What does halachah say about how to improve American health care? Not much.

Someone skeptical about halachah might ask, "Does Jewish law have anything useful to say about a public policy debate as complicated and multifactorial as health care?" Unfortunately, after reading the chapter devoted to health care in Rabbi Jill Jacobs' There Shall Be No Needy, I have to say no.

I wanted Jacobs' book to provide halachic metaphors to help me understand better what it means to support health care reform - and, ideally, to help me judge the relative ethical benefits and risks of various alternatives, even in a general way. I don't need halachah to tell me about the necessity of health care, the critical role of the health care provider, or the community's role in providing such care: these are relatively uncontroversial, things that even opponents of health care reform support. Halachah should be a source of Jewish wisdom and  something more than the deployment of righteous cliches. It should provide a particular perspective, not a reinterpretation of universalist principles which can be found in any liberal ethos.

Rabbi Jacobs' chapter is a skillful summary of the general principles of Jewish law regarding the provision of health care to the individual and community. She discusses the well-known arguments about the healer's permission to "interfere" in Divine creation when healing the sick, the need for the physician to be remunerated for their services; and the requirement inumbent on the community to provide for medical care. In an esthetic and moral sense, the passages she cites are useful - as Jacobs herself points out, they serve as a troubling reminder of the inefficiencies of the American health care system. (1)

After these summaries, however, Jacobs seems to get lost. She acknowledges that "today's system presents us with many more players than the doctor, the patient, and the immediate community" and goes out to find what halachah will tell us about these multiple factors. Unfortunately, there isn't much there (when has there been a health care system on earth as fragmented, oversized, and inefficient as ours?), so she has to limit herself to an unsatisfying historical aside on the history of Jewish hospitals and an unsurprising teshuvah by Rabbi Shlomo Goren holding that the Israeli government is required to provide health care. (2)

Jacobs acknowledges in passing that most Americans today receive health care through their employers (though she neglects to mention that veterans and Native Americans also are cared for by a national system), a state of affairs which has no halachic precedent. What then is there to say?

This is where the rubber meets the road. If there are no exact parallels in halachah to the matter at hand, perhaps there are at least useful metaphors, engaging stories, gripping ultimatums, solid philosophies. Jacobs: "From a Jewish perspective...a major problem with the American health care system is the lack of community oversight over the distribution of funds." This is disappointingly tepid and unfocused.

"Community oversight," like Mom and apple kugel, sounds good on its face. (I supported a public option and I think that a single-payer system is the way to go - I assume this is what Jacob is reaching towards with her "community oversight.") But what we need is help with a hard question: what kind of community oversight is needed, and at what level of government? Do we need more state control of apportionment of Medicare and Medicaid, or less (both could be called "community oversight")? Do we need Congressional interference in decisions about comparative effectiveness research? Should the Federal government have a role in deciding what health care should be available to which doctors? Democracy is all about the conflict of different communities, and "the Jewish perspective," at least as Jacobs is presenting it, has nothing whatever to say about these conflicting priorities.

In a concluding chapter which is useful in understanding her overall approach, Jacobs lays out her vision for how Jewish law and tradition should inform public policy (or the "public sphere," as she vaguely calls it). Unfortunately, this vision is not convincing.

Why unconvincing? Her "essential principles" ("the dignity of human life," "the inherent disparity of power" between different classes, and the reciprocal responsibilities of individual and community) are not unique to Judaism. This would not be a problem if halachah provided a unique perspective on issues of public policy - but I don't see any evidence of that here either. How, according to Jacobs, should Jewish law inform our discussions? "Jewish sources should help us to see various sides of an issue,challenge our assumptions, and enable us to formulate a response that takes multiple factors into account." Again, this is nothing we need halachah for - only a liberal cast of mind and general civic virtues of tolerance and open inquiry. (3)

It is not inspiring to say that halachah offers us no guide in some areas of life, but I think that's the case. I will not ask a posek the next time I prescribe an antibiotic and I don't think I need one either when considering various aspects of health care reform. (4) General moral guidelines about the importance of health care are available in halachah, should one choose to seek them there (though they can be found nearly everywhere else in a liberal society). For practical approaches to systematic reform, we should look elsewhere.

Update: See Rabbi Josh Yuter's shiur on the topic here, which I haven't listened to all of yet.

1. Jacobs says that our country's systematic inefficiencies and profit-driven nature "prevents many patients from being able to afford needed medical care." This is undoubtedly true, but another issue - which Jacobs does not explicitly address - is that Americans want too much medical care: too many labs, tests, and procedures, which drive up costs without improving care. This, among many other complications of the health care system, is something which our halachic predecessors simply could not envision, although I am sure one could, by stretching some precedent to the breaking point, find a proof text of use.


2.  Jacobs calls this teshuvah influential, but I suspect she is mixing up the chicken and the egg. Surely more determinative in today's halachic world is the fact that Israel is a democracy. Democracies legislate and administer national health care. Were Israel not a democracy, or not able to administer health care, the Goren teshuvah would be forgotten.


3. In fact, one could argue that Jewish law - in many places - does not place a premium on tolerance or open inquiry. There is the apikores and the min, after all.


4. In this regard, Rabbi Jacobs' philosophy bears a surprising (and disquieting) resemblance to Charedi daas Torah: that rabbis have a variety of expertise which equips them to offer advice even in practical situations far afield from their formal erudition. 

Authenticity as aesthetic (or: what is coherence and integrity?)

In the Forward, Jay Michaelson says that "the myth of authenticity has got to go." In the liberal circles that he and I travel in, this claim isn't all that surprising or challenging. I believe he's mostly talking to those of us whose subconscious, when asked to provide the image of an archetypal Jew, summons up a fundamentalist of our time or a prehistorical figure - anything but one of our own hyphenated, conflicted kind. But the hyphenations and conflicts, say Michaelson, are part and parcel - perhaps even the most admirable element - of Judaism. Most of what we value is transient, and always in flux.

What should we pursuing if not this myth? Michaelson gives several rephrasings of what I presume is meant to be the same idea: whatever religious, literary, or cultural form "speaks to the depths of what it is to be human," "get[s] to what matters" or is "resonant." Finally, though, he comes down to the core of his alternative definition: "a personalized notion of authenticity measured by integrity and individual coherence." I don't know what that means, but let's say for the sake of argument I pretend to. I can think of two problems with this.

First, coherence is a cousin of consistency, the hobgoblin everyone loves to hate. There's a reason for that: we all know complete bastards who are thoroughgoing and consistent in their personal behavior. What resonates with them, unfortunately, is nothing the rest of us would touch with a 10-foot pole. I suppose this is why "integrity" makes an appearance, but that's a slippery fish itself, and Michaelson owes us a more rigorous definition.

The second problem is that Judaism, for all its flux and change, is not predominantly a collection of individual non-interactors, each (with integrity and individual coherence, naturally) pursuing their own direction: a Brownian-motion people. Things get popular and define, in large measure, the majority of the Jewish community. So American Jews like "bagels and not jahnoon" because there are more Ashkenazic Jews than other varieties. Similarly, "Joseph Caro’s legalistic Shulchan Aruch" beat out his radical, mystical “Maggid Mesharim” because the former became popular and frequently referred to while not the latter. It's not complicated: people seek community. As sociologists (most notably Arnold Eisen) have pointed out, the majority of American Jews light Chanukah candles and make some sort of Passover Seder even if they don't know or care about the halachic or historical underpinnings of the holiday.

The problem, in short, is that whatever Michaelson's aesthetic (for that's what it is - and I mean that as a believer in the importance of aesthetics), there will still be practices and assumptions regarding Judaism which the majority of a certain community of Jews adopt. Unless "internal Jews" like him find a way to convince the rest of us what exactly he means by that coherence and integrity, we will be left out of his aesthetic. I don't know whether that would be more to his or our detriment.

How liberal Jews can be as successful as Chasidim

I'm a modern Jew, trying to live in a way both authentically Jewish and culturally liberal. I enjoy ubiquitous technology and freedom of thought. My daughter can be a rabbi, a scholar, an artist, or something else entirely, unfettered by restrictions. But are we modern, liberal Jews still going to be around in a few decades? If my granddaughter will still be a Jew, what kind of Jew will she be?

The Hasids hold up their allegiance to their way of life, and none other, as an answer to these questions. No, I am not an authentic Jew. My Judaism is endangered by modernity. Liberal women are led astray by their freedoms. My granddaughter will be without any particular ethnic identity at all.

As a proportion of the Jewish community, liberal Jews are decreasing and fundamentalist groups (including Hasids) are growing. They spill over into neighboring communities and their towns (like Kiryas Joel in upstate New York) split at the seams. I worry they might be right. Perhaps liberal Jews are doomed to extinction.

Is there a way we can hold on to what we believe in and not be washed away by the surrounding culture? What can the Hasids teach us about being Jews in modernity, and is there anything about their techniques which we liberal Jews can learn from?

I've asked this question of myself time and again, because I am fascinated by Hasidim. I am by turns attracted and repelled by a Jewish group succeeding beyond all expectations despite predictions a few decades ago of their imminent demise, while motivated by ideologies that are in large measure strange and forbidding to me.

I feel a kinship to them for two reasons: one, they are Jews, and like them I am religiously observant (though in a way they don't recognize as observant); and two, I speak Yiddish. Because of this kinship, I have spent time with and developed meaningful friendships -- and some adversarial relationships -- with a number of Hasids, read a considerable amount of their contemporary literature, and devoted quite a bit of thought to the question of what liberal Jews can learn from Hasidim. I have done this while trying (in my Yiddish writing) to defend liberal Jewish ideology to Hasidim.

Wouldn't it be wonderful if liberal Judaism's ideologies and cultural institutions were to enjoy success and relatively ensured longevity, just like the Hasids, while keeping to our own liberal, Jewish values? At times I have thought that we should emulate Hasidic success by copying Hasidic strategies As a strange contemporary Jewish type - the Yiddishist - I have thought that we should, like the Hasids, retreat into an isolated community and talk Yiddish to each other. And I have thought that that might also be a solution to the difficulties of the other Jewish ideologies I identify with. If Conservative Judaism is most successful in scattered enclaves outside of New York (mostly college towns), why not found a Conservative enclave in the middle of nowhere? If we care enough about what we believe in, shouldn't we be willing to retreat behind the walls to keep out what will wash away our way of life?

The reason why this wouldn't work is obvious. We liberal Jews are modern, and we find value in that. Every interaction between Jewish and non-Jewish culture is not a source of anguish but the normal material of our life. It would be weird for us to choose to interact only with Jews, even if they were liberal Jews. That would take away our modernity.

So we can't build walls - or rather, if we are to be consistent with our ideologies, we can't. What should our survival strategy be? We can't set out to win the demographic war, as our lifestyle doesn't lend itself to strategic procreation. Perhaps (as many contemporary Jewish organizations seem to believe) we should make Jewish life as attractive as possible. Let's send young people to Israel, and maybe on the way to their paid vacation they will find meaning in Zionism. Let's try and create entertaining Jewish events which will pull in the disaffected and unaffiliated.

Such a strategy, however, becomes caught up in itself. If we are always reaching out with a Jewish liberal modernity, when do we start reaching in? What is it, after all, we want to preserve?

This is the most important lesson the Hasidim can teach us, even if we are unwilling or unable to build walls. Their way of life is successful, picturesque, rich, and in many ways meaningful, but its approach is one we cannot take. It is not for the obvious reasons that we are not Hasidic, and their ideology is not ours - that goes without saying. It is because of what their success teaches us about how movements can work: in spite of, not because of worries about survival.

What does this mean? Take two examples of successful, relatively recent (in historical terms) Jewish ideologies. Zionism was not predicated on the notion fhat the Jewish population of Eastern Europe would be nearly exterminated in the Holocaust. To be sure, many Zionist thinkers predicted that Diaspora Jewry was untenable, but as a general matter this claim has proven to be unfounded (the American Jewish community is in no danger of extinction). The success of Zionism has to do with the success of the ideology: Jews constructing a modern Jewish state in the Land of Israel. Whatever its flaws, that country does exist, thanks to Zionism. The ideology has succeeded. Even if Jewish communities around the world thrived, and Israel were comparatively small and insignificant in terms of Jewish life, its success would still be significant.

Similarly, Hasidism as a culture is not merely a means to an end of survival. Hasidim have large families and live lives of chosen isolation because they believe strongly that their observance of strict Jewish law is the only way to God's approval. If, through some demographic or historical quirk, this caused them suffering or disappearance, they would still feel this way. Their ideology - by their lights - would still be a success.

So I come to the conclusion that my worries aren't wrong, necessarily (maybe modern, liberal Jews are bound to decrease in numbers), just misplaced. If we believe that contact with non-Jews and a wide variety of ideas is beneficial to us, if we think that a spectrum of Jewish practice and culture is valuable, and if we own up to these ideologies with confidence, we can be free of the relentless demographic drumbeat which our own worries and the worries of our institutional demographers pummel us with. We can be confident, modern, liberal Jews, in other words, and succeed by doing what we believe in, whether or not our communities and adherents grow by leaps and bounds. We can be as successful as the Hasidim even if we can never be fruitful and multiply, or be as picturesquely isolated, as they are.

Liberal "Torah Judaism"
Much as I hate the term.

Is there "da'as Torah"? Are there scholars lay, rabbinic, or talmid-khokhemdik who immerse themselves in the Torah so completely that their system of reference is different from others'?

This is plausible -- with a caveat. These learned Jews aren't to be found just in the ultra-Orthodox streams of Judaism which have popularized the term. Even liberal Jews can have daas Torah. It's just that their -- our! -- Torah is different (cf. "seventy sides/faces/tongues/languages to the Torah").

Abundant kibitzing
In which I half-articulate what might be wrong with the Conservative movement.

This Shefa list I talked about earlier is turning out to be pretty interesting: a lot less personal bellyaching and a lot more considered and creative thought about where the Conservative movement should go from here. Here's an e-mail I sent to the list that might not make the moderator's cut:

1. One distinction which might be helpful is between LIBERAL and LAX. Conservative Judaism is very much a liberal movement, for the following reasons (all of which are discussed, or at least adumbrated/hat-tipped, in Emet veEmunah): recognition of the importance of individual decision-making as something which can't be coerced into homogeneity by communal institutions; or, relatedly, the notion of religious responsibility (mitsves) as intertwined with individual religious progress cum exploration and contingency. There is a connection to be made between the looser, layperson's meaning of "liberal" and liberal political theory, but "this is no place to be lengthy."

In general, C. Judaism is liberal because it tends to be meykil rather than makhmir. It is important to understand what "meykil" does not mean; it is NOT to be equated with laxity, lack of stringency for its own sake. (Those who equate laxity with the term "kule" [leniency] do not understand the latter.) Ideally, the C. movement should be a rigorous application of both liberal and (this is where we've differed
from our friends on the left) halachic ideas. Liberal *and* rigorous Judaism -- isn't this what we want?

2. However (and this is perhaps where rubber meets road, or theory meets Action Plans), this liberal stringency (or stringent liberality) must be based on a wide range of possibilities for vibrant Jewish life. For the past few years, I have harbored a suspicion that dare not speak its name: that the C. movement's loud protestations of its "halachic" nature are meant as a response to our critics on the right. Of course, halachah is the blood of our Jewish being, but it is not the all. There is much more in addition to halachah which goes into living a God-fearing and humane Jewish life. A convenient term for it is "culture." I don't just mean books on Jewish topics, or Woody Allen, or Jewish music (though all these have some role to play). I'm talking about the ways in which a Conservative sensibility can inform a Jewish religious culture. In other words: the Orthodox have their sub-culture, so why don't we have one? Why are we satisfied to participate in secular Jewish culture when Conservative Judaism has something both religious and worldly to bring to the table?

Let me give an example of where culture can play a role. (There are many other ways, of course.) Mishnah Yomit is a worthwhile initiative of the USCJ. But where's the promotion? Where's the advertising? Where is the pop-culture soupcon of kitsch which has made Daf Yomi a "smash hit" phenomenon among the Orthodox? (To head off an expected comment: adopting this strategy of the Orthodox does not at all mean agreeing with their religious approach.) Or another example: what does Conservative Judaism have to say about American secular Jewish culture? Is there any alternative to provide? I think our answers might be at once more congenial and more convincing than those provided by modern Orthodoxy.