Rabbi / Obama Health Care Conference Call

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Yesterday morning I was one of 1,000 Rabbis listening in on a conference call with President Obama on the hot button issue of heath care reform. The call was organized by coalition of Conservative, Reform, and Reconstructionist organizatoins including
The Central Conference of American Rabbis, Union for Reform Judaism, Rabbinical Assembly, Reconstructionist Rabbinical Association, and coordinated by the Religious Action Center of Reform Judaism.

Technically speaking I'm not sure I'm "supposed" to write about the call. The intent of the call was less informative on Obama's position, but more for the Rabbis to explore how to address the health care controversy in their upcoming High Holiday sermons. (In a nice move by Obama's handler's he began his health care discussion by referencing unetaneh tokef). Nevertheless there were point which I took away from the call that I feel are worth sharing with the public at large.

Despite the primary focus of the call being health care, Obama introduced his remarks by reiterating his support for Israel, its security, and its democracy. He then reiterated his push for a two-state solution, which he said was in Israel's best interest. This of course is Obama's publicly stated opinion, though I'm always confused when one follows praising a democracy with an assumption that he knows what's better for the people.

  1. Obama is using religious organizations to promote policy - The role of religion in advocating political policy is an area in which I am both interested and concerned. For example the religious Christian right condemns abortion and gay marriage, and effectively interject their religious beliefs into the political public square. On the other hand, Liberal religious groups use their own interpretation of their respective faiths to promote certain social agendas as well. As I understood the intent of the call, the point for Obama was to have community leaders sympathetic to his agenda correct "misinformation" about his health care plan or the larger need for health care reform, in particular for use in their High Holiday sermons. (One Rabbi even asked, "if the President were to address my congretation on the holiest day, what would he say?") To be sure, most of the Rabbis on the call probably would advocate for substantial health care reform anyway, and I do not know to what extent the President sought out religious leaders or the religious leaders proposed the audience with the President. In either case, I find the blurring of church and state to be disconcerting not only on political grounds (and legal/tax purposes), but also for competency. Rabbis have enough difficulty understanding the nuances and intricacies of their own religion to be promoting specific policies in areas for which they have no expertise.

  2. The "public option" isn't dead - One of the misconceptions Obama sought to clear up was the idea that he was interested in a government takeover of health care, but providing a marketplace for health care. Though he did not explicitly endorse or push for a public option, he did include it as an option for increasing competition in the marketplace.

  3. Obama's approach to insurance is fundamentally flawed - This requires some explanation. One of Obama's positions, stated repeatedly, is that he wants a system where people are not discriminated against for having pre-existing conditions. If he's truly advocating a marketplace for insurance, this is simply an untenable position. The point of insurance is risk management where one pays a certain amount of money to avoid incurring a financial disaster in the future. Insurance companies, responsible for paying out policies, profit through the pooling of risk i.e the individuals with limited risk pay premiums to cover those with higher risks of the company having to pay. If there is no discrimination for pre-existing conditions, the principle of calculating appropriate risks is eliminated since every participant would be treated as an equal. Worse, if there is no disadvantage to pre-existing conditions, then there is no incentive for the individual to purchase insurance until after the health problem materializes. At that point there is no risk from the purchaser because he knows he needs treatment, but the insurer is forced to burden the entirety of the costs. Based on Obama's position on pre-existing conditions, I'm forced to conclude that either he really is advocating a government controlled health care (or at least mandating individuals purchasing health care), or he simply doesn't understand how insurance works.

  4. Stories trumping substance - Not so much of a hiddush here, but the strategy seems to be to use anecdotal evidence of people harmed (or not hepled) by the system to demonstrate its flaws. It's an effective rhetorical tool and an appeal to our emotions, but the reality is in any large scope system, some will inevitably be left behind.

  5. Medicare is a "wild card" in the debate - By this I mean Medicare has been employed in the discussion as both a positive and negative, often in the same argument. One of my favorites - and here I fully empathize with Obama - are the seniors who protest government involvement in health care while adamantly insisting that their Medicare not be touched. On the other hand Obama used Medicare as an example of governement successfully running a health care initiative with lower costs. However, despite taking up nearly 13% of our Federal Budget, Obama claimed that Medicare will run out of money in 8 years.

Personally I found the entire experience to be enlightening in many ways - I don't even have time to discuss the "text study" which followed Obama (fascinating on many other levels but you're free to pursue them here). I'm not sure how or if I will include any of the above into a High Holiday sermon (though I did discuss my take before my prayer class), but I will state briefly that Obama is absolutely right that not only do we need an intelligent civil debate on the issues but that we need to remember that our ultimate concern must always be the overall well-being of our fellow Americans.

Clarification: I've received several comments asking what was the response of the listeners to some of Obama's statements. The call was "listen-only" and we were all on mute except for the select people who were honored with asking Obama the questions. There were only two questions asked, both of which were selected beforehand. There was no opportunity to speak to the president directly.


RJY, thanks for this - interesting. With regard to stories vs substance, true that any system has flaws, but please realize that the American (cobbled-together, jerry-rigged) system is notably inferior to many others in care delivery, cost control, and insurance. See the report by the Commonwealth Foundation comparing various countries' systems; happy to provide the link if you like. A gutn khoydesh, a gut yor & greetings from Baltimore.
Zack B.

Dr. Berger - I'm sure I can find anecdotal evidence of people getting screwed by national options. At some point I hope to write about health care in greater detail.

And if you're in Baltimore, stop by my father's shul downtown.

Rabbi Yuter,

I'm curious why the President is quoting scripture "I am my brother's keeper" and then trys to push a system where the government becomes my brother's keeper?

To me in seems that if the government takes money out of some individual's pocket to pay for someone elses health care that the compassion the first person would have for the second individual disappears. Why help someone if the government will do it?

I feel uncomfortable that the government is trying to insert intself between my GOD and myself. Why trust in and praise GOD during trying times if the goverment will supply?

One thing I find annoying about Obama's rhetoric re: uninsured, preexising conditions is that he ignores the ways those people currently do get health care. So instead of expanding or improving the systems we already have in place, he sets up a false dichotomy between no health care and a government takeover.

I can see why you said what you did about charging different amounts to different risks, but actually community rating began as the norm. Risk rating is not intrinsic to the economic purpose of insurance and only came about as a result of competition in the early insurance industry as competitors poached away Blue Cross's healthy patients in the 1930s, causing a community rating death spiral. States such as New York already mandate pure community rating in health insurance, and states such as Massachusetts have something similar for auto insurance, and their markets work just fine.

Insurance markets only work if the low-risk subsidize the high-risk disproportionately. This subsidization happens either directly through higher premiums or indirectly by using government as the insurer of last resort (see for instance Kathy Swartz's book Reinsuring Health), but either way a small group of people at high risk of expensive diseases simply can't cover their own costs.

Why does Obama feel God needs a partner? Does he really believe he is equal to God? Did anyone question this statement or just let it slide? If it was left to slide without question, could that be seen as Obama's sly way of making you equal to God in this statement?

I have a big concern with the leader of the free world, promoting to the point of enforcing by new unconstitutional laws, less freedom on the people.
Peace be with you,

Donna - I don't know Obama's intent or what he personally believes, it's possible he was just tailoring his rhetoric to his audience.

If we do take it seriously, a good question to ask what the difference is for Obama to think he's God's partner and Bush saying that ">God told him to invade Iraq.

The "good question" is easily answered, Rabbi. One individual believes he is the servant of God, the other believes he is God's equal.

Donna and Dean:

It's standard Jewish rhetoric to describe humanity as "God's partner" in creating and improving the world.

I have a problem with anything he says,after being in a church with Rev.Wright for 20 plus years and NEVER hearing any of his jew hatefull beliefs, and NOW wanting our Rabbi's to help him!

I am sure that Obama understands how insurance works. As an insurance professional, the health care discussion grated on me until I realized that people use the term "health insurance" to refer to "health care expense coverage." It's a usage that has made its way into common parlance, even though, as you point out, it's technically incorrect.

Health Policy PhD beat me to explaining why your #3 is wrong. There are many ways to make private insurance markets work without discriminating on the basis of preexisting conditions, for example the risk equalization pools used in the Dutch, German and Swiss systems, which all are based on competitive private insurance markets. Your concern that people will not purchase insurance is addressed, in the current bills, by a mandate.

Also, I'm mystified by Sarah Brodsky's comment: none of the bills being considers propose a "government takeover" of health care, and all propose "expanding or improving the systems we already have in place" by reforming the insurance markets and medicare/medicaid. The House bill include a public insurance plan only as an option, not a requirement.

Government can set the cost to join the private option below market rates, crowding out all private plans. I.e. a takeover.

In fact, if costs were set at or above market rates, no one would want the option because it would be an obviously bad deal. That is assuming quality at least stays constant--which is doubtful, given the bureaucracy and mismanagement in every other endeavor the federal government gets involved with.

And I was talking about the uninsured, who are not covered by insurance or Medicare. Insurance and Medicare are not the systems that help the uninsured, because by definition the uninsured are not covered by them. There are other ways they get health care and Obama is not focusing on them.

In reply to Sarah Brodsky:
Even the proposed House bill, which includes a public plan, requires that it it be an unsubsidized, self-sustaining plan after start-up costs, whose rates will be set in the market, not by government fiat. As envisioned, it can't offer services below cost. The Blue Dogs insisted on this. The logic of the public plan, as proposed, is that it will have different incentives than private insurers, leading to lower costs, not that it will achieve lower costs by subsidy.

As for the uninsured, no proposed bill attempts to cover them exclusively through a public plan: they do so by a combination of expanding medicaid, insurance market reform (perhaps including the option of a public plan into that market under the House bill), and through subsidies for the purchase of insurance, whether private or (in the case of the House bill) public.

All of this can be verified by reading the relevant sections of the proposed bills.

So, contrary to your repeated assertions, Obama and Congress are focusing on "other ways to get health care", not on a government "takeover".

Church leaders have remained SILENT for too long.

The call to care for one another is clearly outlined in the OT; simply read the Book of Amos,rabbi, if you want confirmation of what is required and the consequences of inaction!

Justice rolling down like a river means social justice on the issues of healthcare, poverty, equitable use of our resources, and more... Rectifying inequities is the main job of the church; who will listen to you if you tolerate evil?

The Christian churches are (finally) stepping up to the plate to say, "yes, we have a responsibility to those in need." It has taken them forever and a day to do so.

But, where are the rabbis? Your silence is duly noted. As is that from the other major religions.

"I the Lord hate and despise your religious celebrations and your times of worship. I won't accept your offerings or animal sacrifices--not event your very best. No more of your noisy songs!
I won't listen when you play your harps. But let JUSTICE and FAIRNESS flow like a RIVER that NEVER RUNS DRY." (Amos 5:21)

There is no other option than obedience to God's desire for us to care for the widow, the poor, and the sick.

“Not so much of a hiddush here, but the stragegy seems to be to use anecdotal evidence”


You didn't study Obama's plan well enough - or he neglected to inform you of some impoirtant detail. He wants an individual manadate. Everybody would be forced to buy insurance.

That's how he takes care of the end to discrimination on the basis of pre-existing conditions.

Dear Rabbi Yuter,

I wanted to let you know I referenced your blog on the conference call in my article that will be published tomorrow, entitled, "Obama gets Religion." I was particularly impressed with your analysis of his naive approach to pre-existing conditions (your point 3).

I thought it was interesting that Obama prefaced his remarks by mentioning his supposed support for Israel. I remember him doing something like that when he spoke to a group of Jews here in Florida and pledged that Jeruslaem would always belong solely to Israel. The next day he spoke to CAIR and told them that Jerusalem would be divided between Jews and Muslims. Does he really think that we are too stupid to put his conflicting statements side by side?

By the way, Conservative Truth truly suppports Israel, simply because the Bible tells us that we should - not for any political reasons.

Shalom, be blessed.

Tom Barrett

"Insurance markets only work if the low-risk subsidize the high-risk disproportionately. This subsidization happens either directly through higher premiums or indirectly by using government as the insurer of last resort (see for instance Kathy Swartz's book Reinsuring Health), but either way a small group of people at high risk of expensive diseases simply can't cover their own costs. " I'm not sure where you learned about insurance, but having low risk subsidize high risk is not 'insurance', it is cost sharing. A small group of people at high risk of expensive diseases can pay for as much as they can afford. Society has a limited amt of resources and can't pay as much as is necessary to keep a limited group of people well. I think Obama has megalomaniacal tendencies, but I do agree with him that under a nationalized health care plan like he is talking about, the government will and should end up rationing care. Having said that, I don't think that the government should be God in the health care debate. Also, I think that saying that Obama's plan is 'reform' is giving him too much credit. it is more like 'change' than reform. Reform suggests improvement, he is going to change health care delivery but almost definitely will not be improving it.

for Health Policy PhD - would you share insurance with a small group of home owners, 9 normal home owners and one pyromaniac?

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