The American Health Care System, and Intermediate-Level Talmud Study
Anyone who has ever had to deal with health care in the United States of America knows that it is complicated.
The simplest questions do not get simple answers.
Try asking, and you get long, difficult explanations, or no explanation at all, to these apparently straightforward inquiries:
How much does this procedure cost?
Why does it cost that amount?
Does insurance cover this procedure?
Who employs this health-care worker?
Who receives the payments, and who receives a share of the payments, when we pay for treatment?
What do the items listed on my hospital bill mean?
People who study the health care system work at developing accurate answers, and we admire them for their efforts.
Thinking about their topic of study reminded me, oddly enough, of how I transitioned from a beginner at Talmud study to becoming a kind of intermediate student. At first my teachers helped me learn how to translate the words of the Talmud. The effort to understand the Hebrew and Aramaic words, to figure out what was a question and what was an answer, took all my brainpower as a beginner.
When I had finally managed a modicum of that skill, I was shocked to discover that something came next. When I met teachers who introduced me to a conceptual method for understanding the text, I had graduated to intermediate-level Talmud studies. They aspired to develop a precise analytic terminology to formulate, not just what the Talmud said, but it means to say such a thing. These teachers aspired to an ahistorical analysis: They knew a great deal about how the text developed, and they did not want to care about that. However it grew did not matter much; they wanted to know what it says now.
Years later, I met another group of teachers, who took exactly the opposite tack. They knew that the Talmud says something now, but they really wanted to know how it came to say that. They looked at the layers of material in the Talmud, the way a geologist might look at strata of different materials in the walls of a valley. They aspired to analyze the historical forces that resulted in producing each layer of the text.
People who want to understand health care in America could benefit from understanding these two methods of approaching this as a difficult text. The historians try to find out what forces developed this complexity. Historians explain that once, during a labor shortage (during World War II), Government price controls kept employers from offering raises. Employers who needed additional workers would try to find perks that could replace higher wages as an inducement for potential hires. Would the Government enforce price controls against health care? No? So then companies could offer health insurance to attract workers. Stakeholders argued about this health insurance. The tug of war involved insurance executives who wanted this market, doctors who feared socialized medicine, hospitals, drug companies, and other interested parties, all pulling in different directions. Our health care practices solidified at the truce lines where these battles ended, temporarily. Of course, the result does not look too coherent. Different interest groups succeeded to some extent, and failed to other extents, in protecting their concerns. The result, of course, does not speak coherently.
Conceptual scholars might dismiss this historical analysis as too much detail. What we have now grew however it grew. What happened, happened. Current practice does speak coherently, however much fighting went into developing current practice. We have employer-based health insurance for unionized workers, and for well-paid full-time employees. That speaks: It says that people who have good jobs deserve medical care. They have earned it. People who do not have good jobs, the unemployed, gig workers, part-timers, unskilled workers, do not deserve medical care.
According to a conceptual analysis of our practice: Medical care is a commodity, not a right.
Our current practice makes exceptions for the disabled and the elderly. The government provides for them. Conceptual analysis forgives these non-productive humans: Through no fault of their own, they are out of the work-force. Current practice has less generosity for the unskilled or the poor, or undocumented immigrants.
The historians and the conceptual analysts both contribute to our understanding health care, as they contribute to our understanding of Talmud.