Opinion | The Power of ‘And’

I was very touched when my rabbi asked me to give a 10-minute presentation on the night before Yom Kippur — the holiest night on the Jewish calendar. The rabbi’s invitation was very specific in that during this year’s “High Holidays” we would be talking about “The Power of ‘And’ ” — the ability to hold multiple perspectives and realities in our heads simultaneously — a subject that transcends religion in our society at this moment in time.

The rabbi’s request coincided with the 2nd anniversary of the publication of my book How Covid Crashed the System: A Guide to Fixing American Health Care, and I felt that some of the book’s themes spoke to the notion of balancing multiple perspectives in the midst of “post-pandemic realities.” She and I agreed that my presentation would center on how my work (pre- and post-COVID) embraces a paradox that can be connected, in spirit, to Judaism. I hope our readers will indulge me as I share some very personal reflections in the following (much-abridged) version of my presentation.

“Whatever your political beliefs might be, allow me to share some facts about the COVID pandemic and then juxtapose those facts alongside some other research. I hope you’ll be open to embracing this thought-provoking paradox with me.

“By 2015, average life expectancy in America was in reverse gear. Most of this was attributable to the Four [Horsemen] of the Apocalypse: drug abuse (especially opioids), suicide, depression, and alcoholism. Just before the pandemic’s onset in 2019, the U.S. was spending $10,000 per person annually on healthcare services while, collectively, we were spending only $400 per person on the public health infrastructure.

“Despite spending more money on healthcare than any other country in the world, by whatever measure we might apply, America does not achieve value for the money that we spend. The pandemic was illustrative in that more than 1.5 million Americans died from COVID and over a million more are still out of work with long COVID.

“Many experts have called our healthcare system an “engine of inequality.” In our great city of Philadelphia, maternal and fetal mortality rival statistics in Sub-Saharan Africa. Most of these terrible outcomes are driven by poverty and lack of education.

“Consider that in America we have three specialists for every primary care doctor, while in our peer countries, the ratio is exactly the opposite. Gun violence is probably Philadelphia’s biggest public health emergency today and, given that the Surgeon General of the United States has made this a key part of his platform to improve health, our city is a poster child for this dilemma.

“Now comes the paradox. Philadelphia is known as the “Meds Ed City” — that is, a city whose principal economic engine is driven by medical education and the presence of four top academic medical centers. The city is home of two of the largest private medical schools in America – the Sidney Kimmel Medical College on the campus of Thomas Jefferson University and the Drexel University College of Medicine. Many experts believe that nearly one out of four doctors in America passed through Philadelphia at some point in their training. God forbid if you were to be really sick, I hope you’ll come to Jefferson.

“How can we reconcile the wealth in our city as it relates to this paradox: the fact that medical technology, scientific research and the training of new doctors is the envy of the world while, at the same time, the city is beset by the problems I just outlined. Is there a spiritual – and distinctly Jewish – connection to embracing this paradox?

“My answer would be “yes”. Remember those clanking pots and the hospital signs that read “Heroes Work Here” during COVID? I submit that we need to reframe the conversation. Simply put, it’s not heroism; it’s all about humanism. We need to refocus on the fact that doctors, nurses and pharmacists are part of a very complex system, and bestowing heroic titles on them as individuals subverts a clear understanding of the complex ‘systems nature’ of care. I believe that humanism is a form of Tikkun Olam – the Jewish belief that everybody has a responsibility to improve life for all.

“Historians have had long held that ‘When the dying stops, the forgetting begins.’ Who really wants to talk about COVID in the fall of 2024? Once again, a deeply felt Jewish connection comes to mind – our belief in ‘never again.’ Can we apply ‘never again’ thinking to the next pandemic? I sincerely hope so.

“Together, do we have faith in the future? I certainly do when I recall our amazing ancestors — particularly Rabbi Tarfon, who wrote in the year 70 CE, ‘You are not obligated to complete the task, but neither are you free to desist from it.’ In the coming year, let us collectively recommit to fighting prejudice, reducing poverty, passing gun control legislation and making our healthcare system more equitable.”

Well, there you have it. Based on comments following the service, I believe that my fellow worshippers grasped my message and were appreciative. Stop and consider whether you find spirituality in your work. I hope you do.

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