Is health care better when you pay more?

In a New York Times article today, Reed Abelson makes the bold statement that a new hospital study provides “stark evidence” that higher payments do not translate to better medical care. He is citing a Pennsylvania government study of the 60 hospitals in Pennsylvania that perform heart bypass surgery. Two of the highest paid hospitals also had the highest death rates. This could be for many reasons. These hospitals might take the most difficult cases or the most costly. Either example would cause higher costs and poorer results.

So, the study is too narrow to make sweeping generalizations about health care costs, but it does raise some questions. Noting that this particular study does not prove much, Abelson goes on to say, “Still, the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine.”

Implied in the article is a call to adopt a pay-for-performance model for health care. The idea is that physicians and hospitals with better outcomes would receive higher pay. On the surface, this seems like a good idea, but there are potential problems. One way to improve outcomes is to deny service to high-risk patients. Abelson’s article notes that Geisinger Health Care is offering a 30-day warranty on its cardiac surgery. Private hospitals are able to choose the best candidates for surgery and have a much better chance of making good on the warranty.

Public hospitals face other dilemmas. Hahnemann University Hospital now says that its record keeping probably did not give an accurate picture of how sick its patients were before coming for surgery. Public hospitals and teaching hospitals take all patients and do their best to save them. Those with the sickest patients are likely to have the worst outcomes. This is not proof of poor care.

The question of how to compare care at different facilities or among different doctors is not one easily answered. Most will agree that better performance should be rewarded, but getting an accurate picture of care quality will require more than counting deaths and dollars. Dr. Richard Snyder of Independence Blue Cross, is quoted as saying, “Philosophically, you’re not going to get an argument from us. We believe we should pay more for high quality than poor quality.” Implicit in his statement is frustration over how to measure quality. Recognizing the complexity of the question is the first step to formulating possible answers.

The Personal is Political

For decades now, feminists have been telling us that what goes on in the private sphere affects the public sphere. The rallying cry of “The personal is political!” was heard by many. Some, such as Susan Okin, even predicted the problem this would cause for men. In order for women to enter the public sphere, men would have to enter the private sphere. If women were paid less and given less respect because their commitment to their jobs was diluted somewhat by family obligations, employers were likely to be even more harsh with fathers who wanted to be part of family life.

Though the warnings were unheeded, they were not unjustified. Katherine Reynolds Lewis has just published an article describing the struggles modern fathers face. It was assumed in the past that fathers would rather not take responsibility for changing diapers, taking sick kids to the doctor, and going to meet with teachers. This assumption turned out to be false. Fathers in the past were afraid that if they were more involved in the private sphere of home and family, they would be punished by their employers. Their fears have been realized. Fathers have been passed over for promotions and even fired after insisting on taking leave to be with their children.

Liberating women for equal pay will require liberating men as well. As society we should assume that all parents love their children and want to be with them to ensure their healthy development. Some fathers and mothers are not good parents to be sure, but rewarding rather than punishing those who are will benefit us all.

What can ethics courses achieve?

In a Houston Chronicle commentary titled “Where’s Right and Wrong in Ethics?,” Donald Bates explores why required university courses in ethics fail to produce ethical business practices. Bates lists many familiar examples of unethical behavior in public life (Enron and WorldCom, for examples) and blames them conveniently on the separation of church and state.

Bates claims that ethics is taught from a position of Utilitarianism (the greatest good for the greatest number), egoism (what most benefits the long-term interest of the individual), rights (deontological forms of duty to others or entitlements for oneself), or abstract principles of justice. This is his first mistake. University ethics courses teach the theories listed by Bates, although his list is far from exhaustive, but ethics instructors are not wont to teach “from a perspective.” To understand the study of ethics, students must be familiar with competing theories, but universities provide education, not indoctrination.

Bates goes on to say, “Trying to teach ethics without a religious underpinning means absolutes do not exist, everything is situational.” This is his second mistake. The fact that many competing ethical theories (and religions, for that matter) have emerged over the centuries is not evidence that absolutes do not exist. It is evidence only that absolutes are extremely difficult to discover and agree upon. Teaching ethics from the standpoint of a “religious underpinning” is to teach from a standpoint of absolute knowledge of right and wrong and good and bad, which would require professors to claim to know the mind of God, a claim that would be met with suspicion for good reason.

Expecting ethics courses to make the world more ethical is a little like expecting professional athletes and pop stars to be good role models. Ethical solutions and agreement are not easy to come by. Claiming that the state should enforce morality founded in religion begs the question of which religious perspective is correct and who will decide on the proper perspective. Rational people of good will disagree on ethical practices each day, and this is a good foundation of a pluralistic society.

If we are lucky, we might be able to teach a few students a little humility and respect for the efforts of others to discover right from wrong. Many students will claim that ethics is just a matter of common sense. Oddly enough, Bates seems to agree. In each case he presents, he believes there is a universally accepted opinion of what is right and wrong. If he is correct, students do not need to be taught what is right, they need to be prevented from being evil. It is unlikely that the leaders of Enron and WorldCom made a mistake in ethical thinking. More likely, they decided to do something that showed no concern for the harm it caused others.

An ethical society requires skeptical humility from its leaders and educators, recognition of the humanity of others, and a desire to limit harm to all. This lesson is not easily taught but it is easily shared by the way we live.

Future of Bioethics

Many problems of bioethics revolve around the value of life. Many bioethicists accept the Judeo-Christian view that human life and human life only has great intrinsic value. As a corollary it is taken that anything thing that is both alive and human possesses a right to respect and continued life.

These assumptions are powerful and pervasive, but go against the intuition of many people. The assumption that human life has great value and is even sacred would lead one to assume that it is proper to create as much human life as possible, but only a few people actually believe this. The prevalence of contraception and encouragement of abstinence belies an underlying belief that perhaps not every human life is of great value simply because it is possible for it to exist.

Similarly, rights are not granted uniformly to all that are human and alive, although many pretend that they are. When consciousness ceases to exist or fails to begin in living human tissue, many people will regard this being as perhaps being worthy of dignified treatment, but the idea that it is of the same value of all other human life is not represented through everyday actions of most people.

Concern for the “right to die” is some circumstances also implies a rejection of the view that life is sacred in all cases. Alternative views of the value of life can be useful in resolving the apparent contradiction between the actions many people take and their declared respect for life and individual rights. Not all people see life as sacred and valuable. The first noble truth of Buddhism, for example, is that life is suffering. We seek continued existence as a result of desire, which intensifies our suffering. Life becomes valuable, then, because it fulfills a desire which is itself irrational. Other views see life as the inevitable consequence of physical laws or nature. The fact that humans exist and desire life is a brute fact that is morally significant only because of the suffering generated by the desire for life.

We may recognize that life is valuable for reasons that are not metaphysical. A pre-embryonic collection of cells may be of great moral significance to a certain man who is hoping, with a bit of desperation, to become a father and see his child before he succumbs to a life-threatening disease himself. For this man, these human cells are not morally significant because they are endowed with rights and dignity at their first creation. He is not concerned with the metaphysical status of the cells. He is concerned, instead, with their ontological status. They exist and he wants them to survive because he is interested in their continued existence. In this case, we may feel morally obliged to take great measures to ensure the survival of these cells because they mean so much to this hopeful father. We are concerned for this father and he is concerned for his progeny. The moral commitment arises from concrete human relationships.

For similar reasons, non-human life may become of great moral concern to us. Police officers who have worked with service animals for many years will often refer to a deceased animal as a “partner” and such animals sometimes receive funerals and memorials. Few would claim that service animals are accorded respect and value because of the sanctity of life.

In both the cases I’ve given above, it can be claimed that the duties accorded to life are indirect duties to the ones who care about the life. While that is true, the moral commitment could arise from a direct concern for a life. An individual may value her own life because she enjoys being alive and wants to continue her existence. Her own concern for her life makes her life something of value. Our of a concern to reduce her suffering at the thought that her life may not be preserved, medical professionals will devote themselves to preserving her life.

In such cases as outlined above, it is compassion, sympathy, empathy, or care that creates moral demands for the preservation of life. This view of the value of life will not appease the demanding vitalist, but it may be accepted by many people from different faiths and philosophical backgrounds. It helps us reconcile the strong drive to preserve and extend life with our belief that some people have a right to die, that some non-human life deserves extraordinary care and respect, and the view that some human cells are precious while others are less precious.

Cartesian Ethics: Concern for Self and Others

Cartesian Ethics: Concern for Self and Others

When examining the ethics of Descartes, it is easy to focus exclusively on his interest in virtue and concern for self-interest. As a result, discussions of his ethics often have what Cecilia Wee called “a persistent image of the Cartesian agent as a selfish or egoistical individualist” (255) in her essay titled “Self, Other, and Community in Cartesian Ethics.” According to Descartes, by using reason to understand the nature of God and the moral order of the universe, humans are able to control their passions and accept their fate in life with equanimity. We may not be happy in the sense of being exuberant. Rather, the virtuous person is rewarded with a “satisfied mind.” Virtue and contentment is not the end of the story, however. In a typical description, Donald Rutherford describes Cartesian ethics in this manner:

In agreement with the ancients, he takes philosophy’s practical goal to be the realization of a happy life: one in which we enjoy the best existence that a human being can hope to achieve. Descartes characterizes this life in terms of a type of mental flourishing, which he calls “contentment of mind,” or “tranquility.” Here the influence of Stoic and Epicurean ethics is evident. (1)

In Descartes’s philosophy we find some echoes of previous moral views such as the virtue ethics of the ancients, but we also see that Descartes anticipated many modern moral theories, including Kant’s respect for persons and utilitarianism.

Many have lamented the fact that Descartes was never able to develop his moral theory in the formal manner of his metaphysics and epistemology. There is no cause for despair, however, as Descartes has left us plenty of grist for the grind. If we take as a given that the aim of philosophy is to enable us to live better lives, we cannot only examine Descartes’s comments on morality, but we must also evaluate how his metaphysical and epistemological claims promote eudaimonia. By this, we do not mean to see whether Descartes has found a way to make us all happy but whether he promotes a sense of being better off and flourishing, for it is clear that cheerfulness is not the supreme good. He writes to Princess Elizabeth, “Seeing that it is a greater perfection to know the truth than to be ignorant of it, even when it is to our disadvantage, I must conclude that it is better to be less cheerful and possess more knowledge” (CSM III, 268).

In this, we can see that epistemological concerns have a moral dimension for Descartes, so it is appropriate to evaluate his epistemology from a normative standpoint. His epistemology, of course, rests on his metaphysical assumptions. For the purposes of this paper, I will take his metaphysical assumptions as discoveries that are proven through his writings. He counsels Elizabeth that although there are many things we cannot know, we must content ourselves with the most useful truths. Most importantly, he argues that “there is a God on whom all things depend, whose perfections are infinite, whose power is immense, and whose decrees are infallible” (CSM III, 265).

If we take Descartes at his word and accept that the provisional morality expressed in the Discourse is truly provisional, then the value of examining his comments there is dubious. On one view, the provisional morality is nothing more than a literary or rhetorical device designed to heighten excitement for the epistemological project. The need to take a provisional morality implies that skepticism is extremely risky. With the proper preparation, however, one can be sure to make things no worse than they are. Descartes reassures his readers both that he is doing something extremely bold and also that he is taking no chances with the stability of society and morality. Descartes is giving his promise that he will not abandon all standards of behavior while completing the skeptical experiment. On the other hand, he does seem to be claiming that the provisional morality is good enough for himself until his metaphysical and epistemological foundations can be established.

Further, he suggests that others may choose to embark on a similar project, so he seems to be endorsing his provisional morality for anyone with the proper will and disposition for the project. Excluded from the endeavor, as he notes in the Discourse, are those who believe themselves “cleverer than they are” so that they judge too hastily and those who recognize they are better to “follow the opinions of others rather than seek better opinions themselves” (CSM I, 118). For himself, and anyone wishing to follow his lead, he laid out “three or four” maxims. The confusion over the number may stem from the fact that the fourth is more of a decision than a maxim.

One value of the Cartesian metaphysical project is that it gives a sense of serenity in knowing we only accept what is certain as true. We can know that there is a good God, free will, and a moral order to the universe. Since God is perfect, we know we are never being deceived. We also know that God does not create evil, as evil is not a thing. Further, we know that we can always choose what is good and correct. Error is the result of will, not intellect, which derives truth from God.

Descartes’s metaphysical argument regarding evil and free will is, unfortunately, incoherent. The problems with his view of humans become apparent when compared to the lives of animals, angels, and the human mind when separated from the body. Animals, lacking free will or intellect, act in a perfect manner and are not capable of evil. In his early writing, he says, “The high degree of perfection displayed in some of their actions makes us suspect that animals do not have free will” (CSM I, 5). Of course, animals also lack moral agency and are of no concern morally. The suffering animals endure has no moral significance. He makes this point distressingly clear when he describes a vivisection by saying, “If you slice off the pointed end of the heart in a live dog, and insert a finger into one of the cavities, you will feel unmistakably that every time the heart gets shorter, it presses the finger” (CSM I, 317). An animal’s behavior is never to be faulted. However, it also should never be praised.

Angels, lacking bodies, are not subject to the errors that arise from preconceived opinions. Angels do not contain all the perfections of God, else they would be God, but they are immune from the confused and obscure thinking that plagues those of us burdened with sensation. Their ideas must be clear and distinct, as they are pure intellect. In a letter to Chanut, Descartes declares, “We regard the least of the angels as incomparably more perfect than human beings” (CSM III, 322). Angels also have free will. They are not part of the mechanistic material of the universe. Given that angels have free will along with an intellect that is not clouded by obscure and confused ideas, it is difficult to see why the existence of humans in the universe is of any value.

Humans are burdened with an infinite will, a finite intellect, and an unreliable body that gives rise to false opinions. Through great effort, humans are able to enumerate and simplify their ideas until they are left only with clear and distinct ideas that are true and certain. This process of elimination of error from the human mind is supposed to be of obvious value. By coming to certain knowledge, we are able to make accurate and positive judgments, and these result in proper virtue. This is the source of esteem for humans. In The Passions of the Soul, he writes, “I see only one thing in us which could give us good reason for esteeming ourselves, namely, the exercise of free will and the control we have over our volitions. For we can reasonably be blamed only for actions that depend on this free will. It renders us in a certain way like God by making us masters of ourselves, provided we do not lose the rights it gives through timidity” (CSM I, 384). Here Descartes seems to imply that angels, “incomparably more perfect” than humans, are less praiseworthy since they need not struggle against the limitations of the physical body. In this case, it is not clear why we should consider it a blessing to be praiseworthy.

Being more perfect seems to be a good alternative to being praiseworthy, as being capable of praise brings with it a host of afflictions. Having a soul connected to a body and a body whose actions are imperfect as a result of free will leads to no small amount of suffering. For Descartes, this is not cause for alarm or self-pity.

Rather than feeling remorse over the afflictions and inconveniences of life, Descartes sees things differently. In a letter to Princess Elizabeth, he says, “There is a God on whom all things depend, whose perfections are infinite, whose power is immense and whose decrees are infallible. This teaches us to accept calmly all things which happen to us as expressly sent by God” (CSM III, 265). Given that suffering results from the soul being connected to body, it may seem that God is responsible for evil, but Descartes rejects this notion as well. God is not the author of evil, because evil is not a thing. In the Principles, Descartes claims that God is the source of all things, but he hastens to assure us, “When I say ‘everything,’ I mean all things: for God does not will the evil of sin, which is not a thing” (CSM I, 201). Sin is, rather, the result of bad judgment and movement of the will. God could have given us perfect judgment, but “we have no right to demand it of him . . . we should give him the utmost thanks for the goods which he has so lavishly bestowed upon us, instead of unjustly complaining that he did not bestow on us all the gifts which it was in his power to bestow” (CSM I, 205). Humans are the authors of and remedies for evil.

Evil is only a privation of our perfections, rather than a thing created by God. This scholastic account of evil is a rather cold comfort for the miserable wretch suffering a multitude of afflictions. Still, even contemporary theologians offer us the same reassurance. John Hick, for example, tells us that the world without suffering might be quite pleasurable, but it would be “very ill adapted for the development of the moral qualities of human personality. In relation to this purpose, it would be the worst of all possible worlds” (115). This ignores the possibility of a universe with neither pleasure nor pain—a universe with no sentient life.

Arthur Schopenhauer, under the influence of Indian religious and philosophical writings, sees this scholastic view of evil as being completely backward. He says, “I therefore know of no greater absurdity than that absurdity which characterizes almost all metaphysical systems: that of explaining evil as something negative. For evil is precisely that which is positive, that which makes itself palpable; and good, on the other hand, i.e. all happiness and all gratification, is that which is negative, the mere abolition of a desire and extinction of a pain” (42). Taking a moral framework that seems diametrically opposed to the view of Descartes, Schopenhauer sees compassion as the greatest moral good. He says:

Boundless compassion for all living beings is the firmest and surest guarantee of pure moral conduct, and needs no casuistry. Whoever is inspired with it will assuredly injure no one, will wrong no one, will encroach on no one’s rights; on the contrary, he will be lenient and patient with everyone, will forgive everyone, will help everyone as much as he can, and all his actions will bear the stamp of justice philanthropy, and loving kindness. (229)

Further, Schopenhauer points out that it would seem illogical to claim that a person was unjust and immoral and still claim that person to be very compassionate. In this way, morality supervenes on compassion. At first look, it appears Schopenhauer has made a huge departure from the kind of morality perceived by Descartes (this is confirmed if we look at their views of animals), but Descartes makes some statements that are surprisingly similar. In following passage, Descartes almost appears to be a precursor to Schopenhauer:

Those who are generous in this way are naturally led to do great deeds, and at the same time not to undertake anything of which they do not feel themselves capable. And because they esteem nothing more highly than doing good to others and disregarding their own self-interest, they are always perfectly courteous, gracious, and obliging to everyone. Moreover, they have complete command over their passions. (CSM I, 385)

We might object, though, that Descartes is merely advocating compassion as an appropriate emotion or virtue. He may not be arguing that we should set aside our self-interest for others. Descartes is often viewed as an egoist and virtue ethicist (Wee 255). There is plenty of textual evidence to support such a claim, but it is also clear that putting the interests of others out of compassion or duty is, in itself, a virtue. He makes this clear in a letter to Princess Elizabeth:

That each of us is a person distinct from others, whose interests are accordingly in some way different from those of the rest of the world, we ought still to think that none of us could subsist alone and that each one of us is really one of the many parts of the universe, and more particularly a part of the earth, the state, the society, and the family to which we belong by our domicile, our oath of allegiance, and our birth. (CSM III, 266).

In our pursuit of virtue, which is in turn a pursuit of the good life, we must be compassionate and, at least occasionally, put the interests of others ahead of our own interests. In this regard, Descartes takes a step toward the utilitarian theories of Bentham, Hume, Mill, and even contemporary philosophers such as James Rachels and Peter Singer. We will not go so far as to claim Descartes is an early utilitarian, but we can see the rudiments of utilitarian thought in a these passages.

Descartes’s ideas on moral agency also predicted later ethical theories. The material universe, for Descartes, is a mechanical system governed by necessary physical laws. Humans are in a unique position in this universe as humans are the only beings possessing both body and mind. When we consider the interests of others, we consider only the interest of those who are worthy of esteem and blame, i.e. humans. As John Marshall puts it in his book, Descartes’s Moral Theory, “Because they possess intelligence and will, others merit our esteem as beings of a certain kind, beings having the potential for a specific kind of development, both intellectual and moral” (152). Simply possessing free will gives one the potential for virtue, which deserves respect. Because all humans have intellect and will, we must treat them with a measure of respect, even if they behave badly. As mentioned above, Descartes tells us that we are only worthy of praise or blame because we have control over our volitions. This control makes us somewhat like God by “making us masters of ourselves” (CSM I, 384). Thus, all humans deserve respect, but it is only through the intellect and the will that humans choose appropriate actions. Animals, of course, are not capable of such actions, so all humans are in a special category of respect. Even animals can be trained, he says in article 50 of the Passions, to have some control over their impulses. They are not acting rationally, of course, but merely responding to training. He says, “For since we are able, with a little effort, to change the movements of the brain in animals devoid of reason, it is evident that we can do so still more effectively in the case of men. Even those who have the weakest souls could acquire absolute mastery over all their passions if we employed sufficient ingenuity in training and guiding them” (CSM I, 348).

This interplay of reason and will, available only to humans, sounds similar to more modern ethical theories, especially those related to Kant and his categorical imperative. Rutherford describes the relationship by noting Cartesian ethics “is crowned by a principle of moral universalism: in virtue of their free will, all human beings have the same moral status and deserve equal moral respect. In this we find an important anticipation of Kant’s ethics, which emerges from a similar consideration of the unconditional value of a rational and free will” (12).

For Kant, our intellectual abilities and virtues of courage, resolution, and so on will be of no value if our will is mischievous. Rather than saying a good will and rationality will make us happy, he says, “A good will appears to constitute the indispensable condition of being worthy of happiness” (445). This echoes Descartes’s claim that we are praiseworthy when our will chooses what is evident to the intellect. Kant also insists that moral thought “is only possible in a rational being, in so far as this conception, and not the expected effect, determines the will” (448). It is only humans who receive praise or blame for their actions, and concern for non-human beings is of no moral significance. Kant says, “Beings whose existence depends not on our will but on nature’s, have nevertheless, if they are irrational beings, only a relative value as means, and are therefore called things; rational beings, on the contrary, are called persons, because their very nature points them out as ends in themselves” (452). Non-human beings are of concern only with regard to what goods they can provide humans. Kant would, of course, have no objection to the vivisection described by Descartes.

On the question of suicide, Descartes and Kant take a different approach, but it seems unlikely that Descartes would object to Kant’s argument. First Descartes tells Princess Elizabeth that suicide is to be avoided because “natural reason teaches us also that we have always more good than evil in this life, and that we should never leave what is certain for what is uncertain. Consequently, in my opinion, it teaches that though we should not seriously fear death, we should equally never seek it” (CSMK 276). In contrast, Kant claims that anyone who seeks suicide would be acting from a self-contradiction. He says, “Now we at once see that a system of nature of which it should be a law to destroy life by means of the very feeling whose special nature it is to impel to the improvement of life would contradict itself, and, therefore, could not exist as a system of nature” (450). Kant’s rational argument would surely not contradict Descartes’s vision of will, intellect, and virtue.

Descartes’s position in the history of normative ethics is similar to his position in the history of philosophy as a whole. Although he set out to establish a new philosophy, he never fully broke with the ancients of the scholastics. Still, he broke new ground and provided fertile fields to be plowed and cultivated by thinkers such as Schopenhauer, Bentham, Mill, and Kant. Even if Descartes was not able to provide a fully developed account of how we should live, he gave considerable details as to what the good life is and how it can be achieved. Rather than trying to determine what his ethical system might have been, philosophers might be better served by trying to determine how Descartes’s ideas can serve contemporary ethical theories. We must be committed to the idea that philosophy can make life better, and Descartes at the very least provides sufficient detail for us to ponder his larger questions.

 

Works Cited

Descartes, Rene. The Philosophical Writings of Descartes: Volume I. Trans. John Cottingham, Robert Stoothoff, and Dugald Murdoch. Cambridge: Cambridge UP, 1985.

—. The Philosophical Writings of Descartes: Volume II. Trans. John Cottingham, Robert Stoothoff, and Dugald Murdoch. Cambridge: Cambridge UP, 1985.

—. The Philosophical Writings of Descartes: Volume III. Trans. John Cottingham,

Robert Stoothoff, Dugald Murdoch, and Anthony Kenny. Cambridge: Cambridge

UP, 1991.

Hick, John. “There is a Reason Why God Allows Evil.” Philosophy of Religion.

Englwood Cliffs, NJ: Prentice Hall, 1963. Rpt. in Philosophical Questions. Ed.

William Lawhead. Boston: McGraw Hill, 2003. 111-16.

Kant, Immanuel. The Foundations of the Metaphysics of Morals. Trans. T. K. Abbott

(1873). Rpt. in Philosophical Questions. Ed. William Lawhead. Boston: McGraw

Hill, 2003. 111-16.

Marshall, John. Descartes’s Moral Theory. Ithaca: Cornell UP, 1998.

Rutherford, Donald, “Descartes’ Ethics”, The Stanford Encyclopedia of Philosophy

(Fall 2003 Edition), Edward N. Zalta (ed.),

URL = .

Schopenhauer, Arthur. Essays and Aphorisms. Trans. R. J. Hollingdale. New York:

Penguin, 1970.

Schopenhauer, Arthur. Philosophical Writings. Ed. Wolfgang Schirmacher. New York:

Continuum, 1994.

Wee, Cecilia. “Self, Other, and Community in Cartesian Ethics.” History of Philosophy

Quarterly 19.3 (July 2002) 255-73.