Friday, June 29, 2012

Healthcare: A Jewish Response

Maimonides Oath for the Physician

The highest court of the land upheld the Affordable Care Act, often referred to as Obamacare.  Attached is an excerpt from my sermon dealing with the issue of Judaism’s views on healthcare.  “The central crux of this issue as I see it is the question of: does community have an obligation towards providing healthcare to its members? 

To begin to find our answer, we must once again return to the world of the Talmud.  The Talmud states there are ten specific items a community must provide for its members, “It has been taught a scholar should not reside in a city where any of the following ten are missing: (1) a court of justice … (2) a charity fund … (3) a synagogue; (4) public baths; (5) toilet facilities; (6) a moyel; (7) a surgeon; (8) a notary; (9) a shochet (ritual slaughterer); (10) a schoolmaster” (BT Sanhedrin 127b).

It is interesting to note how many of these have to do with public health and healthcare.  In this passage communities are required to have proper facilities with public baths and toilets as well as proper medical personnel such as surgeons and moyels, yes moyels are considered proper medical personnel. Thus we learn from this passage: the state of communal healthcare can and should be a vital concern of the Jewish community.

I would hope that we would all be in agreement that the healthcare system in our country is fundamentally flawed in many ways.  It is outrageously expensive.  Patients often have to wait long hours to receive treatment, and when they do, they are often charged ridiculous amounts for it.  Doctors, who spent years in training, now have to see more patients than ever just to pay their bills, because they receive less and less remuneration for their skills.  Almost no other place in our society are individuals not paid for what they charge.  While at the same time our society as a whole is becoming unhealthier in a lot of ways especially as a result of our expanding waist lines.  Our healthcare system is sick.  We are left wondering is our healthcare system in a terminal state?  Or is there a cure?

Advocates have argued that there appear to be only two solutions to this fundamental problem, which is really at the heart of our current debate.  The first is a nationalized system, which is often referred to as socialized medicine.  Those in favor describe how a system maintained by the government will cure most of our ills.  Those against describe a national healthcare system as being one step closer to communism at best or the French at worst.  It is a system of complete government oversight, which opponents argue will prevent innovation, instead resulting in long waits for important medical procedures. 

However, at least in theory, this sort of system should help keep costs down because it spreads the impact on the entire population.  More than that, it is also quite probable the amounts we pay in insurance premiums are still more than we would pay in taxes for such a system.

A purely capitalist system on the other hand, is focused primarily on profits first and then treatment second.  When a policy holder becomes unprofitable, either their procedures are denied, or they are dropped from the program due to that dreaded pre-existing condition.  You are left asking such foolish questions as how many stitches constitute a case of urgent care versus a true medical emergency.  If you guess wrong, your insurance is likely not to cover this procedure. This system does encourage innovation, but at what cost we often wonder.

So which system, as Jews, should we be supporting?  To find the answer I suggest we again turn back to tradition.  There is a ruling in the Shulchan Aruch which states, “If someone is taken captive and he has property but does not want to redeem himself, we redeem him “with the money his property will bring” against his will.  Even though this source is about redeeming the captive, for the rabbis the principle remains the same, we as individuals have a financial obligation to take care of ourselves. 

But at the same time our tradition also argues that each community is not only supposed to provide the proper medical personnel, but it also “must pay for the healthcare of those who cannot afford it as part of its provision for the poor” (Dorff, Elliot, Matters of Life and Death: A Jewish Approach to Modern Medical Ethics, 1998, page 307).

Thus our tradition proposes setting up a system with both communal and personal elements to it.  Judaism argues it should be a system built both upon personal responsibility as well as communal obligation.”

Tuesday, June 5, 2012

Spiritually Audacious

What of the challenges I have wrestled with both personally and professionally is the modern and popular concept of ‘spirituality.’  I wrestle with it in part because I am not entirely sure what it means when someone says, “I’m not religious.  I’m spiritual.”

The cynic in me has interpreted this to mean, “I’m religious, but I don’t believe in organized religion.”  My usual response is, “Don’t kid yourself, we’re not that organized.”

But to be cynical and flip does not help others or myself really understand what it means to be spiritual.  To this end, I have had the fortunate opportunity to study with Rabbi Avi Weiss, the Rabbi of Hebrew Institute of Riverdale and the founder and Dean of Yeshivat Chovevei Torah, which is based on what he terms, “Open Orthodoxy.”

Open Orthodoxy is an important idea and movement worth exploring, but we will leave that for another blog.  But what Rabbi Weiss has taught about spirituality is that it is, “Being in the moment while feeling the presence of God in the moment.”  As an example he went on to say, “We sing songs about yesterday and tomorrow, but not songs of today.” 

Rabbi Weiss also spoke about how we are, “Always waiting for the next moment, so much so, we fail to live in the moment.  But we have to hold on to the moment with open arms.”  And the way to do this is to recognize, “Prayer as a love encounter.  It is a moment of deep and profound intimacy.”

So ultimately prayer and spirituality should be about connecting us with the Divine, the Holy, with God, with however we imagine that which is beyond us and within us.  But for it to be Jewish, we have to take it one step further which is to bring God’s system of ethics into the world.  In Rabbi Weiss’ view, spirituality is a means to bringing about the goal of ethical monotheism into the greater world.

But there is another step to meaningful spiritual encounters, and that is to be honest and real in our encounter.  As Rabbi David Aaron wrote in Seeing God, “If you want to encounter God’s essence, then you have to be willing to expose your own essence to God.  God can only reflect what you’re presenting… You have to be real to see the Real.”

I am learning that spirituality has less to do with the specific prayers, the specific melodies, even the specific gathering or gathering place, and has more to do with who is in that moment, and whether or not they are choosing to be in the moment and acknowledging God in the moment.

And the best we can do as shleichim tzibur (worship leaders) is to 1. Try our best to model being in the moment, and 2. Offer up worship experiences that have the potential to enable others to be in the moment.  And when I think about this, perhaps the most important concept is to be genuine and authentic. 

This is no easy task.  It requires exertion by both the service leader and those in the minyan.  For in order for it to work, we ascend while the Shechina descends.  And as Rabbi Weiss teaches it is in that intersection we create holistic prayer that “embraces the wider moment and brings it in,” and then enables us to draw it out. “Or as we learn from Psalms (109:4), ‘And I am prayer,’ to which Rabbi Samson Raphael Hirsch adds one word to the translation, ‘And I am all prayer.’”

As Rabbi Weiss goes on to say, “The way I talk and walk and conduct myself in business; the way I eat and love and interact with others; the way I treat the forlorn, the hungry, the homeless – my very being, my very essence, my every endeavor its tefilla – holistic prayer.”

As Chevy Chase said in the greatest golf movie of all time, Caddyshack, “Be the ball.” So too it is with us.  To be spiritual means, “to be the prayer.”