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Posted by on Mar 16, 2017 in Haaretz | 2 comments

Healthcare, not Anti-Semitim, is Liberal Jews’ Priority

I am putting my Zionist work and my Israel advocacy on hold for the next few months.

People participate in a Women's March to protest against U.S. President Donald Trump in New York City, U.S. January 21, 2017

(Stephanie Keith, Reuters)

I am going to focus instead on what I see as the top priority right now for my liberal activism: Saving health care for tens of millions of Americans. My hope is that other liberal Jews will do the same.

I am not abandoning my concern for Israel, God forbid. If a crisis materializes, I will be there. But I don’t expect a crisis, and the fact is that nothing much is happening at the moment, at least as far as America’s role is concerned. The Trump administration’s foreign policy is in chaos, and when it comes to the Middle East, even the experts have no idea what will develop. It is not clear who is in charge of American foreign policy, or what the President really thinks of the Israel-Palestine issue, or how his playing footsy with the Russians will impact Israel’s situation and security.

But what is clear is that President Trump and congressional Republicans have set out with extraordinary zeal to dismantle the Obama-sponsored Affordable Care Act. Their intention is to replace it with a hodgepodge of policies that will, according to the just-released Congressional Budget Office report, cause 24 million Americans to lose health insurance coverage by 2026.

Healthcare: A Republican moral disaster zone

This is a moral disaster on every level. It is a disaster most of all for the working poor, the single mothers, the older Americans not yet eligible for Medicare, those who need long-term care and will not get it, and all the other Americans who will return to the days of uncertainty and constant terror that accompany insurance-less status in our country.

These Americans will once again be forgoing care that they or their children need. And we will again see stories of the mother with a lump in her breast who worries about the cost of checking it out, and the father with chest pains who decides that seeing a cardiologist is too expensive. Many will turn in desperation to emergency rooms for ongoing care and be hounded for years by medical bills they cannot pay. And once again, lack of insurance will send untold numbers of Americans to an early grave and plunge millions of people into severe financial distress.

Sen. Kamala Harris, D-Calif., at podium, cheers health care workers to save the Affordable Care Act across the country outside LAC+USC Medical Center in Los Angeles, Sunday, Jan. 15, 2017

(Credit: Damian Dovarganes, AP Photo)

And what do the Republicans have to say about all of this? Sitting on their fat health insurance provided by taxpayers, most lie shamelessly. They deny the overwhelming evidence that millions of Americans will lose their insurance under their plan. They pretend that massive Medicaid cuts will not happen, or that the cuts will not lead to terrible suffering. And they rationalize their surrender to Koch-sponsored lobbyists by prattling on about the virtues of “choice.” But conveniently forgotten is that “choice” loses all meaning when you are choosing among policies none of which you can afford.

We need to sustain our outrage

The only possible response to what the Republicans are doing on health care is sustained outrage. And after a lifetime of social activism, I am stunned by the level of cynicism and moral indifference that so many of our political leaders are now demonstrating. Can they not see that every uninsured family is a catastrophe waiting to happen? Do they not understand that the time has long since passed when America should do what every other advanced industrialized country has managed to do? To provide all of its citizens with a decent, affordable level of healthcare.

Some say that it is too late; the battle is already lost. But I am not giving up. Every effort must be made to break the cycle of madness from which, we thought, Obamacare had finally extracted us. And Americans are just now beginning to wake up to just how pitifully inadequate the healthcare provided by the Republican plan will be.

My own goal is not to preserve the Affordable Care Act. I am not an expert in such matters, and I am not committed to any specific plan. It is natural that honest, well-intentioned people are going to differ about how to fix healthcare.

But candidate Trump made a promise on healthcare. “I am going to take care of everybody,” he told 60 Minutes. “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.” And in contrast to Obamacare, which still left 25 million people without coverage, he said that Trumpcare would feature “insurance for everybody.”  If Republicans have a way to do that other than the current model, fine with me. That’s what we pay the politicians for—to find some reasonable compromise. But a promise was made, and the American people must demand that it be kept.

Jewish activism – and not out of self-interest

We Jews have a stake in this issue, of course. We are an older ethnic group with many members in the 50-60 age range who are far from affluent. We are, therefore, particularly sensitive to the inefficiencies and runaway costs of an out-of-control healthcare system. Still, this is not primarily a matter of Jewish self-interest. This is a matter of what is right for America. This is a matter of saving America’s democracy. Because America cannot be great unless her greatness is shared—and this includes providing healing for the sick. And because, as Michael Walzer has suggested, democracy is at risk when the fellowship of citizens resonates so weakly, and when we are so unready to come to each other’s aid.

This file photo taken on March 13, 2017 shows US President Donald Trump during a meeting about healthcare in the Roosevelt Room at the White House in Washington, DC

(Credit: Nicholas Kaam, AFP Photo)

As I work for healthcare reform in the months ahead, I hope that the major communal organizations of the American Jewish community will play a leading role in this effort. There was a time when the Jews of America would have spoken with a single voice on this issue. There was a time when to be a Jew in America meant not only to care for our own, to fight for Israel, and to educate our children as Jews; it also meant that whenever we saw injustice afflicting our neighbors, our Jewish souls would rush in to bring balm to their wounds. But I fear that is far less true today than it once was.

In recent years, there has been a feverish conversation among communal leaders about how to connect young adults to Jewish life. We all agree that they need Torah study, Jewish ritual and connection to Israel. But all of this has not been enough.

Well, here is my suggestion to these leaders about what they need to do next: They need to throw themselves into the battle for healthcare in America. They need to offer some thoughtful healthcare proposals of their own. They need to talk a little less about anti-Semitism—as vitally important as that is—and a lot more about the moral imperative of guaranteeing affordable, comprehensive health insurance for all.

A Judaism that ghettoizes itself has no real mission

Because our young people are very wise. They know that a Judaism that ghettoizes itself has no real mission and therefore no real purpose. They don’t understand how Jews can pray for the sick every day and then do nothing to get health care to those who need it. In the end, if the Judaism we offer our young does not speak to the great moral issues of their lives, healthcare surely included, it will fail to capture their imagination or their hearts.

We must not delude ourselves. The healthcare plan that the Republicans are offering will lead to disaster for America. And if that happens, no matter our other accomplishments, we will have failed as a people and a nation.

And so Americans must work for healthcare reform, piece by piece, person by person. Jewish Americans should be at the heart of this struggle, and whenever possible, in the lead. And we must continue the battle until no cry for a doctor’s care goes unheard.

Only in this way can we Americans do what the Constitution demands: “Establish justice” and “promote the general welfare.” And only in this way can American Jews honor the values of the Jewish tradition, making their community more honest and less insular in the process.

 

2 Comments

  1. Very important message from Rabbi Yoffie, a friend who I deeply respect. As a Canadian, I look at the American health care issue through the lens of someone who has universal health care provided by our governments (federal and provincial). While far from perfect (it does need to be updated in terms of services provided, wait times for medical procedures etc.), all Canadian residents are covered and need not worry about receiving basic health care and treatment for serious illnesses. There are parts of the system that require individuals to pay some or all of the costs, e.g. drugs but overall the system does work.

  2. Dear Rabbi Yoffe,

    Thank you for your letter about Healthcare. Rationale people don’t care whose program we use, but just want Healthcare Reform that gets people insurance that they can afford and use. Unfortunately, Healthcare and Insurance is expensive, so Government has to subsidize many people. Since different States vary so much in whether they care for their lower income citizens, it really needs to be Federal program.

    Most people do not realize that if Obamacare is in a Death Spiral, it is because the Republican Congress has starved it. The creators of the Affordable Care Act (ACA) knew that this was a market that nobody understood and that some Insurers would end up with many more sick people than they had planned for. The ACA had three programs Risk Corridors, Re-insurance, and Risk Adjustments, to subsidize companies that lost money because of an imbalance of sicker clients. The money was part of the program considered by the CBO that led to a 10 yr Debt reduction.
    http://kff.org/health-reform/issue-brief/explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors/

    Unfortunately, Congress, led by Marco Rubio, passed a law that restricted HHS from paying the money that was needed by the Insurers. That is why they lost money and were either forced to exit the Exchanges or jump Premiums. In 2005, HHS could only pay 12.5% of what was needed, event though they had the funds to pay it all. Adding these back would lead to the Insurers thriving. https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affordable-care-act.html

    More recently, the Congress and President are doing everything they can to sabotage Obamacare and make it whither and fail. https://www.washingtonpost.com/opinions/the-gop-masterminds-behind-obamacares-death-spiral/2017/03/14/ad798b5a-08ed-11e7-b77c-0047d15a24e0_story.html?utm_term=.7f48c1c917b0

    Here is a program of suggested items that I have sent to Chuck Schumer and many others Democrats and moderate rational Republicans in Congress that suggests what they could do to develop a very robust and successful Healthcare upgrade.

    Proposed Second Healthcare Reform
    1. Keep the Affordable Care Act, but make the following changes, in addition to removing Obama’s name from it.
    2. Establish irrevocable funding of the ACA Risk Corridors, Re-insurance, and Risk Payments for the next 5 years to keep Insurers profitable. Restart the Co-Op Insurance Companies with Guarantee Risk Corridor payments. This will
    stop any Death Spiral of ACA and will let the Insurers thrive.
    3. Extend Exchange Subsidies to 800% FPL, or higher (This moves the subsidy cliff to $190K for a family of 4.) and taper it off.
    4. Limit Deductibles to $2000. (This will raise Premiums, but balance that against usability and the additional subsidies it will require.
    5. Add HSAs to help pay during the Deductible Phase. Keep special subsidies for incomes below 250% FPL to cover Deductibles, co-insurance, and copayments, for the lowest incomes where they can’t afford to create HSAs.
    6. Leave Essential Benefits, but make Pregnancy and Pediatric coverage as opt-out options for the buyer.
    7. Make the bottom subsidy bracket “0-250%” so adults without children in States that didn’t Expand Medicaid can buy insurance on the Exchanges and get an appropriate subsidy.
    8. Add a Law that Medicare and Medicaid are only allowed to pay for drugs at the lowest price that the selling company sells those drugs for anywhere in the world. This keeps control of safety, but stop gross overcharging in the US.
    9. Keep all the ACA taxes. Your new Law will still need to be paid for.
    10. Continue funding for PCORI, CMMI, Medical Homes, ACOs, Bundled Payments, IPAB (if needed), EMR, etc (The AHCA seemed to forget that the ACA was 75% focused on healthcare delivery, improved quality, and reduced healthcare
    costs.)
    11. Include money in the Law to form an Office of Healthcare Education. There are
    millions of people who never had healthcare insurance, or Healthcare, before. They need to understand what it means to have insurance, how it all works, what their costs will be, and how to most effectively use the healthcare insurance they now have.
    12. Change Employer Mandate to all companies with more than 50 equivalent full-time employees (i.e. more than 2000 hrs/week) and taper HHS assistance as they grow through and past 50 employees. This eliminates anyone considering
    moving full-time workers to part-time and removes any restriction from growing past 50 employees.

    I think this eliminates the complaints with the existing system, while keeping all its benefits and fixing most of the problems.

    Thank you for reading this far.

    Sincerely,
    David Matz
    matzdj@comcast.net

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