Sen. John Thune (R-S.D.)

Hunk hawks hideous health bill

John Thune is the most handsome man in the U.S. Senate. Square jawed, gleaming smile, cowboy tan, the 6’4” South Dakota Republican’s rugged good looks are antipodal to the mien of majority leader Mitch McConnell, whom Jon Stewart has definitively established is Yertle the Turtle’s doppelgänger. If the human brain’s positive bias toward attractive people didn’t cue me to infer that Thune is a great guy, a real straight shooter, I’d be as outraged by the assault on Americans’ health that Thune and his co-conspirators are currently waging, and by the subversion of American democracy they’re using to ram it through, as I am when its public face is McConnell’s.

Thune is a member of the all-white, all-male “gang of 13” staunchly conservative Republicans whom McConnell tasked two months ago with secretly writing a new GOP health bill in the Senate.

Because a parliamentary tactic will embed this Affordable Care Act (ACA) repeal — and alleged replacement — into a budget reconciliation bill, it’s exempt from being filibustered by Democrats. That means the bill will need only 50 of the 52 Republican senators, along with Vice President Mike Pence’s tie-breaking vote, in order to pass, instead of the 60 votes it takes to shut down a filibuster, which would require at least eight Democrats to defect.

Because the House also must pass the bill with only Republican votes, it needs to be mean enough to win over the House’s far right Freedom Caucus, “mean” being President Donald Trump’s new description of the formerly “beautiful” House health bill he fêted in the Rose Garden in May. That’s why the American Health Care Act (AHCA) that McConnell and House Speaker Paul Ryan want Trump’s signature on before July 4 likely will deprive 23 million Americans of health insurance; end Obamacare’s minimum benefits, like mental health services and maternity care; deny coverage for pre-existing conditions; permit lifetime benefit caps; cut $800 billion from Medicaid and turn it into block grants to states, effectively killing the program — oh, and give the top 0.1 percent of households an average tax cut of nearly $200,000.

I say “likely,” since the actual content of the bill has been shrouded in secrecy. Because a majority of Americans oppose those changes to a law that a majority of Americans support, McConnell knows that his only chance to pass it before the public catches on and rises up is a total blackout of information as they write the bill, which is what’s happening now, and once they reveal it, a blitzkrieg without committee hearings or time for town halls, hurtling toward a final vote within a matter of hours.

This is not normal. It’s not how a bill affecting one-fifth of our economy is supposed to be considered. McConnell’s plan is to make it seem normal, which is why they’re deploying the credibility of John Thune’s chiseled cheekbones: to sell a coup d’état as if it were a “Schoolhouse Rock!” civics lesson.

The day after a gunman opened fire on a Republican congressional baseball practice, prompting calls to for a return to civil discourse in our politics, Thune was on MSNBC’s “Morning Joe” saying we all must do our part to achieve the unity that this moment requires. Speaking of unity, journalist Mike Barnicle piped up, what about the health care bill being written in secret? “Nobody knows what’s in this bill,” Barnicle said. As a starter, he asked, in the spirit of reaching across the aisle, of bipartisanship and openness, “How about … telling us what’s in this bill?”

Thune’s answer made me marvel that a man with such good hair could deceive so baldly.

There’s really no bill to share, he said. What’s going on now is just discussions, just policy options. It will be openly shared when it’s reduced to legislative language, he said, as though that’s just how the lawmaking process works.

It’s not. Drafts of bills are routinely made public long before legislative language is locked in. They’re distributed as outlines, memos, letters, emails, talking points, PowerPoints, lists, charts, conference calls, cut-and-pastes, works in progress, principles, summaries, overviews, abstracts. They’re the basis for innumerable meetings with constituents, stakeholders, interest groups, media, members of both parties, think tanks, analysts and experts. That’s American democracy in action. What’s happening now is not.

Besides, Thune added, there’s been so much discussion of health care over the past decade, “it’s like any of us are unfamiliar with what the issues are.” We’ve already discussed them.

The ACA was the subject of hundreds of committee hearings and markups, hundreds of hours of congressional debate, hundreds of town halls and public forums and two years of news coverage. But that discussion was about expanding Medicaid, not eliminating it; about increasing benefits, not cutting them; about providing health insurance to millions, not giving tax cuts to millionaires. If the media were to give the AHCA’s issues the kind of scrutiny and airtime it gave Obamacare, Republicans would now be running from it like a dumpster fire.

To be sure, John Thune would make one handsome fireman. But I doubt even he could convince his colleagues in Congress to bunk in a burning building.

MARTY KAPLAN is the Norman Lear professor at the USC Annenberg School for Communication and Journalism. Reach him at

Calendar: March 24-30, 2017



Kenny Aronoff & Friends will perform two sets in their long-awaited return to The Baked Potato stage. The trio features Aronoff (who has played with John Mellencamp, Melissa Etheridge and John Fogerty) on drums, James LoMenzo (Megadeth, White Lion, David Lee Roth) on bass and vocals, and Brent Woods (KISS, Sebastian Bach, Vince Neil) on guitar and vocals.  9:30 p.m., $30; 11:30 p.m., $25. The Baked Potato, 3787 Cahuenga Blvd., Studio City. (818) 980-1615.


Andrew J. Tabler, the Martin J. Gross Fellow in the Program on Arab Politics at the Washington Institute, will discuss the dynamics of Syria and how it affects Israel, the broader Middle East and the United States. Tabler, who has appeared on CNN, NBC, CBS, PBS and NPR, is the author of “In the Lion’s Den: An Eyewitness Account of Washington’s Battle With Syria.” Co-sponsored by the Jewish Journal. 9:30 a.m. Shabbat service; 11:30 a.m. lecture. Free. Limited seating; RSVP at Beverly Hills Hotel, 9641 Sunset Blvd., Beverly Hills. (310) 276-4246.



For five generations, the Streit family business has held strong to Jewish tradition, but even these New Yorkers are not immune to the challenges that small businesses face. Come see the tradition and resilience surrounding this Lower East Side matzo factory in the documentary directed by Michael Levine. 2 p.m. $10; $6 for students; free for members. Skirball Cultural Center, 2701 N. Sepulveda Blvd., Los Angeles. (310) 400-4500.


Leaders of the Islamic Center of Reseda will answer visitors’ questions, such as: What are the core Islamic values? How do Muslims feel about Jews? Does Islamic theology drive ISIS? Hear about this and more at the Temple Etz Chaim Men’s Club Sunday Brunch. 10:30 a.m. $10; $8 for club members. Temple Etz Chaim, 1080 E. Janss Road, Thousand Oaks. (805) 497-6891.


cal-wolfsonRon Wolfson, Fingerhut Professor of Education in the Graduate Center for Jewish Education at the American Jewish University in Los Angeles, will discuss “The Seven Questions You’re Asked in Heaven: Reviewing and Renewing Your Life on Earth.” Wolfson’s books include “Relational Judaism: Using the Power of Relationships to Transform the Jewish Community” and “The Best Boy in the United States of America.” 10 a.m. brunch; lecture to follow. Free. RSVP to Kehillat Ma’arav. 1715 21st St., Santa Monica. (310) 829-0566.


Shirin Raban, an award-winning designer, cine-ethnographer and educator, and Saba Soomekh, associate director of research at UCLA’s Alan D. Leve Center for Jewish Studies, will talk about Persian Passover ritual. 4 p.m. Free. RSVP required. USC Doheny Memorial Library, Room 240, 3550 Trousdale Parkway, Los Angeles. (213) 740-1744.


Join the opening reception for “The Inner World of Ilse Kleinman: Reflections on Oppression,” featuring a presentation by the artist’s son, Dennis Kleinman, and remarks by art psychotherapist Dr. Esther Dreifus-Kattan. The artist and her parents fled Berlin in 1933 and settled in South Africa as the country was facing the rise of apartheid. Kleinman’s art features Holocaust- and apartheid-related motifs. 2 p.m. Free. Los Angeles Museum of the Holocaust, 100 The Grove Drive, Los Angeles. (323) 651-3704.



Jess Salomon and Eman El-Husseini

Stand-up comedians Eman El-Husseini and her wife, Jess Salomon — one Palestinian and one Jewish — will perform. They will be introduced by comedian Noël Elgrably. Food and drinks will be available. 7 p.m. $15. Pico Union Project, 1153 Valencia St., Los Angeles.


This Los Angeles Jewish Abilities Center workshop will focus on “Working While Receiving Benefits.” Jerri Ward, who specializes in Protection and Advocacy for Beneficiaries of Social Security with Disability Rights in California, will lead the program and cover topics such as Social Security’s calculation of income, “substantial gainful activity,” a nine-month “trial work period,” work incentives, and contribution of Medicare and Medi-Cal. 6:30 p.m. Free; RSVP required. The Jewish Federation of Greater Los Angeles, Goldman Center Rooms A&B, 6505 Wilshire Blvd., Los Angeles.



Joseph J. Levin Jr., co-founder of the Southern Poverty Law Center, will discuss the history of the organization’s work, then talk about the current landscape of crimes, anti-Semitism and the pursuit of justice on behalf of vulnerable communities. Q-and-A to follow. 7 p.m. wine and cheese; 7:30 p.m. lecture. RSVP at Temple Isaiah. 10345 W. Pico Blvd., Los Angeles. (310) 277-2772.



Brandeis San Fernando Valley Chapter presents lunch and a presentation by three authors — Gina Nahai, Carole Bayer Sager and Jonathan Shapiro — followed by a Q-and-A. The session will be moderated by Jewish Journal staff writer Eitan Arom. Book purchases and signing available. 10 a.m. Skirball Cultural Center, 2701 N. Sepulveda Blvd., Los Angeles.



Harkham GAON Academy welcomes all Los Angeles high school students and their parents to an event focusing on learning Passover-related topics that can be shared at the Passover seder, as well as general information about Judaism on a college campus. 6:30 p.m. Harkham GAON Academy at the Westside Jewish Community Center, 5870 W. Olympic Blvd., Los Angeles.


A preview screening of the upcoming film “Holocaust Escape Tunnel” on PBS’ “Nova” (airing April 19) will be presented by the American Jewish University’s Sigi Ziering Institute with the Los Angeles Jewish Film Festival and the United States Holocaust Memorial Museum. The film reveals the story of a lost city — Vilna, Lithuania — which for centuries was one of the most important Jewish centers in the world, until the Nazis destroyed it. A team of archeologists excavating the remains of the city’s Great Synagogue uncovers a hidden escape tunnel dug by Jewish prisoners inside a horrific Nazi execution site. A panel discussion and Q-and-A will follow the screening. Free. 7:30 p.m. American Jewish University, Gindi Auditorium, 15600 Mulholland Drive, Los Angeles. or (310) 440-1279.


cal-maggie-antonMaggie Anton is the author of the “Rashi’s Daughters” trilogy, “Rav Hisda’s Daughter” and its sequel, and, most recently,“Fifty Shades of Talmud: What the First Rabbis Had to Say About You-Know-What.”  The writer, who was born in Los Angeles and still resides here, will take part in a book reading and discussion. 7 p.m. Free; donations appreciated. Temple Menorah, 1101 Camino Real, Redondo Beach. (310) 613-8444.



Yaakov Katz

Jewish Journal’s Crucial Conversations, in partnership with Modern Minds on Jewish Matters, presents Yaakov Katz, editor-in-chief of The Jerusalem Post and co-author of “The Weapon Wizards: How Israel Became a High-Tech Military Superpower,” in conversation with TRIBE Media Corp. President David Suissa. 7:30 p.m. $10 in advance. Beth Jacob Congregation, 9030 W. Olympic Blvd., Beverly Hills. (310) 278-1911.



Jewish settlers and J Street experience their fair share of demonization in the Jewish community and beyond. Both desire a secure Jewish future for the State of Israel — and Jews worldwide — amid the Israeli-Palestinian conflict, but their vision for the path to that objective could not be more divergent. What happens when we stop paying attention solely to those who agree with us and listen to the other side? Temple Emanuel of Beverly Hills will address this and other topics in the third of its Behrendt Conversation Series, “Competing Visions for Israel: J Street and a Settler in Conversation,” with Yishai Fleisher, spokesman for the Jewish community in Hebron, and Alan Elsner, special adviser to the president of J Street (see their op-ed pieces on Page 12). 7 p.m. Temple Emanuel of Beverly Hills, 8844 Burton Way. For more information or to RSVP, go to:
conversations or email

Photo from Pexels.

Letters to the editor: Criticism and love for columnists, response to GOP health care bill

Dennis Prager Misses Mark With Crime Wave Premise

Congratulations to Dennis Prager. His splenetic “No Wave” column exceeded his usual repugnant level of see-through propaganda (“There Is No Wave of Trump-Induced Crime in America,” March 10). This inexplicable Nazi/white power apologia reached all the way to outright sick-making (especially appearing in a Jewish publication).  

Bonus points for tacking on, at the thrilling conclusion of this slop, blithe lecture-y dismissals of the effects of climate change, AIDS, rape and racism among police, too (efficient!). Love how you brought a little Kellyanne into our Jewish world — fun!  


Steve Heller via email

Columnists Stir Strong Feelings Among Readers

Dennis Prager and David Suissa appeared to be an oasis of credible journalism and well-thought-out commentary in the March 10 edition. It wasn’t a Purim joke; it was rational, credible journalism. In particular, Dennis Prager clearly showed that there is no wave of Trump-induced crime in America. David Suissa exposed the so-called Women’s March as a political movement with a bias toward the liberal left (“Why I’m Protesting the Protests of March 8,” March 10). The Women’s March completely ignored the real persecution of women, such as in some countries that persecute women under Muslim law.

Rob Eshman should, by now, get the message that his bias toward the liberal left has created a disconnect with the Los Angeles area Jewish community. He should take a lesson from and try to emulate Dennis Prager and David Suissa.

Marshall Lerner, Beverly Hills

Thank you, David Suissa. Your take on recognizing Trump as a bullshitter (“Is Trump Worse Than a Liar?” Feb. 24) and on handling acts of Jew-hatred in America from a position of strength (“Fight Jew-Haters but Don’t Promote Them,” March 3), I found right on the mark.

And I especially want to thank Gina Nahai for her firsthand illuminating account of life under the shah (“The Nature of Rubbish,” March 3). I gained tremendous understanding and compassion for what her family and other Persians went through. We Americans need to understand and appreciate how people cope with and survive totalitarian regimes, including “fake news.”

Sharon Alexander, Torrance

GOP Caught in Health Care Trap

Michelle Wolf wrote that the proposed Republican health plan will drastically cut Medicaid benefits from the most needy and vulnerable Americans (many of whom voted for Trump) (“The Cruelest Cuts of All,” March 10).

That is only part of the story. Many, but not all Republicans would like to repeal Obamacare altogether and do away with all government assistance to the medically needy. They got elected on the promise to abolish Obamacare.

However, when it comes to reality, there is a conundrum: Many Republicans campaigned on the shortcomings of Obamacare that, indeed, over promised. They not only promised repeal, but a substitution program which would retain all the popular provisions of Obamacare and add more benefits but cost less.

Now they are caught in the trap of over promise. The actual proposed plan (Trumpcare) would indeed cost less, but would drastically cut benefits, leaving about half of the approximately 20 million newly insured without insurance and most of the rest paying more for less. There is no magic. You usually don’t get more for less. If there is a lesson to be learned from what happened to the Democrats, the Republicans have not learned it.

Or maybe they just painted themselves into a corner. Consider turning over a new leaf: Medicare for everyone.      

Michael Telerant, Los Angeles

Watch Your Language, School Board Candidate

Thank you very much for your coverage of the Los Angeles Unified School District Board candidates, including Nicholas Melvoin (“Melvoin: ‘New Blood, New Ideas’ and Charter Schools,” March 3). If I were Harvard, I’d ask Mr. Melvoin to return his English diploma: “Me and Steve could be brothers.” This from someone who is seeking a seat on the Board of Education? Why would anyone support a candidate who cannot construct a simple declarative sentence correctly?

Mine will be one less vote for Mr. Melvoin.

Beryl Arbit via email

Robert Glazer, Medical clinic operator indicted on health care fraud

Robert Glazer, 67, a Los Angeles physician, was indicted on June 3 for conspiracy to commit health care fraud.

Over the course of eight years, Glazer is alleged to have been party to a scheme to defraud Medicare of more than $33 million, according to a June 3 statement from the U.S. Department of Justice and Health and Human Services. Medicare paid Glazer more than $22 million on what are called “false and fraudulent” claims in a press release issued on June 3 by the United States Justice Department

“From approximately January 2006 through May 2014, Glazer allegedly billed Medicare for services that were not medically necessary, and at times were not provided to the Medicare beneficiaries. In addition, Glazer allegedly signed prescriptions, certifications and other medical documents for medically unnecessary home health services, hospice services, and power wheelchairs and other durable medical equipment.

“Glazer’s co-conspirators then sold the prescriptions and certifications to… supply companies, home health agencies and other providers, knowing that the prescriptions and certifications were fraudulent,” the statement said. The claims filed by Glazer amounted to “approximately $33,484.779.”

Glazer ran a family practice on Santa Monica Boulevard in East Hollywood. And, last month, he was one of “nearly 100” medical professionals “from across the country, including Los Angeles county, [who] were charged with scamming Medicare out of $260 million,” according to reporting by the Daily News.  Multiple calls to Glazer’s clinic went unanswered.

The Medicare Fraud Strike Force, an agency conceived to deter Medicare fraud, participated in the investigation of Glazer’s actions.

Since its conception in 2007, the Medicare Fraud Strike Force “has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion,” the Justice Department said in the release.

Plan for future pitfalls

Changes in the economy and workforce have taken their toll on baby boomers, a generation that carries a longer life expectancy than its predecessors as well as the financial burdens that come with it.  

People are working longer and retiring later in life. Possible cuts in government spending could result in reduced payouts to Social Security and Medicare, making things even more challenging. 

The good news is that while boomers may have less time to weather the ups and downs of the stock market than younger investors, it’s not too late for them to plan for their financial future. In doing so, experts suggest considering not just financial goals, but one’s values and the type of lifestyle one desires.

For those in the “Me” generation counting on a pension, Social Security benefits or some type of mutual funds, make sure in advance that the fund will be enough to maintain a desired standard of living. Otherwise, you may have to consider working past your anticipated retirement age, according to Karen Codman, an investment adviser from Long Beach.

Take into account the fact that you won’t be working. Because of that, you may be tempted to spend more. 

“The conventional wisdom that they hear on the radio is that it’s going to cost so much less when you retire,” Codman said. “I’ve heard estimates between 50 and 70 percent of what it costs now. The reality is you now have 365 days of shopping and travel time, and most people don’t want to reduce their standard of living.” 

When you add this to potential medical expenses, you may find that you actually need more than you originally allocated. 

Ira Cohen, 54, of Long Beach has been a crane operator since 1979 and plans to retire in eight years. He is practicing living below his means now, so that he will be used to living off his pension. 

“Six years ago I had a wake-up call, and I took a look at how I was living and really simplified my lifestyle,” Cohen said. “I’m living today as if I was collecting my pension and trying to save the extra money.” 

And if you are considering retiring early, understand that sometimes it’s better to work until you are eligible to receive full Social Security payments. 

Codman said that if you have an investment portfolio, make sure that it is both diverse and tax-efficient. She advises putting funds that will be needed sooner in life in conservative investments while other money goes to riskier investments. 

Take into account how the monies will be taxed and decide if a Roth IRA fund is right for you. This will allow you to pay the taxes on these accounts up front so you won’t have to worry about it on the back end. This can help keep your tax bracket lower during retirement so your Social Security doesn’t get taxed as much, Codman advises.

Financial adviser Marc Weiss of Archer Weiss Insurance in Woodland Hills said that several of his clients are looking to only make conservative investments due to the uncertainty in the market. 

Some baby boomers also are taking out life insurance policies on their parents with plans to use the death benefits to support themselves later in life, Weiss said.

In general, both financial advisers agree that everyone should meet with a financial adviser instead of basing financial decisions solely on what they read in the paper or hear on the news. One size rarely fits all when it comes to financial planning, 

In addition to your personal financial planning, a customized estate plan is another helpful tool to help avoid problems for loved ones, according to Benjamin A. Brin, an estate planning attorney from Los Angeles.

“You actually already have an estate plan, whether you know it or not,” Brin said. “You’ve got a one-size-fits-all, supposedly free plan from the government called ‘probate.’ ”

Probate court is the process the government uses to transfer ownership of assets. An estate plan circumvents this by providing a pre-arranged transfer of your assets after death. Even if you have a will, you may still have to go through probate, and the only way for Californians to avoid the process entirely is to include a living trust as part of an estate plan. This will save your loved ones money in lawyer fees, time and court dates, as well as a lot of potential discord, Brin said.

One of the most important things to keep in mind when it comes to planning for the future, however, could be knowing the difference between money you can and can’t afford to lose, he added.

“Unless you are a professional investor, then don’t think of savings as investments; think of them as savings.” 

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.

The final Obama/Romney showdown: A note to a stiff-necked people

To those Jews planning to vote for Obama:

Are you prepared to explain to your children not the principles upon which your vote is cast, but its probable effects upon them? 

Irrespective of your endorsement of liberal sentiments, of fairness and “more equal distribution,” will you explain to your children that top-down economic policies will increasingly limit their ability to find challenging and well-paid work, and that the diminution in employment and income will decrease their opportunity to marry and raise children?

Will you explain (as you have observed) that a large part of their incomes will be used to fund programs that they may find immoral, wasteful and/or indeed absurd? And that the bulk of their taxes go to no programs at all, but merely service the debt you entailed on them? 

[Related: [Related: A note to Jewish grandparents:

Marty Kaplan: How to lose the next debate

President Barack Obama and Republican presidential nominee Mitt Romney during the first 2012 U.S. presidential debate in Denver on Oct. 3. Photo by REUTERS/Michael Reynolds

A couple of weeks ago, when I wrote a “

Mitt Romney, Paul Ryan and Florida Jews

In 1992, Paul Tsongas of Massachusetts mounted a strong campaign for the Democratic presidential nomination. The pundits considered him a brainy guy who was willing to take on the sacred cows of Social Security and Medicare. Gov. Bill Clinton of Arkansas, by contrast, seemed like a flawed candidate. Tsongas stung Clinton by calling him “pander bear.”

Tsongas won the New Hampshire primary. With the wind at his back, he headed south to Florida. And there, like an alligator in the Everglades, waited Bill Clinton.

Clinton took Tsongas to the woodshed, running a devastating television campaign that highlighted the threat Tsongas’ plans posed to the entitlement programs so revered by Florida’s Democratic Party electorate. Florida was Tsongas’ Waterloo. His campaign never recovered.

I was reminded of that 20-year-old electoral watershed when I heard that Mitt Romney had selected Congressman Paul Ryan (R-Wis.) as his vice presidential candidate.

Romney has been working hard to break the Democratic hold on Jewish voters. As Dan Schnur pointed out recently (Los Angeles Times, Aug. 12), since Obama already has a lock on New York and California, the Jewish vote really matters strategically in only three battleground states for the presidential race: Florida, Pennsylvania and Nevada. Florida is the most important, and it has held some opportunities for Romney.

Florida’s Jews, concentrated in three southern counties of Broward, Palm Beach and Dade, represent 3.3 percent of the state’s population, but their turnout share is as high as 4 percent of the statewide vote.

Jewish voters in Florida, especially those who are elderly, preferred Hillary Clinton in the Democratic primary in 2008, although they voted in a strong majority for Obama in the general election. Generally, Obama has done better with younger than older voters, and this is true among Jews as well. And the Florida Jewish electorate is comparatively elderly.

Florida had 613,235 Jews in 2010 according to a North American Jewish Data Bank report by Ira Sheskin and Arnold Dashefsky. Florida held the top six places in the country in proportion of the Jewish population older than 65 years of age, led by South Palm Beach at 62 percent and West Palm Beach at 57 percent. By contrast, the elderly Jewish population of Los Angeles is only 21 percent.

Israel is the one issue that gives Republicans a chance with Jewish voters, and Romney’s recent trip to Israel enabled him to run commercials in Florida that noted that Obama has not yet visited the Jewish State. There is also discontent about political conflicts between Obama and the Israeli political leadership. Republicans have been gaining with older white voters, even as they struggle with young and minority voters.

But expecting older Jewish voters to go to the next step of voting for a Republican is not a given. Romney still has had to convince those who might be skeptical of Obama that he is a safe choice, and that he won’t be a tool of the most conservative wing of the Republican Party. And here is the problem. What Romney needed to do in his selection of vice president to unite his party is exactly the opposite of what he needed to do to make inroads among Jews.

Had he made a safer choice, Rob Portman of Ohio, for example, he might have been able to reassure some Jewish voters that his ticket would be a safe harbor for their discontent with the incumbent president. For these voters, boring would be good, especially if boring meant no change to Medicare and Social Security. According to the Kaiser Family Foundation, Florida has 3,390,801 Medicare recipients, 18 percent of the state’s population. According to the AARP, one in five Florida residents received Social Security benefits in 2006. Strikingly, for three out of 10 Floridians older than 65, Social Security provided their sole source of income.

Ryan’s plans for a full or partial privatization of Medicare and Social Security will be anathema to older voters. These ideas are so unpopular — and to many people so unfathomable —  that the Democrats have had to struggle to convince voters that anybody would actually propose it. Now Romney’s selection of Ryan as his running mate clearly aligns him with Ryan’s plans.

If the debate turns to Medicare and Social Security, the debate over Americans’ relationship with Israel may become less compelling. And certainly older voters in general will be paying very close attention to what happens with entitlement programs.

Although there is no guarantee that the famously undisciplined Democrats, prone to scattershot campaigning on numerous fronts, will press the advantage, but if they do, the Romney-Ryan ticket could mean that their prospects could be very bright, not just in the presidential campaign but in congressional elections nationwide as well. Romney’s selection of Ryan likely will have the unintended consequence for the Republicans of shifting the debate from focusing on insufficient jobs for Americans of working age to the otherwise dormant questions of health and income security for the high participation, retired senior citizen voters.

It is hard to imagine more difficult terrain for the Republicans in an election year that for them began with so much promise.

Raphael J. Sonenshein is executive director of the Edmund G. “Pat” Brown Institute of Public Affairs at California State University, Los Angeles.

Editorial Cartoon: Mitt Romney’s electrifying choice

HEALTH CARE DECISION — Jews react: Los Angeles Jewish Home CEO & President

Molly Forrest, CEO and president of the Los Angeles Jewish Home, had surgery to alleviate arthritis in her neck in December 2010.

Stuck in bed for 35 days, she read the entire Affordable Care Act – all 2,080 pages of it. She has since read it again so she knows it well, and she takes it personally.

“If I were unemployed now, I would not be able to get insurance, and I’m not old enough for Medicare,” Forrest remembers thinking after her surgery.

The Supreme Court’s decision today to uphold the law “settles a 100 year debate about whether access to health care is a right that each American has,” Forrest said.

The 1,000 elderly clients who live at the Jewish Home in Reseda, as well as the 1,500 non-residents it serves and the employees the organization insures all will benefit from the law as implementation goes forward, she said.

“Seventy-five percent of our clients rely on welfare programs to support whatever care they receive, and so anything that threatens or affects Medicaid or Medi-Cal dollars is of enormous concern and importance to us,” Forrest said.

Forrest said she supports the one adjustment to the law the court made—prohibiting the Federal government from withholding Medicaid funds from states that do not comply with the Affordable Care Act.

“We already face such enormous challenges with funding programs for the needy in this state, that for us the decisions of the Supreme Court at least removes the threat that the Federal government could penalize the state in any way for not fully complying with the Affordable Care Act,” Forrest said.

Forrest sees many benefits in the law.

Not only will those with preexisting conditions not be denied coverage now, she said, but the law prohibits insurers from charging highly elevated premiums to those with complicated conditions. This will help many disabled adults get private insurance, she said, since previously their pre-existing conditions either shut them out of insurance or made it entirely unaffordable.

She also sees much benefit in removing insurers’ lifetime cap and the annual cap, and in allowing children to stay on parents’ plans through age 26.

“I think there are a lot of good things here,” she said. “I know there is a lot of controversy around this, but this is America, and I think in the end this will work out and American will be better for it. I know the health of American will be better for it.”

Opinion: Medicaid reforms need not undermine services

During February, Jewish communities across North America observe Jewish Disability Awareness Month. It is an opportunity for us to raise awareness of the needs, strengths, opportunities and challenges of individuals with disabilities in our communities, and to ensure we are building more inclusive communities that celebrate all of our neighbors.

The Jewish community, through its institutions and social service agencies, has been increasingly effective in serving the critical needs of individuals with disabilities and their families. At the same time, we recognize the indispensible impact that Medicaid has on the ability to provide for these needs.

For many members of our communities with disabilities seeking healthy, independent lives, Medicaid is an essential resource. Earlier this month, Jewish leaders from across America came to Washington to express to Congress how vitally important Medicaid is to the disability community, as well as the agencies and communities that serve them.

More than 8 million individuals with disabilities in America rely on Medicaid as their sole source of comprehensive health and long-term care coverage. Medicaid ensures that people with disabilities have access to essential services, including transportation, medical care and personal care assistance. This, in turn, ensures that they are able to contribute economically, socially, politically and spiritually to their communities.

Unfortunately, under several prominent congressional proposals being considered as part of deficit reduction efforts, Medicaid would be restructured by capping funds flowing to states and/or creating a block grant formula. Block granting or capping Medicaid funds would result in the denial of health and long-term care to millions of Americans, including those with disabilities. These kinds of spending cuts and harmful changes to Medicaid would undermine human dignity by limiting the choices and opportunities for people with disabilities.

Terry Burke and Andy Berman of St. Louis Park, Minn., say that Medicaid has truly been “the saving grace in their family.” Their 23-year old daughter, Rachel, who has cerebral palsy, epilepsy, autism and moderate cognitive disability, is the joy of their lives, but things have not always been easy.

When Andy was diagnosed with chronic lymphocytic leukemia, he and Terry quickly learned that juggling the demands of health care for Andy and care for Rachel was extremely challenging. Through Medicaid, Rachel is able to have personal care assistants, or PCAs, help her with basic needs, ranging from showers and meals to helping with her visits to the doctor. She also has the opportunity to participate in programs that truly contribute to her happiness and “allow her to really have a life,” such as recreational social nights, exercise programs and making dinner with her PCAs.

As Terry and Andy grow older, as they balance managing the health needs of Andy and Rachel, and their ability to manage Rachel’s care declines, they cannot imagine a future without the services provided through Medicaid.

Leading Jewish organizations have made it a priority to fight to protect the services and benefits that individuals with disabilities and their families receive under the Medicaid program. We as a community believe that while there is still a need to reform the program to ensure it remains sustainable through a time of austerity, the program provides services to individuals with disabilities and their families that must remain intact.

Collectively, the Jewish community sees a number of effective ways that Medicaid can be reformed while realizing cost savings. These proposed recommendations range from allowing funding for home- and community-based services (services that cost less than comparable institutionalized care) to be accessed without the current burdensome waiver process, to promoting preventative measures such as chronic disease management.

Other recommendations include enrolling beneficiaries in drug and care management programs, which ultimately would improve the delivery of services and generate savings.

Any reforms to Medicaid to make it financially sustainable for future generations must be made with the mind-set that Medicaid remains available as a source of health and long-term services for individuals with disabilities and other low-income populations.

Jewish organizations and social service agencies across America stand ready to work with our federal and state governments to ensure that individuals with disabilities are able to live healthy, independent lives. We all have a role to play in ensuring this end, and Medicaid is an essential tool in that effort.

Rabbi David Saperstein is director and counsel of the Religious Action Center of Reform Judaism. William Daroff is vice president for public policy and director of the Washington office of The Jewish Federations of North America.

Jewish Dems defend Wasserman Schultz after West’s attack

Jewish Democrats slammed Rep. Allen West (R-Fla.) for his vituperative attack on Rep. Debbie Wasserman Schultz (D-Fla.) as a pro-Israel PAC raised funds for the congresswoman based on the attack.

West emailed Wasserman Schultz, who is also the chairwoman of the Democratic National Committee, after she chided West on the U.S. House of Representatives floor for backing a plan she said would increase costs for elderly Medicare recipients in their adjacent districts.

“Look, Debbie, I understand that after I departed the House floor you directed your floor speech comments directly towards me,” he said in an email obtained by a number of news outlets. “Let me make myself perfectly clear, you want a personal fight, I am happy to oblige. You are the most vile, unprofessional, and despicable member of the U.S. House of Representatives. If you have something to say to me, stop being a coward and say it to my face, otherwise, shut the heck up. Focus on your own congressional district! You have proven repeatedly that you are not a Lady, therefore, shall not be afforded due respect from me!”

The National Jewish Democratic Council, where Wasserman Schultz launched her career, blasted West for his “hostile tone and belligerent language.”

In a statement, the NJDC said that West’s declaration that Wasserman Schultz is “‘not a Lady’ and will not be ‘afforded due respect’ confirms yet again that West has a problem with progressive women. American Jews overwhelmingly support women’s rights and have nothing but tremendous respect for Debbie and all that she’s accomplished.”

JACPAC, a Jewish political action committee that focuses on Israel and reproductive rights, launched a fundraiser based on the attack.

“Our best response is to make sure friends like DWS are re-elected and foes like West are defeated,” said the PAC in its appeal. “People like West who resort to personal attacks, rather than disagree respectfully with their colleagues, demean the institution in which they serve. The government they denigrate is not their punching bag.  It is us!”

JACPAC mostly backs Democrats, although it has also supported moderate pro-Israel Republicans.

Other Democrats have rallied to Wasserman Schultz’s defense and a number of fundraisers have been launched based on West’s attack.

West is also using the exchange to fund-raise.

Both lawmakers are seen as pro-Israel stalwarts; the Republican Jewish Coalition championed West last year when he ousted Rep. Ron Klein (D-Fla.).

Marty Kaplan: The Monsters Are Due on Maple Streets

The power has gone out in a typical American town.  Wait—it’s not just the electricity.  The phones don’t work, either.  Portable radios are dead.  Cars won’t start. 

But then lawn mowers and cars and lights inexplicably start and stop on their own. What’s going on?  A meteor?  Sunspots?  Or are there, as Tommy’s comic book suggests, aliens among us, preparing for a takeover? Suspicion poisons the air. Neighbor turns on neighbor. A scapegoat is blamed. A shot is fired.  Panic, madness, riot.

And while the humans behave monstrously, the real monsters watch from a nearby hilltop, working a little gizmo that messes with the power on Maple Street and marveling how easy it is to manipulate these earthlings into destroying themselves.

In what is arguably the best “Twilight Zone” episode ever, “” target=”_hplink”>declared their willingness to return to the table and negotiate a shared sacrifice. The monsters are on Wall Street, where state pension funds were sunk into toxic sub-prime mortgage-backed securities.  The monsters are on K Street, where lobbyists are fighting financial industry oversight. The monsters are the politicians who are using Wisconsin’s deficit as a pretext to ” target=”_hplink”>so be it” language of their leadership, you’d think that the federal deficit is caused by the very people who who’ve been suffering the most in this recession.

But the monsters aren’t low-income ” target=”_hplink”>health insurance to cover them; or ” target=”_hplink”>Pell Grants; or people who think their government’s job includes preventing their air and water from ” target=”_hplink”>billionaires who’ve benefited from a massive transfer of wealth from the middle to the top and whose political puppets protect them from paying their fair share of taxes.

They’re the corporations whose cash has convinced Congress to deregulate industry after industry, despite all evidence that it is the enforcement of rules – not the magic of the marketplace—that protects the public’s rights.

They’re the defense contractors and pork appropriators who’ve used the cover of “national security” to shield the Pentagon’s budget and its procurement process from the cuts and reforms that even Republicans like the Secretary of Defense are advocating.

They’re the front groups and propagandists, like FreedomWorks and Fox, who use class warfare and culture wars in order to turn Americans against their own economic interests.

They’re the Supreme Court justices whose Citizens United decision, overthrowing a century of settled law, has made our campaign finance system an open sewer, and whose indifference to ” target=”_hplink”>coming case promises to throw sick people back onto the tender mercies of insurers and to destroy our best hope to curb Medicare costs – further ballooning the deficit and providing cover for even more draconian cuts.

The game in Washington is to use the deficit as camouflage for destroying government’s capacity to promote the general welfare.  The game in Wisconsin and other states whose new Republican governors and legislative majorities are feeling their oats is to shelter the income of the wealthiest, and to balance the budget on the backs of the middle class. 

At the end of the episode, Rod Serling says this:  “The tools of conquest do not necessarily come with bombs and explosions and fallout. There are weapons that are simply thoughts, attitudes, prejudices to be found only in the minds of men.  For the record: Prejudices can kill, and suspicion can destroy, and a thoughtless frightened search for a scapegoat has a fallout all of its own—for the children, and the children yet unborn.  And the pity of it is that these things cannot be confined to the twilight zone.”

Sometimes it’s hard to watch the news and not think that things are surreal.  The other day, when what’s been happening in Madison reminded me of what happened on “Maple Street,” I suddenly realized the theme music that goes with it.

Marty Kaplan is the Norman Lear professor of ” target=”_hplink”>USC Annenberg School for Communication & Journalism.  Reach him at

Proposed State Cuts in Funding Pose In-Home Care Threat

Suzanne Heredia, 39, spends most of her days caring for her daughter. Born with cerebral palsy and congenital hydrocephalus, a condition that causes pressure within the brain due to excess fluids in the brain, Priscilla, 13, needs round-the-clock care. Heredia does everything from changing IVs to repositioning Priscilla’s body.

Through income provided by In-Home Supportive Services (IHSS), a state-funded program that allows clients to receive ongoing medical care in their homes, Heredia manages to care for her daughter, even as a single mother with four other children.

But in the throes of the ongoing budget crisis, Gov. Arnold Schwarzenegger recently suggested eliminating IHSS altogeher. The possibility leaves Heredia and many others wondering where they would turn.

“[Priscilla] is my baby,” she said. “It would be devastating to the family if I lost the in-home care.”

With state funding of nearly $5 billion, IHSS funds 350,000 caregivers who serve 450,000 California residents. Priscilla represents the minority of clients — 37 percent are disabled, while 63 percent receive help based on their status as seniors who are over 65.

By providing funds directly to consumers, IHSS allows clients to hire a caregiver that best meets their needs. Some go through state-sponsored providers or nonproifts. Others, like Heredia, opt to stay within the family.

By receiving a paycheck, many make caring for a sick or elderly realtive their full-time job.

Depending on their needs and the funds that the state deems necessary for their care, consumers may hire a caregiver for up to seven days a week or may need to parcel out their care — planning, for instance, to buy groceries for the weekend if they will be left home alone.

Because so many IHSS consumers are low-income — 90 percent are below the poverty line — they qualify for full assistance from the state. Those who are above the poverty line split the cost of care between IHSS funds and whatever out-of-pocket income they have.

If the proposed budget cuts go through, Los Angeles County, which accounts for 40 percent of the IHSS population with 185,000 IHSS consumers, would be hit particularly hard.

“The most current proposal would pretty much wipe out the IHSS population in L.A. County,” said Hortensia Diaz, IHSS program director.

Anthony Jaimez, 42, would be among those left with few options.

Left paralyzed at 19 after a violent attack, Jaimez relies on his older brother to care for him. But without the guarantee of a paycheck, his brother would have to find another full-time job.

“I would probably have to go into a convalescent home,” said Jaimez, although he doesn’t have the insurance to cover it. “To be honest with you, I wouldn’t even begin to know how to go about it. It would just completely change everything around for me.”

Senior citizens who receive IHSS funding would also face unique difficulties.

“A family member would have to rearrange their lives, otherwise they’d go to assisted living,” said Paul Castro, executive director and CEO of Jewish Family Service of Los Angeles, many of whose clients are senior citizens and receive IHSS funding. “That’s if there are beds available.”

For many, the change would present more than a hassle. Because of the cost, a majority of consumers would simply not be able to afford to move out of their homes and so would stay and risk injury.

“People will be doing things they aren’t supposed to do,” Diaz said. “They will have accidents in their home and no one will find them.”

Some insiders also wonder if the proposed cuts would have the cost-saving effects promised by lawmakers.

According to Diaz, the cost to Medi-Cal — which many IHSS consumers have — of putting someone in a nursing home is $5,698 a month. The average cost to the state for IHSS care is $850 a month.

“The assumption and premise [of IHSS] is that it’s cheaper to bring services into the home than to go to nursing homes,” said Castro, adding that emergency rooms would likely also become much more crowded. “When seniors are in a position of crisis, they would have to go to the ER, and it would be a much greater expense for the state.”

Jaimez agreed, saying, “If they have a big influx of people that will have to go rushing to convalescent homes, how is it going to affect them? Are they gonna be able to handle those people? They want someone to blame [the budget crisis] on, and they’re going to go after the old and the weak first.”

Over 65 group could decide who wins this year’s presidential election

Many millions of dollars are being spent in both current presidential campaigns emphasizing personal qualities over clarifying the candidates’ stands on the issues. Now seniors take their politics seriously: While the 65-and-older demographic comprises only 12 percent of the nation’s population, in the last presidential election 73 percent of seniors reported that they voted—the largest percentage of any age group, according to a U.S. Census Bureau survey.

But neither candidate on the campaign trail has spoken often on issues that matter to seniors, and when they have, it’s been underreported by much of the media. So at the end of the day, how different are the candidates—and their respective political parties—from each other when it comes to issues of great importance to seniors, such as long-term care, Social Security, medical insurance and taxes?

Simply put, “the real fault lines between the two candidates’ positions are over how to treat people in the highest tax brackets. It gets to the heart of their economic philosophies,” said Leonard E. Burman, a senior fellow with the Tax Policy Center, a nonpartisan Washington-based tax reform group.

Sen. Barack Obama (D-Ill.), specifically through his campaign Web site and implicitly through the official platform of the Democratic Party, would shore up the needs of seniors at the lower end of the economic spectrum. He has proposed to eliminate income taxes for seniors making less than $50,000 a year.

“This will provide an immediate tax cut averaging $1,400 to 7 million seniors and relieve millions from the burden of filing tax returns,” the official Obama literature asserts.

Additionally, Obama would rescind the Bush administration’s income tax cut (that Democrats claim has benefited only the nation’s wealthiest citizens) and apply the windfall to his social programs, together with revenues from a slight tax rate increase for those earning more than $250,000. The increase would secure Social Security—without cuts and raising the retirement age—and finance his ambitious national health care proposal.

Although seniors already enjoy universal health care through Medicare, Obama argues that the program requires some tweaking because “catastrophic expenses” were “routine” and that, as currently applied, Medicare benefits do not cover expenses for most long-term care. His goal, he told the AARP, was to ensure that the program “protect seniors and families from impoverishment and debt.”

Sen. John McCain’s (R-Ariz.) and Obama’s positions are similar regarding the estate tax—sometimes referred to by the Bush administration as the “death tax.” Both candidates would retain a reduced version of the estate tax, although McCain would reduce it more than Obama, according to and

The Democratic candidate has proposed to apply the tax only to estates valued at more than $3.5 million ($7 million for couples), holding the maximum rate at 45 percent. McCain would apply it to estates worth more than $5 million ($10 million for couples), with a maximum rate of 15 percent.

Unlike Obama, McCain would renew the Bush income tax cut when it expires, which the Republicans believe will give citizens more cash to choose their own health care coverage options, should they use their rebate to pay for it.

The McCain attitude shaping policy—and that of the Republican Party, generally—is that seniors can manage their own lives without the intervention of government and that they should be free to choose their own way to solve many of these concerns. The Republican Party would not offer income-tax relief to seniors with incomes less than $50,000. The GOP believes that seniors already get federal help through Social Security and Medicare and often have economic advantages over other demographic groups.

It should be noted that McCain is a major proponent of privatizing Social Security, a program he termed “disgraceful” this summer, touching off protests by seniors at his campaign appearances in Pennsylvania and Colorado.

For seniors requiring expensive long-term care, McCain would privatize services and leave choices to individuals. He is a proponent of recent state-based experiments such as Cash and Counseling or the Program of All-Inclusive Care for the Elderly, through which seniors are granted a monthly stipend from which they can choose to pay home-care workers and purchase care-related services and goods.

McCain told AARP that eldercare matters should be decided within families and that “any way we can help caregivers” offset costs through tax credits or other financial incentives should be considered as “part of an overall policy regarding health care.”

How the senior vote will affect the presidential race in November is still a matter of debate. In 2004, voters ages 65 and older went Republican for the first time in years, backing President Bush more heavily than the rest of the electorate. Many of today’s seniors were influenced by Reagan conservatism, according to analysts in both parties, and they’re better off financially than the Roosevelt-era seniors, a fact that may favor the current Republican candidate.

Both campaigns are comin’ a courtin’ the senior vote. Obama has appointed a national seniors constituency director and the McCain campaign has launched an effort to encourage seniors to talk to their peers. States with the largest proportion of seniors based on total population—Florida, Pennsylvania and Iowa—are considered “swing states,” meaning that pensioners could very well influence the outcome of the national election.

How well informed senior voters will be is perhaps the most important issue of all.

Stanley Mieses is a writer, editor and broadcast commentator based in New York.

With the Republican base on the ropes, all eyes are on Florida — again

Most Jews live in three states, two of which, New York and California, are already in the bank for Sen. Barack Obama.

It’s the third one, Florida, that has the presidential campaigns in a frenzy. There are roughly 650,000 Jews in Florida, out of 18 million residents. Concentrated in South Florida in three counties (Broward, Palm Beach and Miami-Dade), they are older, high-turnout voters with whom the Democrats have a big edge.

This is familiar territory. Unless tens of thousands of Jews had a sudden epiphany in 2000 that revealed Pat Buchanan to be a friend of the Jews, Al Gore won the election with a groundswell of Jewish votes that were interpreted incorrectly because of the butterfly ballot in Palm Beach County.

In 2000 we didn’t know how important Florida Jews were until it was too late. In 2008, elderly Florida Jews are political rock stars. Sarah Silverman has a ” target=”_blank”>Jackie Mason has recorded an online countervideo to make the Republican case. Jon Stewart’s “The Daily Show” has had two segments featuring a ” target=”_blank”>making calls to Jewish voters that in all innocence ask if it would bother the voter to “know” that Obama has supported the PLO. That this stuff works is testimony to the challenge of a young black candidate, not yet well-known in the Jewish community, and to the complex undertow of recent black-Jewish tensions. Remember that many Florida Jews moved there from New York City, with its long and difficult history of black-Jewish conflict.

Indeed Florida itself seemed out of reach for Obama until a few weeks ago. But as in all the battleground states, the Wall Street crash and bailout transformed the campaign and a raft of new polls give Obama a small but significant lead in Florida.

If Obama wins Florida’s 27 electoral votes, it’s over. If Sen. John McCain holds Florida, he still has a chance. So it looks as if Florida and its Jewish bloc are back in play.

The surrogates are all over the place, with Sen. Joe Lieberman plugging McCain and Obama pulling in former New York City Mayor Ed Koch, Florida Rep. Robert Wexler and Middle East expert Dennis Ross. Joe Biden is very popular with Florida Jews, and he is pulling his weight. With the advantage of the Republican brand, and McCain’s own familiarity, he does not need as many surrogates as Obama.

So why did McCain’s economic adviser, Douglas Holtz-Eakin, pick this moment to tell the Wall Street Journal that McCain plans to pay for his health care plan by taking blocks of money from Medicare and Medicaid? Politically, this makes no sense in Florida, where an attack on Medicare, joined to McCain’s support for private accounts in Social Security, could shake loose thousands of older voters.

McCain is on a precipice with those voters, many of whom are trying to decide whether to take a risk on the unfamiliar and cast a vote for the young black guy instead of the older white guy everybody knows. The older the voter, the more difficult the decision. Why then would McCain make it an easy choice?

I imagine that while Holtz-Eakin spoke accurately, his timing reflects the chaos within the McCain campaign, especially in regards to economic policy. But the substantive explanation might lie in the pressure on McCain to explain his health care plan, under which he proposed to provide tax credits for Americans to buy private insurance while removing the tax deduction for employer-based health care.

This approach leaves the taxpayer paying more in payroll taxes for the pleasure of navigating the private market (with its well-known aversion to insuring anybody who might someday get sick or is sick now). So the McCain people said that there would be no payroll tax increase. But how to pay for the new tax credit? Thus the decision to take it from Medicare and Medicaid. From their standpoint, they get to further the privatization of health care and still avoid the charge (fatal with the Republican base) of raising taxes.

Put more simply, it seemed safer to risk losing older voters in Florida than to risk the Republican brand of no new taxes, hoping that those Floridians won’t have heard about the interview or will believe when told that Holtz-Eakin was talking out of turn, or will just be confused because the whole thing comes across as such a complex muddle.

Because, if the McCain camp doesn’t find a way around this, how can it continue to attack Obama for raising taxes?

The problem for any Republican nominee is that what pleases the base (e.g. Sarah Palin, privatization, lower taxes) may end up turning off everybody else. If McCain loses Florida, that may be the lesson for his party. The base can never be fed enough.

McCain would have probably been better off with no health care plan rather than one that eviscerates employer-based insurance and cuts Medicare and Medicaid. But it’s too late now.

Now, the question is whether the Obama campaign can boil down for Florida voters the peril to Social Security and Medicare from a McCain-Palin administration. This is a job for Bill Clinton, the one Democrat who can reduce complex policy issues to a story about a frog sitting on a fence post. Clinton really hurt Paul Tsongas on the Social Security issue in the 1992 Florida Democratic primary.

The Republicans meanwhile plan to push farther and deeper into the attacks on Obama as a “friend of terrorists,” as a “different kind of American” and more. It is already ugly out on the campaign trail, and reporters in the field are feeling the heat of the rising anger of a Republican base on the ropes.

This is Florida 2008. Fasten your seat belts.

Raphael J. Sonenshein, a political scientist at Cal State Fullerton, is spending the semester in Paris as the Fulbright-Tocqueville Chair at the University of Paris VIII.

Drug Plan Proving Bitter Pill for Seniors

After sorting through piles of brochures, Millie Topper thought she had finally found the right Medicare Prescription Drug Benefit plan to pay for the high blood pressure medications she wanted.

But once the 77-year-old resident of Silver Spring, Md., crunched the numbers, she realized she couldn’t afford the plan’s heavy deductibles and monthly premiums. Grudgingly, she signed up instead for a plan that forces her to take a generic drug in lieu of the brand name she prefers.

“I don’t know which way to turn,” Topper said.

Her friends, she said, complain that “you’d have to be a rocket scientist to figure out the Medicare drug benefit.”

It’s a familiar story for Jewish officials who staff the community’s elderly help lines, where phones have been ringing off the hook in advance of the May 15 deadline to enroll in a prescription benefit plan. The benefit, which took effect Jan. 1, has been financially detrimental to some Jewish seniors and helpful to others — but bewildering to almost all.

“I haven’t heard anybody say, ‘Boy that’s terrific,'” said Beth Hess, director of aging and disability services for the Jewish Social Services Agency. “Nobody’s dancing on the ceiling with enthusiasm for this.”

Its consequences are important for a Jewish community with disproportionately large numbers of seniors. A recent survey recorded 19 percent of U.S. Jews as seniors, as opposed to 12 percent in the general population.

The benefit is the fruit of the Medicare Prescription Drug Improvement and Modernization Act of 2003, which for the first time covers all Medicare beneficiaries. The government turned to private enterprise to handle the massive new entitlement, against the backdrop of escalating drug costs. Incentives were offered to private companies to administer the benefit at the lowest possible cost. The idea was to encourage profit-driven companies to compete against one another to enlist seniors, causing prices to drop.

Under the rules of Medicare’s new prescription drug plan, known as Part D, beneficiaries must choose a plan offered by a private insurer. Each Part D plan — and there are dozens in each state — has its own “formulary,” a restrictive list of drugs, pharmacies, monthly premiums, co-payments and yearly deductibles.

Finding the best and most affordable plan has Jewish seniors grousing about the maze of options. The jargon has added to the confusion.

“I didn’t even know what ‘formulary’ meant,” Topper said.

For those enrollees who stand to benefit from the new system, the immense confusion triggered by the transition has overshadowed the more affordable costs. With many seniors on multiple prescription drugs at once — along with the ever-present prospect of needing new medications, finding the right formulary has become a tall order.

One way of searching for plans is by accessing the “plan finder” on the Web site, a process many experts say can be confusing for anyone, let alone seniors who may not be computer savvy.

Some seniors pore over each individual formulary brochure they receive in the mail. But most chafe at sifting through the formularies or using the Internet to find the best plan. Many Jewish seniors have turned to their children and grandchildren for help

“What’s most impressive is how active children are in trying to help their parents, regardless of how much money they have,” Hess said. “Active adult children are making it a lot easier on Jewish seniors.”

William Peirez, president of B’nai B’rith International’s MetroNorth region, enrolled his 87-year-old mother in an AARP plan. Peirez is angry about the new system, which he says is far too complicated.

“An 80-year-old can not figure this out,” he said. “It doesn’t make sense. It’s too difficult for me, and I’m 62 and a lawyer.”

Jewish leaders and policy analysts agree that some of the biggest losers from the benefit are the indigent on Medicaid, including a number of Jews.

“There is this stereotype that all Jews have money,” said Rachel Goldberg, director of senior advocacy at B’nai B’rith International. “We forget that while the average income for Jews is slightly higher, we still do have older Jews living in poverty.”

At the beginning of the year, all 6 million Americans who qualify for both Medicaid and Medicare were automatically enrolled in random private plans under the new benefit.

Prior to the switch, Medicaid recipients, who are in the lowest income bracket, had received their drugs without cost. Now they are saddled with more restricted options and face co-payment costs of a few dollars each time they request a prescription.

“Many are paying more than they used to, and simply cannot afford it,” Goldberg said. “What sounds like coffee money to middle-class people, if you’re living hand-to-mouth, can [determine] whether or not you make your electric bill.”

Goldberg and other Jewish leaders are also highlighting lower-middle and low-income seniors who come close but do not qualify for Medicaid. This group has the most to gain from the benefit but also the most to lose, they said. Many seniors lack assistance in paying for their drugs, though there are subsidies for people who pass an assets test. But poorer seniors are less likely to have access to advisers and the best information to find the right plan. Without help, many feel powerless and are avoiding the benefit altogether, experts said.

Another lightning rod for confusion and concern is gaps in the benefit structure, called “doughnut holes.” If drug costs — including out-of-pocket costs and Medicare’s portion — exceed $2,250, Medicare pays nothing, while the beneficiary must cover 100 percent, until costs reach $5,100. Then Medicare defrays 95 percent of costs.

Many Jewish seniors don’t know whether it’s worth spending the extra money in monthly premiums to receive a plan that will fill in all or part of the gap.

Jews who are better off financially and already receiving their drugs through separate plans are unsure whether they would fare better or worse under Part D. Opting into the benefit may result in worse or more costly coverage and lead to the termination of former plans — but seniors also want to avoid late fees incurred if they enroll after the May 15 deadline.

Seniors “are resigned to struggling with a very complicated situation, where what’s right for them can change over time,” said David Gamse, executive director of Jewish Council for the Aging.


Health – Take the Bite Out of Dental Health Pains

Since most Americans lose their dental insurance benefits when they retire, the majority of people over 65 pay out of pocket every time they visit a dentist. Medicare does not cover routine dental care (nor does Medicaid in most states) and more than 80 percent of older Americans have no private dental insurance, according to a recent report by nonprofit advocacy group Oral Health America.

Yet, older adults may need dental care more than any other age group.

“Patients age 65 and over will have potentially an increase in cavities or decay on the root surfaces of the teeth,” said Dr. Matthew Messina, an American Dental Association consumer adviser and practicing dentist in Cleveland. “And that comes secondary to the medical condition of dry mouth — a decrease in the amount of production of saliva because of age and certain medications…. We also see periodontal disease in patients of that population.”

Messina advises his older patients to see a dentist at least once every six months for an oral cancer screening and recommends an annual visit for denture wearers.

So what’s a person with no dental insurance to do? If you can pay out of pocket, ask your dentist if he or she will offer a discount or work out a payment plan.

“A lot of times for patients paying in full at the time of service, some offices will offer some degree of bookkeeping courtesy,” Messina said. “There are a number of ways that offices are creatively handling finances for patients of all ages to make dentistry affordable.”

Local dental schools are another option for reduced-cost care — if you’re not in a hurry.

“Our fees can be about half the cost of private practitioners,” said Dr. Janet Yellowitz, director of geriatric dentistry at the University of Maryland Dental School in Baltimore. “The downside is that because it’s a training program, it takes time — you’re working with students who are being supervised.”

She suggests contacting schools with graduate training programs for slightly more costly but quicker treatment, or looking into clinical trials at your local dental school.

Neighborhood health clinics sometimes offer dental services, according to Yellowitz and Oral Health America’s Elizabeth Rogers. However, they are not always widely publicized. Of course, people in extreme pain can go to the closest hospital emergency room, where they most likely will be given painkillers and get their tooth pulled, Rogers said.

“But that is by no means a solution,” she added.

If this doesn’t sound like a lot of options for those without dental coverage, it’s not. But a few organizations around the country are trying to change that. One is Minneapolis-area Apple Tree Dental, a nonprofit clinic that aims to improve access to dental care for underserved populations, including seniors. The full-service clinic — which treats more than 30,000 patients each year in the Twin Cities area, including on-site visits with patients in long-term care facilities — has been cited as a national model for dental care and has received requests from all over the country and Canada to present on their model.

“What I’m interested in is ensuring that we have programs in place that at least get primary care needs met for seniors,” said Dr. Carl Ebert of Apple Tree Dental. “Because when you look at the demographics and the fact that more people are keeping more of their teeth as they get older, you’re going to be facing a huge dilemma…. Then add to that the nationwide problem of the significant decrease in the sheer numbers of dentists … and the sort of seller’s marketplace we have right now in dentistry where dentists can pick and choose who they see — some exclude all insurance patients, some just cater to high-end patients seeking cosmetic services. When you start to multiply all these factors, you’re looking at a tremendous problem.”

Abigail Green is a freelance writer and editor based in Baltimore.


God, Gays and Guns: The U.S. Fault Line

About the same portion of Americans describe themselves as being liberal (19 percent) as believe that the world will come to an end in their

lifetimes (17 percent).

Right-wingers have so effectively besmirched the term (“wishy-washy liberals,” “tax-and-spend liberals,” “limousine liberals”) that only a few political martyrs and masochists publicly proclaim their allegiance to the cause once championed by President Franklin Delano Roosevelt.

The word preferred by left-of-center types in the United States is “progressive,” which harkens back to the earlier Roosevelt, Teddy, a turbocharged Republican who whipped monopolists and gleefully asserted the power of the federal government.

FDR’s robust liberalism focused on social justice at a time when one in four workers had lost their jobs in the Great Depression, and then on social solidarity, when the United States entered World War II. By now, much of that twin legacy has disappeared.

But look beneath current political labels and you find a nation still clinging to several liberal ideals. Polls show, for example, that an overwhelming majority of Americans support Social Security, unemployment insurance and a minimum wage, as well as Medicare for the elderly (courtesy of Lyndon B Johnson), strong environmental protections (Richard Nixon’s contribution, surprisingly enough) and a graduated income tax.

Most believe that government has no business snooping into people’s private lives without cause to believe that they have been involved in crime. The vast majority favor equal civil rights for blacks, women and ethnic minorities.

And George W. Bush’s swagger notwithstanding, most Americans oppose unilateral assertions of U.S. power abroad. An overwhelming majority believe we should work in close concert with our long-standing allies, including France. The shrill, right-wing rantings of radio and television talk show hosts do not reflect the views of most Americans — or the manner in which they disagree with one another.

The political fault line in modern America has become cultural. It is about religion, sex and firearms — or, in the vernacular, God, gays and guns. Since Sept. 11, the culture war has been extended to global terrorism.

On the conservative side are Americans who attend church regularly, believe that homosexuality is morally wrong, want the government to ban abortions, take offense at out-of-wedlock births and think they have a God-given right to own any gun they wish. They also want the United States to exterminate all terrorists, including anyone with terrorist leanings.

Most of the people who think this way reside in rural and southern parts of the nation, towns and small cities and outlying suburbs. They are the majority in what are now called “red states” — states that lit up bright red on the electronic TV maps late on election day 2000 and 2004, when returns showed that most of their voters had cast ballots for Bush.

They dine nightly on meat, potatoes and a vegetable, watch Fox News, shop at Wal-Mart and enjoy NASCAR races and wrestling on TV. They earn between $20,000 and $60,000 a year — straddling the middle and working classes, doing jobs ranging from mechanic to clerical worker, beautician to physical therapist and low-level managerial and technical work.

On the liberal side of the cultural divide are those whose church attendance is irregular at best, who harbor far more permissive attitudes toward sex and think government should control gun ownership and ban handguns and assault rifles. They believe terrorism is a complex problem, requiring better intelligence and more effective ways to win the hearts and minds of Muslims who now opt for suicide missions.

They tend to inhabit America’s sprawling metropolitan regions in the northeast and on the West Coast, the larger cities and the inner suburbs. They are the majority in the “blue states” that went for Al Gore in 2000 and Sen. John Kerry in 2004.

Their tastes in food tend toward varied national and ethnic cuisines. They watch the major TV networks or public television and play golf or baseball. They typically earn between $60,000 and $200,000 a year or they earn under $20,000.

Cultural liberals tend to be both richer and poorer than cultural conservatives — moderately paid professionals such as teachers, lawyers and social workers or else low-paid employees, such as hospital orderlies, retail and restaurant workers and hotel personnel. In other words, they are more cosmopolitan than cultural conservatives and more diverse.

Why God, gays and guns? They are proxies for two distinct temperaments that divide the United States like a meat ax.

On the conservative side is a moral absolutism that views the nation’s greatest challenge as holding firm to enduring values in the face of titanic economic and social changes. The common thread uniting strong religious conviction, rigid sexual norms and an insistence on owning a gun is the assertion of authority, typically by men.

The task is to apply strict discipline to those who might stray from established norms and to win what are repeatedly seen as “tests of will.” Since Sept. 11, this has also taken the form of patriotic bravado and stubborn pugnacity.

America, say cultural conservatives, must remain the strongest nation on earth. The best way to deal with terrorists is to demonstrate toughness and never waver. Better to be feared than loved; better to be consistent than appear indecisive. The tough-talking, born-again cowboy president, Bush, perfectly exemplifies this worldview. “Bring ’em on,” he says. “You’re with us or against us.”

On the liberal (progressive) side of the cultural divide is a belief in tolerance, reason and law as central tenets of democracy. Americans who hold to this view consider all public issues to be soluble with the correct and relevant information, subjected to objective analysis and full deliberation. Religion and sex fall outside the public sphere, because they are inherently private matters.

A vibrant democracy must tolerate different beliefs and personal choices. Gun ownership directly affects the public sphere and, as such, is subject to regulation if there are good reasons to limit it. (As there are.)

By extension, the battle against global terrorism requires that we be smart rather than merely tough. We have to get our facts straight (Saddam Hussein had no weapons of mass destruction), tell the public the truth (Iraq played no part in Sept. 11), apply rational analysis (our first priority must be to keep nuclear weapons out of the hands of potential terrorists) and respect international law (work through the United Nations and NATO, and don’t torture prisoners).

We also need to get at the causes of terrorism — the hate and hopelessness that fuel it. If you want to understand Kerry, look no further.

Cultural conservatives condemn liberals as having no strict moral compass, as being “moral relativists” and “flip-floppers.” These charges predate the 2004 presidential campaign.

Conservatives fear liberals will sell out, because they don’t know what they stand for. In fact, liberals do have strong beliefs (again: tolerance, reason, democratic debate, the rule of law), but these beliefs seem more about process than substance and do not lend themselves to 30-second sound bites.

To liberals, most issues are complicated and nuanced. This attitude drives moral absolutists nuts. American liberals, for their part, worry that the right-wing conservatives are stubborn, intolerant zealots who shoot before they think. Recent history seems to bear out these fears.

Presidential elections in modern America have been about these contrasting worldviews since at least 1964. Starting with Sen. Barry Goldwater’s failed bid in that year and continuing through Nixon, Ronald Reagan and the two Bushes, the new right has emphasized moral absolutes and the need for authority and discipline to enforce them. By contrast, Jimmy Carter, Bill Clinton, Gore and now Kerry have focused their campaigns on tolerance, reason and democracy.

Republican candidates repeatedly talk about toughness and resolve, while liberals talk about being correct and thinking problems through. On balance, toughness and resolve have proved the easier sell, especially when American voters are worried about something big.

What about social justice?

This part of FDR’s liberal legacy has been eclipsed by the culture wars. Odd, when the biggest thing voters worry about is their jobs and paychecks, and the paychecks (including wages and job benefits) of most Americans have been declining for two decades, adjusted for inflation.

The gulf between rich and poor in America is now wider than at any time since the robber barons of the late 19th century monopolized industry and bribed the government to do nothing about it.

Yet, in recent years, Democratic candidates have not dwelled on the subject. They have bought the conventional view that economic populism does not sell, because most Americans still want and expect to become rich one day.

That is rubbish. Upward mobility has just about ground to a halt. And it’s circular reasoning.

Economic populism would sell if Democratic politicians explained to the public what has been happening and why. To his credit, Kerry didn’t duck the issue. He promised to end the Bush tax cuts for people earning more than $200,000 a year and use the proceeds to make health care affordable for the working class and the poor.

America is splitting into “two nations” (as Sen. John Edwards, the Democratic vice presidential candidate said), because the twin forces of globalization and technological change are rewarding the educated and well-connected, while punishing the less educated and the disconnected.

What to do about this?

There are solutions that do not require protectionism and neo-Luddism, solutions much in keeping with the liberal legacy of FDR, but too few of today’s liberals have been discussing them, and the American public doesn’t have a clue. You hear them discussed mostly in the rarefied precincts of university towns such as Cambridge, Mass., and Berkeley, whose inhabitants talk to one another and convince themselves that the rest of the nation must be saying the same things.

One hopes that the conversation will be much wider.

Robert B. Reich, former secretary of labor in the Clinton administration, is professor of social and economic policy at Brandeis University and the author of “Reason: Why Liberals Will Win the Battle for America” (Knopf).

Jewish Elderly May Pay More for Drugs

A law that was supposed to ease the burden of prescription drug costs for the elderly may force some Jewish seniors to pay more than they do now.

The Medicare reform legislation, signed by President Bush this week, grants some relief in prescription drug costs for seniors. But other provisions of the law might adversely affect more affluent seniors, including Jews.

Jewish groups still are learning what the law will mean for Jewish seniors and already are looking at ways to amend it. Several Jewish groups opposed the legislation, claiming it did not go far enough to aid seniors. They are looking to join coalitions of other advocacy groups to seek a new Medicare reform bill, or amendments to the current one, before most of the provisions go into effect in 2006.

Other organizations, including representatives of Jewish nursing homes, say the law will grant Jewish seniors some relief and is a step in the right direction.

The Medicare issue is an important one for Jews, since they are older on average than the general American population. According to the National Jewish Population Survey 2000-01, 19 percent of the U.S. Jewish population is over age 65, compared to 12 percent of the U.S. population as a whole.

Because Jewish seniors tend to be more affluent than seniors in the general population, they may be adversely affected by the new Medicare laws. For example, Jewish seniors currently are more likely to be using private insurance, known as Medigap, to supplement what Medicare covers, including prescription drugs. But the new law prohibits Medigap policies from covering prescription drug costs, so seniors who rely on that service may soon have to pay more out of pocket.

The same is true for seniors who are on prescription drug programs through their employers or pensions. Some Jewish policy analysts fear that the prescription drug provisions in private insurance programs will be dropped or downgraded for retirees because of the availability of the optional Medicare program.

While the new law contains subsidies to encourage employers to keep prescription drug benefits for retirees, it’s unclear how good drug benefits must be for businesses to receive the subsidy — and analysts say some employers may downgrade their programs to the minimum required.

Another possibility is that Jewish seniors who currently have low drug costs will pay more to opt into the program when it begins in 2006 or when they turn 65, to avoid penalties for joining later.

B’nai B’rith International opposed the legislation, along with several other Jewish groups. Rachel Goldberg, B’nai B’rith’s assistant director for senior services and advocacy, said the main concern was a gap in prescription drug coverage for seniors.

While the law offers discounts for those who spend less than $2,250 a year on drugs, the next discounts do not start until after one pays $5,100 a year.

"People are going to be really surprised when they look at it," Goldberg said.

The demographics of the Jewish community mean Jews may be among the first to see how the new provisions affect spending on senior services.

Not only is the Jewish community older, but Jewish families also have fewer children than the U.S. average, meaning that there are fewer sources of income to offset growing costs in a family.

"What’s going to happen nationwide, we’re a microcosm of that," Goldberg said. "It’s going to happen to us first."

That includes assisting poorer Jews. While Jewish elderly generally have more money than elderly in the general population, 9 percent of Jews over age 65 live at or below the poverty level, and 18 percent live in households that earn $15,000 or less a year, according to the population survey.

Another 15 percent live in households that earn between $15,000 and $25,000.

People on Medicaid will have to begin paying a small co-payment, and poor Jews who do not apply for Medicaid may have to deplete their assets to receive increased benefits, Goldberg said.

"The low-income portions of the bill are better than we feared, but nowhere near as good as we hoped," she said.

Jewish groups say they’re beginning to educate their membership about the new laws and are working with other advocacy groups to mobilize an effort to repeal portions of the legislation.

Advocates say several factors could help them make changes to the law, including the fact that 2004 is a presidential election year and that a lot of the law’s provisions don’t take effect until 2006.

But there is concern that some lawmakers will be disinclined to reopen the Medicare issue so soon after a long fight on Capitol Hill produced this legislation.

Bert Goldberg, president and CEO of the Association of Jewish Family and Children’s Agencies, said his organization will analyze the law and try to advise seniors how to take advantage of its options.

"We now at least have something that deals with drugs for seniors, and we’ve never had that," he said. "That’s at least something to be pleased about."

The Editor’s Corner

My mother is87. Or is it 90? As long as I can remember, I thought that she hadbeen born in 1910, was named Miriam Euffa, and brought here from Kievas a 5-year-old by parents who were educated, and who had been partof what must have been a turn-of-the-century minority: theRussian-Ukrainian Jewish professional class. Now Medicare tells methat her Social Security card lists her year of birth as 1907.

At this point, I ask myself, what difference canit make? My mother has Alzheimer’s. The disease has ushered her intoa realm where days, weeks, years hardly seem to matter. Until just afew days ago, she resided in Cedars-Sinai Medical Center, where shewas recovering from pneumonia (which she apparently contracted aftershe broke her hip and underwent surgery at Midway Hospital inJanuary, followed by three weeks of physical therapy at the BeverlyHills Rehabilitation Center in February).

Thanks to her two-month period of extended stay inthese three separate medical facilities, I have become knowledgeable(and dismayed) about hospital life for the elderly. I have watched mymother move rapidly from living as a woman who was mobile,semi-independent and trapped in the early stages of Alzheimer’s tosomeone who is now a patient, stripped bare, functioning in a stateof helplessness, or what a doctor described as delusionalpsychosis.

Is this a natural decline, one in which the bodymalfunctions and the Alzheimer’s mind quickly follows suit? Or is it,in some large measure, a fallout from our cutting-edge,multimillion-dollar corporate hospital system? I have come to believethat this health-care system, with the best intentions in the world,failed me and the aging parent I turned over to their highlyspecialized care.

I know, this could just be my way of release, anexpression of despair, depression and, yes, an underlying ragebursting through after months of frustration. My mother enteredCedars because she had been overmedicated and had become highlyagitated. Once she was admitted, Cedars’ proficient medical expertisecame into play: Tests were given; X-rays taken; new medicationprescribed. It became evident that several weeks earlier, either atMidway or at the Beverly Hills Rehab Center, water had settled in herlungs. She had contracted pneumonia, but it had not shown up before,or else no one had noticed.

Treatment for pneumonia moved into high gear, but,in the process, her mind became more disoriented. Medication for herdementia became a hit-and-miss affair as doctors struggled valiantlyto find a combination of drugs and a proper dosage that would serveher (and the nurses) well. And I rediscovered what had begun to dawnon me earlier– namely, that the operating procedures at all threemedical facilities ran counter to my mother’s particular needs. Toput it bluntly, while the pneumonia was checked, her mental stateslipped radically. She needed individual care, and that apparentlywas outside the hospitals’, and the rehabilitation center’s, range ofcaregiving — in part for budgetary (read financial) concerns, inpart for organizational reasons. Had I known then the limitations andconsequences of her hospital care, I would have limited her stay ineach medical institution to a bare minimum.

The catalog of breakdowns over the two months hasbeen extensive, but I will cite only a few. At Cedars, for example,someone had been inattentive and let my mother struggle out of bedalone. She has no short-term memory and, so, is unaware that shecannot yet walk. The result: She fell on her head. A quick trip toX-ray revealed that this 90-pound 90-year-old sustained only a bump,soreness and some swelling. No concussion, no broken neck or hip, nosevere damage. And no immediate or direct communication withme.

In part, because of this fear for her safety, thenursing staff began tying her down in a quite effective way: arestraining band across her chest and, at times, her feet strapped tothe ends of the bed frame. I walked in once at Cedars to find herscreaming frantically for help, unclear where she was (she thoughtprison) or why these people had tied her down and locked the door.She was agitated and terrified. And convinced that the nurses wereplotting against her. Why else would they treat her this way?

The nurses were clearsighted about the answers.First, she was “restrained” to protect her from falling and breakingher hip again. Second, the door was closed because she made too muchnoise, calling for assistance or simply asking for attention. Inshort, she was a nuisance, and there was neither time nor staff tofill these needs of hers. She was being protected for her own good,to be sure, but there was a strong likelihood, as her doctorsverified to me, that she also was being driven mad.

“The reality is,” explained one of the nurses, “weare not equipped to give patients one-on-one care. Someone like yourmother needs an available nurse around the clock. We don’t providethat.” Hire private nurses, one of her doctors advised me. Eitherthat or send the family to care for her.

The difficulty appears to be that the system inplace is designed for maintaining order and organizationalefficiency, for diagnosing and treating illness, for deliveringbabies and removing someone’s appendix, for heart surgery andrespiratory ailments, but not necessarily for the individual care ofthose elderly who require personal attention. “Get your mother out ofhere as soon as possible,” a staff member at the rehab centerconfided to me when I complained that my mother’s needs were oftenignored and that her bed often reeked of urine. “This place hasexcellent facilities and people for physical therapy,” I was told,”but is totally unprepared to deal with Alzheimer patients.”

The problem largely has to do with money. Theresimply are not enough funds available to cover one-on-one nursingcare. Or at least it is not given high enough priority. Hospitals arestruggling to raise dollars in order to provide decent medical care.Medicare payments barely scratch the surface of costs andexpenses.

Fault also lies with the nursing system that hasbeen put in place. Nurses rotate on 12-hour shifts and are assignedeight or nine different rooms and patients each shift. What they arenot given is a set of individual men and women whom they follow fromadmission to release. The process works against the possibility thatnurses will become familiar with the rhythm of a patient’s life, orthat they will empathize or bond with anyone in their care. It makesfor impersonality when precisely the opposite is often desperatelyneeded for many seniors.

It also leads to a reporting system that isparticularistic but rarely complete. Nurses can only report todoctors what they have observed during their shift: percentage offood eaten, medication taken, a rasping cough, agitation. But thereis little intimate linking of these facts to the rise and fall of apatient’s mood, spirits or progress. When I made these observationsto a doctor, he exclaimed, wearily, that he had been fighting thatbattle (in vain, he implied) for more than 10 years.

One evening, when I slept in my mother’s room, Iheard a woman crying for help. She was half awake, half asleep nextdoor. I looked to see if a nurse was available. Yes. Someone was atthe nursing station, another nurse in the corridor. I went back tobed. But the cries — a constant moan now from a wan, elderly,delirious woman — continued. It had become half plea, half chant. Islipped into her room, touched her forehead and held her hand. Shequieted. What she seemed to want was assurance that she was notalone, abandoned in some strange, twilight world.

In fairness, I should add that not all the nursesare inured to the plight of patients or exhibitthis form ofdistance. Two, in particular, who pulled a shift with my mother –Marlene Williams and Daisy da Silva — responded to her in verycaring ways. But then I discovered they were LVNs (licensedvocational nurses), subordinate to the RNs. They had not had time, Ithought, to be subsumed by the system.

Then there are the physicians. They are the Lordsof the Manor, but, alas, mostly visiting Lords. The doctors I came toknow at Cedars, those responsible for my mother’s well-being — JayJordan, a cardiologist and her main physician; Ronald J. Davidson, apsychiatrist and her geriatric doctor; and Martin Gordon, a pulmonaryspecialist (along with Isaac Schmidt, her surgeon from MidwayHospital) — were all splendid, top-of-the-line, well-trained, caringand straightforward. No sentimentalizing, no euphemisms. Concernedfor their patient and concerned for me.

The gap between them and the daily life of thehospital — where, for the most part, they diagnose and prescribe forpatients and seem to function somewhat like specialized consultants– is enormous. They speak to the relevant nurses, who implement thecare, but who manage patients according to rotational shifts.

What gets passed along then are literal messages,often by telephone: Do this; stop that; change the medication. Allwritten down and passed along from one nurse to another. The rest,the details, the context, the exceptions, the parenthetical asides,the possibility that something may be amiss outside the illness thatis being treated, these all fall between the cracks. There are fewlengthy exchanges — little in the way of discussion.

It will probably come as no surprise to you thatabove and beyond the hospital bills, which Medicare and my mother’ssecondary insurance mainly covered, I hired two private caregiverswho agreed to look after my mother in the hospital, each taking a12-hour shift six days a week. They were not registered nurses,though they had considerable experience caring for seniors,particularly those with Alzheimer’s. The doctors listened attentively(and with gratitude) to their comments on my mother’s health andstate of being, for these caregivers became the best and mostconsistent guide to her moods, her behavior and her health — eventhough they were outside the hospital’s regimen and were notofficially accountable or responsible for her medicaltreatment.

I realize after the fact that what I had set upwas a process of caring for the sick and dying outside the legalentity we call a hospital. Actually, it is a practice I firstobserved more than 30 years ago, when I was a young journalist inWest Africa. There, I witnessed a handful of overworked well-traineddoctors ministering to more people than seemed humanly manageable.Alongside them, an overwhelmed cadre of nurses, not trained well byour standards, tried their best to render patient care underconditions that would never pass muster in the United States.

But every family shared the burden of caring fortheir sisters, brothers, parents, nieces and nephews by moving intothe hospital room. They remained there until it was possible to bringtheir relative home — or until death silenced everyone. It is ironicto me that in the midst of high-powered multimillion-dollar medicalinstitutions, great and wonderful and humane complexes, complete withsuperbly trained doctors, that is where I now find myself.

Early last week, I spoke to my mother’s doctors.Was there any point in keeping her in the hospital? I asked. Couldshe not just as easily be ill at home? Perhaps with more dignity? Andperhaps with more personal attention, since the two women who tendedher in the hospital will take turns living and caring for her. And ifshe is dying, is it not more humane to let her live her last monthsin her apartment, surrounded by familiar objects and personal voices,than in a hospital room? A place where we can all eat and laughtogether, touching her and letting her eavesdrop on us as we play outthe cycle of our lives?

Their answers were rational, direct, filled withcommon sense. Last Saturday, I removed my mother from the hospital.We carted home an oxygen connector and a backup tank. — GeneLichtenstein, Editor

For a story with a happier ending, see WendyMadnik’s description of The Jewish Home for the Aging.