Yom Kippur Day Sermon: A Jewish Obligation to Reform Health Care

Rabbi Anne Persin

The absolute quality of change, the fear embedded in transition, the opportunity for transformation—the timelessness of the Days of Awe reminds us that we are in a constant state of change, transition and transformation.  Throughout this High Holy Day season we are considering the impact that change and transition have on a community and on a society and are exploring ways that we can respond to change and transition so to bring about transformation for ourselves and the world around us.

Change happens all the time, whether we like it or not.  It is neither inherently bad nor inherently good—change simply IS.  In fact, one of the few things that we can absolutely count on in this world is change.  So, just when we think things are coming together the way that we would like and our world is molding into the shape we want, we should not be surprised when everything changes—and not always in the way we may have imagined, or even hoped.

• Jim Beaty worked for Continental Tire North America, a subsidiary of Continental AG, for thirty-two years. Now retired, he and his wife had been looking forward to spending their golden years together relaxing and traveling. That all changed when a letter from Jim’s former employer arrived in November of 2006. This letter stated that due to spiraling insurance costs, the company will be raising retirees’ premiums from $78.00 per month to a staggering $900.00 per month. The company offered to offset this cost by adding money to retirees’ pensions — but there’s a catch. This benefit will only apply to retirees under the age of sixty-two. Jim would not turning sixty-two until March of 2007. As a result, the Beatys were paying more for health insurance in one month than they had previously paid for an entire year. It will be a full six years until Jim’s wife is eligible for Medicare and by that time, the Beaty’s will have spent tens of thousands on insurance premiums. The couple will be able to absorb this cost, but it will completely alter their lifestyle. As Jim puts it, “We’ve worked all our lives to have a dollar to do something, and now with this type of premium we’re going to live paycheck to paycheck.”
• Chicago kidney specialist Dr. Kesani understands what the uninsured face walking through his clinic doors. Not only do patients have to overcome the barrier of paying for current medical needs, but upon receiving news of a chronic condition or some other troubling diagnosis, a patient’s chance of purchasing health coverage forever after can be limited. “I often say if at all possible, work it out in your budget somehow to purchase health insurance now before I make any kind of a diagnosis,” Dr. Kesani explains. Afterwards, it’s very easy to be deemed ‘uninsurable’ or get stuck with high premiums well beyond one’s financial reach.

Dr. Kesani is especially aware of this due to personal experiences. After practicing medicine for several years in North Dakota, Dr. Kesani decided to move to Chicago and partner with another physician. For a year and a half he purchased COBRA, a temporary continuation of his previous employer-sponsored coverage, for $350 monthly. But when that insurance ran out a pre-existing condition exclusion for his Type 2 Diabetes was added to any conversion package offered by Blue Cross/ Blue Shield.

Although Dr. Kesani has successfully controlled his illness through medication and a healthy lifestyle, in order for the pre-existing condition exclusion to be waived with Blue Cross/ Blue Shield, premiums would jump to $1500 monthly! Dr. Kesani says, "I didn’t purchase the insurance because I felt like it was unfair. I had been with Blue Cross/ Blue Shield for ten years.” Other health insurance companies denied him outright or offered a similar deal. So since January 2007 Dr. Kesani has been uninsured and paying for medical costs on his own.

To have a largely manageable and controlled condition, yet still be priced out of the insurance market has left Dr. Kesani with the conclusion that “health insurance is only for the healthy.” Dr. Kesani was quoted for premiums totaling roughly $18,000 yearly. That’s more than what some individuals or some couples live on for an entire year.

These are but two of the thousands of examples that show that the healthcare system of our nation is in crisis.  In a case reported by the Los Angeles Times, the CEO of a hospital and  street-level recruiters face criminal charges for paying homeless people to have unnecessary tests and medical procedures done.  They would then submit fraudulent medical claims to Medicare and the California Medicaid system.  The paper quoted: “The depravity of the alleged scheme startled authorities.”  

Another fact that should startle us: Over 47 Million people in our country have no health insurance.  This is not an isolated problem - it permeates our society and impacts the quality of life of our communities.

Hearing me discuss health care reform from the bimah may seem jarring to many as I have not made it my practice to preach about controversial topics that are swirling about our political sphere.  But as I have followed the debate around health care reform, two things have become clearer and clearer to me.  The first speaks to why this conversation has motivated me to follow it so closely—health care is not, actually, a political issue;  rather, it is a very personal issue;  it is about you and me, our parents and our children, our friends and our neighbors.  To ignore the national conversation is to ignore our own fundamental needs and concerns.

The second is why I bring this conversation here, to our bimah on this day of Yom Kippur.  As I have thought and thought about the health care and the scope of societal responsibility, I have delved into Jewish law and tradition to become fully aware of our historic response to issues of health care and I have found something remarkable: the Torah, the Talmud, Maimonides, Joseph Caro, the Shulchan Aruch—every primary voice of Jewish law throughout Jewish history is in agreement—and that almost never happens.  Yet, in regards to issues of health care, throughout Jewish history and throughout Jewish law, we are taught to consider and tend to the health and well being of every member of our society.

In the Torah, the book of Leviticus tells us, “if one of your countrymen becomes poor and is unable to support himself among you, help him as you would an alien or a temporary resident, so that he can continue to live among you.”  Also in Leviticus, we are admonished to not stand idly by as our neighbor bleeds.  Through the prophet Jeremiah, God bewails our failure to see to the health and well being of our fellow, “Because my people is shattered, I am shattered;  I am dejected, seized by desolation.  Is there no balm in Gilead?  Can no physician be found?  Why has healing not yet come to my poor people?”  The Talmud also reminds us that this is not just about taking care of our own.  As it states, “Our Rabbi taught: the non-Jewish poor are to be sustained along with the Jewish poor, the non-Jewish sick are to be tended to along with the Jewish sick, and the non-Jewish dead are to be buried with the Jewish dead, for the sake of [the ways of] peace.”  (Gittin 61a)

Maimonides, the great Rabbinic scholar and a doctor, himself, declared, “It is obligatory from the Torah for the physician to heal the sick and this is included in the explanation of the phrase and you shall restore it to him, meaning to heal the body.” (Commentary on Mishnah Nedarim 4:4)  Joseph Caro, the Jewish law authority of the 16th century and the author of the Shulchan Aruch which, to this day, is considered by many to be the last word on most points of Jewish law, affirmed that, not only does the Torah give permission for physicians to heal but, “Healing is, in fact, a religious duty that falls under the rules for saving a life. If a physician withholds treatment when he is able to give it, he is regarded as a murderer, even if there is someone else who can heal a patient, because it may be in this case that it is the special merit of this physician to provide the healing for this patient.” (Code of Jewish Law chap 336, sec 1)  In the Shulchan Aruch he speaks specifically to the medical plight of the needy when he states that, “Doctors are required to reduce their fees for the poor. Where that is still not sufficient the community ought to subsidize the patient.”  (Yoreh Deah, 249).  And, he adds, “He who has medicine, and his sick neighbor requires it, is forbidden to raise its price above the proper level.” (Yoreh Deah 3336.3).

Looking through all of the Jewish texts, there is no doubt that we have a religious ethic of caring for the health and well being of everyone in our community—and so, not only do I feel strongly this personal obligation, it is my sacred duty, as a teacher of Jewish law and tradition, to bring the issue of health care reform to this bimah.

I would imagine that everyone in this room has been acutely aware of the pangs of transition that our nation has been feeling over the health care debate.  By their very nature, transitions shake us to our core emotionally, spiritually, mentally, and even physically.  Fear of what has been has caused people to act out.  Fear of what might come to be has caused people to act out.  We are yelling when we need to be listening.  We are intimidating when we need to be brainstorming.  We are advocating hate when we need to be working together.  

I take issue with the lack of civility that has been part and parcel with this debate.  We must stop lashing out at each other for being blue or red.  For this issue is so much greater than party politics, this is about your ability to see a doctor, get a cast, have open heart surgery and still be able to pay your mortgage and buy groceries.  There are three primary proposals that are being debated right now, as well as the initial proposal from President Obama.  I am not here to argue for the supremacy of any of these proposals nor am I here to speak against any of them.  I have reasons to applaud each of them and I have concerns for each.  But there is one thing for which I am certain: we must overcome our fear and our ire and find someway to take care of the multitudes of our nation that are uninsured and that are underinsured.

Contrary to popular belief the multitudes in question are not these lazy indigents.  They are retirees like Jim Beaty and his wife.  They are doctors like Dr. Kesani.  Eight out of ten uninsured people are from working families.  8.3 million kids in our country are not covered by health insurance.  Working families and children are not people that we should be turning our backs on.  “In addition to those who lack health insurance, a significant number of Americans - an estimated 11 million non-elderly families and 12 million elderly families - have inadequate health care coverage and are forced to spend more than 10 percent of their annual income on health care” over and above their insurance. (RAC) We are one of only two industrialized countries in the world that has not found a way to provide health insurance for all of our citizens.

I have heard so much fear and ire specifically around the cost of reform.  But I must ask you, how much are you paying for your health insurance right now?  In the four year span, from 2003 to 2007 health insurance premiums rose by more than 30% but wages only rose by a bit over 10%.  That means insurance premiums increased three times faster than wages.  Currently, the only option for uninsured individuals to access medical care is “mandated treatment and stabilization when afflicted with acute illness in emergency trauma centers.” This is easily the most expensive way to treat any health situation that arises.  So as an alternative to providing preventative medical care, this policy forces hospitals to "spread the cost" of the expensive emergency treatment by padding prices for other patients and insurance companies.  And after all of this pouring money into emergency care, it is estimated that 18,000 Americans die every year prematurely due to a lack of insurance.  That is about two deaths an hour.  No matter how much money we are pouring into our current insurance system, this is simply too high of a price to pay.

But here we stand with the opportunity to transform our nation and fulfill the ethical obligation of taking care of our sick.  Again, I do not claim to have the answer, the proposal for what should be the mechanics of providing health insurance.  But what I do know is that we as a community, as a society, must engage—without letting our fear and anger override us, we must engage in the conversation.  And as Jews there are four values that have been central to our community throughout our history that we must take into consideration throughout this conversation.  In order of importance:

1. HATZALAT NEFASHOT – The Saving of Human Life. So great is the commandment of saving life and health that it is of greater concern than ritual matters. Nearly all religious observances are subordinated to it. We must even violate the Sabbath to save a person’s life (pikuach nefesh doha et hashabbat).

2. SHEMIRAT HABRIYUT – Preventive Care. In addition to requiring a response to illnesses when they occur, Jewish law also requires that we make all attempts to stay well. Maimonides understands this obligation to include positive aspects, such as exercise and seeking out proper medical care, as well as negative ones, such as refraining from damaging one’s body through the consumption of harmful food or drugs.

3. TZEDAKAH – Communal Obligation to Meet Basic Human Needs. Just as the Jewish community recognizes an obligation to provide for such basic needs as food, clothing and shelter through the collection and distribution of communal funds, so too have Jews long insisted that no person be denied access to basic health care on account of inability to pay. While physicians are not required to provide their services for free, communal subsidies are called upon, matched by reduced rates for poor patients.

4. BIKKUR CHOLIM – Visiting the Sick. Judaism recognizes that illness affects the whole person, presenting threats not only to the body, but also to one’s mental state and financial ability. Bikkur Cholim, the mitzvah of visiting the sick, ensures that the needs of the sick are attended to in all these areas, creating a communal support system to complement the work of medical doctors.

With these values in mind, I welcome each and every one of you to join me after services for a respectful conversation on health care reform in the United States.  Together, we can be the voice that brings health and well being to all of the citizens of our land.  We can save whole worlds as the mishnah teaches in answer to the question, why was Adam created alone?  “Only one person was created to teach you that whosoever kills a single soul the Bible considers to have killed a complete world.  But whosoever sustains and saves a single soul, it is as if that person sustained a whole world.” (Sanhedrin 4:5)

This is our chance to bring better health and greater well being to thousands of people—to save thousands of worlds.  Let us rise above the fear.  Let us speak out for health care reform.  Let us transform our nation into one where our health and the health of our parents and our children, our friends and our neighbors is sacred.  Let us answer the call of our tradition that has declared healing as a religious obligation.  Let us find healing for our citizens.  Let us find healing for our nation as a whole.

Ken Y’hi Ratzon~~May this be God’s Will