The final Obama/Romney showdown: A note to Jewish grandparents


I believe there is a unique bond between grandparents and grandchildren. We look out for each other. We have each other’s backs.

This year, the Romney-Ryan ticket and much of the Republican Party have been attempting to divide our generations, pitting one against the other.

We saw it in the first presidential debate. Mitt Romney looked into the camera and told voters, “Neither the president nor I are proposing any changes for any current retirees or near retirees, either to Social Security or Medicare. So if you’re 60 or around 60 or older, you don’t need to listen any further.”

Put aside for a second the veracity of the first part of this statement. The overall implication is disturbing: Older Americans don’t care about policies that affect their children and grandchildren. The Greatest Generation, Romney believes, is actually just out for itself.

[Related: A note to a stiff-necked people: Why you should vote Romney]

The truth is, many of Romney’s proposals would hurt seniors.

Romney has vowed to repeal the Patient Protection and Affordable Care Act (Obamacare). That would mean anyone enrolled in Medicare will pay an average of $4,200 more in health-care expenses over the next 10 years. Annual wellness visits would no longer be free. Those who fall into Medicare’s coverage gap for prescription drugs, sometimes called the “doughnut hole,” would lose their 50 percent discount on brand-name drugs and would no longer see the gap disappear completely by the end of this decade.

Obamacare ensured that Medicare is fully solvent at least until 2024 by getting rid of $716 billion in waste, fraud and needless spending — including $156 billion in unnecessary subsidies to insurance companies.

Romney, by repealing health-care reform and cutting more than $1 trillion from Medicaid, would deny coverage to approximately 50 million Americans who currently have it, including nursing-home patients, people with disabilities, low-income children and pregnant women.

Those are facts Romney doesn’t want you to know. But here are a few facts he thinks you don’t care about, because they may not affect you directly.

President Obama has nearly doubled funding for Pell Grants. He provided students and families with college tax credits worth up to $10,000 over four years. He invested $2 billion in community colleges. And he capped federal student loan repayment at 10 percent of monthly discretionary income.

Romney, by contrast, has vowed to roll back all of these vital programs intended to give the younger generation a shot at the American dream. Why? Because his priority is more special tax breaks for billionaires and hedge-fund managers.

President Obama has the vision to leave my generation with a better world by starting to address climate change and investing in cleaner, more sustainable forms of energy. Romney’s energy plan is to provide wealthy oil companies even more tax giveaways at our expense.

Obamacare will help many young people get health insurance. Without it we are less likely to seek preventive care or heed early warning signs, which can lead to more severe illness and higher medical bills. If we are younger than 26, we can now remain on our parents’ plan, giving them peace of mind and saving all of us money.

Our community has long been in the forefront of efforts to expand civil rights, passing laws and creating a culture that welcomes people who are unwelcome in other parts of the world. President Obama has fought for equal pay and women’s reproductive rights. He appointed two highly qualified women to the U.S. Supreme Court, Elena Kagan and Sonia Sotomayor. He ended laws that discriminate against gays and lesbians.

But you don’t care about any of that, do you? Romney and Paul Ryan seem to believe that you are ready to sell out your kids and grandkids as long as your needs are taken care of.

I think Romney and Ryan are wrong. They and their fellow Republicans are underestimating the bond that exists across the generations, inside our families. Jewish tradition speaks to this obligation, to teach and care for future generations: l’dor v’dor. I experience it in my own family. 

And when we vote, let’s remember what’s at stake for everyone in our families.


Mik Moore is president of the Jewish Council for Education and Research (JCER), which launched “Obama on Israel,” a project aimed at presenting information about the president’s record on Israel.

U.S. Supreme Court upholds Obama healthcare law centerpiece


A sharply divided U.S. Supreme Court on Thursday upheld the centerpiece of President Barack Obama’s signature healthcare overhaul law that requires that most Americans get insurance by 2014 or pay a financial penalty.

“The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice John Roberts wrote for the court’s majority in the opinion.

“Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness,” he concluded. The vote was 5-4.

In another part of the decision and in a blow to the White House, a different majority on the court struck down the provision of the law that requires the states to dramatically expand the Medicaid health insurance program for the poor.

The upholding of the insurance purchase requirement, known as the “individual mandate,” was a major election-year victory for Obama, a historic ruling on the law that aimed to extend coverage to more than 30 million uninsured Americans.

The 2010 law constituted the $2.6 trillion U.S. healthcare system’s biggest overhaul in nearly 50 years.

Critics of the law had said it meddles too much in the lives of individuals and in the business of the states.

Twenty-six of the 50 U.S. states and a small business trade group challenged the law in court. The Supreme Court in March heard three days of historic arguments over the law’s fate.

The court’s ruling on the law could figure prominently in the run-up to the Nov. 6 election in which Obama seeks a second four-year term against Republican challenger Mitt Romney, who opposed the law.

Why We Must Support Universal Health Care


Related: Jews Should Oppose Universal Health Care

Whether or not we are believers in the Obama plan, or any of the particular plans for universal health care currently winding their way through Congress, support for universal health care is an imperative in Jewish law. Although what is available in medicine and its cost have changed radically, particularly over the past century, the fundamental right to receive good care — and to be compensated for giving it — goes very far back in our heritage, though perhaps, ironically, not all the way to the Torah or even the Mishnah.

When physicians could not do much to heal a sick patient, their services were easily attainable, relatively cheap, and, frankly, not much sought after. “The best of physicians should go to hell,” the Mishnah says, reflecting people’s frustration in the second century C.E. with doctors’ inability to cure. 

With the advent of antibiotics in 1938, as well as other new drug therapies, and, especially, new diagnostic and surgical techniques, however, there has been an immense increase in the demand for medical care, precisely as it has become much more expensive. This raises not only the “micro” questions of how physicians should treat a given person’s disease, but also the “macro” questions of how we, as a society, should arrange for medical care to be distributed. It is precisely this argument that is taking place in town halls and in the halls of Congress these days, sometimes in rational arguments but all too often in shouting matches that are clouding the real issues.

Jewish tradition imposes a clear duty to try to heal, and this duty devolves upon both the physician and the society. Jewish sources on distributing and paying for health care are understandably sparse, however, because before the 20th century, medical care was largely ineffective and inexpensive. The classical sources that describe distribution of scarce resources and apportioning the financial burden for communal services deal instead with questions like providing for the needy or rescuing someone from captivity, from highway robbers or from drowning. Still, those discussions raise moral problems and suggest solutions that are often similar to those associated with scarcity and cost in modern medical care. 

One set of issues is this: Who should get what when medical interventions are scarce and/or expensive? The other set of questions is this: Who should pay for health care? I discuss at some length the answers that emerge from the Jewish tradition to both of these questions in Chapter 12 of my book, “Matters of Life and Death: A Jewish Approach to Modern Medical Ethics” (Jewish Publication Society, 1998). I will share here a general sense of how the Jewish tradition responds to these questions, which are at once so ancient and so contemporary. (For specific source references, visit this article at jewishjournal.com.)

The Distribution of Health Care: Five Criteria for Triage

If particular forms of medical treatment are scarce or expensive, who should get them? Although this question of triage is most dramatic when the decision is one of life or death, it affects the quality of people’s lives in less threatening situations as well. Who, for example, should get a hip replacement when society cannot afford to provide one for everyone who needs one? Who should have the benefit of a heart bypass operation or transplant, and who shall be denied that? Which AIDS patients should get the regimen of drugs now available to lengthen their lives, and for whom is that just too expensive? In the High Holy Days liturgy, “who shall live and who shall die” is God’s decision; but with the benefit and responsibility of today’s technology, we find ourselves all too often in the uncomfortable position of having the responsibility to decide that ourselves.

The rabbinic passages that might give us some guidance about triage go in five different directions:

Social hierarchy. One passage in the Mishnah determines priorities on the basis of the victim’s position in the hierarchy of society — with knowledge of Torah trumping all other social stations.

Close relationship. Jewish laws on charity provide a second reservoir of precedents that may guide the provision of health care. In concentric circles, you are most responsible for yourself first, then for those closest in relationship to you, then for the rest of your local Jewish community, then for all other Jews, and then for all other people. 

A hierarchy of social needs. A third set of sources we might use as the basis for a Jewish ethic of the distribution of health care concerns the prioritizing of the community’s duties to fund specific needs. The Shulchan Arukh specifies the order of preferences as follows: “There are those who say that the commandment to [build and support] a synagogue takes precedence over the commandment to give charity [tzedakah, to the poor], but the commandment to give money to the youth to learn Torah or to the sick among the poor takes precedence over the commandment to build and support a synagogue.

One must feed the hungry before one clothes the naked [since starvation is taken to be a more direct threat to the person’s life than exposure]. If a man and a woman came to ask for food, we [Jews acting in accordance with Jewish law] put the woman before the man [because the man can beg with less danger to himself]; similarly, if a man and a woman came to ask for clothing, and similarly, if a male orphan and a female orphan came to ask for funds to be married, we put the woman before the man.

Redeeming captives takes precedence over sustaining the poor and clothing them [since the captive’s life is always in direct and immediate danger], and there is no commandment more important than redeeming captives…. Every moment that one delays redeeming captives where it is possible to do so quickly, one is like a person who sheds blood.”

The Shulchan Arukh recognizes the varying needs of the community — physical, educational, religious and social. Each can be easily justified in terms of broader Jewish commitments to life, human dignity, worship and other religious expression, education, economic solvency and close social ties. Consequently, if one were to create a contemporary list based on these Jewish values for funding communal projects in the United States, it would probably closely resemble the Shulchan Arukh’s list. Saving people who are threatened by human attackers would clearly come first, followed by providing food and clothing to prevent disease, followed by some order of curative health care, defense, education, culture and economic infrastructure.

Interest Increases as Deadline Nears


Susie Tiffany of Beverly Hills suffers from a rare blood disorder and needs monthly infusions of blood components, which her insurance company ultimately declined to cover. She hoped the government’s new prescription drug benefit would help her out because, despite her ZIP code, she’s a low-income senior.

But the possibilities, were baffling: an array of private insurance plans that covered different things, explanations on the Internet that included terms she never had to know before, additional complexities depending on a person’s income and a confusing interplay of state and federal agencies.

However, Tiffany was able to find assistance in her case from Jewish Family Service. A social worker helped get Tiffany’s treatment covered by new state funds intended to help seniors with the transition to the new federal system.

“It’s a good thing that I had a good social worker,” said Tiffany, 65, who lives in a Beverly Hills city subsidized apartment building for low-income seniors.

“There are quite a number of options, and it’s overwhelming,” said Susan Alexman, director of senior services at Jewish Family Service of Los Angeles.

In Los Angeles County, insurance companies have offered 47 different plans for seniors seeking to enroll in the new federally funded benefit. The plan’s May 15 deadline means seniors must sign up without delay or face increased fees for late enrollment.

For some seniors, the financial stakes are high. But while interest is picking up, for most of the past year, social service groups have had few takers when they’ve tried to help.

“It’s strange, but our office has not had any calls on that,” said Deborah Baldwin, public benefits supervisor at Bet Tzedek Legal Services, when asked in March.

At the Fairfax District office of the National Council of Jewish Women, a Democratic congressman’s field staffer set aside four hours over two days in late January to discuss the new Medicare Part D drug plan with seniors. Hardly anyone showed up.

“Just three,” the staffer told The Jewish Journal. “People are putting it off.”

Health care activists, community workers and groups, including Jewish Family Service, have been holding numerous Part D awareness meetings, especially this spring.

“This has been going on for a year and a half,” said Anita Chun, community education coordinator at the Center for Healthcare Rights in Los Angeles. “Now people are paying attention.”

A Part D meeting in March in West Hollywood, put on by Jewish Family Service, attracted about 120 seniors. Attendance also picked up for a March meeting at Temple Isaiah in Rancho Park — after a sparsely attended February session with social workers and experts.

Some seniors said they expect to come out OK under the new system.

“The health program that I belong to enrolled everybody in it beforehand,” said Encino retiree Janet Siskind. Her Blue Shield 65 Plus coverage gets her quarterly refills of the three to four pills she needs. Siskind’s combined prescription fees will increase, but only by about $10 annually.

“I’m in good hands with this,” she said. “It’s something I can afford.”

Siskind’s San Fernando Valley chapter of the Na’amat women’s group held a recent Part D meeting for 25 people.

“We figured, ‘Well, it hasn’t started yet, perhaps it’ll get easier as time goes along,'” she said. “It hasn’t really been explained too thoroughly.”

With so much Part D information online, many seniors are at a disadvantage, because of their discomfort or unfamiliarity with the Internet.

California’s Medi-Cal program, which had covered poor and low-income seniors’ prescription costs, stopped providing service on Jan. 1, when Part D took over. Yet there were startup problems, which included state and federal computers being unable to interact. Many poor seniors were suddenly being asked to pay full price for medications. The reports of hardship prompted Gov. Arnold Schwarzenegger and the Legislature in mid-January to push through emergency prescription drug funding for low-income seniors until May 15.

“It makes the state the payer of last resort for the prescriptions that they need,” said Schwarzenegger spokeswoman Julie Soderlund.

But only until May 15, which could force Tiffany, suffering from the blood disorder, to navigate the system again.

“Good old Part D, the insurance policy that was gonna change it all,” she said. “It’s gonna take some time for me to get happy about it.”

David Merritt, project director at the Center for Health Transformation think tank in Washington, D.C., said that despite such glitches, Medicare Part D transition problems nationwide have been relatively low, with Americans not upset over Part D the way they are over high gas prices.

“Anytime you have a massive policy shift from one system to another system, you’re going to run into problems,” he told The Journal. “The vast majority [of seniors] had zero problems enrolling or getting medication.”

But to Jews dependent on Medicare for affordable drugs, “it’s unfair for seniors to be expected to maneuver through this incredibly messy web,” said Rabbi Zoe Klein of Temple Isaiah. “Health trumps every other problem in your life.”

“They’re basically saying they’re confused, and they want someone to walk them through it,” Klein said.

 

Israel Has Rx for U.S. Health Care


Israel and the United States each have successes and failures in their respective health care systems, but the younger of the modern nations, rooted in its tradition of helping the needy, has much to teach its American ally. When it comes to some of the most important issues facing the American health care system today — universal health care, administrative costs and establishing a national health basket of services — America can look to Israel.

Until 1995, health insurance in Israel was voluntary, although 99 percent of the Jewish population and 97 percent of the Arab population were covered by four HMOs, the first of which was established at the end of 1911. This was a system wherein the insured members paid the HMO, and the employer made a compulsory payment to the National Insurance Institute.

Today in Israel, everyone is covered by health insurance. In 1994, the Israeli parliament passed a groundbreaking health insurance bill that made every Israeli resident automatically insured, no matter their age, financial status or religion. In the United States today, more than 43 million people, including 12 million children, are uninsured.

Israel’s universal health care is characterized by its "national health care basket," which defines the range of services to which every resident is equally entitled. Residents can petition a labor court if they believe an HMO has ignored their rights to a medical service.

Universal access to Israel’s national health care basket means that there is no underinsurance in Israel, which happens when there are gaps in coverage. In the United States, more than 100 million citizens are underinsured — including 40 million with Medicare, 50 million with Medicaid and at least 10 million who are employed in large companies that have self-insurance.

The main health care delivery system for all Israelis is through primary and secondary clinics. These clinics, which are present throughout the country, provide easy and efficient access to care.

The clinics that belong to the HMOs enable quick access to primary medical care and also easy referral to specialists without waiting lists. There is continuity of care, while there is now a tremendous effort to computerize all the medical data.

Ninety-five percent of general care hospitals in Israel are public. There is no wait for diagnostic examinations such as MRI and CT or for procedures such as open-heart surgery. Payment for hospitalization is the responsibility of the HMO, and there is no deductible or co-insurance payment required of the patient.

There is a $3 co-payment for each prescription on the approved drug list covering acute and chronic diseases.

High unemployment and the Israeli economic recession make it difficult for about 10 percent of the population to pay even this, even though there is a $50 biannual co-payment cap.

Caring for the elderly is a core social policy and an integral part of health care in Israel. While in the United States geriatric care is handled by Medicare, in Israel it is part of the health basket and is the responsibility of the HMOs.

Only hospitalization in nursing homes is the responsibility of the Ministry of Health for those who cannot afford to pay for private insurance or from their own means. Geriatric care, being an integral part of health care in Israel, is of high quality.

I do hope that one of the Israeli government’s priorities in an improved economic situation will be to reflect the nation’s social values by exempting the poorest 5-10 percent of the population from drug co-payments.

Israel’s health indicators for longevity and infant mortality are better than those of the United States. This aspect is not unique to Israel, but many Western countries are better in the various indicators of health than the United States. Yet while Israel spends 8.8 percent of its Gross National Product on caring for the elderly, the United States spends 15 percent of its GNP.

In international comparisons of health care systems, Israel ranks among the top 20 in the world. But, even with its favorable standing, Israel faces many challenges, such as the financial limitations of introducing new technologies and prescription drugs to the health basket and the high taxes Israelis pay. Also of concern are high out-of-pocket expenses for cost sharing and for health care services that are covered only by complementary insurance.

Israel’s health care system, while based on the core value of access for all, is still evolving. The establishment of a "health parliament," a private initiative endorsed by the government, enabled input from ordinary Israelis to help set priorities for the future, including the challenges of limited resources and the growing gap between rich and poor.

Obviously, Israel and the United States differ vastly in size, making full comparisons limited. But with the exception of four large states, Israel is similar in size to most U.S. states. The American health system can be improved only if states take responsibility for health care, or, in the case of the four largest states, if there is regional responsibility within the state.

In 2003, the United States spent at least 30 percent of its national health expenditures on administration, while Israel spent less than 10 percent. The United States could have saved at least $280 billion of the $400 billion spent in administrative expenditures in 2003 to cover the uninsured and to close the gap of the underinsured, strengthening the democratic principles it holds dear.


Professor Mordechai Shani is the director general of Sheba Medical Center at Tel Hashomer, Israel’s largest hospital. He served twice as director general of the Ministry of Health, including 1994, when the Insurance Bill and the Patients Bill of Rights were passed by the Knesset.

Plan Seeks to Cure High Cost of Drugs


In this presidential campaign year, the figure is ubiquitous: One out of four Americans, about 70 million people, do not have health insurance. At the same time, Americans are spending about $100 billion on prescription drugs annually, more than double what was spent in 1990.

For the uninsured, that money comes from either government assistance programs or their own pockets. Los Angeles residents, however, may soon be the beneficiaries of a plan to help close the gap.

Councilman Antonio Villaraigosa has unveiled a proposal called, LA-Rx, that would enable the city to make medications cheaper for residents. The plan calls for a city contractor to purchase drugs at bulk rates from pharmaceutical companies and, in turn, sell them to residents at below retail cost.

Although estimates vary about the exact rate of rise in drug costs, anecdotal evidence suggests that there is a serious problem.

"There is no question that prescription drug costs which consumers are paying are escalating and continue to escalate," said Rabbi Hershy Ten, president of Bikur Cholim, a nonprofit organization dedicated to expanding access to health care for the residents of greater Los Angeles.

Concerned with the implications of prescription drug costs for both the Jewish community and the city at large, Ten met with Villaraigosa and his staff to discuss LA-Rx.

The root causes of the issue are economic. Pharmaceutical manufacturers, who have fought court battles with several state governments over health-care costs, claim that they are simply seeking equitable compensation for their risks: Only a very small percentage of drug research ever culminates in a product reaching the market.

The Pharmaceutical Research and Manufacturers of America (PhRMA), an organization that represents more than 100 major U.S. drug companies, also claims that the vast majority of the increase in public spending on prescription drugs is due to the increasing popularity and effectiveness of those drugs, rather than rising costs.

"Some look at the increasing use of medicines and the shift to newer medicines as problems to be solved, not solutions for patients and contributions to affordable health care," said Alan F. Holmer, PhRMA president, in a speech to his colleagues last year.

However, many local governments, health-care providers and ordinary citizens are contesting PhRMA’s position, especially since drug manufacturers expend large sums to advertise their medications.

"In health-care literature, there’s speculation about the dollars spent on marketing vs. true research and development," said Rita Shane, director of pharmacy services at Cedars-Sinai Medical Center. "I monitor [in-patient expenses] on an ongoing basis and deal with the exceedingly high cost of new breakthrough therapies for treatment of patients with severe chronic diseases."

It’s also widely recognized that the pharmaceutical industry enjoys large profit margins, recorded as five and a half times the median of all the industries represented in the Fortune 500 in 2002.

Villaraigosa’s proposal could possibly be the next step in the ongoing battle to reduce drug costs. Several states, including California, Maine and Oregon have already taken advantage of their existing buying power in a variety of ways to coax lower prices from drug makers.

"Many states are responsible for actual delivery of health care to their employees, retirees and Medicaid recipients, [and] they have been pooling their buying power together to negotiate better prices," said Joe Ramallo, Villaraigosa’s communications director.

"No one has yet taken it to the next level, which is what Councilmember Villaraigosa is proposing to do, and use that ability to bulk purchase on behalf of residents as a whole," Ramallo said. "This has been a growing issue of concern to seniors and those who are uninsured."

LA-Rx emerged from a series of town hall meetings on health-care policy sponsored by the Foundation for Consumer and Taxpayer Rights.

The system would work by first enrolling interested Los Angeles residents and establishing the size of the medication buyers pool. Next, the city would contract with an organization called a pharmacy benefit manager (PBM), which would do the negotiating with drug manufacturers.

An open enrollment period would give residents an opportunity to join LA-Rx annually. LA-Rx members would pay an annual fee for administration of the program.

Drug companies, however, would not be forced or coerced to negotiate with the city’s PBM.

"It’s just using market forces, and our understanding is that there are no legal barriers to doing this," Ramallo said. "Drug manufacturers would be foolish not to negotiate if [there is] a pool of 100,000 purchasers, 200,000 purchasers or more. Those are business decisions, and if you don’t do it, your competitor will."

The Jewish community, especially the often-ignored segment of poor, near-poor and elderly Jews in Los Angeles, would stand to benefit from a proposal to cut their drug costs.

The Freda Mohr Center, part of Jewish Family Service, is a nonprofit organization dedicated to aiding a mostly elderly population with health-care issues.

"We see people who [are taking] upwards of 15 to 20 medications," said Nikki Cavalier, center director. "We get a lot of requests for various types of financial assistance … and some of it we can help them with and some of it we can’t."

Cavalier estimated that approximately 80 percent of the center’s clients are Jewish.

Speaking of the prevalence of individuals who cannot afford their medications, Elaine Kau, a center case manager, reported, "I see it on a day-to-day basis. Especially with certain HMOs raising their co-payments and not covering brand-name medications and only covering generics."

"When someone does not take medication that is prescribed by the physician, they are compromising their health," said Ten of Bikur Cholim. "Part of the fiber of the Jewish community is that every life is worth living. That is paramount."

Raising the issue of possible LA-Rx problems, Shane of Cedars-Sinai said, "My concern [is whether] the people administering this benefit [would] end up profiting. Yes, maybe there would be some savings, but it would be hard to know how much of the savings will actually be passed on to the patients."

She added that a local organization might find its work exceedingly difficult "because on a national basis, it is challenging to get [wholesale] pricing on brand-name drugs."

Without accurate nonretail pricing, it would be impossible to know how much money a PBM is saving consumers.

"So my question is," Shane said, "how much additional dollars would be left to the third-party administrator? The purchasing structure of LA-Rx would have to be transparent."

Villaraigosa’s office, however, focused on LA-Rx’s propriety.

"There have been suggestions to regulate PBMs to ensure that they are negotiating on behalf of the pool that they are representing, rather than keeping an unacceptably high level of profit" Ramallo said. "We would go to great lengths to ensure that [PBMs are held accountable]."

One way to do that, according to Ramallo, is to form a nonprofit PBM. "That way there’s no advantage whatsoever for the PBM not to negotiate the best rates for its clients," he said. Under Villaraigosa’s plan, a PBM would be selected through a competitive process that would weigh the benefits of for-profit vs. nonprofit administration.

And although it could conceivably help Los Angeles residents, LA-Rx would inevitably face comparison with the Medicare prescription drug benefit approved by Congress for elderly Americans. Beginning in June, Medicare beneficiaries will have access to Medicare-endorsed drug discount cards and in 2006 full benefits become available.

On the surface, LA-Rx appears simpler and more straightforward than the Medicare drug benefit plan.

"There is a doughnut hole in terms of what people are going to get…. People who are on multiple medications are going to exhaust the benefit very easily, and there is a deductible and monthly premium," Shane said of the Medicare drug plan.

She also pointed out the difficulty seniors will have in understanding their complicated, tiered system of benefits under Medicare.

Cavalier echoed Shane’s concerns about both the Medicare plan and LA-Rx when it comes to the elderly.

"I’d be concerned about the complexity, how people are going to find out about it, how people are going to apply for it … [consumers] already seem to be somewhat confused and uncertain, and they come to us and ask us to help," Cavalier said. "We spend a lot time interpreting and helping them apply for the programs that are out there."

To increase awareness and understanding of the LA-Rx plan, it is currently being circulated within various communities. It may soon be put before the City Council.

"[Consumers of medication] right now have no one to speak for them," Ramallo said. "In this program, they will by pooling together and having a single entity negotiate on their behalf."

"This [proposal] will directly impact the Jewish community, as well as every resident in the city of Los Angeles, [and it] is a process that we want to participate in," Ten said. "This is an issue that crosses all boundaries and borders. If there’s any single unifying factor, it’s the health care of our families."

Planning Ahead Can Save on Health Care


Eva, 74 and a widow, was a healthy and independent woman until she went shopping one day last December and was mugged. She was attacked with a screwdriver and thrown to ground, breaking her shoulder in four places.

"I ended up on the sidewalk, totally helpless," said Eva, who lives in Westwood and prefers to not give her last name. "I went from being very active to being disabled. My recovery was very painful, and I am still not done."

Eva was hospitalized for a month, and when she came home, she found that she needed nursing care and help doing basic tasks around the house, such as bathing and getting dressed.

"A nursing home just didn’t appeal to me," Eva said, and so she found home care. The cost of such care was between $17 and $20 an hour, and Eva needed it at least 16 hours a day for six months.

The cost of her care could have totaled in excess of $55,000 for those six months. However, Eva was able to avoid the expenditure because she had a long-term-care insurance policy that she bought the year before. The premium cost $2,273.

Because elder care can be an enormous drain on an individual’s resources, with nursing homes costing in excess of $100 a day and home care costing even more, planning ahead and buying long-term-care insurance is one way of preventing the costs from being too overwhelming.

For some in the Jewish community, long-term-care insurance — and particularly the home-care policies — can also have a religious significance. They see it as a facet of the mitzvah of Kibud Av V’em (honoring one’s parents), because it allows children to have peace of mind about their aging parents living out their last years with dignity.

In a 1998 article written by Joel Schwartz in the Association of Orthodox Jewish Scientists Newsletter, Schwartz argued that according to Torah, home care is preferable to nursing-home care, because institutionalized living brings with it a certain loss of honor. While some nursing homes are cheery and bright, others may be drab, unfriendly and, in some cases, even detrimental to the health of those who need care.

Government regulations require nursing homes to provide 3.2 hours of care per patient per 24 hours. In some cases, a nursing home might cut corners because it does not hire enough staff to meet the requirement.

In such a scenario, which some experts in the field say is not uncommon, patients who are severely incapacitated will suffer. They said bed-ridden patients might develop bedsores, because they are not turned often enough, and incontinent patients might be diapered to save labor costs.

Few people want their parents to suffer such problems, but many with aging parents have their own families to provide for and do not have the time or resources to take proper care of their parents themselves.

For many people, long-term-care insurance provides the answer to the problem. Although the premiums might appear high — and even seem useless if the person paying them is healthy — they can end up saving people tens of thousand of dollars if the need for long-term care should arise.

Karen Shoff, a Santa Monica gerontologist, insurance agent and author of "There’s No Place Like a Nursing Home: Four Powerful Steps That Will Change Your Life" (Invisible Ink, 2002), believes that planning for one’s physical retirement is as important as planning for one’s financial retirement. Shoff advises people to start planning for their twilight years in their 50s and 60s, so that they will be able to avoid both nursing homes and the costs involved with home care.

Shoff’s plan involves buying a long-term-care policy, appointing a geriatric-care manager who can assist with legal and medical issues and find services, making a living will that spells out how a person wants to be cared for in the event of an illness and finding an ally who will help carry out the plans.

"You can’t wait until the fire’s there, and people are tearing their hair out," she said. "You need to plan ahead logically."

However, there are some who shy away from long-term-care insurance because they see it as unnecessary to pay premiums above and beyond health insurance and Medicare, which they believe will cover most emergencies. Furthermore, many people argue that, depending on the circumstances, nursing homes can provide better service and offer a wider variety of resources than a home care, in addition to having a social setting that might not be available at home.

"There is an understanding in halacha [Jewish law] that sometimes a parent needs to be put in an institution — for example, if the parent has dementia, and the children can’t handle the burden" said Rabbi Elazar Muskin of Young Israel of Century City. "You need to weigh up the circumstances."

Still, others credit their long-term-care insurance and the home care it bought them with peace of mind. "When I took out the policy, my children kept telling me that I was throwing money out the window," Eva said. "But after I was mugged, they were relieved that I had this help, that I was OK and that I was not going to be dependent on them."