Oak Park Temple
B'nai Abraham Zion

1235 N. Harlem Avenue
Oak Park, IL 60302
(708) 386-3937

The fact is that, as a nation, we have all the necessary resources to provide care for everyone, including the 43.6 million people who are presently uninsured. We also have the means to assure coverage for prescription drugs, home care for the aging and disabled, and parity in mental health care. We have the money. We will spend $1.6 trillion on health care this year, nearly $6,000 per capita, which is twice as much as any other nation. We have abundant facilities and high-tech capability -- overly abundant some would say.

We have the knowledge. We have a superbly trained health force of nearly 10 million people, including 600,000 physicians and more than 2 million registered nurses.

The problems in our health system arise from a national penchant to treat health care as a commodity and to blindly pursue a free-market strategy despite the obvious differences between health care and Hummers.

All of the problems of our health care system can be summarized in a single phrase, IT'S ABOUT GREED.

A primitive society only survives if the good of the community comes first. Rules and structure supercede individual wants. If the community ethic is replaced by "every man for himself", the community ceases to exist.

Somehow, as industrialization progressed, as we moved from ancestral tales told around a campfire to sitting alone in front of a computer, we became the "every man for himself" society.

But this is not what Judaism would have us do. "Every man for himself" is not the way Jewish tradition would have us act when called upon to heal ourselves and others.

To begin, there are two central ideas that underlie the abiding Jewish commitment to provide health care to all of God's children.

The first is Judaism's teaching that an individual human life is of infinite value and that the preservation of life supersedes almost all other considerations. We are constantly commanded "not to stand idly by the blood of our neighbors."

The second is the belief that God has endowed us with the understanding and ability to become partners with God in making a better world. The use of that wisdom to cure illnesses has been a central theme in Jewish thought and history.

When members of a society are ill, our responsibility - not only of the medical profession but of all of us - expands to ensure that medical resources are available at an affordable cost to those who need them. This principle is also embodied in the concept of "mipnei tikkun ha-olam" - that we are obliged to act in order to repair the world in which we find ourselves.

The provision of more affordable and more easily accessible health care in America has become a pressing matter for Reform Jews. UAHC and CCAR resolutions on our national responsibility to provide adequate health date back to 1948.

Jewish tradition teaches us that an ethical health care system must provide for no less than universality of access; cost containment; preventative medicine; and a high quality of care. This is our religious mandate. God spoke to our ancestors and said, " Ani Adonai rofecha --- I am Adonai, your healer." Since that time, we Jews understand that if we are to model our lives on God's actions, then the duty to heal the sick is among our most fundamental religious precepts, rooted in the preciousness of every human life.

Since 1975, the national leadership of the Reform movement - both our rabbis and cantors and our lay leaders have called for our nation to adopt a single payer national health system.

TREATMENT:

What do I mean when I speak of a single payer nation health system?

Single payer insurance is commonly defined as a single government fund within each state which pays hospitals, physicians, and other health care providers, replacing the current multi-payer system of private insurance companies and health plans.

• It would provide coverage for everyone including the 43.6 million who are uninsured.
• It would eliminate the financial threat and impaired access to care for the tens of millions who do have coverage but are unable to afford the out-of-pocket expenses because of deficiencies in their insurance plans.
• It would return to the patient free choice of physicians and hospitals, not just choice of restrictive health care plans.
• It would relieve businesses of the administrative hassles and expenses of maintaining a health benefits program.
• It would remove from the health care equation the middleman -- the insurance/managed care industry -- that has wreaked havoc on the traditional patient-physician relationship, while diverting outrageous amounts of patient-care dollars to their own coffers.
• It would control health care inflation through constructive mechanisms of cost containment, rather than controlling costs through an impersonal business ethic.

In sum, single payer national health insurance would provide access to high quality care for everyone at an affordable price

Since this would be beneficial for individuals, businesses, and even the government, why don't we have a national single payer plan? The reason: it's about greed and the power of the insurance lobby.

Just as the NRA has blocked sensible gun control, political money from the insurance lobby has kept serious consideration of a single payer plan out of Congress. The supposed defects of such a plan have been publicized widely by those interests that for ideological or financial reasons are opposed to it. Since the benefits are unimpeachable, we should look at the claims of the plan's critics.

The first misgiving usually expressed is that we cannot afford to pay for comprehensive care for everyone. Every other industrialized nation provides comprehensive care to everyone at a much lower cost than our system that leaves so many out. Other nations spend 6 to 10 percent of their Gross Domestic Product, or GDP, whereas we, the wealthiest nation on earth, spend 14 percent of our GDP. We already have enough funds dedicated to health care to provide the highest quality of care for everyone. Studies conducted by the Congressional Budget Office, the General Accounting Office, the Lewin Group and Boston University School of Public Health have shown that, under a single payer system, comprehensive care can be provided for everyone without spending any more funds than now are spent.

There has been considerable publicity about the queue, or delays in receiving elective services that are characteristic of other nations, especially the United Kingdom and Canada . At 6 percent and 9 percent of their GD Ps, respectively, they are spending much less than us and need only to increase their budgets to escape prolonged queues. Not only do we have more than sufficient funds, we also are a nation that is infamous for our excess capacity in health care. Typical of these excesses is the fact that there are more MRI scanners in Orange County , California , than in all of Canada . With our generous funding and the tremendous capacity of our health care delivery system, the queue will not be a significant limiting factor in the United States .

As for those who say a Single Payer System, as in Canada , cannot hope to provide the same level of healthcare as a private system, that is, as in the United States , consider the following facts:

• Canada spends $1000 less per capita on health care than the U.S. , but delivers more care and greater choice for patients. Combining the single payer efficiency of Canada 's system with the much higher funding of ours would yield better care than Canada 's or ours at present.
• Canadian patients have an unrestricted choice of doctors and hospitals.
• Canadians get more doctor visits and procedures, more hospital days, and even more bone marrow, liver and lung transplants than Americans.
• While there are waits for a handful of expensive procedures, there is little or no wait for most kinds of care in Canada . Yes, the average waiting time for knee replacements in Ontario is 8 weeks, as compared to 3 weeks in the U.S. But patient satisfaction levels with the procedure and care are identical. And the time from first suspicion to definitive therapy for breast cancer is actually shorter in British Columbia than in Washington State . Finally, there are virtually no waits for emergent coronary artery surgery in Canada .
• Surveys show that Canadian doctors are far happier with their system than we are with ours. According to a 1992 poll, 85% prefer their system to ours; 83% rate the care in Canada as very good or excellent, and most physicians would urge their children to enter the profession. Fewer than 300 out of Canada 's 50,000 physicians emigrate to the U.S. each year, and a survey of doctors who have practiced in both nations shows a clear preference for the Canadian system. Medicine has remained an extremely desirable profession; medical school admission is even more competitive in Canada than here.
• Surveys show very high patient satisfaction in Canada . 96% prefer their system to ours, and 89% rate care good or excellent (up from 71% 4 years ago).
• And finally, Canadian physicians' incomes are comparable, in most specialties, to those in the U.S. , and have kept pace with inflation for the past 25 years.

Another misgiving about a comprehensive health care plan for everyone is that, and I quote, "Americans do not want socialized medicine." Understand that socialized medicine is a system in which the government owns the facilities, and the providers of care are government employees. In sharp contrast, a single payer system uses the existing private and public sector health care delivery system, preserving private ownership and employment. The unique feature of a single payer system is that all health care risks are placed in a universal risk pool, covering everyone. The funds are allocated through a publicly administered program resulting in optimum use of our health care dollars. You already know what a single payer system is - think Medicare.

Many contend that government bureaucracies are very wasteful compared with the efficiencies of the private marketplace. In the health care arena, that has just not been true. Our Medicare program, a publicly administered program, operates on an administrative cost of less than 2 percent. The managed care intermediaries consume 9 to 30 percent of health care dollars . The difference is due to large corporate administrations, tremendous duplication of administrative efforts between companies and other intermediaries, and marketing expenses that would be superfluous in a public program. A single payer system has as its mission optimizing resources for better patient care. Funds are not wasted on corporate administrative excesses. Take away the administrative costs and high salaries, and there will be more money available to better reimburse hospitals and care givers. Who would you prefer your health care dollars to go to - the doctor who gets out of bed to do your emergency surgery -- the nurse-midwife who gets out of bed to deliver your baby -- or the managed care executive who sits in his office devising new ways of denying you care?

It is argued that a single payer system, by being universal, would lower the standard of care to a level of mediocrity for everyone, preventing the affluent from exercising his or her option to obtain the highest level of care. Medicare patients receive excellent care and a single payer system does not preclude the affluent from paying, outside the system, for a penthouse suite in the hospital, or for cosmetic surgery, or for any other services that should not be part of a publicly funded program anyway.

Other than the assurance that everyone would have coverage for health care, there is even a greater good that single payer would bring to our nation. Making available to everyone preventive and public health services would significantly improve the level of health of our entire nation. Reduction of communicable diseases and reducing the higher costs of untreated chronic disease helps all of us. Healthy individuals make for a healthier work force, with less lost time at work, greater productivity, and a more positive work environment.

What are the current prospects for reform? Most proposals call for incremental and pluralistic measures. Unfortunately, such approaches cannot meet the goals of universal, comprehensive, affordable health care. As an example, it was recognized that Medicaid was grossly inadequate in meeting the needs of insurance coverage of low-income children. Congress passed the Children's Health Insurance Program - CHID -- to expand the number of children covered. Yet, since enactment, the number of uninsured children actually has increased. Incrementalism will never provide universal coverage.

Pluralistic approaches are popular with the organizations that advocate for them. For instance, the American Medical Association supports medical savings accounts, a scheme that will provide pools of funds for physicians to dip into without any restrictions on fees, or controls on delivery of ineffective services. Although healthy individuals would find medical savings accounts to be attractive, those individuals would be exposed to financial risk should they develop a major medical problem. Another example is the governmental insurance premium subsidy proposed by the Health Insurance Association of America. This subsidy would divert more taxpayer dollars to an industry that is already wasting enough of our health care resources.

Perhaps one of the more inhumane proposals is to offer uninsured patients discounts for cash payments and pass that off as health care reform. This simplistic plan not only exposes the uninsured to financial disaster should a major medical event occur, but it also significantly impairs access to even the most modest care simply because of lack of affordability. While the various pluralistic approaches would meet the needs of special interests, they can never provide adequate coverage and access for the most vulnerable members of our society.

Would Americans accept a publicly administered health insurance program? For over three decades, they have shown strong support for a national health insurance program for our seniors, Medicare. Americans across the political spectrum emphatically reject suggestions that Medicare should be abolished, although they do support needed reform. If we had a comprehensive, affordable health insurance program that covered everyone, Americans would finally be able to say, quite honestly and with justifiable pride, "We have the finest health care system on earth."

With all this said, now it is time to "talk tachlis" - to offer you an action plan whereby all of us can work to bring about such a system.

There are three components to what we must do:

1. BECOME EDUCATED

On Sunday morning, November 9, Ruth Rothstein, recently retired Chief of the Cook County Bureau of Health Services will be the speaker at our annual Hausman Social Action brunch. Mrs. Rothstein is credited with the creation of a public health care delivery system that now serves as a national and international model. What better person from whom to learn about transforming health care in America .

Then, on Sunday morning, December 7, Quentin Young, Convener and National Coordinator of Physicians for a National Health Program, as well as Past President of the American Public Health Association, will be speaking under the auspices of our Social Action Committee. Dr. Young will then be working with a smaller group to create an action plan that will address the health care concerns of our members. The ultimate purpose - to help us take action.

In the meanwhile, I would urge you to begin learning about national health care by visiting two web sites, the exact addresses of which will be available on a flyer following services. If you are a layperson, you'll want to visit the website of the Illinois Campaign for Better Health Care, and if you are a health care professional, you'll want to visit the website of Chicago-based Physicians for a National Health Program.

2 ACT TO SHAPE PUBLIC POLICY

First of all, take note of the health care platform of each of the candidates for President, Senator from Illinois , congressperson, as well as state and local office holders. Then vote with that in mind.

Secondly, participate in the appropriate networks - those that are appropriate for us as individuals, and then the action group our Social Action Committee is putting in place for our congregation as a whole.

For example, there are important on-line petitions of the above mentioned organizations that are awaiting your signature.

If you are a physician, I would encourage you to endorse the "Physicians Proposal for Single Payer National Health Insurance" that is sponsored by Physicians for a National Health Program. Also, prevail upon your colleagues to sign on as well.

If you are a lay person, I would encourage you to endorse the Illinois Health Care Justice Act. Please sign the petition that you will find on the Illinois Campaign for Better Health Care web site. The goal of this legislation is to develop and implement a plan to provide affordable, accessible, quality health coverage to all Illinoisans by January 1, 2007 .

Then, here at the temple, on Sunday morning, October 19, our Social Action Committee, chaired by Gail Fisher, David Levine, and Martha Ackerman, will have a kick-off of the Committee's program for the coming year. You are encouraged to join the Committee and the Health Care Caucus, which will be organizing congregational efforts on behalf of universal access to health care - drawing on the leadership of Ruth Rothstein and Quentin Young, and our own emerging leaders.

Finally, as a member congregation of United Power for Action and Justice, we participate in its health care caucus and would welcome involvement in that as well.

3. OFFER DIRECT SERVICE TO THOSE WITHOUT HEALTH CARE

For those of you who want to get directly involved, the Social Action Committee has a relationship with an Oak Park community health clinic providing services to many uninsured and low income individuals in Oak Park and Austin . Temple members are needed to provide many services, donated goods, and training programs.

Also, as part of our congregation's ongoing commitment to West Suburban PADS, we will be soliciting additional health care professionals to participate in the Monday PADS clinic.

As you leave the sanctuary in the next few minutes, you will receive a flyer listing the concrete ways you can act. Take it home, post it on your bulletin board and put the key dates in your calendars. Then make copies of this material to distribute to friends, and urge them to get involved in their own respective communities.

This takes me, finally, to the PROGNOSIS.

Nothing will happen to change the current state of our health care system if we simply wait for a miracle to happen. There will be no miracle, for there are interests that have stymied health care reform for decades, interests which are well organized and well funded, interests which will avail themselves of all the power at their disposal to prevent the health care reform we need. There will be no miracle unless we work for it ourselves -- joining together, as a congregation, as members of grass roots and professional organizations, and as voters who monitor the actions taken by our legislators and state and national leaders. What is the prognosis? That is a question that will only be answered if all of us work together in concert.

Then, if we do, when we say L'Chaim - to life, it will not only be a prayer, but a prayer made real. And to this, let us all say, amen.

October 4, 2003

Back to Divrei Torah