>Some Thoughts On Health Care…

>Dear Friends,

The bimah or a synagogue blog is not the place for partisan politics. Since the debate (or non-debate) over healthcare reform largely breaks down along party lines one might make the argument that clergy should not weigh in on the matter.
I would respectfully disagree. For while the specifics of a healthcare reform plan may not be appropriate for the pulpit, the NEED for reform, and the commitment to helping those less fortunate gain access to healthcare IS a moral and religious issue.
That was the reason I chose to discuss healthcare during the High Holy Days last year. And it is why I have decided to break from my own personal preference not to publish words that are intended to be oral not written (since so much is potentially lost) and share last year’s sermon.
Again, I am not advocating for or against any specific aspect of the healthcare bill. I do, however, believe that the status quo is unjust. There must be reform– and attempts to undermine ANY possibility of change, rather than refining the specifics in such a bill, are at best problematic and at worst immoral.

Sermon- Delivered High Holy Days 2009
You are twenty-two-years old. You have cervical-cancer but are denied reimbursement for your treatment because someone at your insurance company thinks “you are too young to have the disease;”

You are seventy-nine-year-old. You are on Medicare but you pick up trash at the local Pathmark to pay for medication;

You are thirty-three-years-old. You sew up a trickling five-inch gash in your leg with kitchen thread, because you don’t have medical insurance.
You are a 42-year-old rabbi. You are forced to order one medication from Canada because your health insurance company deems it (quote) “medically unnecessary.”
Over the past six months I have become a statistic in our nation’s on-going healthcare crisis. One minute my insurance company covered my medications. The next they didn’t. Why? Because they decided I didn’t need it. So I now buy an inferior quality medication from India through Canada because purchasing it here in the US is prohibitively expensive. I have health insurance. I have access to the best medical providers, the most current information, and physicians who are committed to advocating on my behalf. And still, I am constantly fighting to receive the treatment deemed necessary by my physician and proven effective by my experience.

I share this because my story is the story of far too many Americans today. According to the US Census Bureau over 46 million Americans have no health insurance. And that number is rising. Perhaps most tragic is the fact that one million of the uninsured are children.
It is a known fact that the uninsured are in worse health and die sooner than those with access to healthcare.
We may be the most powerful nation in the world, but we consistently score at or near the bottom compared to other developed, high income nations when it comes to infant mortality, life expectancy, and the proportion of the population who have real access to health care. It is a disgrace- not only from an economic and social policy- perspective, but from a religious perspective.

How we deal, or do not deal, with the healthcare crisis speaks volumes about who we are as a society. It reveals our ethics. And it reveals our religious view of the world. Our nation’s failure to deliver adequate healthcare to every one of our citizens is a violation of a profoundly religious value that has been handed down through the generations.
“Do not stand by idly by the blood of your neighbor,” we read in the book of Leviticus.
When our neighbor is bleeding or in need of care we have an obligation to offer assistance. Judaism is unambiguous in this regard. When we live among those without access to healthcare, we are required to help them obtain the care they need and deserve.
Jewish tradition regards the practice of medicine, and by extension people’s access to it, as a mitzvah– a religious obligation. In fact, access to healthcare for each and every resident is first on Maimonides’ list of the 10 services a community must provide. (Mishnah torah Sefer Hamadda iv:23) Moreover, Jewish law requires that when the need exists, the community must provide funds to ensure access to medical care for all. (Shulchan Aruch Yoreh Deah 249:16)
According to Steve Gutow, Executive Director of the Jewish Council for Public Affairs,
”the sacred texts and traditions of Judaism teach us that healing the sick is not a matter of choice, but is our responsibility as God’s Servants. “(from cover the uninsured)
One of the great tragedies of our broken system is that physicians take the Hippocratic Oath to provide the best care possible to their patients— and then are not permitted to do so. Insurance companies consistently overrule them; doctors are told which medications they can prescribe and what procedures they are permitted to perform, without consideration for their expert medical opinion.
In The New Yorker Magazine physician, Atul Gawande writes,

“Just this year, in my own surgical practice, I have seen a college student who couldn’t afford the radiation treatment she needed for her thyroid cancer, because her insurance coverage maxed out after the surgery; a breast-cancer patient who didn’t have the cash for the hormone therapy she needed; and a man denied Medicare coverage for an ambulance ride, because the chest pain he thought was caused by a heart attack wasn’t— it was caused by a tumor. The universal human experience of falling ill and seeking treatment—frightening and difficult enough—has been warped by our dysfunctional insurance system.”

Our current system increasingly forces physicians to be technicians and businesspeople rather than healers. Reimbursements are often so low and malpractice insurance so high that an increasing number of doctors must become factories– seeing as many patients in a day as possible. In extreme cases physicians leave specific disciplines entirely—with the best trained and the most experienced often the first to go. That is not the Jewish way.

“I believe,” writes Dr. Rachel Naomi Remen one of the earliest pioneers in the holistic health movement, “that medicine is in a time of crisis. Most people would characterize this as an economic or political crisis, or a crisis of patient access, that sort of crisis. But I think the real crisis in medicine is a spiritual crisis, a crisis of integrity. It has to do with the system, an infrastructure that makes it difficult for people to live by their life values, to relate to people in ways that are compassionate because of economic or time pressures and the policies that come from them. It makes people unable to practice their service according to the best they know, not just scientifically, but also spiritually…” (pages 28 and 29)
What kind of nation trains the best medical professionals and then ties their hands by not permitting them to do what they know is right for the patients they serve?
The most respected Jewish lobbyist in Washington, our own, Rabbi David Saperstein notes that our Jewish religious obligation derives from the concept of Hatzalat Nefeshaot—the saving of a human life. In our tradition, he points out; the worth of each person is not determined by socioeconomic standing, education or political connectedness. The worth of each person is determined by the fact that we are each created in God’s image. Period.
“Oh God, inspire me with love for all thy creatures.”
The great Maimonides, who was both a physician and a rabbi, would pray before seeing a patient, “May I see in all who suffer only a fellow human being.”

Our Reform Movement’s position builds upon Maimonides’ prayer, stating

“…every member of the community (should) enjoy a right to adequate medical care…. To deny medical treatment to human beings because they cannot afford to pay is repugnant to any decent conception of what torah requires of us.”

Health care cannot be a private club for the rich. It is not a luxury. To paraphrase our High Holy Day liturgy, money should not be the arbiter of who shall suffer and who shall not, nor who shall live and who shall die. And every day that we allow the current system to continue is another day that we shirk our religious obligation.
“…if anything is needed in this world today” says Dr. Remen, it is “the ability to move beyond our differences and respond with compassion to the pain and trouble of people whose names we don’t even know, who share with us only the bond of a common humanity.” (Pages 28 and 29)

The system is broken. Everyone knows it, but no one fixes it.

In part, I believe the problem comes from a lack of courage and commitment among our leaders. Every proposal that is introduced is attacked by both sides of the political aisle. The plan does too much… or it does too little. The plan is too expensive, or not enough is earmarked for it. The plan does this, or it does that. Everyone attacks it and nothing gets done—and people continue to suffer and die. Healthcare isn’t a partisan issue. It is a moral one.

When speaking to an audience in Cleveland after the Senate Finance Committee approved an expansion of the Federal Children’s Health Insurance Program to cover nearly 10 million children, President Bush threatened to veto the bi-partisan proposal. “People have access to health care in America,” he told the audience “After all, you just go to an emergency room.”

The president is correct. If you are sick there are public hospitals that will treat you on an emergency basis. But as everyone knows, medical services via the ER cost considerably more to the individual than a visit to the doctor’s office. And if the individual is unable to pay, society picks up the tab. Moreover, using the Emergency room in this way often means people have become far more ill before seeking treatment. A far more cost-effective and ethical approach, is to provide preventative care in the first place.
On May 25th, 1961, while speaking before a joint session of Congress, President John F Kennedy stated,

”I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to the Earth.”

A year later he stated,

We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard…

Imagine if he had instead said,

“Perhaps we should go to the moon? Let’s see if it is financially feasible, politically prudent and socially popular. If it is, we’ll come up with a way to get there.”

Kennedy understood only too well that the only way to achieve a difficult goal or solve a challenging problem is to be fully committed to finding an answer. And we’re not.
I do not know what the solution is but I do know that something is terribly wrong. People shouldn’t have to suffer or watch their loved ones suffer unnecessarily or even die because they can’t afford healthcare.
And I do know this—
I know that our congregation sprang into action after Hurricane Katrina devastated the Gulf Coast. As we should have.
I know that our community continues to speak out about the outrages in Darfur. And we must continue to do so.
And I know that until every one of us demands a real solution to this crisis– through our words, our actions and our votes— nothing will change.

And I know that we have been far too silent, for far too long, while children living just a few miles from here go without the most basic of health care.

And that’s just wrong.

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