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Kol Nidre - 2009 / 5770

09/10/2009 09:21:34 PM


Rabbi Carey Brown

Who shall live and who shall die?

It is a remarkable question – Who shall live and who shall die – mi yichyeh u’mi yamut? The haunting words of the unetaneh tokef from our High Holiday liturgy call to mind the fragility of our lives and the awesome nature of the balance of life and death.   For who is it that makes such a determination: Who shall live and who shall die? According to a traditional understanding, it is, of course, God who decides  our fate.  We simultaneously shudder at and take comfort in the idea that such life and death decisions are in the hands of Heaven.

Yet, in many situations, the answer to that question – who shall live and who shall die? – is beyond the realm of the Eternal. Ultimately, there are countless other factors that have an impact on that fate. 

Who shall live and who shall die?

Consider that a woman in Niger has a one-in-seven chance of dying during pregnancy or childbirth, while the rate in developed countries is approximately one-in-eight thousand.[i] Or that in a 2001 study of life expectancy rates in the United States, the discrepancies among people of varied geographical, ethnic, and socio-economic levels were so vast that there are places in our country where “millions of adults face a risk of premature death like that in parts of the developing world.” For example, in Montgomery County, MD – suburban Baltimore – the life expectancy rate is 81.3 years, but the rate in Baltimore city is only 68.6 years.[ii]  Often, it is the accident of birthplace that determines the lifespan of an individual.

Who shall live and who shall die ?

When a physician saves a life by diagnosing an obscure condition or when a patient’s life is shortened because of a misdiagnosis, we take note of the remarkable impact a doctor can have on determining a person’s lifespan.  Rabbi Abraham Joshua Heschel, one of the great Jewish thinkers of the 20th century, once said of doctors, “The doctor is God’s partner in the struggle between life and death… Medicine is prayer in the form of a deed … The act of healing is the highest form of imitation of God.”[iii]    

Who shall live and who shall die?

And it is an unfortunate reality of our times that one of the greatest factors in answering that question can be found in the details of a health insurance policy, or more dramatically, with a lack of insurance coverage. In recent months, we as a nation have been consumed in conversation about how to reform a system that has left too many people without access to health care. A September 17th study released from Harvard Medical School says that 45,000 Americans die every year from a lack of coverage.[iv] An estimated 46 million Americans, almost all of whom come from working families, are currently without health insurance.[v]  

I have a colleague in the Los Angeles area, Rabbi Don Goor, who gave a sermon last Rosh Hashanah about health care and asked those in his congregation to raise their hands if they could answer “yes” to the following questions:

At any time within the past 12 months, have you, a member of your family, or someone you know, not had health insurance?
Have you or they ever been denied health insurance?
Has a health insurance company ever denied you or your loved one a needed prescription?
Have you or they faced substantial financial loss and/or debt due to expenses related to health care?
Rabbi Goor was surprised by how many people raised their hands in what was demographically a middle- and upper-middle-class congregation. More surprising to him, however, were the dozens upon dozens of comments he received in the following days from people who were so grateful to know that they were not the only ones struggling with health care coverage and costs. I am not going to ask anyone to raise their hands tonight, but I would venture to guess that most everyone here in our congregation has a personal story of how the health care situation in our country has caused significant stress in their own life or the life of someone they love.

Each Spring I have the honor of taking our 10th grade students on the RAC trip to Washington DC. The RAC – the “Religious Action Center” – is the political office of the Union for Reform Judaism. Their mandate is to be a presence in Washington and lobby on behalf of the Movement, according to the resolutions voted upon by the membership of Reform congregations around the country. The RAC runs a fantastic seminar program for high school students in which teens spend a long weekend learning about Jewish attitudes toward social justice issues. The seminar culminates with a lobbying visit to Capitol Hill with the students presenting their opinions on issues as varied as global AIDS, gun control, or carbon emissions. The trip is one of the highlights of my year as it offers me a wonderful opportunity to spend time with our teens and see them shine as they speak passionately about the issues that matter to them. To say that they give me nachas is an understatement. For many of the students, the issues that they speak of come from a larger, more general sense of justice, but not necessarily out of personal experience . The one exception, year after year – the issue that always carries a personal story – is health care: A parent out of work paying exorbitant premiums, a mother with a preexisting condition who cannot find insurance to cover her, a grandparent skipping pills, an older sibling out of college without insurance. I know that this issue is felt deeply at Temple Isaiah. I hear it from our teens, I hear it from our adults of all ages, and we heard it again and again in the house meetings of the listening campaign that kicked off our Temple Organizing project five years ago. 

Many people in our country also affirm the idea that health care reform is an issue of justice. In his address to a Joint Session of Congress a few weeks ago, President Obama read a letter from our late-Senator Ted Kennedy, written shortly before his death: “What we face,” Kennedy wrote, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”  

Yet the idea that universal health care is a social justice imperative is not simply a matter of modern liberal parlance, but is a central tenant of a Jewish vision of justice. One might think this is a progressive stance, but it is actually quite traditional! Now, Judaism does not advocate for any particular form of a health care system. My role as a rabbi is not to promote any specific plan making its way through congress, but to say that what Judaism is clear about is a demand for access to health care for all people. On this point, Judaism does not waver and the current state of health care in our country is not in line with such core principles. 

Jewish law carries a clear imperative to heal – both upon the doctor and the community. The Talmud teaches us that a Jewish community must provide the following ten services in order to be livable. Some of these may seem mundane and even silly for the rabbis to address – but all are absolutely essential. They include:  (1) A court of justice; (2) a charity fund; (3) a synagogue; (4) public baths; (5) toilet facilities; (6) a mohel (circumciser); (7) a surgeon; (8) a scribe [for writing official documents]; (9) a shohet (a ritual slaughterer of meat); and (10) a school-master.  [The Talmud continues to say that]  Rabbi Akiva [also included] several kinds of fruit because they are beneficial for eyesight.”[vi] 

Many of the items on this list are related to health care. Public baths and toilets were essential for maintaining public health, since indoor plumbing was, of course, a luxury not available until the 19th and even 20th centuries in many communities. The surgeon, who in those days was actually a blood-letter, was the most important person in the community to give medical  care. And Rabbi Akiva’s addtion of requiring a diversity of fruit is recognition of the importance that healthy diet can have on a person’s wellbeing as a method of preventative care. 

Almost all self-governing Jewish communities throughout history set up systems to ensure that every citizen had access to health care. Doctors were required to reduce their rates for poor patients, and when that was not sufficient, communal subsidies were established.[vii] One of the most incredible health care stories in the Talmud is of Abba the blood-letter . It was said of him that he placed a box outside his office where his fees were to be deposited. Whoever had money put it in, but those who had none could come in without feeling embarrassed.[viii]

Yet Jewish law about health care does not stand in an idealized realm. The medical support that the community must provide for the indigent individual is not expected to come at the expense of the individual physician. In fact, the Talmud teaches us that a doctor who heals for nothing is worth nothing.[ix]

So, if it is not the individual physician who is expected to bear the financial burden to provide health care to the community, how does Jewish law find the means to assure universal health care? By maintaining that it is the community that is obligated to ensure access to health care to all who are in need. 

There is a larger Jewish understanding of social justice that undergirds this idea. Whether in realms of sickness, hunger, or poverty; education, weddings, or funerals, our tradition demands that communities take responsibility for the individuals within. We cannot turn our backs on those who are without health coverage simply because we ourselves are insured. To those who say that their problem is not my problem, Judaism says no. 

On Yom Kippur, our fast is supposed to shake us into acts of justice and righteousness, foremost those that allow us to care for the most vulnerable in our midst. On the 50th anniversary of our congregation, named with great reverence for the prophet, Isaiah, we would do well to heed the words of our namesake, in particular his words that we read tomorrow morning as our haftarah:

5 Is such the fast I desire,

A day for men to starve their bodies?

Is it bowing the head like a bulrush

And lying in sackcloth and ashes?

Do you call that a fast,

A day when the Lord is favorable?

6 No, this is the fast I desire:

…7 It is to share your bread with the hungry,

And to take the wretched poor into your home;

When you see the naked, to clothe him,

And not to ignore your own kin.[x]

This is Isaiah’s vision of a just society. A society in which those who lack the basic dignities in life will be taken care of by others.

The issue of health care is truly a moral issue, for not only does keeping health care away from individuals violate a significant number of Jewish laws, it also leaves the individual unable to perform his or her important task of coming to know God in the world. Maimonides, himself a physician, taught: “A person should see to it that the body is kept healthy and strong in order that they may be upright to know God. For it is impossible to understand and comprehend wisdom when one is hungry and ailing or if one’s limbs ache.”[xi] We keep holiness out of the world when we allow others to be unnecessarily sick – who knows what kind of contributions people might make in the world, if only they had their health.

Health care for all is an obligation of Jewish living. It is a prime example of the need for the community to help support and protect the individuals that reside among us. We cannot rest on a false notion of individualism against all else. Have we become so fearful and self-centered that it is impossible for us to take bold steps together to take care of each other?

Tomorrow morning we will read from the Torah the words of Deuteronomy, “Choose life, that you and your descendents might live.” On the holiest of days, our tradition mandates that we should focus upon carrying out our lives in a way that affirms life. This is a message that gets to the core of what it means to be a Jew in the world. To choose life at every possible opportunity, so that we might be able to live lives of fullness and purpose.

May this year be a year in which all who seek access to health care may find themselves on the path toward that reality.  May our leaders find the courage to help make the years ahead filled with coverage for all Americans.  And may we and all those we love be blessed in the New Year with wholeness and peace, and of course, with health.



[i] BBC News, January 15, 209. (

[ii] The Washington Post, “Wide Gaps Found In Mortality Rates Among U.S. Groups,” September 12, 2006

[iii] Heschel, Abraham Joshua, The Insecurity of Freedom, 1963, p. 33


[v] DeNavas-Walt, C.B. Proctor, and J. Smith.  Income, Poverty, and Health Insurance Coverage in the United States: 2008.  U.S. Census Bureau., September 2009.

[vi] Babylonian Talmud, Sanhedrin 17b

[vii] Shulchan Aruch, Yoreh Deah 249:16; Responsa Ramat Rahel of Rabbi Eliezer Waldernberg, sections 24-25

[viii] Babylonian Talmud, Ta’anit 21b

[ix] Babylonian Talmud, Bava Kama 85a

[x] Isaiah 58:5-7

[xi] Mishneh Torah, Hilchot Deot 3:3

Sat, December 4 2021 30 Kislev 5782