December 12, 2018

Trump’s ACA Order Creates Health-Care Chaos

US President Donald Trump (L) and White House senior advisor Jared Kushner take part in a bilateral meeting with Italy's Prime Minister Paolo Gentiloni (not seen) in Villa Taverna, the US ambassador's residence, in Rome on May 24, 2017. Photo by Mandel Ngan/AFP/Getty Images

So now we face yet another assault on the health and safety of our nation due to the barrage of efforts by the current administration to dismantle certain provisions in the Affordable Care Act (ACA). This creates great risk and chaos within a system that is aimed at providing both proactive and reactive care to individuals in our country.

As a Jewish community, we should be outraged at the callous attempt to shirk society’s obligation to care for one another, both in terms of last week’s decision to cut subsidy payments to insurers (“cost-sharing reduction payments”) and the ruling to withhold the ACA’s promise of no-cost contraceptive coverage. As conversations and negotiations change by the hour, we are both encouraged to learn of bipartisan cooperation to save the cost-sharing reduction payments while at the same time disappointed with the administration’s insensitive statements and recommendations to eliminate someone’s health care.

This supersedes all other commandments, as it is inferred from one of the most well-known rabbinic teachings, the concept of pikuach nefesh, saving a soul, found in Mishnah Yoma. The text suggests that saving the life of yourself or another is so great that one is permitted to break the laws of Shabbat for the safety of human life. We must interpret this to modern day and protect the lives of millions who will be affected by attempts to cripple the Affordable Care Act. To dismantle a life-saving system is antithetical to the concept of pikuach nefesh.

Furthermore, the book of Leviticus (19:16) teaches that one should not stand idly by the blood of their neighbor. Many among us acknowledge the ACA is not a perfect system and does not go far enough to provide adequate health care to our entire society. Yet, to make provisions that seek to strip health care from any individual is to create a situation in which we as a society will be standing by the blood of our neighbor.

Although negotiations are ongoing, last week’s initial decision by the Trump administration to sign an executive order sends a signal to the insurance companies that their participation in the ACA is not cost-effective for their company. As insurance companies cease their participation in the ACA, it places many people in our society at great risk of losing their health care, putting their lives and the lives of their loved ones at risk.   

The Jewish community must look at the current health care debate and ask ourselves: Is the Trump administration seeking to save lives, or, by suggesting that we eliminate the cost-sharing reduction payments, are its actions creating a risky environment that will harm lives?

The answer is clear. We as Jews have a responsibility to care for one another. If the future health care of an individual is unknown, then we are ignoring our commandment of pikuach nefesh, to save lives.

It is the responsibility of us all to ensure the health and safety of one another.

The administration is taking a further step by issuing rules that would allow employers and insurers to withhold the ACA’s promise of no-cost contraceptive coverage. This is a direct attack on women, who should be the only decision makers for their bodies. Many have celebrated this recent ruling as a win for religious freedom but many organizations have a contrary view.

Any government-backed initiative that allows for discrimination based on religious belief is an affront to our religious freedoms. A provision in Trump’s order puts women’s reproductive health decisions in the hands of their employers and insurers. Our country has a long legacy of religious freedom, and recent attempts to incorporate discrimination into the legislative process based on religious freedom are antithetical to the core beliefs of our religion and the core beliefs of this nation.

We have a strong and healthy tradition of debate and dissent within the Jewish framework, but it seems clear that the dismantling of the ACA creates a dangerous situation in which the health care of many in our society will be in the balance. We must go beyond offering a misheberach for those in need of healing. The ACA and other initiatives that seek to provide sustainable and reliable health care to all link our prayers to our actions as we seek to truly heal those in need. 

Rabbi Joel Simonds is the founding executive director of the Jewish Center for Justice.

Trump’s Changes to ACA Are Worth Celebrating

President Donald Trump on July 24. Photo by Joshua Roberts/Reuters

On Oct. 12, President Donald Trump signed an executive order rolling back a handful of Obamacare’s regulations.

Patients and employers should celebrate the move. The administration is taking action where Congress could not, increasing the number of insurance choices available to Americans — and reducing their cost.

The order directs the Departments of Health and Human Services, Labor and Treasury to come up with regulations that would allow for three key changes.

First, Trump’s order aims to expand access to association health plans, or AHPs. These plans allow small, like-minded employers to join forces to purchase a large-group insurance policy together.

The Obama administration cracked down on AHPs by decreeing that small employers banding together under the banner of an association would not be eligible to buy a large-group policy to cover them all.

That was crucial, because Obamacare imposed many costly regulations and mandates on individual and small-group insurance but not on policies issued in the large-group market.

The administration is … increasing the number of insurance choices available to Americans.

Among those regulations are the essential health benefits mandates, which require all policies to cover 10 benefits, regardless of whether employers or beneficiaries want them.

These mandates inflate the cost of insurance. Many small businesses and employees would gladly take lower premiums and deductibles in exchange for policies that don’t cover expensive services.

But they don’t have that option; their only choice is expensive, comprehensive insurance. So it’s no wonder that only one-third of businesses with fewer than 50 employees offer health insurance — or that just one-third of 1 percent of employees at such firms have coverage through Obamacare’s Small Business Health Options, or SHOP, exchange.

Crucially, those with pre-existing conditions will be protected if their employer opts for an AHP. The executive order emphasizes that employers cannot exclude employees from joining the plan, nor can they charge different premiums to different individuals covered by the plan.

Trump’s executive order also relaxes restrictions on low-cost, short-term health insurance plans. Obamacare set the maximum term for such plans at three months; the executive order will probably extend that term to just under a year and allow the plans to be renewed.

Obamacare slapped strictures on short-term plans to try to force people into the insurance exchanges. But exchange plans have proven too expensive for many individuals, thanks to the many mandates governing them. 

The third component of Trump’s executive order would boost the power of health reimbursement arrangements, or HRAs. These accounts enable employers to allocate tax-free dollars to employees to help them with qualified healthcare expenses.

HRAs are particularly popular with small businesses. Under Obamacare, those with fewer than 50 employees are not obligated to offer health insurance to their workers. Many do so anyway. Others may not be able to afford to provide coverage, especially if their only options are on Obamacare’s expensive marketplaces. HRAs can allow them to give their employees at least some help paying for care.

Under the executive order, the administration is likely to broaden the definition of qualified health care expenses to allow for HRA funds to cover insurance premiums. That could help scores of people who previously could not afford coverage pay for it.

Republicans have promised for the better part of eight years to expand access to low-cost coverage by repealing and replacing Obamacare. President Trump’s executive order finally makes good on that promise, albeit to a small degree.

And, on Oct. 13, President Trump announced that he would immediately stop paying the illegal CSR (Cost-Sharing Reduction) subsidies to insurers.  These payments of $7 billion a year were never appropriated by Congress.  A specific instruction to pay that money is required by the U.S. Constitution before federal money can be paid. 

Sally C. Pipes is president, CEO and the Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute.

American Israeli Medical Association Event Provides Current Status of Israeli Medicine, Startups

Photo from Facebook.

The American Israeli Medical Association (AIMA) held its 10th annual BioMedTech summit on Sunday, focusing on the current state of Israeli medicine and startups and what the medical field will look like in 2030.

The event kicked off with Eitan Weiss, the deputy consul general of Israel in Los Angeles, briefly stating that it was “vital and important” that the United States and Israel maintain good ties in the field of medicine and told those in the field to “keep up the good work.” Later on, Ben Drillings, the director of AIMA, provided some statistics about the Israeli medical field, most notably that Israeli biomedical companies received $4.8 billion in investment in 2016, an 11% increase from the year prior.

Additionally, Drillings noted that there were a total of 568 Israeli biomed companies and 1,350 active life science companies, half of which focused research and development. Israel also has the highest PhDs per capita worldwide.

Dr. Zeev Feldman, chairman of the Israel Medical Association (IMA) World Fellowship, followed Drillings with a presentation predicting the state of Israeli health care and medicine in 2030. Feldman highlighted predictions from a Futurology podcast that 80% of all doctor’s visits would be replaced by automated tests and that 90% of restaurants would use 3-D printers for food, and then proceeded to give a rundown of what Israeli medicine and health care would look like.

Feldman predicted that fragmentation and specialization would continue in the field, as he believes that new specialties will be established and existing ones would be expanded. He also expected technological advancements in the industry to continue, although he pointed out that it’s difficult to obtain the funding for such technology. Feldman predicted that by 2030, most surgeries would rely on wireless energy, people can obtain “hyper-individual medicines” and pharmaceuticals will be nonexistent.

However, Feldman noted that Israel will soon face a shortage in the health care industry as a result of “retirements.” He also provided statistics showing that Israel is fourth worldwide in life expectancy and spends 7.4% of its GDP on health care, which he said was “extremely low.”

Orthopedic surgeon Tzaki Siev-Ner of the IMA World Fellowship followed Feldman by discussing how the Israeli army provides medical aid to those in dire need of it in other countries.

“It is our moral mission to help and support other countries,” said Siev-Ner.

For example, when Haiti experienced a devastating earthquake in 2010 the Israel Defense Forces (IDF) sent field hospital staff members to Haiti in 72 hours, where they treated over 4,000 patients and performed 215 operations in a span of two weeks.

Siev-Ner also pointed out that in 2013, Israel provided care to seven Syrians at the border harmed by the civil war that has ravaged the country since 2011. Israel even ensured that the medical documentation they provided to the Syrians they treated had zero indication that they were treated by Israelis.

The orthopedic surgeon noted that in the moral dilemma on whether to provide medical care to the enemy, “We always remember that the physicians are the neutral attorney of the poor.”

The final keynote speaker was Jon Medved, the CEO of OurCrowd. Medved focused on the thriving startup culture in Israel, stating that it was “second only to Silicon Valley” in that regard. He also pointed out that $5 billion has been invested in Israeli startups and Israeli venture investment has soared by 150% since 2013.

“Israel is one of the top four countries in the world with companies trading in New York,” said Medved, noting that Israel was only behind the U.S., Canada and China. “It’s absurd! Eight million people and we’re doing this? It doesn’t make any sense.”

Medved also stated that “the whole world is being disrupted by innovation,” which is forcing multinational corporations to go to Israel to become more innovative.

OurCrowd, Medved’s company, helps raise money for startups, and some of those companies included ReWalk Robotics, which provides the technology necessary to help paraplegics walk and stand and MedAware, a company that cracks down on prescription errors by utilizing Big Data.





Pirkei Avot, the GOP and health care

Sen. Majority Leader Mitch McConnell, accompanied by Sen. John Barrasso (R-Wy.) and Sen. John Thune (R-SD) and Sen. Roy Blunt (R-Mo.), speaks with reporters following the party luncheons on Capitol Hill on Aug. 1. Photo by Aaron P. Bernstein/Reuters

Moses received Torah at Sinai. He transmitted it to Joshua, and Joshua to the elders, and the elders to the Prophets, and the Prophets to the Men of the Great Assembly. They said: raise up many disciples, be deliberate in judgment, and build a fence around the Torah.

Mishnah Avot 1:1

It is procedure that marks much of the difference between rule by law and rule by fiat.

Wisconsin v. Constantineau (1971)

Process is boring, but it also is crucial, as the Supreme Court observed. And it is particularly crucial for Jews as we consider the Republican effort to repeal Obamacare.

This is a live issue. Despite July’s failure of Senate Majority Leader Mitch McConnell’s plans, Republicans have made clear that they will continue to pursue repeal. And both his and House Speaker Paul Ryan’s abuse of Congressional process show that they are adept at rule by fiat.

To be clear: I believe the repeal plans are a moral abomination. But apart from substance, let’s look at the procedure. The GOP’s Obamacare repeal process mocks democracy. Health care approaches one-fifth of the entire U.S. economy, yet the process was conducted in near total secrecy. On the House side, the bill was written behind closed doors without any input from the Democrats. Ryan rushed it to the floor before the Congressional Budget Office could even determine what its effects would be. If enacted, the American Health Care Act would strip 23 million people of coverage, but the process was designed precisely so that Congressmembers would be kept in the dark.

McConnell’s process was even more secretive; the Senate bill was cooked up in his office with no input from patients, health experts, advocacy groups — or even most of the Republican caucus. The March of Dimes paid for McConnell’s polio treatment as a child; he refused even to meet with the organization. His last-ditch attempt — the so-called “skinny” repeal — was introduced five hours before it was supposed to be voted on, with no hearings or public input whatsoever. GOP senators have announced yet another plan to rush through a health package with the same high-handed secrecy.

All legislation resembles sausage-making, but this was fetid even for a slaughterhouse. Julie Rovner, who has covered this issue since the 1980s wrote, “The extreme secrecy is a situation without precedent. … I have been here for 30 years and never seen anything like this.” Journalist Ezra Klein noted that “Republicans are making life-or-death policy for millions of Americans with less care, consideration and planning than most households put into purchasing a dishwasher.” John Podhoretz, no liberal, tweeted, “I have never seen such unanimity in the horror everyone on all sides is expressing toward the Senate process on this health care bill.” (Spare me references to the creation of Obamacare, which took 14 months, included literally hundreds of GOP amendments, dozens of hearings and extended bipartisan negotiations.)

But why is it a Jewish issue? Let’s consider the epigraph from Pirkei Avot. This Mishnah is perhaps Judaism’s most foundational text, and it links the chain of rabbinic authority to three central moral injunctions, particularly “be deliberate in judgment.”

Most classical commentaries, from Rambam to the Chasidic masters, do little with this passage. They gloss it as simply “do not move too fast” or “be careful.” This might be useful, but it really misses the point. Telling us to “be deliberate in judgment” requires us to consider the deeper question of how we do that: What conditions will make us deliberate? Unsurprisingly, much of Avot concerns the proper behavior of public decision-makers: It warns how the wielders of state power betray those who trust them (Avot 2:3).

Being serious about deliberation in judgment means we must establish institutional practices that make us deliberate. Both character and structure matter. This reflects virtually all Jewish spirituality: Our tradition creates practices to bring the soul closer to God. Commanding us to remember God is not good enough. We do it by practices such as uttering blessings, wrapping tefillin, observing Shabbat, etc.

In other words, Avot 1:1 is the “Jewish Due Process” clause. It holds that if anyone makes crucial decisions about people, they must follow proper procedure. Only then can they truly be “deliberate in judgment.” Like long-settled judicial principles of “due process,” “deliberation in judgment” requires that those affected by state power have a right to be heard, to contest those whose interests are adverse, to have transparent and open government, to have decisions made on the basis of evidence and rational judgment rather than arbitrary caprice. If leaders make decisions without hearing from those affected and subjecting their own thoughts to scrutiny, they are not really deliberating at all. Such “process” is not judgment. At best, it is no more than a series of irritable mental gestures; at worst, tyranny with window dressing.

When Congress holds literally tens of millions of lives in its hands, to refuse to listen to those who will suffer mocks the Torah’s requirement of deliberation in judgment. McConnell and Ryan do not care. Do we?

JONATHAN ZASLOFF is professor of law at UCLA, where he teaches, among other things, property, international law and Pirkei Avot. He also is a rabbinical ordination candidate at the Alliance for Jewish Renewal.

Hunk hawks hideous health bill

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

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


President Donald Trump gathers with Congressional Republicans in the Rose Garden of the White House on May 4. Photo by Carlos Barria/Reuters

So it turns out that not even late-night TV host Jimmy Kimmel’s emotionally wrenching story about his newborn baby’s heart defect and subsequent life-saving surgery was enough to persuade three more GOP House members to vote against the latest version of the American Health Care Act (AHCA). Kimmel’s baby, like millions of other Americans, now has a “pre-existing condition” that insurers traditionally have treated almost as a badge of shame, and subject to increasingly high insurance premiums and deductibles.

That’s because the AHCA, as it presently stands, will allow states to apply for a waiver to the Obamacare requirement that insurers must charge all people the same rates, no matter their medical histories. Removing that requirement means that insurers will be able to charge exorbitant premiums if you have a pre-existing condition and have let your insurance lapse, which, in practical terms, can lead to financial ruin in trying to keep purchasing insurance coverage.

The “big 10” of patient advocacy groups, including the American Cancer Society Cancer Action Network, American Diabetes Association and American Heart Association, came together to oppose AHCA, saying in a joint release, “Weakening protections in favor of high-risk pools would also undermine the ban on discrimination based on health status. The individuals and families we represent cannot go back to a time when people with pre-existing conditions could be denied coverage or forced to choose between purchasing basic necessities and affording their health care coverage.”

The last-minute GOP solution to address the issue of people with pre-existing conditions was to add in $8 billion more for patient “high-risk pools,” which were used by 35 states before Obamacare and often came with high premiums, high deductibles and sometimes capped enrollment. A just-released independent analysis from the health consultancy firm Avalere Health showed that the $23 billion earmarked by the bill for those pools would cover only 110,000 Americans, a mere 5 percent of the 2.2 million enrollees in the individual insurance market today with some type of pre-existing chronic condition.

With such a large gap between the available funding and the number of impacted Americans (that will only grow as our population ages), it means that if one of the larger states receives a waiver, there will be even less money to go around. As the summary of the Avalere Health study states: “For example, Texas alone has approximately 190,000 enrollees in its individual market with pre-existing chronic conditions, nearly 80,000 more people than the funds earmarked for the entire country would cover. Florida has 205,000, nearly 95,000 more than the funds allotted nationally amounts would cover.”

What exactly are these pre-existing conditions? Sen. Sherrod Brown (D-Ohio) took to Twitter to list many of them, from AIDS/HIV, acid reflux, acne, ADD, addiction, Alzheimer’s/dementia, anemia, aneurysm and angioplasty to skin cancer, sleep apnea, stent, stroke, thyroid issues, tooth disease, tuberculosis and ulcers. In the hours after the House vote, the No. 1 trending hashtag on Twitter was #IAmAPreexistingCondition, with individuals listing their diagnosed conditions, such as TashiLynnCA writing, “In 2010 my 10 year old brother was diagnosed with stage III Hodgkin’s Lymphoma. This is for him.” Older adults and veterans also shared. “‘I’m a disabled veteran that suffers from PTSD” tweeted RedTRacoon.

Friends of mine on Facebook are sharing that some doctors already are getting calls from worried patients, asking that their diagnoses be expunged from their medical records because they are fearful of having a paper trail documenting their conditions. People will be scared to go to emergency rooms, afraid that they will be identified as having one or more conditions on the list.

For the 20 percent of Americans who have some type of disability covered under the Americans With Disabilities Act of 1990 (ADA), this potential change in how much people with pre-existing conditions can be charged for health insurance hits hard. @LCarterLong from Washington, D.C., wrote, “Born three months premature. Weighed 2 lbs. Alive b/c of an incubator. Have cerebral palsy. Use orthotics to walk.” Alice Wong, founder of the Disability Visibility Project in San Francisco, tweeted, “Wheelchair and vent user. Born with spinal muscular atrophy. Docs told my parents I wouldn’t live past 30.”

This sharing of pre-existing conditions is paradoxically bringing together a very disparate group of Americans who may not have felt much in common before this vote, and who now are being prompted into action. Disability advocacy groups that usually find themselves competing with one another for attention and funding are finding common cause in opposing the ACHA. Republican House members who voted for the bill will be wearing targets on their backs in the 2018 election. As Japanese Admiral Isoroku Yamamoto said after the 1941 attack on Pearl Harbor, “I fear all we have done is to awaken a sleeping giant and fill him with a terrible resolve.”

MICHELLE K. WOLF is a special needs parent activist and nonprofit professional. She is the founding executive director of the Jewish Los Angeles Special Needs Trust. Visit her Jews and Special Needs blog at

The stigma of the unworthy unhealthy

President Donald Trump, middle, gathers with Vice President Mike Pence, right, and Congressional Republicans at the White House on May 4. Photo by Carlos Barria/Reuters

There was something sublimely degrading about the beer bash President Donald Trump threw May 4 for House Republicans who passed his health care bill by the narrowest of partisan margins.

Start with the host, who will say or do anything. By now it’s apparent that the president is untethered to reality. If he were to be impeached, a compassionate chief justice might declare him incompetent to stand trial because he lacks the mental capacity to be responsible for his words or acts. But the Republicans who sniffed his musk last week aren’t blissed by the clueless stupor his narcissism affords him. They’re fearful of their constituents. No wonder that, of the 217 congress members who voted his way, only two — one in Idaho, one in upstate New York — held district town halls this past weekend. They did not go at all well. When the rest of the cowering Republican conference is forced to face their voters, it will be similarly ugly.

They must be baffled by how devoid of mojo their old battle cries have become. “Jobs-killing Obamacare” packs no punch in an economy that’s added more than 10 million jobs since the Affordable Care Act passed. “Disaster” and “death spiral” sound demented to someone who’s gone from no insurance to comprehensive coverage. “Higher premiums, higher deductibles, higher co-pays” may in some cases be accurate, but for Americans long suffering from rising prices, the real news is the slowing of the rate of increase.

Republican capitulation to the Freedom Caucus’ demand to torpedo Obamacare’s coverage of pre-existing conditions has prompted hundreds of heartbreaking — and televised — stories of congenital defects, deadly tumors, chronic ailments, addictions and mental illnesses, whose long-term treatment was until recently made affordable by irrevocable insurance, but which now is slated for sacrifice in exchange for a trillion-dollar cut to Medicaid and a humongous tax cut for the wealthiest. Not only will those stories, juxtaposed with Rose Garden revelry, make for mercilessly effective ads in the coming midterm campaign; they also sound the death knell for the most toxic trope in the Republican rhetorical armory: the stigma of the unworthy unhealthy.

The label descends from the widespread distinction, as recent as a century ago, between the worthy and the unworthy poor. The worthy poor — widows, orphans, the blind — were indigent through no fault of their own, victims of random misfortune, life’s vicissitudes, circumstances beyond their control. But the unworthy poor were the cause of their own impoverishment. Lazy, morally weak, addled by drink, gamblers: They had only themselves to blame. The worthy poor deserved charity; the unworthy, a kick in the pants.

The Depression altered the presumption that bootstrapping is the royal road to success. If there aren’t any jobs, it doesn’t matter how much moxie you have. From our common catastrophe came a new compact. Every person is worthy of basic human decency, a safety net to catch us, a freedom from want we pledge to one another. To secure it? Not the market, not inheritance, not the luck of our genes — the government. And so from Social Security to Medicare, unemployment insurance to food stamps, we committed public resources to promote the public good.

Universal health care was always the outlier in America — not just the notion that government should provide it, but the idea that it’s an inalienable right. You could see that wariness, stoked by decades of propaganda, in a Wall Street Journal-Harris poll two years before Obama was elected. Asked whether unhealthy people should pay more for insurance, a majority of Americans – 53 percent – said yes. You can hear that same animus today in Alabama Republican Rep. Mo Brooks’ defense of Trumpcare: “It will allow insurance companies to require people who have higher health costs to contribute more to the insurance pool that helps offset all these costs, thereby reducing the cost to those people who lead good lives. They’re healthy, they’ve done the things to keep their bodies healthy, and right now, those are the people who have done the things the right way that are seeing their costs skyrocketing.”

“Moral hazard” is how economists describe the ability to evade the bad consequences of risky decisions. The Wall Street bailout, which prevented a global meltdown, absolved the banks of having hell to pay. I get why House Republicans almost sank it; it maddened me, too. To them, the ACA’s passage two years later reprised that escape from accountability. It didn’t penalize people enough for being addicted to nicotine, for consuming the sugar and fat marketed to them, for escaping a stressful day with a sedentary night.

The ACA has helped millions of Americans with illnesses unrelated to personal decisions get access to health care. At the same time, it established a no-fault policy for having made choices that are bad for you. Under current law, your right to treatment doesn’t depend on how or why you became dependent on opioids or alcohol, or whether your high blood pressure or cholesterol might have been prevented by behavior change. All that counts is that you’re seeking a path to health. We don’t punish the sick for being unhealthy; life has done that enough. There are not the worthy unhealthy and the unworthy unhealthy. All there is is us.

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

‘He’s not all bad’: A Democrat defends Trump

President Donald Trump. Photo by Jonathan Ernst/Reuters

Ever since Donald Trump was elected president, I’ve been trying to decipher the indecipherable psyche of The Trump Voter.

I want to understand how a person of conscience could have voted for him and how such a person would defend the actions of his office. 

So I did a little research project by calling my Uncle Rich, a 76-year-old cardiologist and Trump supporter. As far as I know, he’s sane, rational and verifiably humane since he’s spent the last 47 years saving people’s lives.

Uncle Rich and I have been arguing about politics since I was 15. Last week, he emailed me an article about Trump doubling down against anti-Israel bias at the United Nations under the subject line: “He’s not all bad.” I gritted my teeth, took a deep breath and invited him to argue with me a little more — if not for the sake of heaven, then at least for the sake of my column.

First, I asked why on earth he’s a Republican.

“I am a registered Democrat and have been since I was 21,” he declared.

“I have voted both ways. I’m a great believer that America comes first and the parties come second. So, I’m open-minded to any candidate — Republican, Democrat, Black, white, Jewish, woman, etc.”

I asked him to describe his paramount political values, but he said they change with each election cycle. In 2016, his top concerns were: terrorism, the economy and health care.

“In the beginning, I was a little bit ambivalent about [Trump],” he admitted. “But as time went on, I began to see that he was serious. And he was willing to step out of an unbelievably successful business and into a job that I don’t know if I envy. I began to say, ‘Wow.’

“I felt this was a man who really recognized the problem of terrorism. I liked that he was vigorous and emphatic on the necessity of vetting people, particularly from certain areas. You know, profiling is a term I think gets a bum rap.”

This is only one area where Uncle Rich and I part ways. To me, profiling is a form of legalized discrimination that contributes in no small part to the mass incarceration of people of color and the poor.

“I profile in medicine,” he said. “If I see a person of a certain background, I’ll order certain tests based on their background. To say there aren’t certain groups of people who are more likely to be terrorists, that’s foolish. We need to be exquisitely careful in order to avoid a situation of tremendous, tremendous terror …

“As far as [economics], the man is a financial success.”

Never mind his bankruptcies? Or his record of failing to pay employees what he owed them?

“I’m a businessman myself. When I started in medicine, we were told not to be businessmen. We were told, ‘You’re a doctor, and you’ll work for oranges and grapefruits,’ which I would have. We were discouraged from negotiating with a hospital, for example. ‘Just take the job.’ [Trump] is a negotiator, and I became a negotiator.”

If Trump was such a negotiating wizard, I asked, what about his signature failure to “repeal and replace” Obamacare?

“Health care is an extremely complicated issue. At the end of the day, I think Republicans and Democrats want the same things: quality care, access and preventative medicine. Obamacare had great ideas — who could argue with what I just said? The problem is cost. This is a business problem.”

I argue it’s also a moral problem. Part of the reason the legislation failed is because its underlining interests were providing tax cuts for the wealthy and eliminating vital health care services for the nation’s most vulnerable: the old and the poor.

“I don’t think Mr. Trump wants a program where someone who is 64 can afford health care and someone who is 65 can’t. What makes America great is that we have the ability to create a system with some equality. Certainly, you’re going to have concierge medicine the way you can have a Mercedes or you can have a Chevy — but a Chevy is a good car!”

Then why don’t more rich people drive Chevys?

Still, I countered, the Great Negotiator failed to unify his party and pass his first major piece of legislation.

“You want to feel good about the fact that you were right? Come on! He’s been in office for three months. If you tell me three years from now that he’s failed in all his legislation, I’ll say, ‘You know, you’re right, I made a mistake.’ But not three months in.”

Well, what about Trump’s Russia ties? Should he get a pass on that, too?

“I’m not bothered yet because I come from a school of medicine where you have to deal with results. If we find out that Trump did things undercover with the Russians, then I’m gonna be upset about it. But I’m not gonna get caught up in the rumor mill. This stuff is still unsettled.”

It’s clear that where I see moral and legal transgression, my uncle sees a man who hasn’t yet hit his stride. Surely, though, he wouldn’t defend the terrible things Trump has said maligning women, immigrants and Muslims.

“He’s sometimes quick to speak,” Uncle Rich allowed. “He’s a hand-to-mouth guy, and sometimes what he says doesn’t go completely to his brain.

“What I was thinking when that was going on was: If we lived in a dictatorship, I would have been much more worried about Donald Trump than I am in the system we are in, which is a checks-and-balances system. Because a man who sometimes speaks like that may try to act like that.” 

Finally, Uncle Rich, we agree.

Danielle Berrin is a senior writer and columnist at the Jewish Journal.

Jewish elderly advocates take aim at GOP’s proposed changes to health care

U.S. House Majority Leader Kevin McCarthy, House Speaker Paul Ryan, and Representative Greg Walden hold a news conference on the American Health Care Act. March 7. Photo by Eric Thayer/REUTERS.

Two Jewish agencies charged with elderly care sharply criticized the new Republican health care bill.

B’nai B’rith International, which sponsors low-income housing for the elderly, and the Jewish Federations of North America, which advocates for funds for the poor and the elderly, took aim changes contained in the American Health Care Act, the bill Republican leaders hope to pass as a replacement for the Affordable Care Act, known as Obamacare.

“Congress and the Trump Administration appear to be moving quickly to pass potentially devastating cuts to Medicaid,” JFNA said in an action alert sent this week to its constituent groups, urging them to lobby Congress against the cuts.

The organization said the cuts “would greatly impact Jewish federation partner agencies that provide health, long-term care and home and community-based care,” noting that federation partner agencies get about $6 billion from Medicaid each year.

Medicaid is the government program that supports health care for the poor. The bill proposes to cap Medicaid funding to each state according to the number of eligible participants at the beginning of the fiscal year. B’nai B’rith and JFNA said such caps would not take into account changes in enrollment numbers and other unexpected health care cost increases.

“Changing any portion of the Medicaid funding to a per capita cap proposal would have a significant negative impact on seniors, because capping federal funding for Medicaid would add an additional layer of pressure to state budgets, and put the health care and financial security of millions of older adults at risk,” B’nai B’rith said in its March 8 statement.

B’nai B’rith also took aim at a component of the bill that would reduce premiums for younger, healthier Americans, citing studies predicting “low-income adults in their 60s could see dramatic increases in premiums.”

Israel’s Yad Sarah has prescription for U.S. health care system

Photo by Yoninah/Wikipedia

A new Congress and a new administration are reassessing the efficacy of America’s health care system — and exploring solutions to contain rising costs while delivering better care. They could be well served by looking to a small nation thousands of miles away and one organization that has transformed that country’s health care landscape: Yad Sarah. 

Yad Sarah is the State of Israel’s largest volunteer-staffed organization. We take care of anyone in the country after a hospital stay — whether they are a factory worker, a first-time mom, a senior in hospice, a young adult with a broken leg, or a top business or political leader.

The United States might be able to learn from Yad Sarah’s unique model for home health care delivery. Take our signature service: free or low-cost loans of medical equipment — wheelchairs, crutches, oxygen machines — which are available at local branches around the country or delivered to patients’ homes for a few dozen shekels or less. It developed organically and modestly, with our founder, Uri Lupolianski, and his wife, Michal, distributing vaporizers to sick children from their Jerusalem apartment. As the years passed, their ability to help care for people grew to more than 100 branches with thousands of volunteers.

This is much more efficient and cost-effective than the U.S. system, where only those with insurance have access to devices at home, those devices are often discarded after a short period of use, and the devices don’t always arrive in a timely manner. For instance, when my mother-in-law left the hospital and came home to stay with my family, Medicare paid for and sent a wheelchair. She never used the wheelchair and was rehospitalized 10 days later, passing away after a month. For three years, I looked unsuccessfully for someone who could use the wheelchair — no hospital, doctor’s office or other medical caregiver would take it.

Yad Sarah works to give people in Israel access to medical resources for next to nothing, in a way that ultimately reduces stress on the national medical system while increasing the quality of care received. Half of Israel’s families have used one of our services at some point in their lives. Our annual budget of $23 million — drawn almost entirely from philanthropic contributions — saves the Israeli economy $400 million each year in health care costs.

Of course, a volunteer-based program like Yad Sarah cannot work for a country of 300 million people the same way it does for a country of 8 million. But that doesn’t mean a similar program in the U.S. — whether implemented by nonprofit organizations or governmental agencies — couldn’t have a transformative effect. Recycling programs for durable medical equipment could allow for more agile, efficient and cost-effective health care.

Implementing innovative programs has a domino effect: After establishing our lending service, we followed with our home hospitalization program. It allows individuals to be under the care of family members, whether they are in hospice, suffering from a chronic condition or recovering from a severe short-term illness. Most patients would rather have the dignity and comfort of being at home — and they tend to experience less stress, fewer health complications and faster rehabilitation.

The United States might be able to learn from Yad Sarah’s unique model for home health care delivery.

Not only does the home hospitalization make patients more comfortable and drastically reduce costs, it also addresses the chronic overcrowding of Israeli hospitals, where patients too often are lying in hallways, being released prematurely, and dying from infections they receive in those hospitals — 4,000 each year. While the U.S. and other developed countries have home hospitalization programs, none is run by volunteer-staffed organizations, a key element that enables us to ensure everyone has access to these programs in a timely and cost-effective manner. 

Yad Sarah’s other programs are just as effective at supplementing Israel’s medical system to make care more efficient. This includes driving sick or injured people to medical appointments, offering therapeutic programs at day rehabilitation centers, and supporting families coping with domestic violence. We also provide an emergency alarm response service, which offers peace of mind for nearly 20,000 homebound, frail and isolated older adults; free legal information and representation for elderly people at risk for abuse; after-school programs for children with disabilities; and free dental care for adults living in poverty.

This all started with one couple lending out vaporizers in one city. But making part of health care a public, volunteer-supported endeavor serves Israel well. Yad Sarah saves hundreds of millions of dollars and vastly increases patients’ quality of life. We are true partners in ensuring the health and well-being of Israel’s citizens — the elderly widows, the young children, revered politicians, the brave soldiers and, yes, our volunteers and donors themselves. As the U.S. considers how to address our health care challenges, Yad Sarah’s experience can shed light on important lessons.

ADELE GOLDBERG is the executive director of Friends of Yad Sarah.

California and the rust belt: A health care bridge

Donald Trump upset the apple cart, pulling off a victory in the Electoral College by sweeping the Rust Belt states. He ran a brutal, hard-edged campaign on trade, jobs and resentment of immigrants. The shock has not yet worn off. 

Meanwhile, California went totally the other way, giving Hillary Clinton a 4 million-vote margin of victory that was bigger than even Barack Obama’s victory in 2012. 

California meets the Rust Belt.  A multiethnic state that is overwhelmingly Democratic where the economy has done well contrasted with a white, working-class and middle-class region in more isolated states with slower economies turning to the right. Like exploding planets, they are spinning off in opposite directions.

For many Jewish voters, who are concentrated in urban counties in big states such as New York, California, Florida, Illinois and Pennsylvania, there’s a feeling of being isolated in national politics. They are not alone. Throughout the Western world, from the U.K. to France to Poland to Italy, cosmopolitan, modernized urban communities where economies are dynamic are being challenged politically by non-urban, traditional working-class voters.

The difference is that in the United States, the metropolitan coalition commands a popular but not effective majority in our state-dominated system. California’s status as a blue stronghold, in a state where 1 in 8 Americans live, symbolizes the situation. California may guarantee popular vote majorities for Democratic presidential candidates for years to come and still be on the losing end in the Electoral College. Conversely, voters in the Rust Belt may find their hopes dashed if key programs on which they depend are reduced or eliminated. Hard as it is, some bridge building is called for.

I am hearing and seeing a lot of attempts to deal with the Rust Belt and with this shattering election. They vary from pop sociology, anger and contempt, to guilt and self-recrimination. Some say Trump’s voters don’t know their own self-interest and, if so, they deserve to lose their health insurance. Conversely, some are willing to toss out decades of progressive policies to win favor. None of this is ultimately productive.   

But there is another avenue that needs more attention. It starts with health care. The repeal of the Affordable Care Act (ACA) would affect both California and the Rust Belt. But to turn that impact into a bridge, California’s progressives will have to keep an open mind about the Rust Belt voters, including those who went for Trump.  

Never pick a fight with the voters — only with politicians. It would be better to fight with Trump and congressional leaders in Washington, D.C.  

In 2016, Democrats took a gamble by focusing the campaign on Trump and his appalling attitudes and utterances. Instead of drawing a contrast with an increasingly libertarian conservative movement that explicitly promised to shred major elements of the health care system, Democrats tried and failed to drive a wedge between the “unfit” Trump and, by implication, the fit conservatives. 

While all eyes were on Trump, who was making ambiguous noises about repealing the ACA but preserving its levels of access, House Speaker Paul Ryan was quietly laying plans to repeal the ACA, and to privatize Medicare to boot. Consider that eliminating the ACA makes Medicare more vulnerable, since its improved financial status is in part due to the ACA.

In truth, Democrats today are less focused on the daily issues of health care than on social issues. Those social issues are critical to modern politics and I could not imagine the Democratic Party without them. They have helped to build a popular majority, so that the modernizing Obama coalition, with its “identity politics” is far bigger and more consequential than Bill Clinton’s narrow, defensive alliance. But this is not enough without a down-to-earth message that goes beyond identity politics in a political system that provides extra boosts to the representation of nonurban, homogeneous states. 

California, where a great part of the Affordable Care Act’s implementation took place, and where its gains are at most risk, can lead the way. The same state-based system that frustrates popular majorities provides numerous pathways to resist and reshape change.

Retirement and health care security are great assets for progressives in American politics.  Protecting them starts with telling their story.  Voters tend not to believe campaign threats to their health care (“Look at this punim!  Would I kick my own mother off Medicare?”). The looming possibility of the loss of the Affordable Care Act may create an attentive audience.

Social Security, passed in 1935 and signed by President Franklin D. Roosevelt, became the vehicle for later expansions of health care. The Medicare and Medicaid laws signed by President Lyndon B. Johnson in 1965 were actually amendments to the Social Security Act.  President Richard Nixon further expanded Medicare coverage to those who are disabled and under the age of 65.  Medicare, a broad social insurance system like Social Security, became the link between retirement security and health care.

These concrete foundations helped cement the link between Jewish voters and the Democratic Party. My own family history tells a bit of that story. I was born in Washington, D.C., because my father, Israel Sonenshein, was an attorney in the Truman administration working in the Federal Security Agency, the precursor to the Department of Health, Education, and Welfare, that included Social Security. He helped draft a model law for the states to extend protection for those with mental illness, a group that had been left in the dark corners of American society. Naturally the New Deal was a big part of my family’s DNA. I watched LBJ on television in 1965 as he signed the Medicare law in Independence, Mo., with Harry Truman by his side, and learned that Johnson had handed Truman and his wife, Bess, the first two Medicare cards.

The ACA has become the largest expansion of health care coverage since Medicare. It has reached across racial lines, including communities of color and whites (many of whom voted for Trump), and added more than 20 million Americans to the insurance rolls. Except for the requirement to buy insurance, its provisions are very popular. While it does not enjoy the broad support of Social Security and Medicare, there is nowhere near a majority that favors repealing it without replacement, according to a recently released poll from the Kaiser Family Foundation.  

With the ACA, we are inching toward universal coverage. That goal, first articulated by Harry S. Truman in 1945, is visible on the horizon.

If Democrats are searching for a theme to tie together white, working-class voters in the Rust Belt and communities of color, they could start by fighting to protect the extension of health care through the ACA, and linking it to defending Medicare and Social Security against privatization. Just as Medicare linked Social Security to health care, the ACA links the broad social insurance of Medicare to the extension of health coverage to the hardest to reach precincts of America.

It’s time to stop talking about deplorables (unless they are in public office) and start fighting on behalf of voters. You never abandon the groups and communities and issues that are your base, but you find things that cross the lines. One thing leads to another, and more such issues will appear.

Don’t say, “I told you so” to Trump’s voters who may lose their health coverage. You can’t wait until these voters are nicer and more politically correct before fighting for them. And if they write letters to Trump, you can believe it will mean something. 

Don’t expect an immediately favorable response, because there are wide gulfs between communities, but it’s a start. Unlike in European democracies, our debates about government programs are not just practical. They get into perilous moral arguments about who is “deserving” and who is “undeserving,” even when someone is benefiting from a program. That is the hardest thing about the bridge-building I am proposing, and it will take time and patience.

Hold Trump accountable with the people who elected him. Let Red State Senate Democrats take the lead. It may be the only way they can survive. 

Fighting against an assault on health care expansion not only gets public attention, it is also a way to explain it. There are millions of people out there who still don’t know that Medicare is a government program. Every day that Congress debates the ACA or Medicare or Medicaid is an opportunity for civic education.

Health care has many civic benefits, including freedom to change jobs, and confidence that no catastrophe will destroy a family’s finances. In a nation beset with stress and worry, much of it economic, having health care in place may help us navigate the perilous days ahead. A more widely available health insurance system might even start to bring poor people back into the political system from which they have been massively absent.

The future of American politics is up for grabs, as electoral rules give extra advantages to areas of the country that are torn between popular conservative imagery and popular liberal programs. While a popular majority wants to preserve the tentative gains made in recent years, electoral rules make the imposition of the majority’s will a challenge. If the decades of progress made toward universal health coverage are lost in a fog of misinformation and distraction, there will be decades more to regret it.

Raphael J. Sonenshein is executive director of Cal State L.A.’s Pat Brown Institute for Public Affairs.

The function of the university in the age of Trump

The modern university, as we know it, originated from the imaginative proposals of Wilhelm von Humboldt, a Prussian philosopher and civil servant. In 1810, von Humboldt devised plans for educational reform that called for a new type of institution — one in which research and teaching would be unified, academic freedom would be guaranteed and freedom from state intervention would be assured. This plan gave birth to the University of Berlin, now known as the Humboldt University of Berlin, on which the great American and world universities are based.

I have been thinking a great deal about the origins and function of the university in the age of Donald Trump. To put it mildly, the initial shock of his election has not passed. On the contrary, it has been compounded by the president-elect’s intemperate and ill-considered statements, on subjects ranging from the Broadway smash hit “Hamilton” to well-established American policy on China. His roster of appointments has done little to alleviate fears of the thorough erasure of the boundary between politics and business, with the concomitant threat of the privatization — and resulting monetization — of once-treasured government tasks.  And, of course, lurking in the background is Trump’s opportunistic bigotry, stoked by his alt-right supporters, whose chief targets to date have been Muslims, but also have included at times Jews, women, gay and transgender people, and journalists.   

All of these worrisome signs, which point to an ongoing assault on the democratic institutions of this country, make it vitally important to fortify civil society. The university, in particular, must become a key site of vigilance, resistance and critical thinking in American civil society in the age of Trump. This is not a violation of its historic function but consistent with the Humboldtian ideal of the university as an institution in the service of society. Not as a tool of the state, but in the service of society at large!   

At many points in modern times, the university has been an ally — and even beholden — to the state. And at various points in time, the university has been a site of resistance to the hegemonic impulses of the state. One notable example arose when the German-Jewish scholar of medieval history, Ernst Kantorowicz, refused to sign an anti-communist loyalty pledge at the UC Berkeley, in 1949. Despite his own conservative and anti-communist views, Kantorowicz, who took flight from Germany in 1938, feared government attempts at thought control.  Another example of wider impact was when Students for a Democratic Society (SDS) and other groups mobilized millions of university students in the late 1960s to protest  the United States’ military engagement in Vietnam.

Today is another moment when the university needs to prepare itself to stand as a force of resistance to the most dangerous tendencies of Trumpism. It is entirely possible that the alarm bells that the president-elect has triggered in those concerned about the fate of democracy will be for naught. But it also is possible that Trump will continue to promote his xenophobic brand of populism to damaging effect. In that case, the university must provide a central line of defense. In what concrete ways can the university play this role?

– University officials must articulate clearly that their institutions will not only remain sites of free and open discourse, but that all students, regardless of their origins and legal status, will be protected on campuses.  

– Philosophers must use their analytical precision to hone the critical thinking skills of students and join with them in defending the intellectual foundations of a just society. 

– Political scientists must use their knowledge of the American political system to warn against the erosion of democratic institutions and consider ways to shore them up in the face of a hostile executive branch.

– Legal scholars must use their knowledge of the courts to strategize about ways of resisting mass deportations, threats to free speech and other assaults on the constitutional order of this country.

– Health economists must use their knowledge of the country’s labyrinthine medical system to assist those poor Americans who will suffer as a result of the projected rollback of Obamacare.

– Public policy officials must use their knowledge to conceive anew of local and state jurisdictions as bastions of support for average Americans who may no longer be served by the federal government.

And scholars of Jewish studies also have a role to play.  A month ago, hundreds of Jewish studies scholars published a letter in the Jewish Journal that was shared on Facebook more than 21,000 times. The letter noted that students of Jewish history understand well “the fragility of democracies and the consequences for minorities when democracies fail to live up to their highest principles.”  

In the months and years ahead, Jewish studies scholars — and historians more generally — must use their knowledge to identify warning signs that, in the past, led to state-sponsored stigmatization of groups, abrogation of rights and violence. And they must caution us against ignoring warning signs today. 

All of this vigilance does not mean that the classroom should become a bully pulpit for one ideology or another. It means that first-rate scholarship must not wither in the face of pressure. Indeed, it means the university, now more than ever, must remain true to its Humboldtian origins as the site of academic freedom — and as an institution that serves society by applying knowledge of the past to the betterment of society in the present. 

David N. Myers is the Sady and Ludwig Kahn Professor of Jewish History at UCLA.

Sacha Baron Cohen, Isla Fisher donate $1 million to help Syrians

British actor and comedian Sacha Baron Cohen and his wife, actress Isla Fisher, have donated some $1 million to help Syrian children.

The couple is giving about half the sum to the Save the Children charity to pay for measles vaccinations for children in northern Syria and the rest will go to the International Rescue Committee to help refugees in Syria and in neighboring countries. The latter donation will help pay for health care, housing and sanitation, the French news agency AFP reported Sunday.

Cohen, who is Jewish, starred as Borat in the movie of the same name and in other films. Fisher converted to Judaism when she married Cohen.

The New York-based IRC is run by former British Foreign Secretary David Miliband, who is Jewish.

What a GOP Senate would mean for the Jewish communal agenda

Should Republicans win the Senate and maintain control of the House of Representatives on Nov. 4 — as many observers expect them to do — the political gridlock that has characterized much of President Obama’s term is poised to intensify.

Jewish strategies, however, will remain the same: focus on areas, however marginal, where successes are within reach. Among the areas: funding for elderly care and resettling refugees; working at the state levels on issues such as poverty relief and advancing gay rights; and keeping the major issues suffering from legislative neglect, like immigration, alive in the public eye.

An exception is foreign policy, where a GOP win could mean movement on some issues, including Iran sanctions.

With midterm elections less than a month away, here’s an issue-by-issue look at what the Jewish community can expect if Republicans gain control of the Senate and House.

Social welfare spending

With deadlock expected, reforms to major programs like Medicare and Medicaid are not anticipated.

William Daroff, director of the Jewish Federations of North America’s Washington office, named as his group’s priorities relatively small-bore issues like increased funding for long-term elderly care, advocacy for the disabled, providing for impoverished Holocaust survivors and preserving current tax deduction rates for charitable giving.

“On those issues there is bipartisan support,” he said.

Meanwhile, Rabbi Steve Gutow, the president of the Jewish Council for Public Affairs, which in recent years has expanded its focus on income inequality, said it’s OK to work the margins when the partisan divide makes it impossible to advance bigger issues, and he expected the divide to grow after the next election.

Gutow cited as an example the Supplemental Nutrition Assistance Program, or SNAP, also known as food stamps. Republicans in 2011 started out by proposing $39 billion in cuts, half the program’s budget. JCPA was among the groups that this year helped broker bipartisan agreement to cut SNAP spending by $9 billion over the next decade.

“We look at what’s realistic and go for it,” Gutow said. “You support the efforts that seem to be those that might win.”

Foreign policy

Republican majorities in both houses may mean more stasis on domestic issues but could advance a number of foreign policy issues. Chief among them is the effort by some pro-Israel groups, led by the American Israel Public Affairs Committee, to pass new sanctions on Iran that would kick in should nuclear talks between Iran and the major powers collapse.

The Democratic leadership in the Senate, at Obama’s behest, has stymied new sanctions, although enough Democratic senators back the legislation that it would likely have a majority should it come to a vote. Obtaining Democratic support even under a Republican majority would be key for a lobby that is keen to show that its initiatives have the backing of both parties.

“It’s likely that an emboldened Republican presence in Congress will want to pursue that vigorously,” said Eric Fusfield, the director of legislative affairs at B’nai B’rith International, a group that has backed the new sanctions.

That does not necessarily mean a confrontation with the White House, Fusfield said. Instead, the majority could spur Obama to reach an agreement with Congress on sanctions.

“There will still need to be a bipartisan consensus,” he said.

Much depends on whether Iran and the major powers meet a Nov. 24 deadline for a deal, Fusfield said.

Dylan Williams, the director of government affairs for J Street, which opposes new sanctions, agreed that Republicans would find it tougher to pass sanctions that may sabotage a deal with Iran.

“If an agreement is reached, it will survive both the current Senate and the next Senate, whatever its constitution,” he said. “I think senators from both parties will understand that if a deal is reached that does provide assurance that Iran will not acquire a nuclear weapon, that it is that or something far worse.”

Obama’s recent pivot toward greater intervention in Syria and Iraq would find a more sympathetic ear in a Republican-majority Congress, said Daniel Runde, the director of the Project on Prosperity and Development at the Center for Strategic and International Studies.

“You would definitely see the willingness to use the full spectrum of American power,” said Runde, a top foreign aid official under President George W. Bush.

Runde noted that much of the reluctance to support the enhanced Middle East involvement that Obama has favored comes from Senate Democrats, as well as some anti-interventionist Republicans like Sen. Rand Paul (R-Ky.).

Health care

Obamacare is here to stay, Fusfield said — at least through the 2016 elections.

“Unless the GOP reaches a supermajority of 60, any attempts to repeal Obamacare will not pass the Senate, and even if both chambers will repeal Obamacare, everyone understands the president will veto it,” said Fusfield, who tracks the issue closely in part because B’nai B’rith maintains a network of elderly care homes.

“You may see Republican tweaks,” he added, for instance in increasing the law’s definition of the workweek from 30 to 40 hours, or the removal of the law’s tax on the sale of medical devices.


On paper, a wholly Republican Congress should see an advance in the most famously deadlocked issue: how to address the 11 million and counting undocumented migrants in the United States, said Hadar Susskind, the Washington director of Bend the Arc, a social advocacy group.

Rep. John Boehner (R-Ohio), the House speaker, has cited differences with Sen. Harry Reid (D-Nev.), the Senate majority leader, to explain the House’s failure to act on a bill passed by the Senate in 2013. Having Sen. Mitch McConnell (R-Ky.) in the majority seat would do away with that obstruction.

Republicans, while eager to court the Hispanic vote, have resisted outlining a path to citizenship until border security is addressed. Democrats want to fast-track citizenship for undocumented migrants who arrived here as minors.

Don’t bet on a change, though, Susskind said.

“They’re spooked by Cantor,” he said, referring to the precipitous fall this year of the former House majority leader, Rep. Eric Cantor (R-Va.), who lost a primary to a Tea Party challenger who said Cantor was soft on immigration — although as majority leader he had actually blocked the Senate bill from advancing.

Melanie Nezer, the Washington director of the Hebrew Immigrant Aid Society, agreed that advancing an overhaul was unlikely and outlined a familiar strategy: work the smaller issues, including renewing the Lautenberg Amendment. Originally fashioned to address the Soviet Jewry crisis in the 1980s, the amendment named for the late Sen. Frank Lautenberg of New Jersey extends refugee status to those persecuted for their religion.

Another focus would be maintaining funding for refugee resettlement, a HIAS focus in recent years, which Nezer said had bipartisan support in part because of the killing fields in Iraq and Syria.


The single area domestically that would likely mean far-reaching change with a Republican majority in both chambers is in confirmations.

Reid changed the rules last year to allow simple majority confirmations and has been rushing this year to fill posts long stymied since 2011 by the earlier 60-vote rule. The majority leader has made some headway, although Republican senators are still able to delay the process to a degree by placing personal holds on nominees.

A GOP majority could put on hold nominations as high profile as the replacement for Eric Holder, the attorney general who has announced his intention to retire, as well as an array of lower court judges.

Nancy Kaufman, the CEO of the National Council of Jewish Women, which has made what she calls “judicial emergencies” a centerpiece of its advocacy, has said that a Republican Senate could precipitate a crisis.

“They have to live up to their responsibility to consider and vote,” she said of GOP senators. “It’s serious now and it’s going to be more serious come the new session.”

One nomination of interest to the Jewish community is that of Rabbi David Saperstein, the longtime director of the Reform movement’s Religious Action Center who has been nominated to serve as the ambassador at large for international religious freedom.

Obama: Lies and Consequences

We teach our kids two things about honesty: One, that “honesty is the best policy,” which means that, ultimately, it’s in one’s interest to be honest. An honest reputation is good for business, telling the truth will keep you out of trouble, and so on.

Parents who aim even higher teach a second, deeper lesson — that being honest is simply the right thing to do, whether it’s in one’s interest or not.

With the recent revelations of his false promises about his health care plan, President Barack Obama has introduced a third — and problematic — lesson on honesty: Sometimes, it’s possible that dishonesty could be the best policy.

Before you gag on that statement, consider the mindset of a president who has a staggering ambition and only a few short years to impact the world.

The biggest, most dramatic change he seeks is something no other president has been able to accomplish: Bringing universal health care to America.

His problem is that, in the midst of a stagnating economy, most of the country did not embrace his controversial plan, which aimed to take over almost a fifth of the economy and add a huge layer of government spending and bureaucracy.

With votes tight in Congress and his plan in jeopardy, the president made a fateful decision: He would say whatever he had to say to push his plan through, even things he knew were not exactly true.

Like, for example, this juicy and memorable promise: “If you like your health care plan, you’ll be able to keep your health care plan. Period. No one will take it away, no matter what.”

“This is a lie,” wrote Michael Cohen of the New York Daily News, “that is today causing the President no end of political headaches.”

He repeated it not once, but 34 times, according to the fact-checking site PolitiFact. If you’re among the millions of Americans today who are or will be forced to look for new plans and new doctors, you have every right to feel cheated and deceived.

Now, why would a president so concerned with his legacy do such a self-destructive thing? I see only one reason: Because, in his mind, it was worth it.

Since telling the truth might have put his plan in peril, he chose not to. He’s hardly the first politician, of course, to play with the truth, but for a president who campaigned on “transparency” and changing Washington’s ways, Obama’s record on this score is especially troublesome.

In fact, although it’s rarely been this blatant, Obama has had a pattern of evading the truth. This latest episode may turn out to be the tipping point that will forever hurt his legacy.

“The broken promises, false claims and tortured truths have reached a critical mass now,” Andrew Malcolm writes in Investor’s Business Daily. “Bludgeoned by Benghazi, IRS revelations, FBI probes, NSA disclosures, Fast and Furious, Solyndra, Syria’s slips and now Obamacare’s sticker shock and outright whoppers, more Americans detect the odor of betrayal, however reluctantly.”

Malcolm adds that for the first time, according to Gallup, Obama’s daily job approval has sunk below 40 percent.

If you’re the president, how do you react to this painful loss of credibility?

One way is simply to accept that it’s the price to pay for getting things done. But losing your credibility is an enormous price to pay when you’re the leader of the free world — even if your intentions are noble.

And there lies the rub: What should a leader do when honesty appears to conflict with noble ambition? When the truth becomes an annoying inconvenience?

President Obama came into office with a laptop full of dreams and a track record of great speeches. When the truth became too inconvenient, as with his health care plan, he didn’t trust that the American people could handle it. Instead, he placed his trust in what Charles Krauthammer calls his “rather bizarre belief in the unlimited power of speech.”

When his bait-and-switch eloquence finally caught up with him, his speech met the limit of its power. Even his forced and belated “apology,” which liberal writer John Dickerson of Slate called “too little, too late,” failed to take personal responsibility for blatantly false statements.

Great leaders level with the people, even when it’s not popular. Early on, Obama could have treated us like adults and told us: “Yes, this plan will cause short-term disruptions, cancellations and, in some cases, even higher premiums. So, I will be asking many of you to sacrifice a little for the greater good of our great country, for a more humane future where no sick person will ever be left behind.”

By failing to level with us in this way, Obama has made his messy, fragile and divisive health care plan that much messier– and bought himself little forgiveness. In any event, if his implicit message is that it’s OK to lie to get things done, then we deserve better.

We already live in a generation saturated by marketing hucksters who tell us only what we want to hear. I suppose it’s natural that politicians—the ultimate hucksters– would follow suit. But great leaders don’t follow, they lead. They trust the truth. They tell us what we need to hear. They appeal to the better angels of our nature.

Maybe now that our president has been caught red-handed and is suffering the consequences, we can remind our kids that even when it’s not popular, speaking the truth is the right and great thing to do. Period.

David Suissa is president of TRIBE Media Corp./Jewish Journal and can be reached at

Wounded Syrians find care in Israel that is no longer available at home

Last February, nearly two years into the civil war still tearing across Syria, a group of seven wounded Syrians dragged themselves to the Israeli border, where they were picked up by the Israel Defense Forces (IDF) and rushed to the nearest hospital.

It was the first public rescue of Syrians within Israel, and reporters flocked to the Ziv Medical Center in Safed, a 40-minute drive from the Syrian border. Facing a wall of microphones, hospital director Dr. Oscar Embon dodged questions about whether the patients, all men, were fighting for or against Syrian President Bashar Assad.

“We treat patients regardless of religion, race, nationality and give the best care we can provide,” Embon told CNN.

The media blitz soon died down, but the mission kept growing. Dozens more Syrians mysteriously made their way into Israel, and three more Israeli hospitals, each with different specialties, volunteered to take in the Syrian patients, while the IDF also set up its own field hospital along the border for emergency care.

“They know where to bring the wounded now, just from ear to mouth,” said Peter Lerner, IDF spokesman for international media. “We haven’t made any public announcement about it, but they keep coming to the same places of access. It seems to be an unwritten agreement: If you need help, you know where to come.”

[Related: Dr. Alexander Lerner, head of the orthopedic department at Ziv Medical Center, with a picture made for him by an 8-year-old Syrian patient. Photo by Simone Wilson

Among the Syrians being treated in Israel is a 15-year-old boy who lost his leg and almost lost his arm, had it not been saved by doctors at Ziv. The boy was riding in a tractor, helping deliver water to neighboring villages in Syria, when the tractor rolled over a land mine. When he woke up, he was in Israel. (The hospital will not release the boy’s name, to ensure his safety in both Israel and Syria.)

“I was surprised, and a little afraid,” the boy said in Arabic, as his social worker translated. “But when I saw people speaking Arabic, I was more relaxed.”

This 15-year-old, one of almost 20 Syrians currently hospitalized at Ziv, shares a room with two other boys — a chubby-cheeked 14-year-old whose arms and legs broke when a bomb sent him flying off the roof of his house, and a third teen who was blinded and lost a hand in another blast. White gauze fills both this patient’s eye sockets. (“I’m not sure he really understands what is happening,” Gil Maor, a spokesman for the hospital, said of the boy who lost his eyesight.)

Their hospital room opens to a balcony with a dazzling, panoramic view of the Sea of Galilee, a longtime point of geographical contention between Israel and Syria.

“I always heard that Israel was the enemy,” the 15-year-old said. “But there are a lot of good things that they give me here.”

On the morning of Oct. 21, the boys’ hospital room was crammed with nurses, social workers and press supervisors. Curious community members brought plastic bags full of snacks to the door — Israeli favorites like peanut-butter-flavored Bamba puffs and Quadratini biscuits — and tried to pop their heads in for a peek. Guarding the room and doing his best to keep the visitors at bay in the hallway, a gangly IDF soldier who didn’t look much older than the Syrian boys inside made repeated calls to his superiors, seeking approval for each new person to enter the room and each Syrian patient to be interviewed. A photographer for the Israeli newspaper Ha’aretz spent 20 minutes setting the boys up in different poses around the room, always with their faces tilted slightly away so as not to reveal their identities. 

By noon, the boys all looked exhausted. “I miss my family; I miss my friends, and I miss my teachers. I miss taking the school photo,” the 14-year-old in the middle bed said, before softly requesting that he be excused from the interview. He made a sideways chopping motion with his hands and rolled over, directing his gaze out the window toward Syria.

Offering (illegal) care, as needed

The border between Israel and Syria is guarded closely by the IDF, and a new high-security fence between the two enemy countries is now 90 percent complete. However, the IDF’s official policy is to accept any wounded Syrian who can make it to the border (oftentimes with the help of an accompanying party).

“We are facilitating urgent medical aid to any Syrians who have reached the fence,” IDF spokesman Lerner said.

Some patients remain unconscious through the journey. And when they wake up in enemy territory, according to Israeli hospital staff, their faces often brim with fear.

“They’re very frightened,” said Dr. Eyal Sela, head of the ear, nose and throat department at the Western Galilee Medical Center in the far-north beach town of Nahariya. “They don’t understand what we’re saying when we talk in front of them — the whole situation is unfamiliar ground. You see it in their eyes.”

But after a week or two, Sela said, “You see that the trust is building up. They learn our faces.”

And as word of the Israeli aid operation spreads within Syria, that initial round of shock is fading.

Fares, a Christian Arab social worker at Ziv Medical Center who chooses to keep his surname out of the press, is the first face Syrian patients see upon their arrival at the hospital. During their stay in Israel, Fares also becomes the familiar face that coaches the patients through treatment, all the way up to their day of discharge.

He said patients have told him his name is circulating in Syria. 

“Some come back from the same village where they told them that I was here,” Fares said. “[New arrivals] say to me, ‘Yes, they told us about you.’ ”

Sela, a facial reconstruction specialist, said he has formed very close bonds with a few of his patients. The doctor is especially fond of his very first case, a “very intelligent” agriculture student who was rushed to the Western Galilee Medical Center with a severe gunshot wound stretching from his jaw through to his lungs.

“He grew up thinking that Israel was bad and that we kill each other here,” Sela said of the patient. “Then suddenly he sees Arabs and Jews are working together as doctors, as nurses. He couldn’t figure out what was going on. He thought it was a show.”

Watching the young man’s perceptions change, Sela said, made the doctor feel, for the first time, like a sort of diplomat.

“It’s not just the medicine — you touch people, and you change people, and you change people’s perspective of you,” Sela said. “And you’re not a monster, as they saw you before.”

But while some Syrians’ personal feelings about Israel may shift after receiving life-saving treatment in the Jewish nation, they must keep the treatment a secret upon returning home. Setting foot on Israeli soil is illegal under Syrian law, and widely frowned upon, besides.

So, when IDF medics send patients back across the Syrian border, they make sure no Hebrew lettering nor Israeli logos are printed anywhere on the patients’ medical equipment or tags.  In some cases — according to Sara Paperin, international liaison at the Western Galilee Medical Center — Syrians have even been sent home with forged discharge papers, made to look like they were printed at a Syrian hospital. (Paperin stressed that the Western Galilee Medical Center played no part in creating these false documents, and that all Syrian patients who come through the hospital are released to the IDF with accurate discharge papers.)

The 15-year-old at Ziv Medical Center who lost his leg in a land-mine explosion said people in Syria would be angry if they learned he went to Israel. “I prefer not to tell them,” he said.

Russian-Israeli surgeon Dr. Alexander Lerner, head of the orthopedic department at the hospital and a leading expert on limb salvation and elongation, is now in the process of building the boy a prosthetic leg. “Next week, I hope he’ll start walking,” he said. “I plan to return him to Syria on both legs.”

With more attention, more patients

The Golan Heights — the 700 square miles of disputed farmland that connects Israel to Syria — is a historically gray area surging with tension between the two countries. On Google Maps, the region is double-outlined by a tangle of dotted lines, with no clear border between Israel and Syria — illustrating almost a century of back-and-forth land grabs. To this day, a special force of United Nations workers, called the United Nations Disengagement Observer Force (UNDOF), patrols the area to keep peace. (According to a UNDOF report from March, Syrian officials accused UNDOF personnel of collaborating with the IDF to “transport across the ceasefire line of injured persons to the Israeli-occupied Golan and back.”)

“There have never been any diplomatic relations between Israel and Syria,” Foreign Ministry spokesman Yigal Palmor said. “It is legally considered an enemy state.” 

Meanwhile, the other four countries that touch borders with Syria — Jordan, Turkey, Lebanon and Iraq — have collectively absorbed more than 2 million Syrian refugees since the civil war broke out, with another 125,000 fleeing to Egypt.

“Refugees tend to go to places where they speak the same language, where they have the same culture,” the IDF’s Lerner said. “So many Syrians have been told that Israel is the arch-enemy of Syria. Why would they come here?”

The only Syrian refugees that Israel has offered to take in are Palestinians — former refugees of the Israel-Palestine conflict who fled to Syria in a time of peace. But had they taken Israel up on its offer, those Palestinian refugees would have been confined to the occupied West Bank and forced to give up their refugee status, which would cut their access to U.N. aid and their hopes for a “right of return” to Israel proper.

Israel’s small Druze community, leftover from Syrian rule of the Golan Heights, has also been pressuring the Israeli government to provide refuge to their brethren on the other side of the fence. Israeli authorities have yet to issue a public response.

“There is no change in our policy as far as the border is concerned,” Lerner said. “No Syrians can pass through.”

The Syrian civil war and refugee crisis have put Israel in an awkward position, as the conflict between Syria and Israel long predates that between the Free Syrian Army and the Assad regime. However, because the Syrian rebels have temporarily set aside their beef with Israel to focus on toppling the oppressive government in their own country, the Israeli medical community has spotted an opportunity to try to plant some seeds of Israeli humanity inside Syria.

Doctors Without Borders, the premier medical aid organization operating in Syria and in surrounding refugee camps, recently urged “all states and non-state actors involved in the Syrian conflict” to devote the same urgent attention to Syria’s medical crisis as to the infamous chemical weapons attack in August that killed some 1,500 Syrians.

“The medical system — like the rest of Syrian society — has been under siege during the conflict and is no longer capable of responding to the acute and chronic medical needs of the Syrian population,” a September report from Doctors Without Borders said. The organization has also warned that health care for refugees in Jordan, Lebanon and Iraq is crumbling under extreme demand.

Israel, on its own terms, has answered that plea.

Whereas stretched-thin hospitals inside Syria are depleted of medical supplies and often targeted by the Syrian military, Israeli hospitals just over the border are able to provide patients with a full team of professionals, from medical clowns to psychiatrists, and cutting-edge treatments they might not receive elsewhere.

As the director of Ziv Medical Center, Dr. Oscar Embon said he would never turn away a patient. “I’m glad I have the opportunity to exercise my values, which is to treat everyone regardless of religion, race — whatever. For me, it’s the natural thing to do.” Photo by Simone Wilson

One of Sela’s current patients lost his entire jaw in an explosion. “It’s totally gone,” the doctor said. “A grenade or something just took it off — the lower lip, the chin, the floor of the mouth and half of the tongue.” So the hospital has ordered a special plate from the United States and plans to reconstruct the patient’s jaw in full.

And over in Safed, Dr. Alexander Lerner at Ziv Medical Center is known for avoiding amputation at all costs. 

A few months ago, an 8-year-old Syrian girl named Aya arrived at Ziv Medical Center with her mother. The woman and child had survived a bombing together, and one of Aya’s legs was almost completely blown off. But through a painstaking process of “temporary acute shortening and temporary angulation” to keep the leg alive, then “gradual realignment” to restore it to its full length, Lerner was able to salvage the limb.

“When it was her first time walking in the department, all the Israeli patients looked at her and started clapping,” Lerner said in a thick Russian accent. “I’ve seen very many interesting situations, but it’s the first time I’ve seen this kind of applause for a small girl walking.”

Aya boarded the IDF ambulance for Syria about a month ago, but she’s become something of a legend at Ziv. Above Lerner’s desk is a picture of a vase of flowers that the young survivor made for him, along with an inscription that she asked her nurse to write in Hebrew: “Dear Dr. Lerner,” it reads, “Thank you for your care. God will be with you and he will guard you.”

Israel has a rare chance to provide world-class health care to a war-torn neighbor, hospital director Embon said. “We try to save limbs. This is the modern thing to do — the right thing to do. The Red Cross is used to amputations. You just cut it, put in a suture, and you can release the patient in two days. And probably if you don’t have the means, this is the right thing to do. But the Red Cross was surprised to see that we are trying to save limbs and doing a lot more modern surgeries.”

Syrian hospitals seem to be catching wind. Two men in their 20s under Sela’s care at the Western Galilee Medical Center told the Jewish Journal that they were transferred to Israel by a hospital in Syria, somewhat against their wishes. And another two patients recently arrived at Ziv with doctor’s notes — one blood-splattered — written in Arabic, pinned to their clothing. One of the men was suffering from a bullet wound through his chest and shrapnel in his diaphragm.

“There was no possibility to suture his liver, and pressure bandaging was applied to his stomach,” his note read. “Please do what is required and thank you in advance.”

Said Embon, director of Ziv Medical Center: “As a physician, I believe in the universality of health care and medicine. And as an Israeli, I believe that we should have peace — and if we are contributing to changing how our neighbors see us, maybe we can bring peace to the area one day earlier.”

One year into the Syrian civil war, Israeli public-affairs consultant Lenny Ben-David hinted at the potential impact of such an operation in an op-ed for the Times of Israel.

“If there’s a tiny chance for coexistence with the post-Assad government of Syria and if Syria doesn’t shatter into ethnic satrapies,” he wrote, “a life-saving medical facility along the Israel-Syrian border may be a good place to start a coexistence process.”

According to the IDF, the medical aid program for Syrians in Israel didn’t begin until early 2013, simply because up to that point, no wounded Syrians had turned to Israel for help. But earlier this year, the IDF said, violence within Syria began to spread to villages near the Israeli border — thus driving Syrians to seek treatment at the fence.

Slowly but reliably, global press outlets picked up on the unlikely story.

“In March, only the director of the hospital and maybe the physicians that were interacting with the Syrian patients knew about it,” said Paperin, international liaison at the Western Galilee Medical Center. “I got involved in June — and since then, that’s really all we’ve been handling here.” Before the influx of Syrians, Paperin’s job consisted mainly of overseeing medical tourism, a booming million-dollar industry in Israel. Now, the young Chicago native is responsible for overseeing a constant rotation of Syrian war casualties — and introducing them to dozens of journalists eager to interview the survivors in a rare cocoon of safety.  

At first, Israeli reporters began visiting Syrian patients at a slow trickle, Paperin said. But in August, a big New York Times piece on young Syrian children being treated at the Western Galilee Medical Center “was really the big burst in the dam. All of a sudden, within a few days of it being published, a tsunami of reporters showed up.”

Maor, a spokesman for Ziv Medical Center, said the same: “We had times where there were three or four media crews here the whole week.”

With the spike in press coverage came more waves of wounded Syrians.

The IDF has since set up a well-oiled distribution system for Syrian patients who make it to the border: Those with less-serious injuries are patched up by mobile IDF medical teams along the border, or treated at the IDF field hospital, and returned to Syria. Those with serious wounds to the torso and limbs are transferred to Ziv Medical Center in nearby Safed. Those with serious head injuries are driven a couple of hours west to the Western Galilee Medical Center in Nahariya. And the most critical patients — only 20 so far — are transferred to the Rambam Medical Center in Haifa.

One woman taken to Rambam, for example, had a piece of shrapnel removed from inside her heart.

“This is the path that all Syrian patients come through,” said Paperin, leading a reporter down a long hall at the Western Galilee Medical Center, its walls painted a calming eggshell and turquoise, and into the hospital’s shock room.

“The connection between the hospital and the IDF starts like this: They pick up the phone and they say, ‘We’re transporting X number of patients — we’ll be there soon,’ ” Paperin said. “But there’s no information about age, or gender, or injury. So the first step is always in preparing the shock room for resuscitation.” From there, patients head to the ICU and — once they’re stabilized — to the hospital ward that best suits their injuries.

The hasbara challenge

From the start, Israel’s normally pushy hasbara (public relations) detail has seemed unsure of how to handle the Syrian issue. The same muddled elements of the Syrian civil war that complicate larger international aid efforts — including the risk of funding terrorist groups mixed in with the rebels — have proven even more complex for Israel, a grave enemy both of Assad and terrorist factions in the region.

A hurried and blood-stained doctor’s note arrived from Syria with one unconscious patient, outlining his injuries and what little treatment he had already received. Photo by Simone Wilson

In September, the IDF permitted a single newspaper, conservative Israeli daily Yediot Aharonot, to speak to the head of the IDF field hospital, Dr. Ofer Merin.

When the Jewish Journal requested access to the hospital and an interview with Merin, a lieutenant at the IDF spokesperson’s office wrote in an e-mail: “At this point, the medical treatment center (as well as staff, patients, etc.) is not open to media coverage.” She later added that the Yediot piece “caused significant internal controversy” within the IDF.

New York Times reporter Isabel Kershner, likewise, told the Jewish Daily Forward in an interview that she faced a ton of pushback from the IDF while writing her piece on Syrian children in Israeli hospitals. 

Israel’s hasbara jitters may originate from a fear of looking like the country is taking sides in the conflict, after the great pains that the prime minister’s office has taken not to get involved. 

Various Arabic-language news outlets throughout the Middle East have accused Israel of indirectly supporting the rebels through medical rehabilitation: Pointed headlines have included “Israeli hospital treats 17 rebel militants” and “Free Syrian Army wounded being treated in Israeli hospitals.” And Egyptian outlet Egy Press wrote last month that Ziv Medical Center in Safed had become “the first resort of the terrorist factions in Syria to receive treatment and rehabilitation before returning to complete their terrorism on Syrian territory.”

An anonymous patient who said he was part of the Free Syrian Army told France 24: “The [Syrian rebel] fighters take the patients without carrying weapons. They put us on a particular spot where the Israeli army can see us. Then the Israelis come and take us. To be honest, I was shocked that Israel took us in.”

The strongly worded French article suggested that Israel’s humanitarian effort could be its stealthy way of intervening against Assad. 

And the speculation is not unfounded: No Syrian patient at an Israeli hospital has ever claimed allegiance to the Assad regime in an interview with the press. And while plenty of wounded women and children have passed through Israel, the majority of patients are still men. (Seventy-seven percent of the patients at Ziv Medical Center, for instance, have been males over the age of 18.)

Israeli officials appear equal parts proud and paranoid. Press supervisors at the hospitals hosting Syrians are eager to show reporters around but steer them away from political questions and only allow them access to certain patients. Throughout these tours, the spokespeople stress that they do not ask — and do not care — if patients were fighting in the war, nor which side they were fighting on.

Media outlets are asked not to print Syrian patients’ names or identities. Not only will this put them at risk of persecution inside Syria for seeking Israeli care, Maor said, but the community surrounding the hospital — a mix of mainly Muslim and Christian Arabs, Jewish Israelis and Druze — have charged opinions about, and even allegiances to, the two camps in Syria.

Inevitably, given the deep roots of the Israeli-Syrian conflict and the greater Israeli-Arab conflict in the Middle East, there is still much public skepticism surrounding the operation. One Lebanese news site accused Israel of “exploiting this matter in the media, in order to promote the image of humanity about them.”

But, in general, the Western media has embraced the Israeli initiative as pure. 

It’s one of the few positive Israeli news events that the Israeli Foreign Ministry has not helped promote at all — perhaps making it that much more attractive to reporters.

“Do we really have to be concerned about our image when we’re giving therapy to children who would be left to die?” Paperin asked. “From this hospital’s standpoint, you can’t make Israel the villain when that’s all we’re doing.”

Merin, commander of the IDF field hospital, told Yediot Aharonot: “I realize that we’re not changing the Middle East here,” he said, “but maybe we can make a small difference in how we are perceived, and that’s certainly worth something.”

However, the Israeli government has been reluctant to pay the price of the good press and goodwill. Hospital officials told the Jewish Journal that the Ministry of Health and the Ministry of Defense are still arguing over who will back the Syrians’ hospital bills, which have so far amounted to a combined $5.5 million, according to hospital estimates.

When asked about the dispute, Defense Ministry spokeswoman Myriam Nahon said only: “No comment.” And the spokesperson’s office for the Health Ministry responded: “The issue will be discussed soon with the director general of the prime minister’s office.”

(Those are just the costs that Israeli hospitals can temporarily absorb. Extra hardware for wounded Syrians, such as prosthetic limbs and wheelchairs, which must be paid for upfront, are purchased through private funds hosted by each hospital. Donations can be made to Ziv Medical Center and the Western Galilee Medical Center at and, respectively. )

Israeli news station Channel 2 witnessed similar hesitation from the Israeli government last year while accompanying a private Israeli aid mission to Syrian refugee camps along the Syria-Jordan border. Aid workers brought a letter from medical-tourism officials, offering a pro-bono eye surgery for a Syrian man that would help him see again. But soon after, Channel 2 reported, the Israeli Ministry of Interior rescinded the offer.

“That’s Israel: One hand extended, the other blocks the way,” said a Channel 2 reporter, who tagged along on the mission.

Later in the broadcast, one Israeli aid worker explained: “When we come to help [Syrian refugees], I look at them and think, ‘If there was war between us now, I’d aim my rifle at him, ready to fire.’ He’d kill me or I’d kill him. For now, I extend my hand to help him. As time goes on, will we shake hands or will we keep fighting? You don’t know what will happen. Do I make him healthy now so later he can take up his weapon against me?”

For Embon, director of Ziv Medical Center, in a humanitarian crisis like the one unfolding in Syria, those questions become irrelevant. 

“I am aware that not all the patients we treat are loving us and changing their minds [about Israel],” the hospital director said. 

“This is not a thing we do because we want to change them. We do this because we know that we have to do it — this is our job.”

U.S. lawmakers close to deal on debt ceiling, reopening government

The U.S. Senate appeared ready to announce a last-minute deal on Wednesday to avert a historic lapse in the government's borrowing ability and a potentially damaging debt default.

But even if the Senate and House of Representatives manage to overcome procedural hurdles to seal the deal before Thursday – when the Treasury says it will exhaust its borrowing authority — it will only be a temporary solution that sets up the prospect of another showdown early next year.

Major U.S. stock indexes rose more than 1 percent on optimism that lawmakers would finally end the weeks-long fiscal impasse, but cautious investors are still wary over the final outcome. Although the cost of insuring U.S. debt hit its highest in over two years, the dollar held its ground against other currencies.

Senate Majority Leader Harry Reid and Republican leader Mitch McConnell were close to finishing a fiscal plan that could be considered by the full Senate later on Wednesday. The leaders were expected to announce a deal when the Senate convened at noon (1600 GMT).

Weeks of bitter fighting among Democrats and Republicans over President Barack Obama's signature healthcare reform law led to a two-week government shutdown, sidelining hundreds of thousands of federal workers.

The initial fight over the healthcare law turned into a bigger battle over the debt ceiling, threatening a default that would have reverberations around the world.

“If we don't get a default, it would be like Y2K. People were staying up all night worried about what would happen during that deadline. Then nothing happened,” said David Keeble, global head of interest rate strategy with Credit Agricole Corporate & Investment Bank in New York, referring to worries about the millennium computer bug in 2000.

Both Democrats and Republicans are confident that the U.S. House of Representatives will have enough votes on Wednesday to pass the bipartisan Senate plan, a top Democratic aide said.

Aides to House Speaker John Boehner, the top Republican in Congress, called senior Senate staff to say the House would vote first on the measure, the aide said, adding that it appears certain to be approved with mostly Democratic votes.

Lawmakers are racing against time. While analysts and U.S. officials say the government will still have roughly $30 billion in cash to pay many obligations for at least a few days, the financial sector may begin to seize up on Thursday if no deal is secured.

“I think folks on both sides of the aisle in the Senate are ready to get this done,” Republican Senator Saxby Chambliss of Georgia told National Public Radio on Wednesday, a day after chaotic developments frayed the nerves of many members of Congress and global financial markets.

Even if a deal is reached, it must still clear the full Senate and possible procedural snags before moving to the fractious House of Representatives, which was unable to produce its own deal on Tuesday.

“Today is definitely not the day to be conducting any serious business as traders across the globe will be hypnotized by their TVs/terminals and anxiously waiting for something to hit the news wires,” Jonathan Sudaria, a trader at Capital Spreads in London, wrote in a client note.

Fitch Ratings warned it could cut the U.S. sovereign credit rating from AAA, citing the political brinkmanship over raising the debt ceiling.

Congress ends default threat, Obama signs debt bill

Congress approved an 11th-hour deal to end a partial government shutdown and pull the world's biggest economy back from the brink of a historic debt default that could have threatened financial calamity on Wednesday.

Capping weeks of political brinkmanship that had unnerved global markets, President Barack Obama quickly signed the spending measure, which passed the Senate and House of Representatives after Republicans dropped efforts to use the legislation to force changes in his signature healthcare law.

The White House budget office told hundreds of thousands of federal workers, the bulk of whom had been idle for the past 16 days, to be ready to return to work on Thursday.

The down-to-the-wire deal, however, offers only a temporary fix and does not resolve the fundamental issues of spending and deficits that divide Republicans and Democrats. It funds the government until Jan. 15 and raises the debt ceiling until Feb. 7, so Americans face the possibility of another bitter budget fight and another government shutdown early next year.

With the deadlock broken just a day before the Treasury said it would exhaust its ability to borrow new funds,  stocks surged on Wednesday, nearing an all-time high. Share markets in Asia also cheered the deal.

Taking the podium in the White House briefing room on Wednesday night, Obama said that with final congressional passage, “We can begin to lift this cloud of uncertainty and unease from our businesses and from the American people.”

“Hopefully next time it won't be in the 11th hour. We've got to get out of the habit of governing by crisis,” Obama said. He outmaneuvered Republicans by holding firm in defense of “Obamacare” to win agreement, with few strings attached, to end the 16-day shutdown.

World Bank President Jim Yong Kim said “the global economy dodged a potential catastrophe” with congressional approval of the deal to raise the $16.7 trillion debt ceiling.

The standoff between Republicans and the White House over funding the government forced the temporary lay-off of hundreds of thousands of federal workers from Oct. 1 and created concern that crisis-driven politics was the “new normal” in Washington.

While essential functions like defense and air traffic control continued during the crisis, national parks and agencies like the Environmental Protection Agency have been largely closed.

Senator John McCain, whose fellow Republicans triggered the crisis with demands that the Democratic president's “Obamacare” healthcare reform law be defunded, said earlier on Wednesday the deal marked the “end of an agonizing odyssey” for Americans.

“It is one of the most shameful chapters I have seen in the years I've spent in the Senate,” said McCain, who had warned Republicans not to link their demands for Obamacare changes to the debt limit or government spending bill. Polls showed Republicans took a hit in public opinion over the standoff.

In the end, the Democratic-led Senate overwhelmingly passed the measure on a 81-18 vote, and the Republican-controlled House followed suit 285 to 144. Obama signed the 35-page bill just after midnight.


Although the deal would only extend borrowing authority until the first week of February, the Treasury Department would have tools to temporarily extend its borrowing capacity beyond that date if Congress failed to act early next year. But such techniques eventually run out.

In addition to lifting the federal debt limit, the deal calls for creating a House-Senate bipartisan commission to try to come up with long-term deficit-reduction ideas that would have to be approved by the full Congress. Their work would have to be completed by Dec. 13, but some lawmakers say the panel faces an extremely difficult task.

The agreement also includes some income verification procedures for those seeking subsidies under the 2010 healthcare law. But it was only a modest concession to Republicans, who surrendered on their latest attempt to delay or gut the healthcare package or include major changes, including the elimination of a medical device tax.

The congressional vote signaled a temporary ceasefire between Republicans and the White House in the latest struggle over spending and deficits that has at times paralyzed both decision-making and basic functions of government.

The political dysfunction has worried allies and creditors such as China, the biggest foreign holder of U.S. debt, and raised questions about the impact on America's prestige. The Treasury has said it risks hurting the country's reputation as a safe haven and stable financial center.

Senate Majority Leader Harry Reid and Republican leader Mitch McConnell announced the fiscal agreement on the Senate floor earlier on Wednesday, and its passage was eased when the main Republican critic of the deal, Senator Ted Cruz of Texas, said he would not use procedural moves to delay a vote.

The agreement stacked up as a political achievement for Obama, who refused to negotiate on changes to the healthcare law, and a defeat for Republicans, who were driven by Tea Party conservatives in their ranks and suffered a backlash in public opinion polls.

There was no immediate sign that House Speaker John Boehner's leadership position was at risk despite having conceded defeat in the budget battle.

Several Republican lawmakers suggested he may have strengthened his standing among the rank-and-file, who gave him a standing ovation at an afternoon meeting.

But Cruz, a Tea Party-backed senator with 2016 presidential aspirations, denounced the fiscal accord as a “terrible deal” and accused fellow Republicans of giving in too easily in their bid to derail Obamacare.

Obama's Democrats avoided claims of victory. “The bottom line is, millions suffered, millions didn't get pay checks, the economy was dragged down,” said Senator Charles Schumer. “This is not a happy day, it is a somber day.”

The fight over Obamacare rapidly grew into a brawl over the debt ceiling, threatening a default that global financial organizations warned could throw the United States back into recession and cause a global economic disaster.

Fitch Ratings had warned on Tuesday that it could cut the U.S. sovereign credit rating from AAA, citing the political brinkmanship over raising the debt ceiling.

A resolution to the crisis cannot come soon enough for many companies. American consumers have put away their wallets, at least temporarily, instead of spending on big-ticket items like cars and recreational vehicles.

“We're sort of 'crises-ed' out,” said Tammy Darvish, vice president of DARCARS Automotive Group, a family-run company that owns 21 auto dealerships in the greater Washington area.

Critical California health insurance coverage

As states across the country prepare for the rollout of health insurance coverage the state of California has become a leader. While some states have chosen not to provide a system for their residents to access affordable health care, California has set up Covered California, a market place or exchange where eligible individuals, families and small businesses can choose from a selection of affordable health care plans.

Enrollment for Covered California is now open and the insurance plans become effective on January 1, 2014. According to the California Healthcare Foundation, in 2011, 7.1 million Californians under the age of 65 did not have health insurance. Many of the uninsured want coverage, but cannot afford it; others who have insurance do not have adequate benefits to cover their needs.

As someone who advocates for social change as a volunteer with the National Council of Jewish Women, Los Angeles, as well as a registered nurse, a marriage and family therapist and a former employee of health insurance companies and brokers, I am encouraged by the prospect that many of those 7.1 million uninsured will now have access to health care coverage. Not all Americans agree with health care professionals like myself that believe health care is a right, not a privilege. The United States, despite being the richest nation in the world, suffers greatly, both financially and in public health outcomes, from not having coverage for all its citizens.

Americans pay twice as much for care per person and have a shorter life expectancy than other industrialized nations. And, sadly, the United States is 21st amongst nations in infant mortality. Despite having the best doctors and medical care in the world, babies still die in this country due to a lack of prenatal care, which costs very little and prevents numerous expensive medical problems.

In addition, according to a recent study by NerdWallet Health, nearly 2 million Americans will go bankrupt this year because of medical expenses. This is a non-existent problem in all other democratic countries.

Providing health care for all citizens is consistent with the family values that many Americans espouse. What could be more valuable to individuals or families than knowing that if they or someone they love gets sick, they have access to affordable, quality health care?

Covered California insurance plans will provide much-needed preventative, medical and prescription services. Most importantly, as of January 1, 2014, no enrollee can be denied insurance coverage due to pre-existing conditions.

I believe that everyone should take the time to learn about and enroll in Covered California. Even young adults in their twenties and thirties who usually cannot afford health insurance, and thus rationalize that they do not need health care, will find a basic health care plan in their price range.

Regardless of age, Covered California has plans for everyone who qualifies. For those whose income is below a certain level of the poverty line, the federal government provides premium assistance in the form of either tax credits or cost sharing subsidies. Individuals who have health insurance through their employers can keep that insurance and do not have to change.

In order to keep health insurance affordable it is necessary to spread the financial risk between individuals who are healthy and those who may have to use more health care services. Therefore, enrollment in Covered California is mandatory, and those who do not enroll will be fined.  The fine in 2014 will be low, but it will increase significantly each year thereafter.  Believe it or not, it is advantageous for everyone to have health coverage.

The Covered California website,, is easy to navigate and has a wealth of information. It also has all kinds of tools to help people figure out if they qualify, what plans are available and what their cost will be.  If you need more help, there are customer service representatives you can call. I urge all Californians to go on-line and learn what citizens of all other democratic countries know: that health care is an essential part of life.

Donna Benjamin is a Registered Nurse, Marriage and Family Therapist, former employee of the insurance industry and an advocate with the National Council of Jewish Women, Los Angeles. She lives in Los Angeles, CA.

Obama blames government shutdown on ‘ideological crusade’

President Barack Obama on Tuesday blamed Republicans for an “ideological crusade” aimed at his healthcare program and urged lawmakers to vote to keep government operations running and to raise the nation's borrowing cap without conditions.

“They've shut down the government over an ideological crusade to deny affordable health insurance to millions of Americans,” he said in remarks in the White House Rose Garden.

“Many Representatives have made it clear that had they been allowed by Speaker (John) Boehner to take a simple up or down vote on keeping government open with no strings attached, enough votes from both parties would have kept the American people's government open and operating,” he said.

The president also warned Republicans against using a crucial mid-October deadline to raise the government's $16.7 trillion debt ceiling as leverage to try to reverse the health care law or achieve other political objectives.

“Congress, generally, has to stop governing by crisis,” he said. “I'm not going allow anybody to drag the good name of the United States of America just to refight a settled election or extract ideological demands.”

A debt default that would result if Congress fails to raise the debt ceiling when it is reached in less than three weeks could be devastating, Obama said. The threat of default in 2011 resulted in a painful debt rating downgrade, he added.

“If they go through with it this time, and force the United States to default for the first time in its history, it would be far more dangerous than a government shutdown, as bad as a shutdown is. It would be an economic shutdown,” he said.

Shutdown may affect Jewish social services

Congress’ failure to authorize discretionary spending for the new fiscal year won’t only impact about 800,000 federal workers or the Americans looking to visit national parks. It may also affect local Jewish social service organizations that rely in part on federal funding. 

That, too, though, is uncertain.

“We don’t know what is going to happen,” Paul Castro, CEO of Jewish Family Service of Los Angeles (JFS), said just hours after the shutdown began. “We spent the morning trying to communicate with our funders to find out what they know.”

The funders Castro spoke with are the state and local government entities that JFS relies upon to provide some services such as meals and transportation programs for seniors. Castro said that if these entities requested funds from the federal government before Oct. 1 — the day the shutdown took effect — some of JFS’ at-risk programs could run for a few more weeks without interruption. Ultimately, though, JFS won’t know for at least a few days exactly how this will play out if Congress doesn’t reach an agreement quickly.

JFS’ annual budget is $30 million, and $5.55 million of that comes — directly and indirectly — from the federal government.

Jay Sanderson, president and CEO of The Jewish Federation of Greater Los Angeles, echoed Castro’s concerns. 

“With the shutdown, the cash flows of our most important social service agencies are at risk,” he said. “If this goes on for an extended period of time, it will definitely impact our social service agencies.”

As for Jewish Vocational Services, whose goal is to help people overcome barriers to employment, it issued a public statement that “programs and services remain fully operational with regularly scheduled hours.”

The last time Democrats and Republicans could not agree on a spending resolution to fund parts of the federal government was over the budget for the 1996 fiscal year, when President Bill Clinton and a Republican Congress clashed over spending levels, largely over Medicare, shutting down parts of the government for 26 days.

This time around, the issue preventing an agreement is again a major health care initiative, the Affordable Care Act (ACA), President Barack Obama’s signature piece of legislation that was passed in 2010.

Republicans in the House of Representatives are attempting to tie any new spending bill to a one-year delay for parts of the bill and a requirement that Congressional members and their staffers must purchase insurance on the ACA’s new health insurance exchanges, which opened on Oct. 1

Despite the shutdown, much of the federal government will continue to operate as normal, including programs like Social Security, Medicare, Medicaid and the military.

Even if Congress reaches an agreement in the coming days or weeks, Castro is concerned about a future potential conflict that could again pose funding problems for local Jewish agencies. Before Oct. 17, when the federal government is predicted to eclipse the “debt ceiling” (the level of debt Congress has authorized the government to accumulate), Democrats and Republicans will either have to raise the debt ceiling or risk many spending promises not being fulfilled.

“Even in resolution we know that is only going to be for a few weeks,” Castro said. 

Bet Tzedek conflict over employees’ health insurance

The chant coming from Bet Tzedek Legal Services employees and their supporters as they marched on the streets of Koreatown on Aug. 22 was unified: “All day, all night, health care is a human right.”

For the past several months, the employees have been fighting with the pro bono legal firm’s management over proposed increases to the cost of their employer-sponsored health care, and they have been hitting the streets to make themselves heard. 

“We’re here to tell Bet Tzedek that we can go forward, even during difficult [economic] times, without destroying [workers’ health care],” said Marc Bender, a litigation and training supervisor, while leading a picket line on Aug. 22. The demonstration took place outside of the office building at 3250 Wilshire Blvd., where Bet Tzedek’s offices are located. Employees also demonstrated Sept. 11 in the same location. They marched and carried picket signs that read: “Don’t Bleed Our Health Care,” “Protect Our Families” and “Si, Se Puede!” (“Yes, We Can!”). 

Bet Tzedek (“House of Justice”) provides services to the poor and underserved in Los Angeles. Lawyers, legal secretaries, paralegals and clerical workers, who make up its 51 non-managerial employees, are unionized members of Bet Tzedek Legal Services Union/American Federation of State, County and Municipal Employees Local 946. 

The two sides began disagreeing over health insurance costs in the spring, several months after employees’ previous contract expired on Dec. 31, 2012. Management and employees have agreed to extend the terms of the previous contract while they negotiate, said Elissa Barrett, vice president and general counsel at the nonprofit. 

Bet Tzedek employees expressed satisfaction with the existing amount they have to pay toward their health care premiums. Currently, employees are fully covered as individals, and are required to pay $20 monthly for a spouse or $30 monthly for a family, if they choose HMO coverage. Juana Mijares, an intake supervisor, earns $49,000 annually  and said coverage for her family of five could cost her $650 monthly under a proposal she said the company is making. 

Barrett declined to specify the details of management’s proposals. “That’s a subject of negotiation,” she said. 

Increases to staff members’ contributions to their health care are necessary for the financial health of the organization, according to Barrett. Health care costs have been increasing over the past several years, leaving Bet Tzedek no choice but to pass a greater portion of the costs of insurance on to to its employees

“Our staff works very hard, they do a fantastic job, we value them greatly, [but] if we did not believe it was necessary for the survival and sustainability of this organization to tackle this health care issue, we wouldn’t be bringing it this strongly to the negotiating table,” she said.

The midweek August protest took place after work hours. Approximately 35 people marched at Wilshire Boulevard and New Hampshire Avenue. Among them was L.A. City Councilman Paul Koretz.

The ongoing disagreement between employees and management has attracted the attention of leaders in the local social justice moment. Those who turned out last month included Leslie Gersicoff, executive director of Jewish Labor Committee Western Region, and Rabbi Jonathan Klein, executive director of Clergy and Laity United for Economic Justice.

Meanwhile, Barrett told the Journal that the employees’ side has “refused to engage, refused to negotiate,” despite Bet Tzedek management offering three different proposals regarding employees’ health care premiums.

“I remain stubbornly hopeful that we will be able to get down to business at the bargaining table and see if there is a solution that we can all live with,” she said.

Let’s be Brazil

I have outrage envy.

For nearly two weeks, more than a million citizens across Brazil have taken to the streets to protest political corruption, economic injustice, poor health care, inadequate schools, lousy mass transit, a crumbling infrastructure and — yes, “>massive demonstrations have “>income inequality, ranking 121st out of 133 countries.  But the U.S. ranks 80th, just below Sri Lanka, Mauritania and Nicaragua.

Wealth distribution.  There are only six countries in the world whose “>growth in student achievement in math, reading and science in Brazil is 4 percent of a standard deviation.  But U.S. educational achievement is growing at less than half that rate: 1.6 percent, just below Iran.

Corruption.  Brazil ranks 121 in “>U.S. ranks 25th – below most other advanced industrial countries and even behind some developing nations, like Oman and Barbados.

Health care.  Brazil’s health care system ranks 125th out of 190 countries.  But the U.S., jingoistic rhetoric notwithstanding, is only 38th.  Among our peer nations – wealthy democracies – “>least progressive in the industrial world.  The most massive transfer of wealth in history, plus a cult of fiscal austerity, is destroying our middle class.  Tuition is increasingly unaffordable, and retirement is increasingly unavailable. The banks that stole trillions of dollars of Americans’ worth have not only gone unpunished; they’re still at it.

For a moment, it looked like the Occupy movement might change some of that.  It’s striking how closely the complaints within Brazil about their protesters are already tracking the criticism of Occupy made in the U.S.:  The only thing keeping them going is the police’s overreaction.  They have too many demands.  Their demands are “>They’re violent. They’re vandals, delinquents, drunks, druggies, terrorists. 

Here at home, those charges, and the advent of cold weather, proved fatal.  So oligarchs rock, plutocrats roll and Occupy rolled over.  Today, with both political parties hooked on special interest money, with demagogues given veto power and media power, hope feels naïve.  You’d have to have just fallen off the turnip truck to look at our corrupt and dysfunctional government and believe that we are the change we’ve been waiting for.

That learned helplessness is what democracy’s vampires drink.  Wouldn’t it be sweet if Brazil’s protest movement turned out to be the garlic we’ve been waiting for?

Marty Kaplan is the “>USC Annenberg School for Communication and Journalism.  Reach him at

Dental care for all

Navah Paskowitz knows that her 4-year-old son, Edwin, is long overdue for a dental checkup, but she’s terrified to take him for one.

About eight months ago, the Sherman Oaks resident and her husband took Edwin, who was diagnosed with autism, to his first visit with a dentist. As soon as they walked in the door, the boy started screaming. 

“There was normal play going on in the waiting room, and just from the sounds of being inside a closed environment with children, he basically flipped out,” recalled Paskowitz, a member of Temple Beth Hillel in Valley Village. “We were completely mortified. We didn’t know what to do. … It was such a traumatic experience that we literally aborted mission, and we left.”

Her experience is not uncommon among parents of children with autism. Because these children often have difficulty processing sensory information, the bright lights and unfamiliar sounds and activity in a dentist’s office can send them into a panic. 

For many parents, the only way to get their child’s teeth checked is to physically hold them down in the dentist’s chair or have them put under general anesthesia. Others may forgo dental visits altogether, putting their child’s health at risk.

To help address the problem, researchers at the University of Southern California (USC) and Children’s Hospital Los Angeles (CHLA) are conducting a pilot study in collaboration with Beit Issie Shapiro, which describes itself as Israel’s leading organization for people with disabilities. The research, funded by a $531,000 grant from the National Institutes of Health, is examining whether a type of multisensory therapy brought to Israel by Beit Issie Shapiro to treat children with developmental disorders and special needs can be effectively used to make dental visits less stressful for autistic children. 

The therapy, known as Snoezelen, involves creating an environment that is both calming and stimulating to the senses. It includes the use of soft lighting, gentle music, enticing smells, cozy fabrics and visual displays such as moving pictures on the ceiling and transparent tubes filled with bubbles that children can touch. In the dentist’s chair, the child is wrapped in a weighted butterfly vest designed to duplicate the feel of being hugged by someone. 

The researchers are working with 40 children — half diagnosed with autism and half not diagnosed with the developmental disorder — to assess their behavioral response to the therapy during dental cleanings. Sharon Cermak, the study’s principle investigator and a professor of occupational science at USC, said her team expects to complete the cleanings by June and then begin analyzing the results. Depending on the findings, the research could eventually lead to changes in how dental care is provided to autistic children, and possibly other children as well, Cermak indicated.

“Our hope is that the sensory-adapted environment will make it easier for children with autism to get their teeth cleaned,” Cermak said. “Our larger hope is that we will then be able to involve more dental clinics and use this as a model to revolutionize pediatric dentistry.”

Beit Issie Shapiro has used Snoezelen therapy in nondental settings for years in Israel as a way to treat children and adults with a variety of problems, including developmental disabilities, cancer, Alzheimer’s disease and post-traumatic stress disorder. There are now hundreds of Snoezelen therapy centers in the country. 

Michele Shapiro, the occupational therapist with Beit Issie Shapiro who brought the therapy to Israel and expanded its use there, began applying it to dental care several years ago, but her research did not include autistic children. The study at USC aims to bridge that gap. 

Shapiro and the head of Beit Issie Shapiro’s sensory dental clinic, Dr. Anat Baniel, will travel to Los Angeles in May to assist with the study. The organization’s executive director, Jean Judes, said she is thrilled about the research happening in California. She said such studies are critical to achieving more widespread acceptance of new therapy ideas that improve the lives of people with special needs. 

“Beit Issie Shapiro is very innovative in its approach. That’s really the core of us as an organization,” she said. “We feel proud that such a wonderful university decided they wanted to replicate this with our consultation. … This could have global implications.” 

Dental care is not the only area of collaboration between Beit Issie Shapiro and southern California institutions. The nonprofit is involved in three other research initiatives at at CHLA concerning children with chronic illnesses and special needs, and the development of a movement program at the John Tracy Clinic, an L.A. nonprofit serving young children with hearing loss.

Ernest Katz, director of behavioral sciences at Children’s Hospital and professor of clinical pediatrics and psychology at USC, is involved in one of the research projects that is using methods developed by Beit Issie Shapiro to provide better care for children under age 5 who suffer from cancer and blood diseases. Katz said the kinds of therapies provided to children with disabilities can also be used to help chronically ill children. 

“This local collaboration that we have with Beit Issie Shapiro [is] to the benefit not only of the children of Israel, but to the benefit of the children of Los Angeles and the Southern California community,” he said.  

Experts from Los Angeles, including Katz, have traveled to Israel to learn about Beit Issie Shapiro’s practices and facilities, and to share expertise. Last December, 10 such experts joined officials from Beit Issie Shapiro in Jerusalem to present research findings at the third International Conference on Pediatric Chronic Diseases, Disability and Human Development. 

He said he has also been inspired by visits to Beit Issie Shapiro to look for ways of bringing different kinds of services at CHLA together — such as hydrotherapy, physical therapy, physiological support and nutrition planning — so children and families can get the help they need in one place.

The Israeli organization also has hosted groups of visitors with disabilities from Los Angeles, including a mission last summer sponsored by The Jewish Federation of Greater Los Angeles. The Federation also helps support the nonprofit’s efforts in a joint project with Israel Elwyn to help people with disabilities in Israel advocate for themselves. 

“We look at ourselves as an organization for social change and betterment of society and not just providing services to people with disabilities,” concluded Benjy Maor, Beit Issie Shapiro’s director of international resource development. 

Senior service providers wary as New Year approaches

They’ve weathered five years of economic crisis, relentless state budget cuts and growing demand for their services. Now, social service providers for seniors in the Los Angeles area are bracing for a new slew of challenges in 2013.

From federal budget negotiations and the looming “fiscal cliff” to state-level pilot reforms of Medicaid — known in California as Medi-Cal — these are uncertain times for seniors, their caregivers and the agencies that help them. 

“We’re not really sure how it’s going to play out,” said Paul Castro, CEO of Jewish Family Service of Los Angeles (JFS). “We try as best we can to anticipate and plan, but it’s a very uncertain environment and there’s so many parts to it.” 

At the top of most agencies’ watch list is the “fiscal cliff,” the dramatic concoction of federal spending cuts and tax hikes slated to take effect Jan. 2, unless Congress agrees on an alternative. Programs in line for automatic cutbacks include nutrition services for the elderly, funding for in-home care providers, low-income heating assistance, and social and legal support for the vulnerable. The sum of these reductions — $55 billion for all nondefense spending — could have devastating consequences for millions of older Americans, providers fear.

In Los Angeles, JFS says federal cutbacks, if they go ahead, would hamper the agency’s ability to help seniors, particularly those living in poverty. The organization receives federal dollars for numerous programs, including in-home nursing care for the sick and frail; community dining and home-delivered meals; and free transportation services for seniors who need help going to medical appointments, meal sites and elsewhere.

Of those, nutrition services are the most critical for low-income seniors, many of whom rely on the agency for their meals, JFS public policy director Nancy Volpert said. If automatic cuts go into effect, the agency will be unable to feed 83 seniors out of the 1,040 it serves daily. 

“If someone loses food, that is an existential problem,” Volpert said. 

Barbra McLendon, public policy director for the California Southland chapter of the Alzheimer’s Association, said state budget cuts over the past few years have already caused programs to shrink and sometimes even shut down, including adult day care facilities for people with dementia. 

“There’s no more fat to be cut,” she said. “They would be cutting into direct services that people depend on.”

Still, McLendon and JFS officials said they remain optimistic Congress will strike a deal before Jan. 2. They also pointed to positive news at the state level. Voters’ approval in November of Proposition 30, which cleared the way for temporary tax increases, should prevent more funding cuts for senior services in the state budget, they said.

Assemblyman Bob Blumenfield (D-Van Nuys) agreed the budgetary outlook for the state has improved with the passage of Proposition 30. Nevertheless, ongoing shakeups of health-related programs affecting seniors, including a new effort aimed at keeping ailing elderly people in their homes, will need to be monitored closely, he said. 

And if big cuts kick in on the federal level, the system could come tumbling down.

“If the feds take us over the cliff, that could cost us $5 [billion] or $6 billion, and we’re back to the drawing board,” Blumenfield said.

Even if federal lawmakers stave off an immediate fiscal catastrophe, the long-term outlook for programs critical to seniors — including Medicare, Medicaid and Social Security — remains shaky. With the nation facing an unwieldy $1 trillion deficit, large social programs are a conspicuous target. 

Republicans, who control the House of Representatives, have already proposed smaller annual increases in Social Security payments, capping Medicaid spending and raising the Medicare eligibility age from 65 to 67, or turning it into a voucher program.

Jim Specht, spokesman for U.S. Rep. Jerry Lewis (R-Redlands), said the congressman believes reforms to Medicare and Social Security are necessary to avoid the programs’ financial collapse in the future.

“Both the entitlement programs, particularly Medicare, are on a course now to run out of money over the next 10 years or so,” Specht said. “Mr. Lewis believes you cannot just allow that kind of a fiscal problem … to continue.”

The fiscal cliff, and the automatic cuts it would imply, pose a greater threat to current seniors than proposed entitlement reforms, Specht said. Changes to Medicare and Social Security supported by Lewis would not affect people now over 55. For younger people nearing retirement age, reforms would be phased in, he said.

Lewis “is not interested in reducing any benefits for current seniors,” Specht said.

Still, U.S. Rep. Henry A. Waxman (D-Beverly Hills) said,“Seniors ought to be worried and aware of proposals that have been put on the table. I’m hoping that President Obama will be able to push back hard enough not to get them into law.”

Meanwhile, Los Angeles senior service providers said they are uneasy over another critical issue dependent on action by Congress: reauthorization of the Older Americans Act. The almost 50-year-old legislation authorizes federal funding for a wide range of senior services, including Meals on Wheels and home-based care programs, which is funneled through the Administration on Aging to state and local entities. It was due for renewal in 2011 but remains in limbo.

“It should have been done months ago. It has been introduced, but it’s just not going anywhere, which is a problem,” Volpert said. 

Failure to renew the act means agencies that receive federal funds to help seniors are not sure how to plan for their future, McLendon said. 

In California, another development is adding to the cloud of uncertainty, although there is hope it could bring about positive change. The state is one of 15 across the country participating in a federal pilot project that aims to shift so-called “dual eligibles” — people who qualify for both Medicare and Medicaid — into managed care. Officials say the change will reduce costs while providing beneficiaries with better-quality care.

Los Angeles is among five counties setting up the plan, which affects some of the poorest and sickest Californians, most of them elderly. About a third of the state’s 1.1 million dual eligibles live in L.A. County. Under the project, expected to start some time next year, local health plans L.A. Care and Health Net would be in charge of financing and delivering both medical and social services to dual-eligible patients. Currently, individual providers, such as JFS, are compensated directly by the government based on the number of services they provide.

Castro said JFS and other organizations in Los Angeles that run programs for seniors are anxious to ensure the transition doesn’t wipe away the current infrastructure and leave the elderly without access to services they’ve depended on for years.

It’s “a dramatic change in the service landscape,” he said. “The question is how much money will the state fund the health plans to do this kind of work, and how much will the plans be willing to spend on these clients, particularly those who are most fragile and imply the most cost?” 

Blumenfield echoed those concerns.

“We’ve really got to watch the implementation and make sure it helps seniors and doesn’t harm them,” he said. “The devil is in the details.” 

On the issues: Obama and Romney on abortion, Iran, Israel and more

JTA reviews the positions of presidential candidates Barack Obama, the Democratic incumbent, and Republican challenger Mitt Romney on some issues of importance to the Jewish community.



Obama says he is “committed to protecting a woman’s right to choose” and has suggested that the Supreme Court decision affirming abortion rights — Roe v. Wade — is “probably hanging in the balance” this election. Obama has opposed efforts to de-fund Planned Parenthood, citing its work as a provider of women’s health care services.


The Republican nominee vows to be “a pro-life president” and has repudiated his previous backing for abortion rights, though he supports allowing abortion in instances of rape, incest and danger to the health or life of the mother. He wants the Supreme Court to overturn Roe v. Wade, thus allowing states to set their own abortion laws.

Romney has said that there is “no legislation with regards to abortion that I'm familiar with that would become part of my agenda.” He has said that he would support a constitutional amendment that defines life as beginning at conception. He advocates ending federal funding of Planned Parenthood, citing its role as an abortion provider.



The president says that the 2010 Patient Protection and Affordable Care Act — often referred to as “Obamacare” — is a historic advance. The law aims to make coverage universal by offering federal subsidies for many insurance buyers, expanding Medicaid eligibility for low-income families, setting up health insurance exchanges to offer choices and mandating that everyone has insurance or be subject to a penalty. It bans discrimination on the basis of preexisting conditions and prohibits lifetime caps on coverage.

On Medicare, the president touts the health reform law’s provisions that he says help close the “doughnut hole” in the program’s prescription drug benefit and achieve an estimated $716 billion in future Medicare cost savings.

He opposes what he characterizes as Romney’s plan to turn Medicare into a “voucher” program, arguing that it would be costly for seniors. The Obama campaign says that the Republican nominee’s proposed cap on federal Medicaid spending growth amounts to a dramatic cutting of the budget for the federal-state program that provides health coverage to the needy.

Obama touts the health care reform law’s requirement that insurers cover contraception.


The Republican nominee promises to work immediately to repeal the health care reform law. He says that individual states should have the ability to craft their own approaches to health care. He says he wants to promote greater competition in the health care system and give consumers more choices.

Romney proposes transforming Medicare into what he calls a “premium support system.” Under the system, seniors would receive a defined contribution amount from the government that could be applied toward an array of private insurance options that Romney says would have to be comparable to what Medicare offers, as well as a traditional government-provided Medicare option that would compete with the private plans. If a plan’s premium exceeds the government’s contribution, seniors who choose such a plan would pay the difference. He promises Medicare would remain unchanged for current beneficiaries and those now nearing retirement age.

He accuses the president of cutting $716 billion from Medicare in order to pay for the other provisions of the health reform law.

Romney has called for transforming Medicaid into a program in which the federal government gives block grants to the states and allows them greater flexibility to define eligibility and benefits. He would place a strict cap on the annual rate of increase in the federal government’s contribution to Medicaid, limiting it to 1 percent above inflation.



The president has said that it is “unacceptable” for Iran to have a nuclear weapon and the United States is “going to take all options necessary to make sure they don’t have a nuclear weapon.” He has ruled out the possibility of simply containing a nuclear-armed Iran.

Obama says his administration has “organized the strongest coalition and the strongest sanctions against Iran in history,” noting the damage that has been done to the Iranian economy.

He said that in any negotiated deal, the Iranians would have to “convince the international community they are not pursuing a nuclear program,” and that there should be “very intrusive inspections.” Obama said Iran would not be allowed to “perpetually engage in negotiations that lead nowhere.”

He accuses Romney of having “often talked as if we should take premature military action.”


The Republican nominee calls a nuclear Iran “the greatest threat the world faces, the greatest national security threat.” He says that Iran must be prevented from getting “a nuclear weapons capability.”

Romney says he supports the further tightening of sanctions against Iran and accuses the Obama administration of not moving aggressively enough on this front.

Romney’s running mate, Wisconsin Rep. Paul Ryan, says the Obama administration has failed to convey to the Iranians that there is a credible threat of U.S. military action. Romney later said “military action is the last resort. It is something one would only, only consider if all of the other avenues had been — had been tried to their full extent.”

Romney said that Iranian President Mahmoud Ahmadinejad should be indicted for incitement to genocide over his verbal attacks on Israel’s existence.



The president points to what he calls his administration’s “unprecedented” commitment to Israel’s security, citing the growth in U.S. security assistance and funding for the Iron Dome system to intercept rockets from Gaza. He has promised to do “what it takes to preserve Israel’s qualitative military edge — because Israel must always have the ability to defend itself, by itself, against any threat.”

He has pledged to pursue a two-state solution to the Israeli-Palestinian conflict, saying that “a lasting peace will involve two states for two peoples: Israel as a Jewish state and the homeland for the Jewish people, and the state of Palestine as the homeland for the Palestinian people.” He has called for using the 1967 lines with mutually agreed land swaps as the basis for negotiating the borders between Israel and a Palestinian state.

Obama opposed Palestinian efforts to gain statehood recognition at the United Nations and said the path to a Palestinian state is “negotiations between the parties.” He has demanded that Hamas recognize Israel’s right to exist, renounce violence and abide by past agreements between Israel and the Palestinians.

While the Obama administration has criticized Israeli building in eastern Jerusalem and the West Bank, it also vetoed a U.N. Security Council resolution condemning Israeli settlement activities.


The Republican nominee says Obama “has thrown Israel under the bus” and has tried to create “daylight” between the United States and Israel. He says the “world must never see any daylight between our two nations.” He vows to “never unilaterally create preconditions for peace talks, as President Obama has done.”

At a meeting with donors that was secretly recorded, Romney expressed pessimism about current possibilities for Israeli-Palestinian peace, explaining that the Palestinians don’t want peace. He suggested the best that could be done would be to “kick the ball down the field and hope that ultimately, somehow, something will happen and resolve it.” But in a later speech he promised to “recommit America to the goal of a democratic, prosperous Palestinian state living side by side in peace and security with the Jewish state of Israel.” He says he “will reject any measure that would frustrate direct negotiations between Israel and the Palestinians.”

He has promised to increase military assistance to Israel.



The president said the “constitutional principle of a separation between church and state has served our nation well since our founding — embraced by people of faith and those of no faith at all throughout our history — and it has been paramount in our work.”

Obama says he “expanded the federal government’s faith-based initiative because it is important for government to partner with faith-based organizations,” citing the role they play in delivering social services.

He says he does not support school vouchers, including to religious schools, because they “can drain resources that are needed in public schools.”

Obama says his administration found a way to respect religious freedom while also ensuring that employees of many religious-affiliated institutions have contraception covered by their health insurance. The administration requires a religious-affiliated institution's insurance provider to directly provide such coverage to employees free of charge when the religious institution objects to providing or paying for such coverage itself.


The Republican nominee said “the notion of the separation of church and state has been taken by some well beyond its original meaning. They seek to remove from the public domain any acknowledgment of God.” He said that America’s founders “did not countenance the elimination of religion from the public square.”

Romney says he would allow low-income and special needs students to use federal funds designated for them to enroll in private schools, including in religious schools where permitted by states.

He criticizes the administration’s application of the health care law’s contraception coverage clause to employees of many religious-affiliated institutions, saying that it infringes on religious liberty. He endorsed legislation that would exempt employers from having to cover contraception in their employees’ insurances policies if doing so would contradict an employer’s religious beliefs or moral convictions.

Romney/Ryan and the lullaby of lying

It shouldn’t have taken Todd Akin’s ” target=”_hplink”>method of conception.” 

If the news media hadn’t grown blasé about the Republican war on women, plenty of pre-Akin Americans would have already known that GOP majorities in Congress and state legislatures have repeatedly voted to narrow the definition of “legitimate rape” to “” target=”_hplink”>personhood” to fertilized eggs, which would criminalize birth control pills, IUDs and in vitro fertility procedures.  If cynicism weren’t the default mode of political reporting, we’d now be seeing Mitt Romney’s feet held to the fire of his party’s ” target=”_hplink”>Reince Preibus’ attempt to dissociate the candidate from his platform would be worth more than a chuckle and a yawn from the press corps.

“The Big Lie” is a propaganda technique that kids hear about in school.  If you learn what Nazis and Communists did, if you read Orwell’s “1984,” you’re supposed to be inoculated against pervasive, outrageous falsehoods.  That’s why Jefferson and Franklin counted on public education and public libraries.  It’s also why the First Amendment protects the fourth estate; it shields muckrakers, investigative journalists, critics and gadflies from censorship.

But today the biggest threat to democracy isn’t government intimidation of the press.  It’s boredom – a consequence of the domination of political communication by paid media, the subordination of news to entertainment, the imperative to monetize audience attention, the fear that information and amusement are locked in a zero sum game. 

Mitt Romney and deep pockets like the Koch brothers and Sheldon Adelson have flooded the airwaves with ads claiming that Barack Obama has eliminated the ” target=”_hplink”>Medicare recipients to fund a ” target=”_hplink”>lazy blacks, there’s no news left in the narrative.  Networks fear that audiences will get bored, so they move on.  And yes, there may be some truth to their understanding of their customers.  We’re hooked on novelty, suckers for speed, addled by ADD.  But billionaires don’t get bored.  They keep paying to pound those ads into our heads, whether we like it or not.  Repetition is the demagogue’s best friend. 

No member of Congress is farther to the right than Paul Ryan.  He’s an acolyte of the ideologue ” target=”_hplink”>safety net that has defined the American social contract since the 1930s, but explaining this takes time, which risks audience share, and in the face of a barrage of ads portraying him as the savior of seniors, it takes the kind of persistence that news executives fear hurts ratings.  He is a ” target=”_hplink”>fraudulent, but hey, how ‘bout the six-pack on that dreamboat?

If the media were doing its job in this election, the story it would be telling over and over is that Mitt Romney’s qualification for the presidency consists of a career at Bain Capital about which we know essentially nothing; that his economic plan is the most massive ” target=”_hplink”>financial disclosure rules that have applied to presidential candidates since his father ran; that his ” target=”_hplink”>identical to the Affordable Care Act he promises to repeal; that he has ” target=”_hplink”>suppress voter turnout may well send him to the White House.

But that’s old news.  Been there, done that.  I’ll leave it to others to make the case that the press is giving Obama a free ride.  If that’s true, then there’s been a double dereliction of duty.  News producers are afraid that indefatigable fact checking of either party will bore the pants off people.  But I don’t smell any fear of ennui emanating from station owners making billions off broadcasting the Big Lie.

Marty Kaplan is the ” target=”_hplink”>USC Annenberg School for Communication and Journalism.  Reach him at

Osteopaths changing the face of health care

If you’re like most health consumers, you probably don’t know what osteopaths are, let alone what sort of medicine they practice. However, osteopathic doctors (DOs) and schools of osteopathic medicine are playing a little known but critical role in stemming the nation’s need for primary care doctors, according to experts at Touro University of California’s College of Osteopathic Medicine in the Bay Area city of Vallejo.

“A lot of medical students are shunning away from [primary care],” said Dr. Michael Clearfield, the school’s dean, noting that osteopathic schools traditionally graduate more primary care physicians, of which the nation is facing a critical shortage.

“It’s just going to get worse as the population gets older and more and more boomers are getting to be Medicare age; there are going to unprecedented demands [for primary care],” he said. 

Since salaries are higher for specialists, Clearfield says, more than half of medical schools with MD programs have made specialty care a priority, which makes the primary care field even smaller.

Touro’s top-ranked College of Osteopathic Medicine says it is situated to help shore up the front lines of patient care with more personalized care.

Osteopathic medicine differs from traditional modern medicine in that it focuses “not only on medicinal medications but also looking at the body as a whole and the intrinsic capability of the body to heal itself,” Clearfield said. 

Osteopathic medicine was developed in 1874 by Dr. Andrew Taylor Still, a physician and Civil War surgeon who pioneered the concept of “wellness” and recognized the importance of treating illness within the context of the whole body, according to the American Association of Colleges of Osteopathic Medicine.

In addition to all of the practices available through modern medicine, including prescription medicine and surgery, osteopathic physicians incorporate a practice known as “osteopathic manipulative treatment,” which uses the hands to diagnose, treat and prevent illness or injury.

“We’re using hands along with other skills and senses, looking and listening, palpating the body to help determine the problem and, if necessary, treat them to get a better effect,” Clearfield said.

Osteopathic medical students also receive classroom training in communicating with patients, according to the American Osteopathic Association. Because of this whole-person approach to medicine, approximately 60 percent of all DOs choose to practice in the primary care disciplines of family practice, general internal medicine and pediatrics.

Clearfield believes that Touro’s strong community focus and commitment to the future of health care gets translated to the students and impacts where they choose to work. U.S. News and World Report rated Touro University of California’s College of Osteopathic Medicine as one of the top 10 osteopathic schools in the nation that produces primary care residents.

Part of the Touro College Network, the Vallejo campus also features a kosher campus, Jewish holidays observed and an on-site chaplain. Of the 1,400 students attending Touro University of California, 15 percent are from Southern California.

Although the majority of students and faculty are not Jewish, Clearfield believes that there is a clear connection through the philosophy of Touro’s founder, Bernie Lander.

“He wanted to improve the world through health care and education. He looked at areas where he could do that, by putting an organization that was based on the principles of Orthodox Judaism out in California,” he said.

Osteopaths undergo four years of medical school, complete three years of residency and are fully qualified to practice medicine and perform surgery.

The attraction of the osteopathic approach, Clearfield believes, is that “it is more personalized … a lot of people are turned off by medicine, feeling more like a widget in an assembly line than a partner in their own health care … so many people don’t ask questions to their doctor, don’t know what they’re taking and why.”

Brandon Stauber, a graduate of UCLA and Touro College of Osteopathic Medicine, said he applied to osteopathic medical schools because he found the philosophy attractive. That is also what led him to his current residency at Oregon Health and Science University in Portland, Ore.

“One of the reasons I came here is that Portland is a very open city when it comes to all types of practitioners,” he said. 

A Sacramento native raised with strong Jewish values, Stauber said he was also drawn to the Jewish roots of Touro’s California location.

He currently works alongside MDs and DOs. In contrast to the MDs, he said, “the DOs get a lot of hands-on experience in our training … by the time we get into residency we’re not afraid to touch people.”

However, Clearfield says that a clear bias against osteopaths exists in many medical establishments.

“That’s been a constant barrage for this profession for 120 some years,” he said. “Our graduates have gone to the most prestigious institutions – Harvard, Stanford, you can name it … [yet] there are physicians that are still biased against our profession and are for the most part misinformed.”

Still, the field is growing rapidly, from six osteopathic schools of medicine in the 1970s to 29 today, Clearfield said. Although the nation’s 80,000 osteopathic physicians practicing in the United States represent one-tenth of the number of MDs, they take on a disproportionate amount of primary care, Clearfield said. 

“As a profession we’ve been community based since inception … which allows students to get wider experience,” he said. “Our students are out in doctor’s offices, clinics … we focus on the first encounter.”

Tough slog ahead for implementing affordable care

If Barack Obama is re-elected as president, the overriding purpose of his second term will be the implementation of the Affordable Care Act. Implementation and the use of executive power have not been Obama’s strengths, but he is going to have to get better very quickly. A powerful presidency mixes the “bully pulpit” with a maximum use of the president’s authority, from conception of a policy to its implementation.

It will be a brutal slog, with inevitable battles between the White House and Republican governors, particularly in the South. There will be conflicts with Republicans in Congress over funding. The rhetoric will be heated. Republicans will say that Democrats want to impose a tyrannical socialism; Democrats will say that Republicans don’t care whether vulnerable Americans die.

But the health care battle is more than just a means to provide insurance to a large number of Americans; it is also a metaphor for the role of government in the midst of very hard times for the public sector. The private sector is slowly but steadily recovering from the recession (the root of the president’s unfortunate comment that the private sector is “doing fine”), while the public sector has been rocked by austerity and cutbacks throughout. To alter government’s role in health care would be a big change.

This high-intensity conflict is critical to both parties. To Democrats, health care is the long-missing piece of the social insurance contract that began with Social Security and Medicare. To Republicans, health care represents a historic overreach of government, and they believe its success would become a serious threat to their party’s political survival. Democrats want to add a third piece to their legacy; Republicans want to roll back parts of the first two.

If Obama can sink the roots of the health care law into American life, he will have completed a historic piece of the Democratic Party’s mission. Republicans are fearful that voters will overcome their initial distaste for the law and come to like it. Democrats wonder if the voters will learn to love it.

This health care program will lack the appealing simplicity of Medicare and Social Security, as the proportion of Americans who already have health insurance is far greater than those seniors who had retirement or medical care when those historic programs were enacted. But many Americans have family or friends who are uninsured, or have pre-existing conditions, or whose children have already benefited from the ability to stay on their parents’ policies until age 26. And, notably, the fact that hospitals will want federal aid to pay for the care of the uninsured will help the president win the battle in the states regarding the expansion of Medicaid.

There are two selling points in the president’s favor. One is that except for the mandate to buy insurance, the individual components of the law already are popular. But the other is that the overall plan is built on a moral philosophy that has yet to be stated clearly: No American should be without the umbrella of health care because he or she does not have enough money, or the right job, or live in the right place.

For too long, the president has argued for his policies on the ground that they “make sense.” The most powerful argument is a much deeper one, that the policy is right. If the president can make that case, and if the voters agree, the path to implementation and enduring change will be brightly lit.

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

Letters to the Editor: Israel, health care, education

The Promised Land: To Whom Was It Promised?

David Suissa compellingly observes that the principal motivator of anti-Israel sentiment is the charge of “occupier” (“Note to Boycotters: Israel Is Not a Thief,” July 6). But then he quotes me as refuting that charge, by way of showing that the West Bank was not legally anyone else’s when Israel captured it. I am not sure to what end I may have written that point, in a paper nearly 10 years old, but it hardly refutes the complaint that drives most non-radical criticism of Israel, to wit: that Israel occupies the people of the West Bank, whatever its claims to the land itself.

In that context, it is self-defeating to trumpet Israel’s territorial rights beyond the 1949 lines. Such talk only lends support to the devastating suspicion that Israelis would gladly rule a piece of land without extending full political rights to all its residents. There are, of course, ways to challenge that suspicion — and doing so is Israel’s only hope of reclaiming legitimacy in the West — but “It was ours all along!” isn’t one of them.

Jeffrey S. Helmreich
Boston, Mass.

David Suissa is correct. There is no country in the world that has to perpetually justify its existence. And Alice Walker’s blanket assessment that Israel is an apartheid state is not only based on abject ignorance but is racist in and of itself.

Alyse Golden Berkley
via e-mail

David Suissa’s claim that Israel has legal rights to the West Bank and the Gaza Strip is based on a selective reading of history.

Suissa misquotes the League of Nations mandate that calls for a “national home for the Jewish people,” but not, as he implies, Jewish authority over the land. And that document goes on to explicitly protect the Palestinian people, saying, “[I]t being clearly understood that nothing should be done which might prejudice the civil and religious rights of existing non-Jewish communities in Palestine.”

Actually, the Israeli Declaration of Independence cites a later legal document, namely U.N. General Assembly Resolution 181, which partitions Palestine into a Jewish and an Arab state. It is quite obvious that if Israel owns all the land, there is no room for a Palestinian (Arab) state, so Israel cannot own all the land.

Suissa and other Zionists may believe that Israel owns all the land, but no one else in the world does. Even Israel’s strongest supporter, the United States, does not accept that notion.

Jeff Warner
La Habra Heights

David Suissa responds:

The critics overlooked my key point: If Israel doesn’t reaffirm its legal claims to Judea and Samaria, its land concessions have no value, and there is nothing to negotiate. That’s one reason peace talks keep failing.

Socialized Medicine an Imperfect System

In arguing for socialized medicine, Rabbi Elliot Dorff acknowledges that in Canada, Western European countries and Israel, waiting months for care can be a problem, although he states that this is only for non-emergency procedures such as hip replacements (“Health Care for All: It’s an American — and a Jewish — Imperative,” July 6).

Perhaps Rabbi Dorff does not know or remember the case of Danny Williams, the premier of Newfoundland and Labrador who in 2010 came to the United States for heart surgery rather than wait the months that it would take in Canada. Williams decided to “choose life” and use his own funds to come here for his heart surgery. Canadians understand that they have a two-tier medical system, one for those who have their own funds (that is called the U.S. system) and the other for everyone else, who get to wait and hope they survive until their turn comes up.

There is no doubt that the U.S. health care delivery system needs to be improved, but increasing demand for services without similarly increasing the capacity to deliver those services (i.e., more doctors and other health care providers) must inevitably lead to long lines and two-tier systems, together with the heart-rending choices of who is to get what services in an increasingly scarce medical environment. Logic and the actual experience of other countries dictate this result.

We should not, however, delude ourselves into thinking that the problems experienced in those countries with socialized medicine either don’t exist or won’t happen here.

Avi Peretz
Via e-mail

Freedom to Read

Thank you for a lovely and comprehensive article on this summer’s Freedom School at Stephen S. Wise Temple (“ ‘Freedom School’ Keeps Reading Alive Through Summer,” July 6). My family and I have been members of Stephen S. Wise since its beginning, and we are thrilled and proud of all our shul has accomplished.

Here at the Ella Fitzgerald Charitable Foundation, we were so impressed by this program that we donated more than 200 brand-new books for the Freedom School children — now each student will be able to start a home library. Miss Fitzgerald, the beloved “First Lady of Song,” established her foundation in 1993 in order to help children and families make better lives for themselves. Freedom School certainly fits that criteria. 

Fran Morris Rosman
Executive Director
The Ella Fitzgerald Charitable Foundation