78 and 79: A Matter of Life and Death


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rabbis, Imams Find Common Ground


 

I recently returned from an extraordinary meeting that took place last month in Brussels. One hundred imams and rabbis from 20 different countries came together for four days of discussion about religion, peace, justice and dignity. Meeting in plenary sessions and breakout groups, over meals and during evening cultural programs, this conference was a public attestation of the possible.

It wasn’t easy for any of us. There was plenty of politicking and internal politicking within the religious communities as well. In one of the many remarkable public statements, the Orthodox rabbinic contingent agreed to participate together publicly with the fully honored representation of Conservative and Reform rabbis.

I had the privilege of leading a breakout session in which we were mandated to brainstorm about “sharing and transmitting without proselytizing.” We began with the standard sharing go-around, in which we were asked to share why we came to this conference. I was riveted by two stories.

One was told by an African imam dressed in white ceremonial robes, complete with a matching embroidered cap. I learned later that he held a high religious post in Tanzania.

Once, while visiting a Congolese friend living in South Africa, he became quite ill and felt that he was having symptoms of heart disease. The friend suggested that he see a doctor friend of his — a Jewish doctor. The imam wouldn’t consider it, because he was certain that a Jewish doctor would use his professional skills to kill him, a Muslim. As he put it, “Perhaps he wouldn’t kill me outright, but he would prescribe something that would poison me undetected.” He therefore decided to wait until he could see his personal physician when he returned home to Tanzania. But his symptoms persisted, so one day, he went to his friend’s house and knocked on the door. But the friend was not home. Who should answer the door but the Jewish doctor.

The doctor questioned the sick man, and discovered that the medication the imam had been taking for migraine headaches could cause a very serious heart ailment, and that was most certainly the imam’s problem. The physician explained quite clearly that if he continued to take the medicine it would kill him. The imam had to choose between very bad headaches or a heart attack. The choice, said the imam, was an easy one. And the doctor also prescribed a different medication that helped to relieve the migraine symptoms.

When asked if that experience had anything to do with him coming to the conference, the imam’s answer was that it had everything to do with it. It was his responsibility to come and to “clear the air,” as he put it.

The other story was told by a prominent ultra-Orthodox rabbi. I had known of him previously through his writings that justified violence in the conflict with Palestinians as a form of milchemet mitzvah, or a divinely sanctioned mitzvah war.

He was living at the time in a Jewish settlement in the Gaza Strip. Although surrounded by approximately 1 million Arabs and hearing the call to prayer every day, he had absolutely no relationship with Muslims. The only contact he had was with Arab taxi drivers.

One afternoon, he was riding in an Arab taxi when it was time for minchah, or afternoon prayer. He asked his driver to stop for him where he could do a brief ritual washing and then engage in that short prayer before continuing the drive. The rabbi noticed that his driver also got out of the car and washed himself. The rabbi stood for his prayers facing north toward Jerusalem; his driver stood near him, but faced south toward Mecca. They both stood there, one next to the other, each engaging in the same act. Both offered thanks to the God of the world for their very existence.

As the rabbi put it, they were “both praying to the same God, one facing south, the other north.” At that moment, he said that he came to the deep, transcendent understanding of the unity of God — for Jews, for Muslims, for all humanity.

“We all pray to the same God,” he said. “One prays in one manner; another in a different manner. One prays in one direction; the other prays in a different direction. But we are all united on this tiny world, so I realized that it was time we got to know one another.”

Most of us don’t have the luxury of such transformative experiences. Most of us simply go through life following the religious and nationalist scripts we absorb intuitively from our tribal environments. This is extremely dangerous.

One of our scripted Jewish positions is the self-righteous question: Where are the Muslims? Why don’t they engage in dialogue? Why don’t they condemn acts of violence?

The simple truth is that they do. The Brussels meeting of 100 imams and rabbis attests to Muslim concern and activism. And Brussels was not their first place of involvement for virtually all of them.

But such public acts often seem to remain somehow under our radar. We don’t pick them up. At USC, where I teach, I’ve been told by the dean of religious life that it is much more difficult to bring Jews to programs and dialogue with Muslims than vice versa.

One of the more interesting new programs I learned about in Brussels is a project partnered by two graduate students, one Muslim and one Jewish, that connects hundreds of Jewish and Muslim teenagers throughout the world via digital photography on the Internet. They have much more difficulty finding Jewish teens than Muslim teens to engage in the program.

We will fail to break out of our current deadlock and malaise without breaking out of our assigned scripts and without becoming more self-reflective about who we are, where we stand in the world and where we are heading.

Rabbi Reuven Firestone is professor of medieval Judaism and Islam at Hebrew Union College-Jewish Institute of Religion in Los Angeles, where he is currently building the new Institute for the Study and Enhancement of Muslim-Jewish Interrelations. The Web site for the international photography project is

Seattle Reform Camp Gets L.A. Support


Reform Jewish parents from the Pacific Northwest who are not willing to put their children on an airplane or drive 15 hours to California so they can go to camp will have an alternative by summer 2005, thanks to the generosity of a Los Angeles family.

The Kalsman-Levy family has donated $5 million to the Union for Reform Judaism (URJ) to buy the property for a new camp in Washington state. Camp Kalsman, named for grandparents Lee and Irving “Red” Kalsman, will become the movement’s 13th camp in North America.

Mark Levy, who along with wife, Peachy, donated the money to buy the camp, says the idea of helping build a new camp in the Pacific Northwest was very appealing to the family.

“As we grew more and more involved in Jewish life, we become convinced that the most important things to keep Jewish kids involved in a Jewish life are Jewish camps and trips to Israel,” Levy said. Their children and all their grandchildren, including one family living near Seattle, have been to Jewish summer camp when they were old enough and Levy adds that Peachy’s parents were also sold on the importance of Jewish camping.

Irving Kalsman and Levy were both real estate developers and Peachy Levy is a Jewish textile artist. The family has made numerous generous gifts to Jewish causes, including a naming gift for the new UCLA Hillel, and a $3 million gift to establish the Kalsman Institute on Judaism and Health under the auspices of the Union for Reform Judaism. The institute operates on Hebrew Union College-Jewish Institute of Religion’s Los Angeles campus.

More than 10 years ago, the family set up the Levy Youth Fund to distribute hundreds of scholarships to enable teenagers to participate in youth conclave weekends, summer camp and high school programs in Israel. The family also has set up a program to enable teens with various physical challenges — mobility and visual impairments as well as autism and other disabilities — to enjoy summer camp at one of the union camps. At last fall’s annual meeting of the URJ in Minneapolis, Mark and Peachy Levy were awarded one of the movements highest honors, the Eisendrath Bearer of Light Award for work in service to the Reform movement.

Levy said he knew the movement was hoping to build two new camps in the near future. They were attracted to help build the camp near Seattle because they have a number of connections to the Pacific Northwest, including their daughter, Janet Levy Pauli, who lives with her family on Bainbridge Island and is involved in both the Bainbridge Reform synagogue, Congregation Kol Shalom, and a Conservative shul in Seattle, Congregation Beth Shalom.

Pauli, who grew up in Los Angeles but has lived in Washington for 25 years, has not put her kids on a plane to attend camp in California. Both her boys have attended the Conservative movement camp near Olympia, Wash., Camp Solomon Schechter, but her family has participated in Reform family camps both in California and Washington.

She is looking forward to having a new place for both kids and families to go to camp in the Pacific Northwest.

“It’s exciting because I so believe in camp. That’s something that has been passed on to me and my generation and I’ve passed it on to my kids,” Pauli said, adding that she also enjoyed hearing at the Reform biennial in Minnesota last fall how excited Jews from Alaska were to have a camp a few states closer to them.

For 10 years, Rabbi David Fine, URJ regional director, and others have been pushing for a new Reform camp in the Pacific Northwest. During that decade, the region has grown from 20 to 33 congregations, with two more due to affiliate within the next year. The number of children and families interested in Reform Jewish camping has grown along with the congregations, Fine says, noting that two Seattle synagogues run their own 10- or 11-day summer camps and 200 people attend a Seattle family camp outside of the city every Labor Day weekend.

“Eric Yoffe, president of the URJ, has expressed a desire for increased camping beds,” Fine said. “Camp is where our young leaders are nurtured and grown. The majority of rabbinical, educator, cantorial and communal service workers grew up in the camping movements.”

The URJ runs 12 camps across the country, including two in Northern California, which attract some young people from Washington, Oregon, Montana and Alaska. Fine said he looked at 35 properties over the past three years before a bankruptcy sale made the beautiful and spacious Love Israel property a bargain the movement could not refuse.

The new camp will be about 60 miles northeast of Seattle, between the towns of Arlington and Granite Falls in Snohomish County, on the western foothills of the Cascade Mountains. There’s a natural lake on the property and it’s less than a mile from a river.

“It’s absolutely gorgeous. It’s a wonderful place for reflection,” Fine said. Surrounded mostly by farms and government property, the camp will also be a great place for kids to make noise and have fun during the summer.

Pauli is the only member of the Kalsman-Levy family to have seen the new camp property and gives the site rave reviews.

“It is just spectacular. The group that’s been there — the Love Israel — people have clearly loved the property, their gardens, the fruit trees, the grape arbors,” she said. “When I left I had this feeling not in the people that I met, but in the physicality of it, that the property was kibbutz-like.”

The URJ paid $4.2 million for the 300-acre property as part of Love Israel’s Chapter 11 bankruptcy plan to pay off a $5.2 million debt. The alternative Christian community, called a cult or commune by some, has nothing to do with the Jewish state or the Jewish people, but rather is a different way of saying the phrase, “love is real,” which is the group’s founding vision. Their beliefs are tied to the 1960s counterculture and the Bible.

The leader of the Love Israel family, who is also called Love Israel, was the only person willing to say anything amusing about the coincidence of the organization’s name and the new owners of the property. When asked by a local newspaper, The Everett Herald, where the group would be going when they left their bucolic Arlington, Wash., ranch after living there for 20 years, he replied, “It’ll be an orderly retreat, an exodus, leaving Egypt for the country. I’ve been able to live in a park. Now I’ve got to park myself somewhere else.”

Rabbi A. James Rudin, the American Jewish Committee’s senior interreligious adviser, wrote in a Jan. 2 column distributed the by Religion News Service that there is nothing very amusing about the Love Israel family. He calls the group a cult and describes them as a “bizarre combination of Christian beliefs and New Age ideology, with a charismatic, dictatorial leader.” He expressed his pleasure that the beautiful camp property would now come under the stewardship of the real “Children of Israel.”


Donna Gordon Blankinship is a free-lance writer living in Seattle.

Humanistic Service Entices the Secular


At Temple Adat Chaverim in the San Fernando Valley, the High Holiday services make no reference to a supernatural God. Adat Chaverim — and members of a sister group in Los Angeles — will join some 40,000 secular Jews throughout the world in Humanistic services.

“A Humanistic Rosh Hashanah and Yom Kippur emancipates us from the beliefs and rites of those who prostrate themselves before an all-powerful deity,” Adat Chaverim reader Joe Steinberg will say when explaining the meaning of the observance to the congregation. “They offer self-forgiveness and the occasion to restate our belief in personal and human responsibility for our lives, our behavior and our destiny. For us, the High Holidays are not a punishment or a threat, but an opportunity to gain ongoing insights into our being.”

The numbers of Humanistic Judaism are small — especially given the millions of Jews in the world who identify themselves as nonreligious — but Rabbi Sherwin T. Wine of Detroit, who founded the Society for Humanistic Judaism in 1969, remains optimistic.

He notes, for one, that Sivan Malkin Haas, the first Israeli to complete the five-year rabbinical course at the International Institute for Secular Humanistic Judaism, is returning to Jerusalem to lead the Humanistic congregation in the Jewish State.

In North America, some 40 Humanistic “communities” will observe the High Holidays, mostly guided by madrichim (trained lay leaders). Only in eight cities — New York, Washington, D.C., Chicago, Detroit, San Francisco, Boston, Toronto and the Miami area — will ordained Humanistic rabbis be available to conduct the services.

At Adat Chaverim, the Valley Congregation for Humanistic Judaism, the resident madrich is Steinberg, who organized the group with three other people two years ago.

“Now we have 53 members,” Steinberg said, “and we rent space from a Methodist church in Tarzana. The next step is to get our own storefront place.”

Adat Chaverim broke away from the older Los Angeles chapter, partially to shorten driving distances, but mainly because “we wanted more music and ritual,” Steinberg said.

A vigorous 82, Steinberg worries about the aging membership of Adat Chaverim, a general concern among many Humanistic communities, as among Jewish organizations and synagogues in general. To attract younger families, Steinberg doubles as director of the congregation’s Children’s Jewish Cultural School. Its goal, notes a brochure, is to teach children “the real history of a real people in all its diversity” and to allow them “to develop their own convictions honestly on the basis of knowledge.”

Attorney Shirley Monson serves as treasurer of the Los Angeles Society for Humanistic Judaism, with some 60 members.

Her grandfather was Orthodox, her parents Conservative and Monson attended a Reform temple, “until I grew out of it and became a Humanistic Jew,” she said. “I also didn’t want my kids to get a [religious] education they didn’t believe in.”

As a secular woman, Monson rarely encounters antagonism when meeting members of more conventional Jewish denominations. But occasionally, when the conversation turns to religion and she mentions that she doesn’t pray to God, “they’ll treat me like I had leprosy” Monson said.

A third center of secular Judaism in the Los Angeles area is The Sholem Community, which consists of 120 families and operates a Sunday school, from kindergarten through ninth grade, for 75 students. The center’s credo is encapsulated in the words, “To the best of our abilities, we are the authors and publishers of our Book of Life.”

Hershl Hartman, Sholem’s vegvayser, Yiddish for guide, recalled that the first secular Yom Kippur was celebrated in Los Angeles in 1973. In preparation for the upcoming High Holidays, Hartman said, “Some traditions change, so we don’t sacrifice a young bull, a ram and seven lambs. Some traditions don’t change, so we blow the shofar.”

It is difficult to ascertain the number and percentage of secular Jews in the United States, with Wine putting the figure at a high of 47 percent.

The 2001 American Jewish Identity Survey by the Center for Jewish Studies at the City University of New York, cited 1.7 million self-identified Jews who described their households as atheist, agnostic, secular, humanist, or having no religion.

Whatever the precise number, given the large pool of like-minded Jews, why is membership in the Society of Humanistic Jews, and similar groups in 11 other countries, so low?

According to Wine, some 15,000 to 20,000 North American Jews are “fully connected” to the Society, up from 10,000 a decade ago, while an additional 20,000 attend lectures and other activities, or get married under Humanistic auspices.

Wine believes that the future growth of his movement is linked directly to the number of trained rabbis it can produce, saying that Humanistic congregations led by rabbis, rather than lay leaders, are expanding and attracting young families.

Currently, there are six candidates studying in the rabbinical program, but, “If I had 50 rabbis to send out, the movement would grow rapidly,” Wine said.

He is convinced that secular Jews must get together and organize, especially in the face of the growing fervor of religious fundamentalists.

“Unless we are organized, we have no voice,” Wine observed. “And ours is a voice that needs to be heard.”

For information on the Society for Humanistic Judaism,visit www.shj.org .