Late last week, I skyped with an old, dear friend, Raj Thamotheram, and hung up with a lump in my throat. Several months ago, he wrote:

Early on Wednesday 9 November we learnt that Donald Trump would be president of the US, and two days later I heard I may have a cancer. Since then, it has been confirmed that the cancer is large, worrying and cannot be magically removed. Outwardly, I look well, but inside, this malignant parasite has been growing – silently – for some years.

It was the first time I had communicated with Raj since learning the news. I had the courage to express my affection, but not enough to give voice to all that was in my heart: how do you tell your friend “I don’t know if I will see you again” and “I should have done more to keep in touch?”

Raj lives in London. He has access to universal health care and, thanks to National Health, he is heading to the seaside this summer day to celebrate his birthday.

A few hours after my call, the U.S. Senate started a marathon series of votes on health care, weighing options from cruel to simply callous. In the dead of night, we came one vote away from depriving 16 million people of their health insurance. One vote.

Today, we breathe a sigh of relief for all those who will continue to have access to life-saving medical care. But for me, and I suspect many others, this victory is bittersweet. We continue to ask ourselves: “how can it be that our leaders were seriously debating whether to take away health care from 16 million versus 23 million Americans? When did it become acceptable for the Congressional leadership to demand $150 billion in cuts to food stamps? What kind of country do we live in, where the Environmental Protection Agency is leading the charge to roll back rules protecting our groundwater and drinking water?

All of that happened in just the last week. We find ourselves facing an Administration and a Congress who simply do not believe that Americans have a collective duty to protect the common good and take care of the vulnerable. Things we think should be a human right – like health care or clean water – are not managed in the public interest for the benefit of all. They are viewed from the lens of profit.

Access to health care is not considered something every person should have, but a commodity to be doled out to those who can afford it via corporations who are on the take. And take, they do. A recent report shows that since the Affordable Care Act was passed, CEO compensation for health companies has shot up. The CEO of Gilead Sciences, which makes drugs to treat AIDS, HIV and hepatitis C took home $900 million.

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Similarly, under this Administration, clean water is not considered a human right, but red tape -- hindering polluters and impinging on their profits. Our great outdoors and our oceans are not considered our shared natural heritage, but resources to give away to oil and gas companies. Food stamps (SNAP benefits) are not seen as a vital safety net for our elders, family and children, but as “big government.”

How did we get here? Part of the answer I think is the result of decades of misguided ideology that has“exalted unrestrained markets, denigrated government and maximized the influence of corporations over our economic and political lives. Today, functions that were once the domain of the public sector – from the provision of services to the protection of our commons, to the fighting of our wars and even the writing of our laws – have been taken over by corporations that put profit before the public interest.”

This Republican Congress seems more driven by this neoliberal ideology than common sense or compassion. Policies promoting “freedom,” “jobs,” and “prosperity” translate into depriving people of life-saving medical care, clean water, and food.

As a society, when our sense of commitment to each other fades, our radius of caring shrinks as well – first to those who look and speak like us, and eventually to only those in our inner circle. It becomes easier for us to think that “those people” without medical care, clean water, or food deserve their lot. We fail to see ourselves as part of what Dr. Martin Luther King described as “an inescapable network of mutuality, tied in a single garment of destiny.”

So what can we do when it feels like a policy battle has been won, but we are slowly losing our humanity?

We must work hard, have hope, and continue to make things better. In the words of my friend who is battling cancer, but still celebrating another birthday:

Some say I should be ‘optimistic’ just as some say we should be optimistic about Trump and other populists. Rabbi Lord Jonathan Sacks has explained why optimism in these times is unwise: “What has happened is a failure to understand the difference between optimism and hope. They sound similar but they are quite different. Optimism is the belief that things will get better. Hope is the belief that, if we work hard enough, we can make things better. Between them lies all the difference in the world.”