Health Care Reform — If Not Now, When?

Rabbi Joel Fleekop

Yom Kippur — Monday, September 28, 2009

Jacqueline, a woman in her 60s, is facing a crisis — though not the first time in her life.

As a child, Jacqueline struggled with a slew of respiratory illnesses and was forced to spend months in an iron lung. In her 20s she was diagnosed with cervical cancer.

Thanks to some good luck, an incomparable spirit, the support of family, and the blessing of modern medicine, Jacqueline was able to overcome these early life health crisis.

Diagnosed cancer free, Jacqueline spent the next three decades of her life making the world a better place. She worked with special education students, organized teens in their efforts to assist the less fortunate, and helped people of all ages connect to their faith.

But a few years back, a chronic illness forced Jacqueline to leave a job she loved.

While grappling with what it meant to no longer work, Jacqueline was confronted with another new reality — the loss of her employer provided health insurance.

Though eligible for disability, it would be several years before she could get on Medicare. No longer part of a group plan, her preexisting conditions made getting private insurance impossible.

Ultimately Jacqueline found coverage under COBRA. While thankful to be insured she is overwhelmed by the cost. Between premiums and prescriptions, she pays more than $1,000 a month — and that is without seeing a doctor.

With only a disability check for income, the cost of health insurance and medicine are quickly eating away at her retirement savings. Jacqueline worries about the future and is afraid of becoming a financial burden on her children.

Jacqueline’s story is a lot like those we read about over the summer in the newspaper or those told time and again by politicians. But there is one important difference. Jacqueline isn’t an anonymous woman from across the country. Jacqueline is my mom, Jackie.

This is my mother’s story, and the story of how my family is affected by our nation’s health care crisis.

I tell it today not because having such a story is unique amongst the congregation, but rather because it is so common. As I’ve learned over the past few years, many if not most of our families have a health care story to tell.

Some of those stories are told by Shir Hadash parents who worry what will happen when their child graduates college or ages out of a parent’s insurance policy. Will their son or daughter be able to find a job with health benefits? What if the child has a pre-existing condition? Will that be covered under a new plan?

The health care stories of our members who are self-employed, own small businesses, or who don’t get medical benefits at work often revolve around the financial challenge of keeping up with health care premiums — an expense that has nearly doubled in the past decade.

Other stories are told by our seniors, who spend hours on the phone fighting for the benefits they deserve, and by our members who have recently battled illness. When people are sick we tell them to focus on getting better. But when I visit congregants in the hospital their minds are often on other things. All too common, there are fears that a certain procedure might be excluded from coverage and worries about how much everything is going to cost. These distracting and draining concerns are part of their health care story.

Doctors and nurses within the congregation also have important stories to tell. These heroes of healthcare went into medicine to help people — and they do every day. But they are also increasingly frustrated with how much time and energy is consumed by paperwork, bureaucracy, and pre-approvals.

And regrettably, these past twelve months more and more of our members have been telling the story of finding themselves suddenly without health benefits. Whether because they were laid off or health insurance was given up as a concession to save co-workers’ jobs, the cost of medical coverage now rests on them — and it is a struggle to squeeze insurance premiums out of an already tight budget.

And there are so many other heart-wrenching stories.

Within our Shir Hadash community there are families delaying treatment or skipping pills because of the expense, and families driven to bankruptcy by hospital bills. There are Shir Hadash families whose medical costs have them worrying about outliving their savings, and Shir Hadash families playing a 21st century version of Russian Roulette — going periods of time without insurance coverage because they simply can’t afford it.

By now we have all heard the statistics. We know that 47 million Americans are without health insurance, that 60% of all bankruptcies are linked to medical expenses, and 45,000 people die in this country each year from lack of care. We know the statistics. But behind the numbers are real people: people from across the country and yes, people in this congregation.

In Pirkei Avot, Rabbi Hillel asks, “Im Ayn Ani Li, Mi Li — If I am not for myself, who will be for me?”

In speaking out for health care reform we advocate for members of our community and for ourselves. As Rabbi Eric Yoffie, President of the Union for Reform Judaism shared in his 2007 Biennial sermon “Providing health insurance for all is about helping a family member, a neighbor, or a fellow citizen because, next time, any one of us could be facing catastrophe. It is not just about them, it is about us.”

Health Care Reform is about us . . . and our safety net. But reform is also about us living our Jewish values — for Rabbi Hillel continues, “Uk-sh’ani l’atzmi, mah ani — If I am only for myself what am I?”

As the prophet Isaiah reminded us in this morning’s haftarah, caring for others is the fast God truly desires.

In our reading Isaiah speaks of providing food, clothing, and shelter — but within Jewish tradition health care is considered no less of an essential need — no less of a right deserved by every human being.

The Holiness Code in Leviticus, from which we will read this afternoon warns, “do not stand idly by while your neighbor bleeds.” And the Talmud, Masechet Babba Kamma instructs, “whoever is in pain lead him to a physician.”

Saving a life — Pikuach Nefesh is considered the highest of Jewish values. So precious is a life that the rabbis teach one can violate the rules of Shabbat, Yom Kippur, every command in the Torah, save three, if doing so leads to preserving a life.

Rabbi Abraham Joshua Heschel writes, “the act of healing is the highest form of imitation of God.” And so it is that those who are the primary instruments of healing — doctors, nurses, and others involved in medicine, are held in high regard. But with high regard comes great responsibility.

Jewish tradition forbids withholding medical treatment from a person in need. At the same time, our sages offer praise for medical professionals who show concern not only for the health but also the dignity of the poor. One such healer is Abba the Bloodletter.

As the Talmud describes, Abba knew that many of his patients couldn’t afford his fee. But he also believed that without his services their health would be in danger. And so Abba developed a unique method for collecting payment. He placed a box in his office, out of his sight and that of the public, where his fee for healing was deposited. Those that could afford to pay placed their money in the box; and those who couldn’t afford to pay didn’t have to and were not ashamed.

Elsewhere, the Talmud explains that Abba made a habit of providing his poorest of patients, students in the bet midrash, with money for a meal so they could strengthen themselves after the procedure.

In rabbinic writings, Abba is often held up as an example to others in the healing professions. But while a doctor is encouraged to make accommodations for the poor, ultimately the responsibility for providing access to health care for those in needs rests with the community as a whole. A 1994 CCAR Responsa asserts, “The commandment of pikuach nefersh is addressed to all of us. The physician has no greater obligation than does anyone else to save life. . . they are agents of the community. Thus, if it costs money to perform the mitzvah [of saving a life], the expense ought to be borne by the community, by all of us together.”

This modern responsa — or rabbinic ruling, is part of the Union for Reform Judaism’s long history of positions and resolutions calling for universal health coverage, a call first issued by our movement in 1975. But the Rabbis and leaders of the Union for Reform Judaism were not the first to highlight a community’s responsibility for healthcare.

In his Mishneh Torah, the great twelfth century scholar Maimonides lists a physician and a surgeon as two of ten essential services a city must provide for its residents. And in fact, throughout history almost all self-governing Jewish communities provided health care for their rich and poor residents alike — a tradition continued on today in the State of Israel.

The Shulchan Aruch — the definitive Jewish law code, teaches that even when resources are scarce, caring for the sick must be a priority. As we read in Yoreh De’ah “the commandment to give money to the indigent sick takes precedence over even the commandment to build and support a synagogue.”

In Jewish tradition, providing universal health care means more than just treating acute illnesses — if that were the case our current reliance on emergency rooms might suffice — albeit it, in a very inefficient way. Rather, it also means providing the preventative care necessary for long term health. As Maimonides writes, “a person should see to it that the body is kept healthy and strong in order that they may be upright to know God. For it is impossible to understand and comprehend wisdom when one is hungry and ailing or if one’s limbs ache”

This summer our nation watched in amazement as tens of thousands of people lined up in and around the Inglewood Forum to receive medical treatment. The huge crowds that gathered — several times what the organizing Remote Area Medical expected — bore testimony to the millions in our country who go without dental visits, blood pressure checks, eye exams, immunizations, and mammograms. This may be considered preventative care, but it is care that saves lives.

The event in Inglewood opened eyes around the country. But for many of us at Shir Hadash, our eyes were already open and fixed on this acute need. For the past four years our congregation has organized a health fair on the East Side of San Jose. Each year our organizers and volunteers diagnose scores of people who didn’t know they had hypertension, diabetes, or other chronic illnesses. We offer eye exams and fix people’s teeth. Our health fair makes a huge difference in the community it serves — but it is just one community, and only one day.

Something more has to be done. Our Jewish values demand it.

And so we return to Rabbi Hillel, who closed his teaching “Im Ain Ani Li, Mi Li? Uk’she’ani l’atzmi mah ani? — If I am not for myself who will be for me? If I am only for myself what am I?” with a third question. “V’Im Lo Akshav, Eymatay — If not now, when?”

The opportunity that exists in Washington, as well as the urgency of need make now the time for reform.

As many of you know, national efforts to reform health care date back to Teddy Roosevelt. But never before has there been so much traction in Washington — perhaps because never before have so many Americans been affected. A full one fifth of all US citizens are either uninsured or underinsured — a staggering 70 million people.

One of the special prayers we read on Rosh Hashanah and Yom Kippur is the Unetanah Tokef. This powerful piece of liturgy describes God inscribing in the Book of Life who will live and who will die — who will perish by flood and who by fire, who by sword and who by beast.

We understand the prayer metaphorically — but in a very real sense the debate over health care reform is about these life and death questions. Who will die from a preventable heart attack and who from an untreated infection? Who will die from a curable cancer and who for lack of immunization?

In the time that I have been speaking, a fellow American has died for lack of care — and another dies roughly every 12 minutes. Expanding health care coverage in America is literally a matter of life and death.

And so we must do all we can to urge reform now.

Some of you may want to get involved with SHOC — the Shir Hadash organizing committee. Based on the findings of their listening campaigns and house meetings — which identified health care as the issue most important to our members, SHOC has been working on the issue of expanding health care coverage — both locally and nationally — for several years. A few years back they led the local push to expand SCHIP and earlier this summer organized community meetings with Congresspersons Lofgren and Honda on the issue of health care reform. I know the members of SHOC welcome your support and energy.

You may also want to speak with your friends and neighbors and let them know why health care reform matters to you and your family. It is a powerful moment when people realize the failings of our nation’s health care system affect Americans in every neighborhood in the country — including their own.

And of course we can call or write our congress members and senators. This type of involvement may seem trite — but it makes a difference; especially when we are willing to share our own health care stories.

Based on the Jewish Values of Pikuach Nefesh — the primacy of saving a life, and B’tzelem Eloheim — the dignity inherent in every person, the Religious Action Center of Reform Judaism — our movement’s voice in Washington D.C., has highlighted affordability and near-universal coverage as goals for reform. As you speak with your elected officials, please ask that whichever proposal for reform they support, it meaningfully addresses these important issues — these important values.

What health care reform will ultimately look like — even what proposals our senators and congress members will have a chance to vote on remains a question. On this the holiest day of the year I will not speak on or advocate for details of policy and politics: whether there should be a public option or not; whether single payer is the only real solution or that all we need are some minor changes — like tort reform and tax credits — to fix what ails our current system. As my teacher, Rabbi Don Goor writes, “the great power that Judaism holds is not to enact legislation. Our greatest power is to advocate for our vision of society.”

That is our greatest power and that is our responsibility.

In this, the season of growth, change, and reform, let us share our vision for reform. Let us speak out for a society in which our friends, neighbors, and our own families are protected from the financial devastation of illness. Let us share our vision of a country in which all have access to the care they need. And let us call for reform this year.

For as Rabbi Hillel teaches, If I am not for myself who will be for me, If I am only for myself what am I? And If not now, when?