gmail.com.

From The Progressive Populist, November 15, 2024

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