Category Archives: health

The Inhumanity of “Affordable Care”

public-opinion-supports-new-proposal-in-health-care-reform_largeA few days ago, the distraction of actual governance in Washington was the report on Employment, the economy, and the effect of the Affordable Care Act published by the Congressional Budget Office (CBO). As usual, the talking head of Washington, Republicans and the Democratic White House included, missed the point.

“It confirms what we’ve known all along: The health care law is having a tremendously negative impact on economic growth,” said Sen. Bob Corker (R – Tenn).

“At the beginning of this year, we noted that as part of this new day in health care, Americans would no longer be trapped in a job just to provide coverage for their families, and would have the opportunity to pursue their dreams. This CBO report bears that out, and the Republican plan to repeal the ACA would strip those hard-working Americans of that opportunity.” – White House Press Secretary.

The point missed by both sides, and it happens all the time, so often that many of us have become numb to it, is that they are talking exclusively in numbers of a system which is just as well, if not better, described by the lives of the people they serve.

An analogy:
I had cause to take my friend Sharon to a dermatologist she had never visited before. It was an emergency visit. Sharon had been in and out of the hospital for a few months, and one day, at home, her arm blew up. Her slender arm, where she had a pic-line for IV fluids she had to take at home, suddenly, within hours, inflated almost beyond recognition. She called her nurse, and she called me. What I saw was a Thanksgiving’s Day Parade version of her left arm. We took a picture and sent it to her doctor – anything to avoid going to the hospital, which she had already seen too much of. The doctor called ahead to this dermatologist to take a closer look.

I took Sharon there. She filled out the paperwork. Along with Benadryl, ice, and then heat, the doctor diagnosed her with an allergy to the adhesive of her bandages. After two hours, Sharon was all better; tired, but better. We stopped at the office counter on the way out, so that Sharon could make whatever co-pay was needed. The office accountant happily announced, “Your insurance said that you’ve already met your deductible; isn’t that great!”

I’m sure that the woman meant to say something positive at the end of the long visit. She probably didn’t realize that a fulfilled deductible also meant an exhausting road of illness. How could she know all that Sharon had already endured, and that this was just one more stop in pursuit of better health?

Sharon set her straight, “Do you know how sick I’ve been before I reached the deductible? It’s not worth the savings.”

doctor-photoThe Washington Post points out that the CBO was less partisan in its actual findings:

“In its assessment of the law’s impact on the job market, the agency had bad news for both political parties. In an implicit rebuke of GOP talking points, the CBO said that there was little evidence the health-care law is affecting employment and that businesses are not expected to significantly reduce head count or hours as a result of the law.
But the report also contained a setback for the White House. The CBO predicts that the economy will have the equivalent of 2.3 million fewer full-time workers by 2021 as a result of the law — nearly three times previous estimates.

After obtaining coverage under the health-care law, some workers will choose to forgo employment, the report said, while others will voluntarily reduce their hours. That is because insurance subsidies under the law become less generous as income rises, so workers will have less incentive to work more or at all.”

Just as the secretary at the dermatologist’s office spoke to Sharon with only an eye to dollars spent or saved (which really required high expenditures first), so it is when politicians speak about Health Care, as if the care we are speaking about is not about people at all.

I take for granted that both sides, liberals and conservatives, are arguing not about whether or not health care is important. They (ultimately, at least) are arguing about how we should go about providing it. Either because of the political climate and the need to score-or-punish, or, the abstraction of talking about the systems underling funding, both sides have lost the language of human value which underlies the necessity of a government caring for people – real people, such as Sharon.

A parallel exists between the health care debate and the Tower of Babel story.The_Tower_of_Babel
What did God see at the Tower of Babel that was so infuriating? The Torah never tells us, but it was so bad that God could not allow this first Biblical community to continue. Our sages suggest that it was not the building of tower itself, but rather HOW the people went about building the tower that drew God’s ire. The people were so focused on building the tower, they forgot their humanity.

“The tower was built with steps on the east side and on the west. Single-file, each person would climb up on the east side, place the brick, and descend on the west side. When a person would fall from the great height, they people of Babel would lament, “How long will it be until someone can bring up a brick to replace the one that was just dropped?”

As we continue to discuss the affordability of healthcare, I suggest that we, and the leaders we elect into office, have in mind real people in our lives who have been in need of great care. My hunch is that over the next decade or so, we will indeed develop better cost structures in health care. What we can’t afford is losing our humanity along the way.

 

Posted on February 11, 2014

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Sex and violence

six-actsA friend of mine recently posted a link to this blog post about a screening of an Israeli film titled Six Acts. I found the post profoundly disturbing, not only because the facilitator of the discussion whose point was to reduce rape, apparently had very little awareness of the facts of sexual violence, or even because of the comments made by organizers and audience members. I felt disturbed as well because we see such a great deal of sexual violence in our society and we are inclined to write it off in various ways.

As a human being, and as a citizen, it should be enough to disturb me. But as a Jew, I feel that there is a great deal more to be said, and I fear that we are not having these conversations in our community at least in part because in the Jewish community, we struggle with modernity in more than one way:

First, because many liberal Jews wear our “Jewish lenses”—our framing of  the world in Jewish terms- too lightly, and we don’t take seriously the idea of sex as a form of intimacy and holiness, whose performance echoes the divine unification of God. And we do not teach sexuality as a sacred act, which is private and precious, rather than an act which is “for fun.”

And second, we also struggle with the reality that in Jewish culture itself, there is a deep inequality between men and women built into our halachic (legal) system. Even though we in the liberal Jewish communities give lip service to egalitarianism, in reality we have not achieved it, neither in our institutions, nor in our personal lives. A cursory examination of the leadership of our institutions (overwhelmingly male at the top) inequality of pay among not only clergy but also the extreme levels of low pay for traditionally female jobs (including regular airing of news stories in various iterations of Jewish press showing preschool teachers and social workers on welfare).

While these items don’t even begin to match the horror of the situation described in the blog post, they are reflections both of our schizophrenic attitudes towards women, and of the unresolved tensions in our two cultures in dealing with women.

Certainly, the secular culture, too, is deeply invested in not examining its attitudes towards sex and sexuality and women. However, as a Jew and a rabbi, I believe that we are failing our communities in not speaking—yes, explicitly speaking—about sex, violence, and sexism, and about  how Jewish tradition talks about all of these matter—both for good and in ways that we should find disturbing- and in what ways Jewish tradition can offer a better way.

**In the DC area, the excellent organization JCADA offers resources for victims of domestic violence. Jewish family services also often offer counseling services. The (secular) organization RAINN can help the victims of sexual violence find a variety of support services, and all RAINN affiliates offer 24 hour crisis hotlines. If you or someone you love has been a victim of sexual or domestic violence, please contact someone who can help you.

Posted on October 9, 2013

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Happiness is Contemplation

happy-cat1Passover ended less than a week ago.

Many Jews say that Passover is our favourite holiday. And why not? On Seder nights, we gather for food, friendship, discussion, and intergenerational activities. Food – both ritual food and just plain tasty food – sits at the centre of the table.

Passover can also be an exciting project, involving creativity and problem-solving. Some people couple it with spring cleaning. Some host a Seder and creatively adapt tradition in new ways each year. Some try out unusual gluten-free recipes.

Passover falls just six months before everyone’s other favourite holiday: Yom Kippur.

Yes, Yom Kippur, the holiday on which more North American Jews attend synagogue and stay home from work than any other. On which people gather in order not to eat. And to engage in 25 hours of self-reflection, stimulated by the poetry of the prayerbook, set to haunting music.

Who would have thought self-reflection could be so popular?

Nowadays it seems people will do almost anything to avoid being alone with their thoughts and feelings.

Years ago, my fellow commuters and I would sit on the bus, watching the passing scenery and musing about human nature. Now we sit staring down at our smartphone screens, playing, reading or texting.

Years ago, a person would take a walk “to clear my head.” Now, when we walk, we stick earbuds in our ears, and listen to tunes or a podcast as we stroll.

These are popular habits. But they don’t represent a shift in the needs of the human psyche. In fact, our love of self-reflection is alive and well.

Recently, the idea of “Happiness” has been dominating the “self-help” psychology book market. Most books echo a single general theme: Happiness begins with self-reflection.

Gretchen Rubin is the author of the best-selling, down-to-earth book The Happiness Project. Rubin’s website tells you how to begin your happiness project: Ask yourself some questions. “What makes you feel good?” “What gives you joy, energy and fun?” In other words, reflect and begin to know yourself.

Robert Holden is an inspirational speaker and veteran of the Oprah show. His latest book on happiness, Shift Happens, hits you with its message right in the first chapter. To find your “Unconditioned Self,” observe yourself, identify the layers of hurt and grievance that obscure this self, and learn to lift them. In other words, reflect, get to know yourself, and understand how you can grow.

Martin Seligman, a research psychologist, directs the Positive Psychology Centre at the University of Pennsylvania. His website invites you to participate in his research on happiness. You can fill out a questionnaire assessing your emotional makeup, character strength, or work-life balance. The questions start you thinking, “How do I approach life, and how does that contribute to my happiness?” You reflect, you get to know yourself, you understand, you begin to make a plan.

Aristotle’s ideas are back on the best-seller list. In the 4th century BCE, he wrote, “Happiness is contemplation.”

The ideas of Kohelet, author of the Biblical book Ecclesiastes, are making a comeback. Kohelet found that, among life’s ups and downs, “wisdom is a stronghold.”

Often we talk about “finding” meaning, as if we can look outside of ourselves and stumble upon it. Perhaps we should talk more about “making” meaning. Because happiness seems to come through the activity of knowing and growing ourselves.

Ancient and modern teachers agree: Happiness is not a product, it’s a process. A process of reflection, forgiveness, self-assessment, and growth. One that we do over and over again.

In spite of all our habits of avoidance, we can’t help but reach for happiness.

Image: robservations.ca; cross-posted at OnSophiaStreet

Posted on April 7, 2013

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Wrong Blessing. Right.

Three weeks had passed since they had put my daughter’s hand in a cast. A small misstep while working with her coach on goalie throws brought her hand into contact with his head. He was fine but her thumb was injured enough to warrant a cast. Writing, typing, and pouring milk had been hard but showering had been really complex and washing hands completely out of the question. It had been three weeks of soccer, band, and playing with our bearded dragon, all with hand wipes and a wash cloth. The moment the cast came off, she hopped off the chair and ran the water over her hands.

Automatically I offered the blessing, Blessed are you Adonai, creator of the universe who has commanded us to wash our hands. To which she offered a heartfelt AMEN!

The moment could not have been more perfect.

Jewish tradition is filled with blessings. There are blessings for seeing rainbows, meeting great leaders, or getting up in the morning. Each of these myriad of blessings has a particular specialized use and meaning. The hand washing blessings that fit the moment so perfectly was traditionally intended for the ritual hand washing one does before one eats bread. Strictly speaking the blessing was not intended for a celebratory hand washing.

Lately I’ve run into several situations where the “wrong” blessing turns out to be exactly right. There is a traditional blessing meant to be said when a child reaches the age of bar or bat mitzvah. Until that moment, the sins of the child are considered to be the responsibility of the parents, but upon reaching the age of maturity that responsibility passes to the child. The parents get to utter the blessing for being released (asher p’tarani) from “ha-zeh” literally this one or this thing. The impersonal nature and the element of irony (I still feel responsible for my teenage son several years after his bar mitzah) had me- like many contemporary parents- forgoing this blessing.

In the last few weeks, however, with no bat/bar mitzvah in sight, being released from “ha-zeh” was exactly the right blessing. A friend finished up a decade of medical training. Sure there are all sorts of celebratory mazal tovs that could and were offered. But by the end of her high intensity, sometimes less than perfect experience, there was a need to recognize the release from the burden that the training sometimes was -and so this blessing of releae was a great choice. The impersonal final nature of this blessing was also the perfect fit for a friend who after years of struggle to be granted a Jewish divorce. Lacking an official prayer of thanksgiving for a divorce, “Thank you God for releasing me from this thing” was exactly right.

Even when there is a “right blessing” it is not always what comes to my mind. One morning I got a short email from a good friend whose school age child had without warning suffered a collapse of his intestines. He was in significant pain and danger. When news came that a difficult procedure had succeeded in restoring function, midst my tears the words that poured out were not those of the blessing for passing through a life threatening event but the words of Asher Yatzar, usually said after going to the bathroom. Thanking God for making all the openings open, was exactly right.

I know there will be those who object to using the wrong blessing in a non-traditional setting, but I’d love to hear from others who have found important new uses for the ancient wisdom of our tradition.

Posted on November 15, 2012

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One Small PRAYvor

Prayer is a very personal and private thing. In fact, to be honest to a fault, let me say that public prayer, with other people raising voices and turning the pages in unison, has become very difficult for me the past few years.  I prefer the more quite, contemplative pace I can do in my own backyard alone.  Appreciate the professional hazard this truth creates for a rabbi who believes both in the power of prayer and in the power of community.  However you pray, or if you pray at all, and the above admission not withstanding, by the end of this blog, I’ll be asking you for a PRAYvor.

What’s a PRAYvor? It’s a word I made up for when someone asks me to pray for them.  I want to ask you to pray, for me – sure, but more so for some very special people in my life.  Scattered across the globe, from the West Coast, where I live, across the continent, and all the way to Israel are some very special people in my life, all facing surgery within the next seven weeks.

נַחֲמ֥וּ נַחֲמ֖וּ עַמִּ֑י יֹאמַ֖ר אֱלֹהֵיכֶֽם.

Be comforted, indeed be comforted, says your God. -Isaiah 40

These are the opening words of this week’s haftorah (the week’s reading from the Prophets).  This is first of seven weeks which count from the the fast day of the 9th of Av. (commemorating the destruction of the Temple (to read more about that, click here) to the beginning of the Jewish New Year, Rosh Hashanah.  It is during this time period that we start to prepare ourselves for the spiritual work of the High Holidays ( for more on how we prepare, see Rabbi Rebecca Sirbu’s blogpost from yesterday).  One way to prepare is prayer, including prayers for health.

I believe that prayer works in healing the mind and the body.

  • On a rational level, I pray like Maimonides, for the wisdom of the doctors and nurses who heal (click here for a download of the English Translation of his Prayer for the Physician).
  • On a meditative level, prayer works to calm the mind and the body, so that we can go on to do the healing we need to move toward.
  • On the metaphysical level, I believe that prayer can do wonders for the person who prays for another (as empathy grows, spiritual awareness deepens), and, prayer can help in the healing process itself (click here for the now classic double-blind National Institute of Health Study of 1998, or here for a much more recent blogpost on the Huffington Post by Candy Gunther Brown, author of Testing Prayer: Science and Healing, Harvard University Press ).

Some people are natural prayers, or have learned how to move themselves to that deeper place through practice.  If that’s you, you know what I’m asking you for, but I know many people who find prayer very difficult.  It’s okay, I get it; I’ve been there myself.

I said “pray for me”, and I wouldn’t mind that at all.  There is no getting around it, while I have every reason to believe that the special people in my life that are getting ready for surgery will emerge ultimately healthier than before, I’m still anxious.  Here’s what I pray when I’m focused on anxiety:

הָ֭רֹפֵא לִשְׁב֣וּרֵי לֵ֑ב וּ֝מְחַבֵּ֗שׁ לְעַצְּבֹותָֽם׃

“God heals the broken-hearted and binds up their wounds.” -Psalm 147:3.

Much more importantly than for myself, I’d like to ask you for a PRAYvor for the special people in my family and beyond, and for the people that you love and care for who could use our prayers of healing.   Over the next several weeks, until Rosh Hashanah (this year it begins on the evening of Sunday, September 16), take a moment each day to pray for those in need of healing, whomever, and wherever they are.

Prayer doesn’t come naturally to everyone.

Need words to start off with? You could do worse than the meditative opening words of the verse quoted at the top of this post:

Nachmu, Nachamu – be comforted, indeed be comforted.”

Need a melody? There are many. I love the melody from my buddy at Temple Aliyah in Woodland Hills, CA, Cantor Mike Stein.  He wrote an evocative modern/classic “Refaenu, Heal Us” (click here to listen), or the late, great, Debbie Friedman classic, Mi Shebeirach (click here to listen and watch  her on youtube).

However you do it, please do it.  If you’ve never been much of a pray-er before, I know it can seem awkward, but despite that, I’m still asking you for this one small PRAYvor.

Posted on July 31, 2012

Note: The opinions expressed here are the personal views of the author. All comments on MyJewishLearning are moderated. Any comment that is offensive or inappropriate will be removed. Privacy Policy

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