78 and 79: A Matter of Life and Death


Like many California voters this week, Rabbi Hershy Ten, president of the Bikur Cholim Jewish Healthcare Foundation, is grappling with how to vote on the Nov. 8 ballot. Either Proposition 78 or Proposition 79 could directly affect his L.A.-based foundation’s efforts to provide health-related services and referrals to needy and uninsured. Either proposition could help by lowering prescription drug prices. But even for Ten, it’s hard to peer through the electioneering and rhetoric.

One thing’s certain: Ten realizes a lot is at stake.

“I know of a man within the last three months who suffered irreversible liver disease because he could not afford his medication,” Ten said. “We were called after he went into liver failure to assist him in receiving a transplant.”

The question before voters is whether the drug companies should regulate themselves, as laid out in Proposition 78, or whether the state should be granted authority to pressure drug companies into providing discounts, as specified in Proposition 79. If both initiatives pass, whichever receives the most votes becomes law.

In the contest of marketing, at least, the outcome isn’t a close call. The pharmaceutical industry has spent more than $80 million backing Proposition 78 (compared to $1.8 million from Proposition 79’s backers, most of it from consumer, senior and health groups).

Putting the hype aside, here’s what Proposition 78 would offer: Most Californians earning up to 300 percent of the Federal Poverty Level would be eligible for discounted drugs, including individuals earning up to $29,000 a year and families of four living on as much as $58,000.

But the salient feature of Proposition 78 is that it includes no state enforcement mechanism. In the case of Ten’s liver patient, it would be solely up to the pharmaceutical industry to select the relevant drug for a discount, determine the discount price (if any), and choose the length of time to maintain it.

There are no state-imposed consequences if a company chooses to keep prices high.

So if the process is voluntary, what’s to stop drug companies from lowering prices right now? Conversely, if drug companies aren’t lowering prices now, why would they under a voluntary plan?

The industry’s response is that Proposition 78 is needed if corporations are to lower prices as a group while also avoiding anti-trust violations.

“We feel we have an obligation to make our drugs affordable,” said Jan Faiks, vice president for governmental affairs and law with the Pharmaceutical Research and Manufacturers of America (PhRMA), the powerful industry trade group. Faiks added that voluntary (and legislatively sanctioned) drug-discount programs in 26 states demonstrate the good faith of drug manufacturers.

These voluntary programs in other states typically have stricter eligibility requirements, and critics say few meaningful discounts are being offered. California’s version, Proposition 78, is identical to the defunct Senate Bill 19, an Arnold Schwarzenegger-backed bill that was defeated by Democrats in the state Senate in early 2005. At the time, the governor estimated that SB-19 would provide prescription drug savings of up to 40 percent off retail, close to the price that HMOs pay for drugs. Proposition 78 proponents have adopted those figures as their own.

This isn’t the first time that this Republican governor’s public health policy has mirrored PhRMA’s interests. In October 2004, Gov. Schwarzenegger vetoed four bills that would have provided information for Californians on obtaining cheaper drugs through Canadian pharmacies. A few weeks later, PhRMA donated several-hundred-thousand dollars to Californian Republican legislative candidates.

Consumer advocates don’t like much about Proposition 78, including the anti-trust justification for why the industry argues that it is necessary. After all, there would never be a legal prohibition barring an individual drug company from lowering its prices. Nor is there any reason why drug companies would have to engage in illegal collusion to lower prices, said Doug Mirell, board member of the Progressive Jewish Alliance (PJA), which is supporting Proposition 79.

Added Anthony Wright, executive director of the Pro-79 group Health Access: “No attorney general or judge would rule against them if they came together to lower prices. There’s no [anti-trust] precedent for it.”

Proposition 79 supporters contend that PhRMA’s real aim is simply to block Proposition 79 from taking effect.

Faiks of PhRMA’s doesn’t deny her group’s desire to thwart Proposition 79, but she insists that Proposition 78 is worthy in its own right.

Proposition 79, backed by consumer groups, unions and the American Association of Retired Persons, sets the discount rate for drugs lower than Proposition 78 (approaching the price Medi-Cal pays for drugs). It also includes patients earning 400 percent of the Federal Poverty Level rather than 300 percent. And it forbids drug companies from charging “unconscionable” prices for medication.

“There are 8 million to 10 million more people who will be benefited by Proposition 79 than Proposition 78,” Mirell said.

Perhaps most worrisome to PhRMA, however, Proposition 79 punishes companies who refuse to cooperate.

If negotiations with the state over discounts break down, the state could curtail that company’s business with Medi-Cal, California’s $4 billion drug discount program for the poor. Medi-Cal patients would have to receive so-called “prior authorization” by the state to use any drug manufactured by that uncooperative corporation. Under this system, the state would first try to find a substitute drug from a cooperative company.

In other words, under Proposition 79 the poorest segment of the population (on whose behalf the state bargains) would be used as leverage to lower drug prices for the next-poorest segment (who today have no bargaining clout).

Even under Proposition 79, Rabbi Ten’s liver patient would not have been guaranteed a different fate. There’s no mechanism, for example, forcing the state to drive a hard bargain for any particular medication. But if it did, the drug’s manufacturer would not easily be able to say no.

Each camp has its own collection of horror stories and feel-good episodes supporting its proposition. Proposition 78 is modeled closely on a voluntary program in Ohio. Consumer advocates modeled Proposition 79 on a program in Maine, one that PhRMA claims is not working well.

Faiks provided The Journal with a report, written by an independent Maine legislative committee, detailing patient frustration with various other systems of prior authorization. PhRMA also points to legal and administrative barriers, most prominently the likely opposition from the Federal Department of Health and Human Services.

“[The Proposition 79] program will never be approved,” said Faiks, who is well positioned to understand the leanings of the Bush administration, which has regularly sided with drug companies.

PhRMA provided The Journal with several letters from federal health officials to various state Medicaid administrators who, over the past several years, have attempted to expand Medicaid coverage to new groups (such as people with specific diseases or those who earn slightly-above-poverty wages). The letters suggest that President Bush’s administration is loathe to extend Medicaid funds or leverage Medicaid patients to benefit new groups unless a state has hard evidence that the expansion prevents these new clients from entering poverty and becoming eligible for Medicaid regardless.

Mirell, of PJA, asserts that technicalities will not cripple Proposition 79, at least not permanently.

“The Bush Administration will not be in power forever,” Mirell said. “Policies do change from administration to administration.”

Mirell also pointed to the “severability” provision of Proposition 79, which allows other provisions to survive even if some can’t be enacted.

“The fact that it may take some months of litigation to implement Proposition 79 shouldn’t scare people away from voting for it, when the benefits that could accrue are so much greater than Proposition 78,” Mirell said.

And the presence and influence of the industry Goliath shouldn’t dissuade the Davids of reform. “It doesn’t mean we should give up, saying they’re too powerful,” said Wright of Heath Access.

A late August Field Poll indicated that Californians largely support both measures: 49 percent voting yes and 31 percent no on Proposition 78; 42 percent yes and 34 percent no on Proposition 79. When the participants learned, however, that the drug industry is backing Proposition 78, opposition to that measure rose sharply.

“People need to ask themselves, ‘Do you trust the drug companies to voluntarily discount their own prescription drug rates?'” Mirell said.

That’s a question that voters are less likely to hear posed exactly that way, given the imbalance in campaign spending.

When he spoke with The Journal, Rabbi Ten was still trying to sort out the pluses and minuses.

“This requires further analysis,” he said. “It requires more information than is readily available through typical media outlets.”

Tax Cuts Bring Shameful Silence


“Listen, we’re broke. Let’s face it,” said Rep. John A. Boehner (R-Ohio) last week, according to the Washington Post. Boehner, the chair of the House Education and the Workforce Committee, spoke as congressional Republicans haggled over big spending cuts for critical health and social service programs.

But the conservative lawmaker spoke only half of the story; the nation is broke, at least in part, because of huge tax cuts demanded by the Republican Congress and administration. And even as they say we can no longer afford programs that benefit the poor and middle class, they are talking about more tax cuts that mostly benefit the wealthy.

Before you criticize Boehner’s blindness to some basic economic realities, take a hard look at the Jewish communal world, where organizations still claim the mantle of social justice activism but refuse to take a stand on the issue that is reshaping America.

That reality will be in full view in the coming months as many Jewish groups lobby against big cuts in critical programs but duck for cover when lawmakers talk about the causes of the budget crisis, starting with tax cuts.

It’s not that Jews don’t care about those less fortunate — including many in our own community. But their organizations are too frightened of their own big donors, too timid about picking a fight with a vengeful administration to wade into the tax fray.

This month House Republicans will try to wrap up work on proposals aimed at slowing the hemorrhage of red ink from federal budget ledgers while finding a way to pay for hundreds of billions of dollars of hurricane relief and for two wars that don’t seem about to end anytime soon.

Proposals include slashing key entitlement programs by $50 billion and reducing overall spending by 2 percent — and cutting taxes another $70 billion.

You don’t need to be a CPA to understand the math flaw here; the results, according to most estimates, will be drastic cuts in critical programs like Medicaid and Medicare and a bigger debt load to pass along to our children.

In the past, emergencies requiring big increases in government spending produced a shared willingness to shoulder the burden. Now, it’s those least able to take care of themselves during trying times who are being forced to sacrifice the most, while the rich just get richer and anti-government ideologues use the explosive combination of tax cuts and high deficits to start dismantling the entire structure of government services.

Jewish groups will fight like crazy to avert cuts to important programs like Medicaid, Food Stamps and subsidized housing for the elderly, all of which benefit many Jews. They will talk piously about their commitment to social justice for all.

But only the Reform Movement has stated the obvious: that big tax cuts under current circumstances can only eviscerate the nation’s ability to respond to new emergencies and undermine what’s left of the nation’s social safety net.

Jewish groups have lost their voices for two very obvious reasons: the fact that many of their top, big-money donors are benefiting handsomely from the tax-cut fever in Washington, and a reluctance to lock horns with an administration and Congress that have made tax cuts an article of faith in their conservative revolution.

There’s a big gap between what Jewish leaders say privately — most believe a policy of big tax cuts at a time of war and growing social needs can only produce economic disaster — and what they say for public consumption, which is essentially nothing.

As the budget fight intensifies, Jewish groups may be able to limit the damage to a few key programs they care about.

But ultimately, their silence on taxes means they are not talking about the policies that are creating unbearable pressure on the budget, guaranteeing that today’s cuts are just the beginning of a trend that will ultimately undo most of what’s left of the nation’s social safety net.

What makes their silence even more destructive is the fact that tax cuts are part of a deliberate strategy by those who have a very different view of the role of the government in helping the needy than do most Jewish groups.

Other religious groups understand the connection. Recently the National Council of Churches wrote to members of Congress criticizing “excessive tax cuts that help only the wealthy,” and calling the combination of cuts in programs and continuing tax cuts “a moral disaster of monumental proportion.”

The U.S. Conference of Catholic Bishops has expressed strong concerns about continuing tax cuts at a time of national emergency.

But Jewish groups continue to tiptoe around the issue, and in doing so they are losing any chance of influencing a debate that will shape life in America for generations to come. Their silence on taxes means Jewish leaders will be forsaking their claim to be champions of social justice, and it will expose all their talk about tikkun olam as just that — talk.

 

Passion to Help Sick Spawns Wider Effort


When Lori Marx-Rubiner underwent a bilateral mastectomy two years ago, she lost the use of her arms for a few weeks. She couldn’t brush her teeth, let alone tackle cooking dinner or driving her son to school.

The Adat Ari El community came to her rescue, bringing approximately 60 meals and even transporting her son home from school. She said the help made what could have been a depressing experience into a “transformative” one.

“My passion became to help others through their illnesses,” Marx-Rubiner explained.

That passion culminated Oct. 24 at a conference she helped organize to train people on how to help the ill and disadvantaged. Hope Abandoned, Hope Redeemed: Training Volunteers for the Mitzvah of Bikur Cholim at UCLA Hillel taught 180 volunteers about bikur cholim, or visiting the sick.

Many local synagogues and Jewish organizations focus on one positive commandment, usually something that involves tikkun olam, healing the world in Hebrew. So why healing the sick and why now?

“There is a significant shortage of trained volunteers, chaplains and others to meet the needs of those in hospitals, nursing homes and hospices,” according to a 2002 survey of all the hospitals, nursing homes, assisted-living facilities and prisons in Southern California.

At least 20 percent of the Jewish community is over the age of 65, 10 percent live in residential care facilities and 4 percent have permanent disabilities, according to the study, “Services to Jews in Institutions.” The 108-page report, written by The Jewish Federation’s planning and allocations department and the Southern California Board of Rabbis, spurred the organizations to create the conference.

Bikur cholim is first alluded to in the Bible when Abraham has a circumcision and three men visit him. Commentators say that the men are actually angels to help him through his convalescence.

While there are other communal organizations that assist sick people — like conference co-sponsors Chai Lifeline, which provides services to families with children who have chronic illnesses, and the already existing Bikur Cholim, which helps provide health services to sick people — this is the first interdenominational, communitywide effort to recruit volunteers for the Bikur Cholim. The conference aimed to show that the mitzvah is a grass-roots affair, which involves all members of the community, young and old alike.

Sponsored by 14 community organizations, the conference expanded the traditional definition of visiting the sick in hospitals to include caring for people with disabilities, chronic or mental illnesses, the elderly and those living alone, as well as drug addicts and prison inmates. The “Institutions” study found that there are approximately 800 Los Angeles Jews in prisons throughout California.

“A lot of people think that the mitzvah of visiting the sick is a mitzvah that is incumbent on rabbis and chaplains,” said Michelle Wolf, assistant director of planning and allocations for The Federation, who organized the conference with Marx-Rubiner. “But it’s a mitzvah that is incumbent on all Jews, the same as giving tzedakah [charitable giving], but it is one that a lot of people don’t usually do and don’t feel comfortable with.”

The conference also kicked off Circles of Support, an initiative to create synagogue committees to coordinate with the sick and help them with their needs, ranging from meals to child care to helping out in the house.

“Some patients are embarrassed to come forth and seek help — some chaplains told us that some people don’t want their congregational rabbi contacted,” Wolf said. “Part of what we are trying to do is create a climate where it is OK to say you are sick and to have a healing process. There is a Jewish tradition that says that every visitor takes a away 1/60 of a person’s illness, and there all kinds of studies that have shown the more community and spiritual support you have, the easier the healing process.”

So far, five synagogues have started Circles of Support. They are Adat Ari El, Beth Chayim Chadashim, Beth Shir Sholom, Leo Baeck and the Malibu Jewish Center and Synagogue.

The 20 sessions at Sunday’s conference focused on aiding volunteers to be strong enough to help the sick.

“To be able to very warmly and graciously open ourselves up to patients takes time and practice,” said Susan Corwin, Mitzvah Corps chair at University Synagogue. She attended the conference to find how to inspire and reinvigorate the volunteers of University’s bikur cholim committee, which was started this summer.

“One of the first congregants I went to visit said, ‘Who are you?’ and I said, ‘I am here representing University Synagogue, and I am here because we care about you,'” Corwin said.

“Where’s the rabbi?” the patient responded.

When Corwin explained she was a member of the congregation and had brought a gift bag, the patient softened.

At the conference, Corwin learned that a volunteer should be sensitive to the patient. She said she was particularly moved by a “creating rituals” activity in the workshop, in which leader Harriet Rosen held a ball of yarn, then asked participants to think of a thought or blessing for bikur cholim. Rosen then threw the ball to them while keeping hold of a strand of yarn. Eventually the yarn formed a web across the room of all the thoughts and blessings.

“I learned that when you walk into a room doing bikur cholim, you are not just walking into the hospital room of the patient, but to the web of relationships that the patient has and that you have,” Corwin said. “The impact is so different on each one of us, and the blueprint to help the patients is inside of all of us.”

For more information on bikur cholim or how a synagogue can form a Circle of Support, call (323) 761-8348.

Community Braces for Flu Shot Scarcity


 

Michael Gabai is on a quest.

The owner and administrator of Ayres Residential Care Home has spent the last two weeks calling physicians, senior centers, grocery stores and pharmacies in search of flu shots for about half of the 18 residents in his facilities who have been unable to get one. Gabai was finally able to secure a reservation for his oldest resident, a 96-year-old, to get vaccinated at a grocery store about 10 miles away.

“We’re scrambling to get it done, Gabai said. “We know how easily [flu] can turn into pneumonia for our elderly clients.”

With the flu vaccine shortage becoming a national — and political — crisis, people working with seniors, like Gabai, are the most troubled.

“Flu is always a concern,” said Molly Forrest, director of the Los Angeles Jewish Home for the Aging (JHA). Vaccinations are normally given to all of JHA’s residents and frontline caregivers willing to be inoculated, she said. However, JHA has not yet received its supply of vaccines from the Los Angeles County Department of Health Services, which has promised to deliver them late this month or early in November. Flu season generally spans from November to March, and affects between 10 percent to 20 percent of Americans.

During the 2003-2004 flu season, there were 1,600 deaths from influenza and pneumonia in Los Angeles County, according to the Center for Disease Control. Also, over the last five years, nearly 90 percent of all deaths from flu andpneumonia were among those 65 or older.

Forrest believes they will get adequate amounts of vaccine to cover the residents, but thinks they might need to seek additional doses for frontline staff.

During her nine-year tenure, Forrest said that JHA had not experienced any serious flu outbreaks. When cases have arisen, they have isolated individual buildings or patients in order to contain the spread of the disease.

Jewish Family Service’s (JFS) Valley Storefront and West Hollywood Senior Center had to cancel scheduled flu shot clinics when the Red Cross failed to deliver vaccines as promised, said Lisa Brooks, one of the agency’s directors.

“We’re waiting to see if more supplies become available,” she said. Directors of JFS’s senior centers are in close contact with sources of the vaccine to find out when that might be.

Additional flu shots might soon be forthcoming from drug manufacturer Aventis Pasteur. The majority of its 22.4 million doses, which were promised but not yet shipped to customers, will be routed to entities designated by the Centers for Disease Control and Prevention (CDC) as priorities. In addition to seniors, those considered most at-risk of developing potentially life-threatening complications from the flu include children under 2 years old (the vaccine is not recommended for babies younger than 6 months old), individuals with chronic medical conditions and pregnant women. According to United Press International, CDC Director Dr. Julie Gerberding said the agency is mapping areas where the vaccine has been sent and those where it is needed and also tracking flu cases by county to quickly identify flu hot spots.

The flu shot shortage does not seem to trouble early childhood educators.

“I don’t think at this time anyone is particularly panicking,” said Betty Zeisl, director of public relations and communications for the Bureau of Jewish Education (BJE), who noted that at a meeting of early childhood center directors last week “the subject didn’t come up.” (While BJE facilities must conform to federal, state and local guidelines, protocols for dealing with illness are determined by each individual center.)

“I don’t think [the shortage] is going to affect us,” said Angie Bass, director of the early childhood center at Temple Beth Am, who believes that sensationalized media reports are needlessly scaring parents. Bass said that the school maintains routine health precautions such as undergoing regular cleaning, a hand-washing policy for staff and students and a practice of sending children home if they need to wipe their noses more than three times in a 15-minute period.

Bass said that “if it really looked like a real epidemic and not just media hype,” she would send home a letter informing parents and include advice from pediatricians. Thus far, however, none of the pediatricians she has consulted have expressed concern.

“As soon as the pediatricians are worried, then I’ll worry,” she said.

“I think it is a potential problem,” said Dr. Carol Berkowitz, professor of clinical pediatrics at Harbor-UCLA Medical Center in Torrance and president of the American Academy of Pediatrics. “We never know how serious a flu season we will have.”

At the same time, she said that last year was the first year that vaccination was suggested for healthy children between 6 and 24 months.

“Flu vaccine has never been recommended for healthy children over the age of 2 years,” she added.

Berkowitz and others emphasize the importance of following CDC recommendations to help prevent flu. These include avoiding close contact with people who are sick, staying home from work or school if you are sick, covering your mouth and nose with a tissue when coughing or sneezing, avoiding touching your eyes, nose or mouth and washing your hands frequently. Certain prescription antiviral medications (oseltamivir, rimantadine and amantadine) can either prevent the flu or lessen its symptoms if taken promptly after exposure to the virus — or soon after symptoms begin. Symptoms may include fever, headache, chills, body aches, dry cough, stuffy nose and sore throat.

Unfortunately, even if individuals take precautions, they cannot control the habits of others. As the JHA’s Forrest notes, this is especially true for the most vulnerable populations.

“The very young and very old, who get help from other people, are incredibly at risk because they depend on someone else’s hygiene,” she said.

 

California’s Budget, Compromised


Just as it seemed his honeymoon governorship was degenerating into insults and whining, Arnold Schwarzenegger finally signed a $105 billion state budget on July 31, about a month late.

The governor kept his promise not to raise taxes, the Democrats flexed their own muscles and won a reprieve from the drastic cuts they’d feared (especially in spending on health care) and most of the midsummer frustration has evaporated. Even Schwarzenegger’s poll numbers saw a rebound.

Jewish political leaders won a major budget victory when proposed cuts to day care for frail seniors failed to materialize. Saving two state-funded services, Adult Day Health Care and the Multi-Purpose Senior Services Program, was the centerpiece of the Jewish Public Affairs Committee’s May mission to Sacramento.

"We were very pleased with the governor’s and the legislature’s final budget," said Jessica Toledano of the Jewish Community Relations Committee, a wing of The Jewish Federation. "All of our programs here at The Federation have been maintained."

To make the bipartisan compromise work, the state budget borrows about $5 billion in bonds and liens on a slew of temporary funds secured from public education ($2.04 billion) and local governments ($1.3 billion). It’s only a stopgap, of course, since those interests are guaranteed all their funding back in 2006.

If all this borrowing and temporary cash sounds familiar, that’s because it is.

"The budget is pretty much concocted the same way that it has been the last two years," said Stephen Levy of the Center for Continuing Study of the California Economy. "It’s the same mixture of stuff that we had before, and what it means is that we’re guessing the long-term budget gap is about $10 billion."

"He did what the voters told him to do: don’t cut spending, don’t raise taxes. It’s worked before," Levy said. "Well, ‘worked’ is a funny word for it, but it’s essentially what we’ve been doing before, which is to postpone the hard choices."

Here’s the upshot: Whichever side of the hard choice you’re on, higher taxes or cutting social services, there doesn’t seem to be a third option. California needs to either spend less or take in more revenue, despite the ongoing appeal of doing neither.

Unfortunately, the state now appears to be on track for a 2005 repeat of last year’s budget nightmare.

"I don’t think the bond houses are going to cut Schwarzenegger too much more slack, and, yes, we’ll be back [in deficit] next year," Levy said.

Sounds like business as usual in Sacramento, perhaps with a few more cigar tents.

Guarding Medi-Cal

No doubt the biggest Democratic rescue operation in Sacramento was the successful defense of Medi-Cal, if only for the moment.

Back in January, the governor had proposed about $900 million in cuts to the program that funds health care for the poor, but he backed down after stiff opposition from Democrats and social service nonprofits. Schwarzenegger’s policy team will return in January 2005 with a revamped proposal.

"About 50 percent of our annual revenues come from the Medi-Cal program," said Molly Forrest, CEO of the Los Angeles Jewish Home for the Aging (JHA), where fully 75 percent of the residents use state assistance to pay.

Forrest noted that the average "multilevel nonprofit health care provider" (more than just a nursing home) has only 20 percent of its residents on state assistance. JHA’s extra assistance to low-income people makes it far more vulnerable to Medi-Cal cuts.

Needless to say, Forrest isn’t content to wait and see what happens in Sacramento in January.

"In the last two years we’ve initiated about $1.5 million in cost cutting," Forrest said.

So to modernize its (already impressive) facilities, the focus is squarely on private donors and volunteers. Private funds, for example, created the fantastically hi-tech Goldenberg-Ziman Special Care Center — a facility for Alzheimer’s patients scientifically designed to feel more warm and comforting by incorporating research into how the disease affects behavior.

"The fact that so many [nursing homes] in California are outdated is related to the [Medi-Cal] reimbursement rate that the state is willing to pay," said Forrest. "The way we were able to [expand] was through the generosity of donors."

Alex Padilla, president of the Los Angeles City Council, said cuts in state-level assistance mean city officials should be taking a harder look at health care.

"I think the city can be supportive, financially and otherwise, of organizations who are trying to fill a void," Padilla said

"I believe there are fundamental human rights, and among them is the ability to live your golden years with dignity. The Jewish Home for the Aging provides that," Padilla said.

And not just for the wealthy, either.

Learn to Work

In a final bit of governor-related activity, the California Performance Review (CPR), a four-volume compendium of proposed changes to California’s government, was released by Schwarzenegger’s team on Aug. 3.

Though the report suggests reforming everything from taxation to wildlife management, some of the most interesting suggestions concern the issue on which the state spends more money than anything else: education.

Enter the Department of Education and Work Force Preparation, the CPR report’s answer to California’s education woes. That department would set policy from preschool to the university level, and adjust it to fit "the needs of employers," according to the report.

"I think it’s a misreading of the American public school and its history to say that good schools need to serve the marketplace," said David Tokofsky, who represents about 600,000 people on Los Angeles Unified School District’s Board of Education.

"Good schools have a far more important role in invigorating democracy, the civic socialization role," he said.

At the head of this new bureau would sit the governor’s own appointed secretary of education (currently Richard Riordan), not the state’s superintendent of public instruction (currently Jack O’Connell), who is actually an elected official.

"There’s a real danger in the attraction of nonelected people in charge of schools," said Tokofsky, who was first elected to the Board of Education in 1995. He noted that the nature of American federalism runs counter to centralizing all power in the hands of one official.

It’s highly likely that the reforms contained in the CPR report will be picked apart, revised, edited and amended innumerable times before any are passed into law. Nevertheless, taken as indicators of this administration’s values, they are very telling.

"It’s an irony that the Republican Party that’s always for the theme of local government against Democratic centralism, is, now in power, singing the very tune of what it condemned just years before," Tokofsky said.

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."

Bill Seeks to Cure Health-Care Plague


“Whoever enlarges on the telling of the deliverance from Egypt, that person is praiseworthy.” These words, included in the Passover seder, which will soon be read by Jews all over the world, remind us that the story of Exodus is meant to be applied to our lives today.

The Bible tells us that Moses and Aaron went to Pharaoh again and again, telling him that God said to let the people go. But Pharaoh’s heart was hardened. He refused to free the Israelites, and God afflicted Egypt with plagues.

After each plague, every one worse than the one before, Pharaoh’s counselors begged him to change his mind. But Pharaoh’s hardened heart interfered with his reason. Even though he brought nothing but calamity on his country, he would not accept the changes that were needed to make the suffering stop.

Today we are beset with a series of health-care plagues, each seeming worse than the one before. The number of Californians without health-care insurance coverage hovers between 6 million and 7 million people — that’s about one in five of us. About 85 percent of those people are working in jobs where health care is not provided. Nationwide, health-care costs are the second largest cause of personal bankruptcy.

For those people who do have health-care coverage, premiums, co-pays and out-pocket-expenses due to lack of adequate coverage are out of control. There is an over-reliance on emergency-room care by the uninsured, as well as the underinsured, who often wait so long to seek care, their once-treatable chronic condition has worsened.

Treatable high blood pressure leads to strokes; diabetics discover their condition only after a coma. This results in pain for the patients and their families, and, since emergency-room treatment is much more expensive than preventive care, there is an increased burden on California’s health-care budget.

Hospitals, doctors and clinics are passing on the costs of treating patients who cannot pay their bills to those patients who are insured. Insurance companies drive up the costs of premiums for hospitals and cut back on reimbursements. In some cases, hospitals are seriously considering shutting down.

Jewish tradition is clear about the importance of health care as a shared social concern. Maimonides put health care first on his list of the 10 most important communal services that a city had to offer to its residents.

As Conservative Rabbi Elliot Dorff reminds us in his teachings, Jewish tradition says that it is a positive commandment to save the life of a person in danger from illness, as it falls under the general obligation of saving life: “Thou shalt not stand idly by the blood of your fellow,” (Leviticus 19:16).

So great is the mitzvah of saving life that Jews are directed to violate the Sabbath to fulfill it. The Shulchan Arucha calls for communities to take financial responsibility for those unable to pay for health care themselves.

In 1976, the Reform movement’s Central Congress of American Rabbis adopted a resolution, affirmed in 1991, in favor of “universal access to health care benefits, including access to primary and acute health care, immunization services, early diagnostic and treatment programs, provider and consumer education, programs of extended care and rehabilitation, mental health and health and wellness promotion. Such a program should provide for education, training and retraining of health-care workers, as well as just compensation and affirmative action in hiring. An effective plan will provide for cost containment, equitable financing and assure quality of services.”

That resolution could have served as a model for Senate Bill 921, a comprehensive health-care reform bill that I introduced last year, and which, after having passed the state Senate, is now up for consideration by the Assembly.

Senate Bill 921 will put no new burden on the state’s General Fund. In fact, it will save billions of dollars in health-care costs by reducing the 25-27 percent of every California health-care dollar that is now spent on administration to between 3-5 percent.

Senate Bill 921 will save that money by creating a single, streamlined claims and reimbursement system in place of the fractured, hodgepodge of public and private systems we have now. It will replace all of our current inflated premiums, deductibles and co-pays with a single means-based premium that each of us can afford, while covering everyone under the same generous and flexible plan, which includes medical, dental, vision, mental health service and prescription drug coverage. Senate Bill 921 will also provide every Californian with the freedom to choose his or her own health-care providers.

Senate Bill 921 also relieves employers of the exclusive responsibility for their employees’ health coverage. Like individuals, businesses will be assessed a means-based premium as their only contribution to this plan. Like individuals, businesses will pay what they can afford, and they will find themselves on a level playing field with regard to health-coverage expenses.

They will also find their expenses for workers’ compensation dropping dramatically, because this bill folds the medical portion of workers’ comp into the state insurance plan. This deep reform will save money for employers, while improving actual care for people who are injured.

Senate Bill 921 will provide every Californian with prescription drug coverage, because it mandates the state to buy pharmaceutical drugs and durable medical equipment directly from the companies, in bulk.

In this season, as we approach our time to celebrate the Exodus of the people of Israel from their confinement in Mitzrayim, we have an opportunity to reflect on the tight spots we find ourselves in today and how we can free ourselves. One of the saddest things about Pharaoh’s hardened heart is that it would not let him see that the compassionate option really was the most sensible option as well.


State Sen. Sheila Kuehl (D-Los Angeles) represents the 23rd Senate District. She and other experts will take part in Zey Gezunt, a panel on health care, SB 921, on March 18 at 7 p.m. at Temple Beth Am, 1039 S. La Cienega Blvd. Los Angeles. The forum is free. For more information, call (310) 441 9084.

Community Briefs


Programs Survive State Budget Slash

Several programs that cater to a largely Jewish clientele have survived California’s budget ax — for now.

The Adult Day Health Care Center in North Hollywood, which had been expected to close with the passage of a state budget, got a new lease on life when the Legislature voted to exempt most long-term elder-care programs from cuts. That move also helped the Los Angeles Jewish Home for the Aging, an 800-resident facility that had braced itself for cuts in nurses, social workers and such programs as exercise and knitting.

Intensive lobbying in Sacramento by the Jewish Public Affairs Committee (JPAC) of California helped sway the politicians. So, too, did a mission of influential Jews to the state capital, including several members of The Jewish Federation of Greater Los Angeles, said Jessica Toledano, director of government relations for the Jewish Community Relations Committee, a department of The Federation.

Despite the victory, Toledano said continuing budget woes made the future less than bright.

“I think we have stalled the serious cuts for at least one year,” she said.

To protect programs for seniors, JPAC plans to form a coalition with Catholic Charities, AARP, the Salvation Army and other groups, she said.

In related news, the Multipurpose Senior Services Program (MSSP), which provides poor seniors with taxi vouchers, home meal preparation and other services to keep them out of nursing homes, suffered a financial setback. The Jewish Family Service-run program will receive 5 percent less from the state because of Medi-Cal cuts. Davis had initially proposed 15 percent reductions. Because of the reduced funding, MSSP will care for about 50 fewer patients. — Marc Ballon, Senior Writer

Custody Case Allows Boy to Live inIsrael

After two years of litigation, a Los Angeles appeals court has ruled that it is safe for 5-year-old Yuval Abargil to live in Israel.

Yuval has been at the center of a custody fight by a divorced Israeli couple, in which the mother, Michal Abargil, wished to take him back to her native country. The father, Aharon Abargil, argued that the boy should stay with him in the United States, because terrorist attacks made Israel too dangerous a place to raise the child.

Justice Laurence Rubin, in upholding the decision of a lower court, concluded that, “We would be naive to believe that there is no danger in living in Israel…. [But] few, if any, places in the world are safe from all danger, be it political, ethnic, religious, natural or random.”

Michal agreed with the three-judge panel.

“When you live in Israel, it’s not nearly as scary as it looks from the outside,” she said in a phone interview.

The case was complicated from the beginning. Aharon and Michal met and married in Los Angeles, but each had earlier entered the United States on a tourist visa and illegally stayed on after the visas expired.

Aharon has two applications pending for permanent residence here, while Michal has been barred from re-entering the United States for 10 years.

Under the circumstances, it will be impossible, in the foreseeable future, for the father to travel to Israel to see the child, or for the mother to bring Yuval to America to see the father.

To assure Aharon’s parental rights and long-distance contact between father and son, Rubin ordered that the case would remain under California jurisdiction, though registered and enforced by an Israeli court.

Michal has returned to Israel with Yuval and said she will settle permanently in either Ramat Gan or Givatayim, where she has relatives. She hopes to find work as a graphic designer. She also hopes to find a publisher for her recently completed children’s book on divorce, titled “When Mommy and Daddy Are Getting Separated.”

“The most important thing is to convince the kids it’s absolutely not their fault that the parents are getting a divorce,” she said. — Tom Tugend, Contributing Editor

Federation Lays Off JCRC ExecutiveDirector

Michael Hirschfeld, the executive director of the Jewish Community Relations Committee (JCRC), has been laid off after nearly a quarter-century on the job due to financial difficulties at The Jewish Federation of Greater Los Angeles.

In an e-mail to his colleagues, the 24-year JCRC veteran said his job had given him immense personal satisfaction over the years and praised JCRC programs that combat illiteracy in schools, blunt anti-Semitism on campuses and create new leaders for the Jewish community. “We in the JCRC have contributed to the life of our Jewish community and our Los Angeles civic society immeasurably,” he wrote.

Hirschfeld declined to comment.

His departure comes at a time when The Federation, JCRC’s parent, has completed an internal audit to improve its efficiency, increase its relevance and boost its fundraising. The Federation, as part of its restructuring, has eliminated JCRC’s executive director position. At least one member of The Federation’s communications department was laid off.

The Federation’s fundraising has been flat for nearly a decade, although it has edged up slightly this year.

Under Hirschfeld’s leadership, JCRC developed KOREH L.A., a literacy program that places Jewish volunteers in public elementary schools to tutor students. JCRC also helped create the Campus Coalition Initiative to teach Jewish university students to respond to anti-Zionist propaganda at campuses. — MB

Bronfman Offers Young Leaders Chance at$100,000

An annual $100,000 award to recognize Jewish leaders of the future under age 50 has been announced by the family of philanthropist and business leader Charles Bronfman.

The international award will “celebrate the vision and talent of individuals, or a team of individuals, whose accomplishments on behalf of others enrich Jewish life … and inspire the emerging generation of Jewish people,” the announcement stated.

The Charles Bronfman Prize was conceived as a 70th birthday tribute to the Montreal-born philanthropist by his children, Stephen Bronfman and Ellen Bronfman-Hauptman, and son-in-law Andrew Hauptman. The Hauptmans are co-chairs of Andell Entertainment and Mission Pictures, headquartered in London and Los Angeles.

Nominations may be submitted in English or Hebrew, with a deadline of Oct. 31. The inaugural award will be presented in spring 2004.

For information and forms, go to www.TheCharlesBronfmanPrize.com,e-mail info@TheCharlesBronfmanPrize.com  or phone the New York office at (212) 572-1035. — TT

California Jews Lobby for Medi-Cal


Nearly 200 Jews descended on Sacramento this week to lobby California’s most powerful politicians to protect major programs that serve the poorest and frailest Jews and other Californians from the budget ax.

Jews from throughout the state, including Los Angeles, San Francisco, San Diego and Orange County, canvassed the state capital Monday, May 19 and Tuesday, May 20 to fight against proposed cuts to Medi-Cal, the state’s health insurance for the poor. They also networked, learned how to become effective advocates for Jewish causes and attended workshops on issues ranging from how to manage the media to the need for Jews to build coalitions.

The mood among participants, against the backdrop of a ballooning state budget shortfall estimated by some at more than $38 billion, appeared less ebullient than in the past.

"In prior years, when the state had a surplus, the discussion was on expanding programs and creating new initiatives," said Esther Netter, executive director of the Zimmer Children’s Museum in Los Angeles. "This year, everyone had a defensive posture, and the mood was more somber."

State Controller Steve Westley warned participants at a breakfast speech that California’s budget problems were even worse than they seem.

Attendance for the two-day mission, which was sponsored by the Jewish Public Affairs Committee (JPAC) of California, the state’s main Jewish lobbying group, was 190 — off by more than 8 percent compared to last year, organizers said. They attributed the drop to holding the event a week before Memorial Day weekend, the poor economy and a belief among some Jews that their voice wouldn’t make a difference.

Still, Cliff Berg, JPAC legislative advocate, said he thought the group’s collective message would get through to legislators because of participants’ commitment to deliver it in person.

"I think the fact that you’re willing to take a couple days off work and come to Sacramento will resonate with [the politicians]," he said. "It shows there are others who feel the same way you do and others behind them."

Gov. Gray Davis has proposed cutting Medi-Cal reimbursements by up to 15 percent to help close the growing state budget deficit. That belt-tightening would save more than $1.4 billion, but would do so at the expense of California’s most vulnerable. Medi-Cal underwrites a slew of programs that cater to a largely Jewish clientele locally, including the Valley Storefront Adult Day Heath Care Center in North Hollywood, and the Multipurpose Senior Services Program (MSSP), which provides indigent elderly with taxi vouchers, home-meal preparation and other services to keep them out of nursing homes.

The Valley Storefront would have to close down, along with an estimated one-quarter of the state’s 307 adult day health-care centers, if the Legislature enacts the suggested cuts. MSSP would shed 110 of its 734 monthly clients and lose one of its two full-time social workers.

"I think it’s immoral to turn our backs on the elderly," said Jessica Toledano, director of government relations for the Jewish Community Relations Committee, a department of The Jewish Federation of Greater Los Angeles. "These programs keep their [seniors’] dignity, and also keep them out of nursing homes, which are far more expensive."

Motivated by Toledano’s and others’ speeches, mission participants made their way to the state capitol where they collectively lobbied 60 legislators or their aides, admonishing them to forego the proposed Medi-Cal cuts. The newly minted lobbyists also asked politicians to support a resolution condemning the Arab League’s revived economic boycott of Israel and to support legislation that would train teachers on the prevention of hate crimes in schools.

It is unclear whether their efforts had much impact.

Assemblyman Leland Yee (D-San Francisco) told a group of five neophyte lobbyists that many Democrats opposed Medi-Cal reductions, but that Republican unwillingness to raise taxes or other fees to balance the budget muddied the picture.

"You need to talk to Republicans about revenue generators," he said.

Even if Medi-Cal cuts pass, mission members deserve credit for fighting a battle on behalf of those who sometimes go unheard, said L.A. attorney Matthew Ross, a former business-affairs executive at CBS.

"We’re up here talking about the poor, immigrants and the elderly, people who don’t often have lobbyists," he said. "We’re their lobbyists. We’re their voices."

To become legislative advocates, mission participants attended a nearly two-hour session in the nuts and bolts of lobbying. JPAC’s Berg told group members to be clear, "stay-on-script," exchange business cards with politicians and, most important, to remain polite, regardless of the reception to their ideas.

"Our broader goal is to build relationships and work on [getting the politicians] to nurture and understand the Jewish community," he said.

Sarah Jaffe, a 19-year-old sophomore at UC Santa Barbara, said participating on the mission gave her a chance to try to create positive change. For her, cutting Medi-Cal is akin to slashing the social safety net that might one day be needed catch her parents — or herself.

"Being a young person and seeing the changes affecting Medi-Cal makes me worry about the future," she said. "Even though I’m not affected now, in a few years, cuts could hurt my parents and, a few years later, me."

Health Care Requires Resuscitation


Eric Moore is frustrated. Within weeks after losing his computer consulting job, the 30-year-old UCLA graduate collapsed from a pulmonary embolism. He has since recovered, but faces a $14,000 hospital bill.

Dr. Alexandra Levine is frustrated. The head of the USC-Norris Cancer Center faces numerous barriers to providing the care she’d like to provide to her patients. One patient required a medication that could be taken at home via injection. Since Medicare doesn’t cover prescription drugs, but will pay if the drug is administered in the hospital, Levine’s 91-year-old patient was forced to make a thrice-weekly trek from the Valley to the center, and each time the tab to Medicare was twice as high as it would have been had the medication been taken at home.

Luis Jiminez is frustrated. The 29-year-old entrepreneur started an online marketing and Web business, which now boasts a staff of 11. But he can’t afford to provide health insurance for his employees.

"We have a continuing crisis in this country of millions of Americans without health insurance, and that’s just plain wrong," said Rep. Henry Waxman (D-Los Angeles), who will speak Friday, April 25 at Leo Baeck Temple as part of a series on health care.

In 2001, approximately 41 million Americans — more than 14 percent of the nation’s population — went without health insurance for the entire year, and another 20 to 30 million lacked coverage for part of the year. With health care premiums increasing at about 11 percent a year, big companies are paying a smaller percentage of those premiums, and small businesses are finding they can no longer afford to provide health care at all. These factors, combined with job layoffs resulting from a weakened economy, have left a growing number of people without health insurance.

Meanwhile, health care costs are skyrocketing. In 2000, $1.3 trillion was spent on health care in the United States, a 7 percent increase from the prior year.

According to Rabbi David Saperstein, director of the Religious Action Center of Reform Judaism in Washington, D.C., the average family spends four times as much on health care today as it did in 1980.

"This country has yet to make a decision that every man, woman and child has a human right — a civil right — to health care," said Los Angeles County Supervisor Zev Yaroslavsky, speaking at Leo Baeck Temple last month. While implementing such a decision "may be complicated and expensive," he said, "it’s not as expensive as not doing it — not as expensive financially and not as expensive morally."

Because those without coverage tend to postpone seeing a doctor, preventable conditions become severe illnesses, needlessly harming patients and unnecessarily driving up health care costs. The uninsured also tend to use emergency rooms as their only source for medical treatment, limiting the ability of those facilities to provide more urgent care. And while many believe the majority of uninsured are unemployed, 80 percent of the uninsured come from working families.

In Los Angeles County, one out of every three residents lacks health insurance. More than 80,000 of the uninsured are children. Budget shortfalls spur continued cuts to county health services. Twelve public care centers and four school-based clinics have closed since June 2002, and High Desert Medical Center in Lancaster and Rancho Los Amigos National Rehabilitation Center in Downey are currently targeted for closure. These closures put an added burden on remaining facilities, raising the troubling specter that crucial services will be unavailable when we most need them.

"Whether you live in Bel Air or in Torrance or in Pomona … you have a stake in providing health care to the maximum number of people," Yaroslavsky said. Otherwise, he said, you had better hope "that a mother who has a kid with an ear ache doesn’t come to the ER … and gobble up space … while your heart attack is going on."

For those who consider the predominantly poor, immigrant patients who use county facilities somehow less deserving of care, USC’s Levine had sharp words.

"Who we see at this hospital is you — your mothers, your grandmothers, your great-grandmothers. All of us were immigrants in this country…. And what do these people do? They train every physician in the U.S. Did I learn how to do a spinal tap on you? No I did not. I learned on someone in the county hospital…. We owe them because of our roots and because of what they do for all of us on a daily basis."

As for the national picture, "reform must become a reality because we have no other choice," Saperstein said. "The question no longer is whether there will be health care reform, but what form these changes will take."

A number of proposals are on the table nationally and on the state level. Some aim to expand availability of health care coverage by pooling individuals or small employer groups into large groups. Others seek to expand Medicare, Medicaid and/or the State Children’s Health Insurance Program. Still others propose use of tax credits to help families purchase insurance or tax incentives to encourage employer-sponsored plans and benefits.

Waxman is particularly critical of the Bush administration’s approach to health care.

"The Bush administration is trying to undermine the programs we’ve got, and nowhere is this more obvious than Medicare. They refuse to add a meaningful prescription drug benefit to traditional Medicare…. Instead, they want to use a drug benefit … to force people into private insurance plans or HMOs, where they won’t have guaranteed benefits or assurance that they can see their own doctors."

Saperstein and Yaroslavsky say the way to get effective legislation passed is to make sure lawmakers know health care is a priority for voters. Politicians need to hear from their constituents about this issue, and to know that it drives contributions and votes.

"We have got to raise the political stakes nationally to make provision of health care a priority," Saperstein said.

Rep. Henry Waxman will speak about "The National Crisis in Health Care," on Friday, April 25, at Leo Baeck Temple, 1300 N. Sepulveda Blvd., Los Angeles. Services begin at 8 p.m. For more information, call (310) 476-2861.

A Pass-SOVA Tradition


A jar of gefilte fish, a bottle of Tzali’s grape juice, Manischewitz matzah ball soup mix, Streit’s macaroons, Trader Joe’s horseradish, matzah, Sun-Maid raisins. All the makings for a Passover seder — even if you’re homeless.

On a sunny Friday morning in March at SOVA’s humble West Los Angeles storefront, about 10 people — young and old — work together in assembly-line fashion to package these nonperishable items. These volunteers are unpaid, and the Passover kits are aimed at low-income, homebound and even homeless Jews.

Helping the needy is what SOVA (Hebrew for “eat and be satisfied”) has been doing since 1983, when Santa Monica deli owner Hy Altman and wife, Zucky, created the nonprofit organization.

SOVA’s three storefronts are open for four hours a day during the weekdays, during which the Los Angeles and Valley locations provide grocery packages for more than 2,000 people a month. A typical four-day supply of groceries — designed for homeless people without cooking facilities — includes canned and packaged grocery products, produce, liquid supplements and can openers. In addition to its food pantry services, SOVA provides referrals to an array of employment, legal and medical help services, as well as bus tokens.

There is a cap on how many times people off the street can solicit SOVA’s services: twice a month for the homeless, once a month for low-income, although exceptions are made for emergency situations.

Originally a Jewish Community Centers (JCC) program, SOVA transferred over in 2002 to the authority of Jewish Family Service of Los Angeles (JFS), a beneficiary agency of The Jewish Federation of Greater Los Angeles, as part of a post-crisis reorganization of JCC assets. SOVA operates on an annual budget of $560,000 culled from The Federation, government and municipal grants, the Federal Emergency Management Agency and private donors, such as the Edelstein Family Foundation and Carolyn Spiegel. Spiegel, who has purchased and donated products to SOVA for several years, even developed a system for combining coupons and advertised grocery store specials to donate goods. In 2002, she single-handedly donated more than $39,000 worth of products for SOVA’s clientele.

“Their income is so low, they can’t afford to cover their day-to-day costs,” said Leslie Friedman, SOVA’s director since the JFS takeover.

SOVA is a real roll-up-your-sleeves kind of team effort.

“The most rewarding element has been working with volunteers,” said Lirona Kadosh, the 25-year-old manager of SOVA’s West L.A. location. “In the end of the day, it’s tough, it’s draining. But you learn a lot.”

SOVA thrives from food collection campaigns supported by more than 50 area congregations, as well as other community entities. Passover — along with Rosh Hashana, Thanksgiving and Chanukah — is one of several holidays each year for which SOVA holds special distributions. The food collected during the High Holidays translates into an estimated $80,000 saved.

“We have a lot of regulars — homeless veterans, Russian immigrants, Latino families that just can’t stretch enough,” said volunteer Myrna Dosie, who is in her 12th year as a volunteer. About a quarter of those helped by SOVA are Jewish, many of them elderly, some Holocaust survivors.

Enter Hans, a man with a German accent, who comes in for his typical SOVA care package, which might included cooking oil, tuna, pasta, rice, spaghetti sauce, tea, cereal and toiletries, such as toothpaste, shampoo and hand lotion.

Minutes later, in walks another regular, Paul, who lives in the Crenshaw District. He feeds a family of five and has been turning to SOVA twice a month for supplemental help since 2000. He also has AIDS.

“They’ve been very helpful,” said Paul, an African American who learned about SOVA through AIDS Project Los Angeles. “They’re very personable and have always treated me with kindness. I don’t know what I’d do without them.”

Since 1989, Paul and Ruth Mittleman have dropped by the West Los Angeles station every week to donate their time. Ruth even got her friend, Dosie, involved.

What might not be so obvious on the surface is that SOVA not only assists total strangers, but often even helps the very people volunteering for the nonprofit organization.

Ezra Shemtob, 82, struggles to suppress tears as he tells his story, even after nearly two decades have passed. The Mittlemans helped Shemtob adapt to America when he was just a stranger to the United States in 1989. The former high school teacher came to this country a broken man — his apartment, career and car confiscated by Iran’s government, simply because he was Jewish. Upon his arrival in America, his wife died of a heart attack as a result of all of the stress they had endured.

Every day after synagogue services, the observant Shemtob comes down to SOVA to volunteer a few hours of his time. Given all that he has experienced, Shemtob credits the volunteering as crucial to his mental and spiritual health.

“He’s been here for 14 years,” Paul Mittleman said. “He’s been very sick, but he’s OK now. He’s been a very loyal worker.”

Shemtob, who has a son living in Los Angeles and a daughter stuck in Iran, gives back to the community “as a mitzvah, for the United States, which gave me everything.”

He appreciates the scope of SOVA’s outreach.

“SOVA is a good organization,” Shemtob said. “They don’t look at race, what color, what religion — they help everybody.”

Also helping expedite things on this Friday morning are a clutch of students from the Archer School for Girls and Harvard-Westlake School who are fulfilling required community service hours. Abram Kaplan, a Harvard-Westlake 10th-grader, chose SOVA because he remembers the charity group from his Temple Emanuel days.

“I’ve met a whole lot of cool people like Ezra,” said Kaplan, 16, who sees SOVA as something he would volunteer for even if his school did not require him to. Kaplan roped in his classmate, Eyal Dechter, who was less enthusiastic about his community service detail. But he conceded that SOVA is a good cause.

“It’s a good idea to help others in need, but I do it mostly because I have to,” said Dechter, 15.

First-time volunteer Simon Yeger had no problem getting into the SOVA groove.

“Everyone’s been very helpful,” said Yeger, now retired for four years and looking for ways to give back to the community.

What SOVA needs most right now is more volunteers, who can donate a couple of hours per week, and vendors, who would be joining supermarkets such as Ralphs and Gelson’s.

“We are very open and interested to hearing from vendors who’d like to contribute goods,” Friedman said.

Kadosh has seen a difference for the better since JFS took over SOVA.

“All of the adjustments have been for the better. We’ve had more access to food, an increase in help, more drivers and stronger support.”

And volunteers see SOVA’s mandate as an extension of what the Torah commands Jews to do.

“The middle name of Judaism is tzedakah,” Ruth Mittleman said. “Offering help to people is just a way of Jewish life, and here you can see your money at work. This is as hands-on as it gets.”

The SOVA Food Pantry Program is located at 13425 Ventura Boulevard, Suite 200, Sherman Oaks. For more information, call (818) 789-7633 or visit www.jfsla.org/sova/.

The three SOVA storefronts are: SOVA Valley, 60271¼2 Reseda Blvd., Tarzana. (818) 342-1320.

SOVA Metro, 7563 Beverly Blvd., Los Angeles. (323) 932-1658.

SOVA West, 11310 Santa Monica Blvd., West Los Angeles. (310) 473-6350.

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."

Russia’s Jews Rediscover Roots


Lev Entin, a 90-year-old resident of St. Petersburg, has spent the past year relearning something he spent most of his life trying to forget: his Judaism.

Entin’s father was a shochet (ritual slaughterer), and until Entin was 12, he attended a cheder (Jewish school). But after that, Entin, "a product of the Bolshevik Revolution," as he puts it, did not pay attention to his religion.

But in the past year, Entin has reintroduced himself to his tradition by reading books and brochures he receives from his local Hesed welfare center.

"Only this year did I become a Jew again," he said.

Roughly 175,000 Jewish elderly in Russia are now served by the 88 Heseds across the former Soviet Union. These centers, run by the American Jewish Joint Distribution Committee (JDC), account for about one-half of all Jewish social and welfare organizations in the former Soviet Union.

They provide basic services, such as food and health care, to the large numbers of elderly who were impoverished both by the chaos of post-Communist Russia and by last August’s economic collapse. But the Heseds, which mean "charitable deed," also play a role that is just as important in creating a Jewish community for the Russian elderly.

When the JDC began opening Heseds in the former Soviet Union earlier this decade, the organizers were afraid of two things: that the centers would be overwhelmed by requests from non-Jewish clients, and that the centers would lead to an anti-Semitic backlash. None of the fears has come true.

Indeed, in some places Hesed centers serve as a model for similar state-run organizations. In St. Petersburg, for example, Hesed Avraham is among the most successful welfare organizations in the city of 4 million. Last year, Hesed Avraham started a joint project with a local government-funded welfare organization, where one of the Hesed dining rooms is now feeding 100 non-Jewish needy elderly.

The success of the Hesed program has led to some problems. Indeed, in some cities, local authorities ignore the needs of Jewish clients because there are other organizations to take care of them.

"The state sometimes wants to lay its responsibility onto the Heseds. But Jews are citizens of this country just like non-Jews and the state has certain obligations toward them," says Benjamin Haller, director of the JDC’s William Rosenwald Institute for Communal and Welfare Workers in St. Petersburg, which trains Jewish social workers and conducts sociological research of the Jewish elderly in the former Soviet Union.

But there is one aspect of the Hesed activities where the state welfare system cannot help: reconnecting people to their Judaism.

"People are coming to Heseds not only to get a piece of bread. They come to taste the spirit which makes us unique, distinct from other similar organizations. This is the spirit of belonging to the Jewish people," Haller said.

For example, in the city of Tula, some 190 miles south of Moscow, about 50 elderly Jews gathered on a recent Friday night at the Hasdei Neshama center. A concert by a local klezmer band was followed by a Shabbat service and a meal conducted by a Moscow rabbi who comes to the city every weekend.

In St. Petersburg, Hesed Avraham publishes Hesed Shalom, a bimonthly newspaper with a print run of 15,000.

This process of creating a community extends beyond the clients served by the Hesed centers to the volunteers who assist.

Last year, about 7,000 volunteers participated in the provision of welfare and other social services in the centers.

"Any program we run involves people helping other people. Even a bedridden person can call another bedridden [person] so that they will not feel lonely," Haller said.

In most communities, youths and students of Jewish schools occasionally volunteer in some social programs. But the average volunteer is recently retired and is in his early 60s. These people deliver food to the homebound, do home repair or work once or twice a week as hairdressers, shoemakers, electricians. Medical doctors conduct regular free consultations for Jewish elderly in almost every Hesed center.

Despite all the good work they are doing, the future of the Heseds is not entirely rosy. With the ongoing economic crisis and the depreciation of pensions, money is becoming rare, particularly to supply medicines.

The multimillion-dollar annual budget of the Heseds comes from several sources. Most Russian Heseds operate with the money channeled by JDC from funds raised by the joint campaign of the United Jewish Appeal and local federations in the United States. These funds go primarily to support the most fund-consuming part of the Hesed operations — food programs, including monthly and holiday food packages and distribution of hot meals through community dining rooms and meals-on-wheels programs.

While the activities are operated by the JDC in conjunction with local groups, including the Russian Jewish Congress, a majority of the funds for the multimillion-dollar project are provided by the Conference on Jewish Material Claims Against Germany — particularly in Ukraine and Belarus, which were under Nazi rule during World War II.

Most observers say Hesed programs have been the most successful — in their scope and outreach — of all similar projects supported with local and foreign funds.

They appear to be successful for Sofia Shapiro, an 80-year-old retired engineer who receives several services from her local Hesed in Yekaterinburg. The homebound Shapiro and her bedridden blind sister, Vera Brook, have no relatives and a caretaker from Hesed visits them daily. The center also gave Shapiro a walker made by some of the eight staff workers and 39 volunteers who assemble a total of 2,500 wheelchairs, walkers, walking canes and crutches a month at a plant in St. Petersburg.

"There is a sticker here," Shapiro says, pointing at the bottom part of the walker. "It says, ‘Live with Hope.’ So I do."

Caring Across the Miles


Fifty-eight-year-old Ruth recently took early retirement from her bookkeeping job so that she and her retired husband, Harry, could see more of their children and grandchildren, who are scattered around the country. The two have also been looking forward to doing some traveling overseas.

In the past year, though, Ruth’s mother, who lives alone and is a two-and-a-half-hour drive away, has become increasingly frail and is starting to show signs of forgetfulness. Ruth finds herself worrying about her mother daily and making an increasing number of phone calls and car trips to check on her. Often she ends up staying for the weekend when she visits.

She and Harry have put their travel plans on hold.

Ruth is just one of approximately 7 million Americans involved in the care of an older adult — usually a parent — who lives in a different area, be it an hour’s drive or a plane trip away. The average travel time to reach their relative is four hours.

At the best of times, caregiving involves a certain amount of stress, but often, the anxiety is compounded when there are many miles between the caregiver and care recipient.

Long-distance caregiving can be emotionally and financially draining. Worries about a parent’s physical, mental and emotional health and safety can be overwhelming at times. You may wonder if plans you’ve set up are being implemented properly, or if you’re going to get a call that there’s a crisis.

You may also feel guilty that you can’t be there on a daily basis to see how your parent is doing — which may be quite different from what he or she reports — and provide assistance as needed. You might wonder if you should be making more sacrifices — either moving closer or inviting mom or dad to live with you.

Then there are the financial costs: the many long-distance telephone calls, travel expenses, wear on your car and perhaps the cost of hiring a companion or personal support worker because you can’t be there yourself. If you’re employed, you may have to take time off work to deal with crises; some employers are less sympathetic than others.

Despite these challenges, there are many ways to maintain peace of mind while providing long-distance care:

  • Make it easy for people to get in touch with you. Get an answering machine if you don’t already have one and perhaps a cell phone or pager as well. E-mail may also be advantageous.

  • Set up a regular time to call your parent (many people choose Sunday evenings).

  • Find someone local who can check with your parent daily, either by phone or in person. This could be a reliable neighbor or relative or even a volunteer from a telephone reassurance service.

  • Keep important phone numbers handy: your parent’s neighbors, close friends, family physician, local pharmacy and any home health-care providers. Ensure all of these people also have your name and contact information and encourage them to call you with any concerns. Stay in touch to get their ongoing perspectives on how your parent is doing and don’t forget to express appreciation for their assistance.

  • Shop around for a good long-distance savings plan so you don’t have to be too concerned about the frequency and duration of caregiving-related telephone calls. You might consider getting a private, toll-free number so that friends, neighbors and health-care providers have no reservations about regularly calling you.

  • Maintain a file of key information, such as your parent’s medical conditions and surgical history, medications, medical specialists, banking institutions and other financial contacts, lawyer, clergy and daily or weekly schedule, plus any upcoming appointments. Obtain a local phone directory if possible.

  • If your parent has a chronic illness, obtain information from the appropriate organization (for example, the Parkinson Foundation) to help you understand the disease and get an idea of what to expect in the future.

  • Investigate other available resources in your parent’s community, which might include: personal emergency response systems; letter carrier or utility company alert services; accessible transportation; adult day programs and other leisure programming; outreach services, such as foot care and seniors’ dental clinics; home health services involving nursing, homemaking, therapy and companion services and alternative housing. Such information can be obtained from the local area agency on aging. (To find the appropriate office, call the Administration on Aging’s toll-free Eldercare Locator Service at (800) 677-1116 or search online at www.eldercare.gov.)

When you do have an opportunity to visit, pay close attention to your parent’s physical condition, mental functioning and mood. Consult his or her family doctor if you have any concerns.

Perform a safety assessment of the home environment to identify potential hazards — for example, throw rugs that don’t stay in place — and do what you can to remove them. Visit a medical supply store and check out the many products that might make daily activities easier and safer for your parent. Better yet, locate an occupational therapist who performs home assessments and can make recommendations in this regard.

If you have siblings in the area, arrange a family meeting to discuss your parent’s needs and determine who can provide help.

Ideally, plan to stay with your parent long enough so you’re not rushed. That way, you’ll have ample time not only to attend meetings (try to set these up in advance of your arrival) and run errands but also to enjoy your parent’s company.

Even if he or she appears to be managing well right now, it’s a good idea to begin learning about resources in the community should your parent require help in the future.

Keeping one step ahead will help make your role as long-distance caregiver a little easier.


Lisa M. Petsche is a geriatric social worker and freelance writer.