Rabbi Jon's Website and Blog

Health Care Reform

As the health care debate reaches yet another crescendo, here are some interesting things:

• Statistics from Dr. Ken Dolkart's presentation at Temple Beth Abraham on January 31, 2010.  One of the most interesting was how much the growth in people working in medicine-related administration (offices, insurance companies, hospitals, etc.) has outpaced the growth in the number of physicians starting in the mid-1980s.
  
  
• The famous article by Dr. Atul Gawande about how Medicare dollars are spent so differently in two different places, and the lessons that might be drawn.
  
  
• An interesting and entertaining (!) overview of the American health care system and its costs by Uwe Reinhardt of Princeton, one of the country's leading health care economists.
  
  
• The Rabbinical Assembly, the organization of Conservative rabbis, is a member of Faithful Reform in Health Care, an interfaith coalition.

Dear President Obama -- A Response to a Conversation about Faith and Health Care

On Wednesday, August 19, I participated in a conference call with President Obama on the subject of health care reform.  The call was organized by the Religious Action Center of the Reform movement, in conjunction with the Conservative and Reconstructionist rabbinical associations.  I formulated my response in the form of a letter, which I read in shul last Friday night and am sending to the president.

August 21, 2009

Erev Shabbat

Dear President Obama:

I was honored to join a thousand of my rabbinic colleagues on the telephone with you this past Wednesday, to hear your charge to speak about health care reform in this country when Jews gather next month for the High Holidays.  Just to hear the voice of the president of the United States coming out of my own telephone -- I confess I put it on speaker, so my children could hear too -- it brought me once more to appreciate the great blessings of freedom and equality that we enjoy as citizens of this country.  Little more than a century ago, all my family still lived as they had for centuries in places where because they were Jewish, they did not enjoy the privileges of citizenship.  In places where the government was often their enemy, and certainly not their agent.

Mr. President, you approached us this week as fellow people of faith.  I wondered how you would do that, what would be different in this conversation from your other talks about health care.

You began by reminding us of the most vivid of our prayers on Rosh Hashanah.  We say that on our choices depend who shall live and who shall die, who will have the chance to live out the fullness of life's years and who will not.  Who will be serene and who will be tormented because they don't have the means they need to face life's challenges.

You reminded us that the discussion throughout the country right now is about how we take care of the sick, and whether in fact we do take care of everyone who is ill or injured.  While the talk is about dollars and cents, public options and cooperatives, the real issue is life and death.  Who has the care they need to live, and who will die because they cannot afford it.  You said that caring for our brother and sister and for our neighbor is a teaching of every faith.

Then you told us that you know we hear the stories of medical care denied, as pastors and counselors and open ears in our communities.  And you told us the principles and goals of your reform proposals.

To be frank, Mr. President -- it was a good beginning.  But that was all it was, and I was disappointed.

If we rabbis, and the many other pastors and people of faith you addressed later that day, are going to ask people to raise voices for the changes you seek, you are going to have to do more.  And you are going to have to rely on us, religious people and religious leaders, in a deeper way, as more than a possibly sympathetic interest group.

We're going to need you to be a better teacher.  We're going to need that voice of yours, that prophetic voice, that captivated so many people last year.  Then we might be in a position to speak out, about health care bills moving through Congress, from a standpoint of faith.

So let me presume to give you some teaching advice, and some Jewish advice.

If you are going to teach us, you'll need to remember that telling us the goals of your proposals is not the same as explaining how and why they'll work.  When the financial system collapsed in the 1930s, President Roosevelt's fireside chats were models of clarity.  He explained what a bank is, what a system of banks is, what happens when there's a run and exactly how, step-by-step, his acts would reopen the banks.  Slow down with us.  If someone would trust us and break it down, any of us would listen, even those on the far right or the far left.

For goodness sake, find one of the kids who has been working at Pixar on Toy Story 3 and get her to stand you in front of a green screen.  They do wonders digitally these days -- you could appear to walk with a dollar as it moves from employer to insurance company to hospital to employee or equipment maker.  You could use split screens to show how medical dollars are spent for the same need in Miami on one side, and the Mayo Clinic on the other.  Help us see the savings that are supposed to pay for all this.  Surely all those young folks Tweeting for you in the campaign can help you out here.

On the moral level, I want to tell you some things you can learn from the Jews.

It's true, a lot of people use the word "community" or talk about the general idea of "love your neighbor as yourself."  It's common language, and I know you want to use it to reach across religious lines.  In Jewish ethics, we are very practical about this.  Who is your neighbor?  What is loving your neighbor?  What is the community?

In our Torah reading for this week, in Deuteronomy 21, we get some very specific answers. Here is a fascinating law.  A body is found -- God forbid! -- out in the open, outside a town, and no one knows who killed the person.  The elders and judges of the nation go out, and they measure the distance from the corpse to each one of the towns in the area.  Whichever town is identified as the closest -- the elders of that town are now presumed to be guilty of a murder.

Their only way out is to perform a ritual, involving the blood of a calf that has never pulled a plow, at a pristine river bed not used for irrigation.  They wash their hands, and then they must declare out loud -- "Our hands did not spill this blood, nor did we see what happened."  They say:  We know that we cannot bear to live in a land where innocent people are killed.  Only after the ritual, and their words out loud, is their guilt cleared.

Who is your neighbor?  If it's not a friend or relative, the Torah says:  Take out a measuring stick, and the closest community in miles, that's how you define neighbors.  It's as simple and concrete as that -- you are responsible for a neighbor's life because she has passed this way.

As this ritual was interpreted later, the Talmud sharpens a few details.  The death took place in a remote place, but the leaders of the nation respond, personally.  They can't staff it out.  Whichever town is responsible can't send a small delegation of its leaders to perform the cleansing ritual -- every leader of that town has to show up.

Finally, the Talmud interprets the words at the ceremony.  "Our hands did not spill this blood" -- It's not that anyone thinks the leaders murdered someone.  Rather, the leaders say -- We did not let this person come into our town hungry and leave without feeding him.  We did not let this person think it was safer to go away from us into the wilderness, rather than stay in an unfeeling place.  We did not let this person leave town without an escort as he went into unfamiliar, dark terrain where there might be bandits.  We didn't act like we were responsible only until he left our sight.  If we had seen him, we would have cared for him and protected him, until we could see him to another safe place.  Though we didn't see him, we know that his death is a blot on our community -- because he passed through, and the last place he was whole was with us.

What is "love your neighbor"?  Keep him safe, keep him fed, keep him alive.  What is community?  Community is who does those things, because there won't always be an individual looking who can do it.

Mr. President -- the words of "love your neighbor" don't answer the question by themselves.  So say more than cliches. Tell us that each person who falls ill without access to health care walks with an invisible string unfurling from behind, attaching back to every place she passed while she was in good health.  Ask us what we would do if, God forbid, she became incapacitated or died, and the measuring led back to our community. Ask us if we can truly wash our hands and say we don't see the person who chooses between food and drugs, between paying the rent and seeing a doctor.  I know you like the positive, Mr. President, but as you yourself said, this is about who shall live and who shall die.  Don't let us hide from that.  A little fire and brimstone wouldn't hurt.

To your credit, Mr. President, you are stepping up, just like the leaders in the field from Deuteronomy.  So are many other leaders, at all levels and in both parties.  Some aren't.  Some of those who aren't read the Bible too, so you may want to bring this story from Deuteronomy to them.

I am sharing this letter with my congregation as we welcome Shabbat in our synagogue.  As a religious gathering, we embody even more about the meaning of community.  Some of the people here tonight live here, some come from elsewhere -- yet we know that we are linked.  We know in our bones to identify with people welcoming Shabbat all over this country and the world.  So we know that community is not only the measuring stick, the potentially visible, but also our unseen distant connections.  When you speak to us as people of faith, remind us to teach others what we know about community.  That we are linked, and responsible beyond what our eyes see.  That we as faith communities have a unique role to play because we experience community ourselves in a unique way.
 
You asked us rabbis on the phone to be a shofar, and call out on this matter of caring for the sick.  You please do that better, Mr. President.  Help us see that to you and our other leaders ,this is a matter of conscience and faith.  Then we will find words appropriate to our role.

You closed your call by wishing us a Shana Tova.  Right back atcha, Mr President -- I hope you have a good year too.  I know we need you to.

Shabbat Shalom,
Rabbi Jonathan Spira-Savett