On a single day last week, we were stunned by news of the Charlie Helbo attack in Paris and a bomb going off at an NAACP office in Colorado. At the same time, this day was no different than any other: our media regularly saturates us with stories of death and violence. In her prophetic book All About Love, bell hooks describes this phenomena as a symptom of America’s death-obsessed culture. She says, “It may very well be that…the constant spectacles of dying we watch on television screens daily, is one way our culture tries to still that fear [of death], to conquer it, to make us comfortable.” Our culture’s efforts to comfort us and conquer our dread depict deaths that are sudden, faceless, and violent. This ultimately deepens our anxiety about death.
The day before, in my role as rabbi of the VNA-Hospice of Philadelphia, I gave a blessing to the social workers, nurses, administrators, and chaplains with whom I work. Words of blessing came easily as I beheld a roomful of people engaged in holy work. The hospice staff regularly facilitates family conversations about what is important to loved ones at the end of their lives, and does its best to care for the dying according to their desires. My coworkers and I often need to initiate these conversations because, as hooks writes, “The more we watch spectacles of meaningless death, of random violence and cruelty, the more afraid we become [of death] in our daily lives.”
We feed our anxiety when we only hear about death “out there” and deny it is also part of our story, and can even be a meaningful and peaceful part of our story. A 2013 survey says that 90 percent of Americans believe it is important to discuss the way we want to live at the end of our lives while we are able, but less than 30 percent of us actually have had this conversation: Parents don’t want their adult children to worry about them; children don’t want to think their parents will ever die. Locked into a mutual conspiracy of denial, families wish they had spoken only when it is too late. A recent Institute of Medicine report notes that most people nearing the end of life are not “physically, mentally, or cognitively able to make their own decisions about care.” According to many doctors, how we end our lives is the most important and costly conversation America is too afraid to have.
Fortunately, recent initiatives like The Conversation Project are shifting all of this. In collaboration with “Death Over Dinner”, adults of all ages have begun, over the last few years, to discuss their wishes for end of life care at a structured dinner party using guiding questions like, “How long do you want to receive medical care?”, “How involved do you want your loved ones to be?” and “What role do you want them to play?” Having these conversations over dinner, or tea – as long as we have them – improves our chances of receiving the type of care that we want, and helps decrease family discord should our families be called upon to make these difficult decisions for us. Perhaps, when we make the choice to confront our cultural anxiety and acknowledge the inevitability of our own death, we can give ourselves to love and to life more fully.
A 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.
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.”
The 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.
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.
As a synagogue rabbi, I feel as if we have been running a religious marathon for the past month. since. After the majesty, power, and spiritual rigor of Rosh Hashanah and Yom Kippur, building a sukkah, celebrating eight days of Sukkot (along with the under the radar holiday of Shmini Atzeret that no one understands), and partying through Simhat Torah, I admit to a little religious exhaustion. I am sure that, for some of us, there is no end to the amount of time we want to spend praying in communal settings. But I get the sense that, for many of us, we are all shul-ed out. Our spiritual and ritual reservoirs are depleted, and the thought of setting foot in synagogue anytime soon is anathema.
So now what? We have nearly two months before we can start talking again about how weird it is that Hanukkah will occur before Thanksgiving this year. We have almost a month before we can start debating the propriety of Jews celebrating Halloween. So where should we put our religious-cultural energies?
Well, it just so happens that our political system has gone completely batty since we left 5773. Our political leaders are so dysfunctional that, today, the federal government has been shut down. Why? Though cable news outlets and partisan websites will try to spin the shutdown in different ways, the facts are pretty simple: the leadership of the House of Representatives, including the Jewish Majority Leader Rep. Eric Cantor, refuses to introduce a bill to fund the federal government without simultaneously trying to stop or at least delay the implementation of Obamacare. The actions of the House—re-litigating a law that was already passed by Congress, signed by the President, affirmed by the Supreme Court, and re-affirmed by the American people when they re-elected President Obama—are reprehensible and demand condemnation. Were there no side effects to shutting down the government, the actions of the House leadership could be dismissed as childish. But at a cost of millions of dollars daily, with hundreds of thousands of now-furloughed government workers, shutting down the government because you are mad that a law is going into effect is fiscally and morally irresponsible. As Republican Representative Devin Nunes recently put it, “It’s moronic to shut down the government over this.”
Obamacare, which gives millions more Americans access to health insurance, also is a Jewish issue. Many Jewish legal texts speak the necessity of the community providing access to health care for all. For example, the Talmud teaches that “a Torah scholar should not live in a community unless that community has available medical care.” (PT Kiddushin 4:12 [66b] and BT Sanhedrin 17b). Moreover, “doctors are required to reduce their fees for the poor. Where that is still not sufficient the community should subsidize the patient.” (Shulhan Arukh, Yoreh De’ah, 249).
I think it is time for the Jewish community—clergy and laity alike—to start agitating for common-sense political actions that are deeply steeped in our tradition and that should resonate morally for all of us. We—especially those of us who live in Republican districts—should demand that our representatives pass a simple budget without partisan gamesmanship so that the government reopens. We also should demand that the House pass the Senate’s immigration reform bill, another piece of legislation that is so central to the Jewish narrative of being strangers in foreign lands. And we should demand that Congress pass gun control legislation that imposes more stringent background checks and gun lock requirements.
There are many issues which we, as diverse individuals with diverse viewpoints, can and should disagree. On intervention in Syria, for example, I would strongly caution any Jewish leader from claiming a mantle of Jewish consensus. But where there are issues that are integral to our moral sensibilities—health care, immigration reform, and gun control among them—we should be bold advocates. We should amplify the chorus of the reasonable over the din of the extremists who seek to hold American politics hostage to their radical agendas. Let’s take those spiritual investments of the past few weeks, the existential grappling and the communal celebrating, and channel them into transforming the world in which we currently live into the kind of world we want it to be.
A few posts ago, while the Supreme Court was still hearing arguments on the legality of the Healthcare Act, I said, “If the Supreme Court strikes-down the Health Care Act, and we have to start health care reform all over again, instead of fixing the imperfect beginnings that are already underway, I’m just going to freak out.” So, it has passed, as a tax and not under the Inter-State Commerce Clause, but in any case, now we’ll have it- Obamacare (properly referred to as The Patient Protection and Affordable Care Act).
What does this mean to congress? Not much. And that’s the nature of sinat hinam, baseless hatred. The rabbis of the Talmud said that it was for baseless hatred that the Second Temple in Jerusalem was destroyed in 70 C.E. If the Democrats like something than you can be sure the Republicans will hate it, and vice versa.
This type of tit-for-tat bickering is not just exhausting for the country to watch, but it’s downright destructive for our society, which, before politics became so partisan and divisive, prided itself on the strength of our diversity.
Consider the classic cautionary tale about why Jerusalem was destroyed. There was a mix up on the invitations to a party. Two men whose names sounded awfully similar each thought that they were the rightful guest at a party. The problem is that that hated each other, couldn’t stand each other, and nobody set them straight. Even the sages that were present at the affair said nothing. You can read the whole story here, but to get to the juicy part, one of the men incited the Romans against the Jews. He told Caesar to send the Jews a goat to sacrifice at the Temple, a goat that would seem perfectly fine by Roman standards, but that the Jews would find blemished, unfit as a holy offering at the ancient Temple:
The Rabbis wanted to offer it, despite its disqualifying blemish, to preserve good relations with the authorities.
Rabbi Zekharya ben Avkolus said to them: “People will then think that blemished animals may be offered upon the altar.”
They wanted to kill the person who brought the animal, so he could not go and inform on them. Rabbi Zekharya ben Avkolus said: “People will say that anyone who places a blemish in a sacrifice should be killed.”
RabbiYochanan said: “The humility of Rabbi Zekharya ben Avkolus destroyed our temple, burned our sanctuary and exiled us from our land.” (Gittin 55b-56a)
By analogy, the debate regarding Obamacare , even after Chief Justice Robert’s tie-breaking vote to affirm the legality of the law, is likewise so toxic that it feels like we’ve been boxed in. In truth, nobody loves the law as it stands, Democrats wanted more, and Republicans in the House have already set a date to repeal it (July 11th).
What we know will happen with this admittedly (by everyone) imperfect law, is that when the cracks start to show, Conservatives will say, “we told you so.” You can set your clocks to it. And, they’ll be right.
But here is where we should learn the lesson of baseless hatred: When the costs rise instead of fall, or coverages shift in ways we did not predict and do not want, let us not throw out the baby with the bathwater. Let’s just make more calculated adjustments.
The truth is, the middle is messy. The law that was passed was built on the Centrist idea that a few steps forward are better than waiting for the perfectly crafted bill to be born, which would never have happened in the polarized system we currently have. When we become intrenched, clinging to one good ideal over any other (“I will never raise taxes”, “Everyone should have healthcare coverage”) we freeze up; we fail to act in the best interest of those we care for, and when that happens, society’s moral compass falters.
Republicans should not waste time trying to repeal Obamacare (a repeal will never pass the Senate even if it passes the House), they should be trying to improve it, and Democrats would be wise to listen to them.
I can’t seem to decide, do I want to move America “Forward” or do I “Believe in America”? I’m not sure if it matters that I back President Obama or Governor Romney because what I really worry about is what they can or can’t get done. Congress seems so divided that precious little can ever get done. According to Gallup, Congress’ Approval Rating was at 10% in February; now it is up to 17% (April). By comparison, BP’s approval rating during the horrible oil spill in the Gulf was 16%. I won’t be surprised when I see“Congress, we’re kinda like cheap gas” on the bumper of the Subaru that keeps my neighborhood politically informed.
The system of checks and balances that we have in this country looks to the Justice System, the Supreme Court, when the other two need sorting out. With life-time appointments, our highest justices are suppose to be the adults in the room. Are they? Before the Supreme Court, right now, is the best Health Care bill our great nation has been able to produce since the creation of Medicare. It’s not perfect, but I believe in incremental progress when the alternative is gridlock and argument while those in need suffer.
The need for progress in health care is startling, and marks a divide be in our county between those who have and can afford access and those who cannot. The journal Health Affairs, recently presented us with this stark reality:
“…Access to health care and use of health services for adults ages 19–64—the primary targets of the Affordable Care Act—deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist.”
The central role of government is to keep us safe, which includes much more then external military or terrorist threats, but also our physical and mental health. The Talmud teaches that a rabbi is prepared to interpret law, when he or she can prove that which is unkosher to be kosher in twenty-four different ways. I assume the same thing of Supreme Court Justices, civil jurists of the highest ability. Activists or strict Constitutionalists, I believe that they can find what they want in the law to say whatever they want. Which brings the issue to a moral question – Everyone deserves medical coverage. In one of the most affluent nations in world history, it is an embarrassment that 5000 people have to wait once a year outside a sports area to get free health care (a big “thank you” to the volonteers at CareNow LA, now called Care Harbor).
If the Supreme Court strikes-down the Health Care Act, and we have to start health care reform all over again, instead of fixing the imperfect beginnings that are already underway, I’m just going to freak out. If the Health Act tanks, Obama won’t save us, and Romney won’t either. Rabbi Abraham Joshua Heschel taught that “in a free society, some are guilty, all are responsible.” So if they mess it up, its on us, people. We’ll have to act. If they do strike it down, this is what I want you to do: “I want you to go to the window, open it, and shout, ‘I’m mad as hell, and I’m not going to take it any more!‘”
No matter how much we “believe in America”, it may take a collective crescendo of rage to move us “forward”.