Sermon given March 7, 2003, by Rabbi Barry H. Block
An old stereotype suggests that Jewish people are obsessed with our own health. Perhaps you already know the joke I recently heard from Rabbi Samuel Karff, the one about the German, the Frenchman and the Jew, who were shipwrecked, tossed at sea for three days and nights, with no food and water, before landing on a barren, deserted island. The German said: “I’m hungry; I’m tired; I’m thirsty. I really need a beer.” The Frenchman said: “I’m hungry; I’m tired; I’m thirsty. I could really stand a fine bottle of wine.” The Jew said: “I’m hungry; I’m tired; I’m thirsty. I must have diabetes.”
Yes, it’s a stereotype, but not an anti-Semitic one, or even quite false. The truth is that seeking appropriate health care is not just a Jewish obsession, it’s a mitzvah, a religious obligation before God. One verse in Deuteronomy begins, v’nishmartem m’od l’nafshoteichem, “carefully guard your lives.” The Rabbis interpreted those words to mean that we are required to protect our health. When the Talmud declares: “Whoever is in pain should be led to the doctor,” the Rabbis conclude that Jews are commanded to live in proximity to available medical care.
But what is the basis for a commandment, a mitzvah, that we take care of our own health? Doesn’t my body belong to me? Our modern society and culture would seem to suggest that I am autonomous, and therefore free to behave as I please, as long as I don’t hurt anybody else.
I recall a movie, from some years ago, in which Richard Dreyfus plays a young man, diagnosed with a terminal illness. I haven’t seen the film recently, but as I recall, the man is encouraged to pursue significant medical treatment, which he ultimately refuses. The decision to eschew treatment may indeed be appropriate in this particular character’s case. However, the premise on which he makes this decision is troublesome. The movie’s point of view is embedded in the rhetorical question that is the movie’s title: “Whose Life Is It Anyway?” The apparent answer to this question, for the film and for our modern world, is that each of our lives is our own.
Judaism would disagree. Our bodies, indeed our very lives, are merely on loan to us from God. When we die, our bodies will return to the Earth. Our souls shall return to God. The ancient Rabbis would make an analogy, which I will modernize a bit: Suppose that the President of the United States came to you with a highly fragile original copy of the Declaration of Independence. Imagine that he asked you to guard it for safe keeping, until he could come and retrieve it. Would you not invest a great deal of energy to ensure that the document remained safe, secure, and in tact? Of course you would! How much the more so, then, should we guard our bodies, flesh and blood, not mere paper, on loan not just from the President, but from God.
Sadly, we Americans are doing a poor job as stewards of our own bodies. While we spend enormous dollars on medical care, studies indicate that we follow doctors’ orders twenty to fifty per cent of the time, at best. Too many among us use and abuse mind-altering substances, including alcohol, engage in unhealthy sexual activity, drive without wearing seat belts, and smoke cigarettes, to name a few.
Obesity, in particular, has reached epidemic proportions. As we heard this past week, to our shame, San Antonio has again been declared the fattest city in the nation. Now, I am certainly not one to lecture people about proper diet and exercise. Having struggled with my own weight for most of my life, I am well aware that obesity is a complex matter, not easily explained by gluttony and sloth. And yet, the disastrous health consequences of being significantly overweight can not be ignored. Nor may we minimize the negative role played by our cultural and societal attachments to fatty foods, sugar, super sized quantities and fast food franchises. We have a problem in the United States, and we have a special challenge in San Antonio, which threatens to be not just the obesity capital of America, but also the center of diabetes, heart disease, and a host of other maladies. I am constantly in awe of the people I know, who have conquered their long-standing weight problems, through hard work, discipline, commitment to exercise, and even surgery. We must follow their brave example; we must do better, as individuals, as a city, and as a nation. Observing the mitzvah to care for our bodies is a matter of life and death.
Health care professionals bear a particular responsibility for the mitzvah of maintaining good health. The great Rabbi Moses Maimonides was also a leading physician of the Middle Ages. While there may be no such thing as a medical doctor in the Torah itself, Maimonides interpreted several passages of the Torah as obliging the physician to heal the sick. The Medieval Jewish law code, Shulhan Aruch, records a requirement that doctors reduce their rates for poor patients.
Physicians today work under terrible strain. Too many managed care companies offer rates that will not cover the doctor’s overhead costs. Often, physicians are not paid promptly, and they must submit the same legitimate claim, over and over again, merely to receive what they are justly due. Adding insult to injury, managed care not infrequently directs the doctor to practice medicine in ways that he or she does not believe to be in the best interest of the patient. At the same time, the threat of law suits, both meritorious and frivolous, constantly hangs over even the very best practitioners. The high cost of malpractice insurance has left some communities with a dangerous lack of physicians, particularly in the border regions of Texas.
Our physicians must be permitted to continue fulfilling the mitzvah to heal. Their issues must be effectively addressed in our Legislature and in our courts, without restricting the rights of those who have been injured or bereaved by very real medical error. At the same time, let us be grateful for those doctors who have not become cynical, but have maintained their commitment to their patients, treating all with care, insured or not, able to pay or not. Even in difficult times, may our physicians continue to give thanks to God for the healing gifts that God has given them, and for their ability to support themselves and their families in the practice of a profession that gives meaning to their lives.
Even patients and physicians, together with health care professionals at all levels, hospitals and medical schools can not preserve our nation’s health on their own. Indeed, Judaism teaches that health care is the responsibility of our entire society. Maimonides listed medical care first on his list of the ten most important communal services that a city is required to provide to its residents. In ages past, Jewish communities established communal subsidies, when doctors were overburdened with caring for patients who were too poor to pay for their services.
In his great Jewish law code, the Mishnah Torah, Maimonides quotes that famous passage from Leviticus: “You shall not stand idly by while your neighbor bleeds.” His interpretation is that anyone who is able to save another and does not is guilty of sin.
Tonight, my friends, the United States of America is guilty. The State of Texas stands accused. Here, in the greatest nation on Earth, with all the wealth our land possesses, more than forty-one million Americans lack any type of health care coverage, and more than eight million of them are children. Our fellow Americans are suffering, and we, as a society, are standing idly by.
In Texas, the situation is particularly dire. Our beloved state ranks near the bottom among the fifty, in terms of the amount of money the state allocates to cover the health care needs of the poorest among us. In many cases, we Texans are specifically in violation of Maimonides’ law, for we have the resources to save lives, but we choose not to use them. Time after time, Texas elects not to participate, when the federal government offers to match health care spending, even more than dollar for dollar.
A particularly egregious example is something called the Medicaid Waiver for Women’s Health Care. Today, a poor woman in Texas is offered basic preventative health care, including cancer screening, family planning, and the like, only if she is pregnant or has a baby less than four months old. What’s unbelievable is that the federal government will supply fully ninety per cent of the money needed, if Texas will elect to participate in a program for all women. We are able to save poor women in Texas, but some will die, because we refuse to offer them the basic health care services they need.
Four years ago, Texas finally signed onto the Children’s Health Insurance Program, or CHIP, another example where the federal government provides much of the money. Sadly, our state leaders have failed to provide all the funds that are needed to cover the eligible children. Now, they propose cutting out many of these poor kids. We will be guilty of sin, standing idly by while babies are denied adequate health care.
Two years ago, our Legislature at last enacted a law to simplify the process for registering children for medicaid. Instead of having to fill out the lengthy and complicated forms twice every single year, impoverished medicaid recipients and their parents would only have to deal with that bureaucracy once a year. Now, on the eve of that reform’s taking effect, some state leaders propose saving money by going back to the old, more complicated and cumbersome way. They have cynically devised this plan, knowing that it means that fewer deserving children will receive the coverage they need. If we let them get away with us, we will have blood on our hands.
Each human being is responsible to care for his or her own body. Preserving our health is service to God, for we are stewards of these bodies that our Creator has lent to us, for life. That’s not optional. It’s a mitzvah.
Those God has endowed with the special skill of healing are obligated to care for the health of their fellow human beings, for they are God’s agents in bringing divine healing powers to Earth. Even when it’s hard, it’s compulsory. It’s a mitzvah.
Every citizen of our nation is required to assure that each and every one of our fellow Americans has access to the medical care that God has permitted to humanity. It’s not a luxury. It’s a mitzvah.