I was sitting in my cubicle mid-day when an email with an odd subject line tumbled into my inbox: “JBMDL Afghan.” It was from a bona fide sender, so I opened it and took a look. It turned out to be an email from the director of financial services at a major hospital system, making reference to a new medical services “payor,” as we spell it in the trade. It was, in other words, the Joint Base McGuire Fort Dix Lakehurst Afghan payor, i.e., the payor of medical services for Afghan refugees housed at McGuire Air Force Base/Fort Dix Army facility in Lakehurst, New Jersey. Otherwise known as the US military.
The hospital system is a client of ours. Their financial services people are setting things up at their end to add the JBMDL Afghan payor to their list of payors. Meanwhile, we’re getting ready to help them “mine” the JBMDL Afghan account. Yes, that really is the way we talk. In other words, we’re all looking forward to the arrival of these doubtless sick and injured Afghans, so that we can generate revenue–make money–on their illness and injury, and if there’s reimbursement for mental health services, their misery. When I turn my computer on tomorrow, there’ll be JIRA tickets waiting for me and my colleagues in Aergo Ops, getting people in place to work the Afghan account. I’ll be sitting at my cubicle at 9 am sharp, ready to make my contribution to the grasping greed of the invisible hand.
That makes it sound bad. It really isn’t a bad thing, is it? We’re not hurting or exploiting anyone, are we? On the contrary. The JBMDL account means (I assume) free medical care for the Afghans. The payor is, I assume, the American people–care of the US military, care of Joint Base McGuire Fort Dix Lakehurst. I don’t know whether it’s funny, sick, or sad, but JBMDL is coded a “Commercial” payor in our system. I certainly hope Congress allocated enough to pay for it all,* however it’s coded, but I somehow doubt JBMDL Afghan will rival the biggest payors in our market. Will JBMDL pay out as much as Horizon Blue Cross? Aetna? Medicaid? We’ll see. If anything, you might think that JBMDL Afghan was a contribution to rectificatory justice, a small attempt to pay down the debt we incurred over twenty years of destruction in Afghanistan. Not that it exactly rolls off the tongue sounding that way.
Truth to be told, it feels somehow like an Eichmann-esque contribution to the banality of evil. No hush fell over the office when that email came in, no dramatic gasps or melancholy sighs. The flag isn’t going to fly at half mast in front of 33 South Wood Ave tomorrow, or in front of the offices of the hospital system, or, I suspect, in front of JBMDL. It seems melodramatic and silly to have expected any particular reaction at all.
No, the JBMDL Afghan account is business as usual. The clinical staff of the hospital system will do the well-remunerated work of healing. The hospital system’s billing people will chase down the money they’re owed. We’ll streamline the workflow, fine-tune the strategy and tactics, and find the pockets of unpaid accounts like the financial GPS’s we’re all trained to be. But I doubt a single one of us will lay eyes on one of these Afghan refugees–unless, maybe years from now, they find their way off the base, “assimilate” into our society, re-package Afghan food as something that can compete with good Indian and mediocre Chinese, and live the American Dream with names that Americans can pronounce. Until then, they’ll be accounts and units, debits and credits, revenue and write-offs.
It’s a long way from the blood-soaked killing fields of Afghanistan to a bloodless cubicle in Iselin, New Jersey, but also not far from Iselin to the killing fields of Ground Zero, where (putting things rather myopically) “it” all began. A perfect circle, in some sense. We’re just a few weeks away from the twentieth anniversary of September 11, and you can feel the late summer heat and hear the late summer crickets that remind people around here of 9/11, the day itself. I wonder how long I’ll feel this same sense of disquiet as we work the Afghan accounts. The names and numbers will fill spreadsheets. The revenue will roll in. It seems an oddly incongruous way to mark the end of a war. But this is America, and that’s how we do it. Either you blend in, or you don’t.
*For opposing perspectives, here is HIAS, and here is CIS. A paper on access to medical treatment for Afghan refugees in Iran.
I’m a Junior Analyst at Aergo Solutions, in Iselin, New Jersey. The opinions I express here are exclusively my own, and do not represent Aergo Solutions, its leadership, or its clients. No private, proprietary, or confidential information was divulged in this blog post.