Pittsburgh is the home of the steelers , and US Steel , and Andy Warhol , and Mr Rogers and PPG , and Carnegie Mellon , and Wiz Khalifa , and UPMC.
Which one of those didn’t fit in the sentence?
(engages audience)
[The answer I had imagined is UPMC, although others are possible].
I bring up this thought experiment because Pittsburghers are fiercely proud of so many things about this city, including french fries on sandwiches and Mario Lemieux and August Wilson. Many Pittsburghers are also fiercely proud of being a Steel Town, and of being the city that makes stuff for the rest of America, with companies like US Steel and PPG. And in theory, we should also be proud of being the home of a large health care provider like UPMC. UPMC employs more than 92,000 people, making it the largest non-governmental employer in Western Pennsylvania. They do more than 600 organ transplants a year. UPMC hospitals deliver around 25,000 babies a year. So why did I know that many of you would find UPMC to be the odd duck out in this list of things we Pittsburghers are proud of?
Last week, the head of United Healthcare was murdered on a street in New York City by a man. Etched on the bullets he fired were the words Delay, Deny, Depose; those words are borrowed from a 2010 non fiction book, delay deny, defend, about the tactics of health insurance companies in trying to increase profits by denying claims for services. The same day Brian Thompson was killed, another health insurance company, Anthem, announced that they would pay only for anesthesia treatments for the length of time that a procedure or surgery is estimated to require; in other words, if your surgery runs long, either Anthem won’t pay the hospital to keep your anesthesia running, or in theory your doctors should just keep operating on you without anesthesia. Amid a public outcry, the decision was reversed a week later. However, the fact that health insurers get to decide whether or not you get anesthesia; whether or not to pick up the cost of lifesaving medicines like chemotherapy or instead decide that they would prefer another, cheaper treatment, is a fact of life in America. In this country, 100 million people hold some form of medical debt. Medical bills are among the top three reasons for personal bankruptcy in America. I imagine that almost everyone in this room has a scary story of a medical or hospital bill they were once presented with or a rejection letter for coverage they experienced.
Just two years ago our family had a brief but Kafka-esque experience with a specialized medical procedure for an implant that was initially priced at $42,000, but we were told there was a manufacturer's coupon that brought the price down to $17,000. This all occurred because our health insurance company denied that the procedure was essential. We appealed. They relented. But the sheer fact that such a massive bill is entirely up to the whims of some group of corporate managers and not simply a decision for doctors in the best interests of their patients is both maddening and scary.
Take a step back, though, and remember that what kicked off my entire screed against for-profit healthcare and its ills in America was a man being gunned down in the street. Murder is murder and it is wrong. However, I am following that sentence up with a sentence that starts ‘however’. That in itself is disturbing – that we have to take a moment to consider the context of a murder because it has mitigating circumstances.
There have been a myriad of memes, cartoons, and social media posts that have cut to the essence of our country’s sad ambivalence towards the death of a man who symbolizes an industry that is deeply disliked and vilified. One post noted that United Healthcare’s $10,000 reward for information leading to the killer was less than the Out of Pocket Maximum on one single health insurance policy. And some are painting the killer as a kind of vigilante folk hero.
There are two aspects to the killing of Brian Thompson – the first is internal - that this killing evokes complex feelings for me, and I imagine for each of you.
None of us would condone murder and yet we would all strongly react in the negative to the actions of the leader of an organization generating profits by causing people suffering and hardship. It is easy to be mad at a nameless, faceless corporation that has done harm to thousands of people - the Purdue Pharmas and the Monsantos and the Exxon/Mobils and the Phillip Morrises of the world. And if the proverbial head of an immoral company falls off his yacht and drowns, I suspect we each would feel different than if we heard an internationally acclaimed humanitarian or the winner of the nobel peace prize were to die. And that’s normal - it is normal to feel different about the death of someone morally questionable, or overtly evil, than someone we see as morally good. But it doesn’t feel good. It doesn’t feel good to me that I felt a brief moment of joy, of rebellious pride, in the death of another human, a husband and father, even if he and his company made choices every single day that caused suffering, financial ruin, and even death for thousands of Americans. He did bad things, but I don’t feel good in rejoicing momentarily in his downfall.
The second complex aspect is external - about how the Jewish tradition, the source of our collective moral compass - regards a complicated case such as this. The punishment of the wicked for wrongdoing is not in doubt. Psalm 94, which we recite every Wednesday, makes it clear:
“God of retribution, LORD, God of retribution, appear! Rise up, judge of the earth, give the arrogant their deserts! How long shall the wicked, O LORD, how long shall the wicked exult.
Happy is the man whom You discipline, O LORD,
to give him tranquillity in times of misfortune,
until a pit be dug for the wicked.
Judgment shall again accord with justice
and all the upright shall rally to it. Who will take my part against evil men?
Who will stand up for me against wrongdoers?”
- Until a pit be dug for the wicked - I don’t think that’s a subtle line, or a soft line, about what the Jewish tradition thinks happens to those who are unjust or evil. The psalmist here is also treading a very thin line between saying ‘I’m not sorry that guy perished’ and the psalmist implying a much more active role in the demise of the evildoer. And I have to say, I’ve also often wondered why, when the rabbis had 150 choices of psalms to assign to each of the days of the week, they chose that we should say this one. Every. (pause). Wednesday.
We rabbis often promote the rabbinic tradition in teshuvah - repentance, change - is always possible. A favorite Talmudic story I use regularly is the story of Rebbe Meir and Beruria from Berachot 10a.
“There were these hooligans in Rabbi Meir’s neighborhood who caused him a great deal of anguish. Rabbi Meir prayed that they should die. Rabbi Meir’s wife, Berurya, said to him: What are you thinking? The Torah says “Let sins cease from the land” (Psalms 104:35), It does not say “let sinners cease from the land.”
Rather, pray for God to have mercy on them, that they should repent. Rabbi Meir saw that Berurya was correct and he prayed for God to have mercy on them, and they repented.”
But that tradition flies in the face of what I read in Psalm 94. And of course, it flies in the face of the God we Jews often have to defend ourselves to Christians about, the old testament God of wrath and retribution found in some of Numbers and all of Deuteronomy, as well as the prophetic books of Isaiah and Ezekial and Jeremiah and Micah and Amos. That God believed in individual punishment for individual sin and national punishment for national sin - that when a whole people errs, particularly the Israelites, that there would be a price to pay. On the small scale, when Aaron and Miriam speak ill of Moses’ wife Tzipporah, they are afflicted with a terrible head to toe skin infection. On the large scale, a national perversion of justice results in the destruction of the Temple and exile.
In Isaiah 5 we read first the warning, then the punishment:
For the vineyard of GOD of Hosts
Is the House of Israel,
And the seedlings he lovingly tended
Is the citizenry of Judah.
And [God] hoped for justice,
But behold, injustice;
For equity,
But behold, iniquity!
Three lines later we get this:
Assuredly,
My people will suffer exile
For not giving heed,
Its multitude victims of hunger
And its masses parched with thirst.
In other words, cruelty and injustice will be met by consequences. I will note, importantly, that those consequences will be meted out by God and not by vigilante justice. But I will also note that in the mindset of the prophets, only Israel and Israelites had free will; all other nations could become tools of our God in our national punishment. The Assyrians, the Babylonians, and the Romans are understood to have done violence and destruction by Gods hand because of our sins.
Our haftarah for this week happens to include my favorite prophet, Amos. He was also one of Dr. Martin Luther King Jrs favorite prophets too. King like to use Amos’ line from chapter 5 verse 22 - that justice should roll down like water and righteousness like a mighty stream. In hebrew the verse is Yigal k’mayim tzedek, mishpat k’nachal eitan, and thats why we named our eldest child Yigal. But in the selection we read today, the text begins at chapter 2 verse 6 with this:
Thus said GOD:
For three transgressions of Israel,
For four, I will not revoke the decree:
Because they have sold for silver
Those whose cause was just,
And the needy for a pair of sandals.
[Ah,] you who trample the heads of the poor
Into the dust of the ground,
And make the humble walk a twisted course!
Interestingly, before Amos begins to prophecize doom against Israel for injustice, he begins by pronouncing doom against any of the other regional powers if they and their leaders engage in injustice. Amos forecasts the downfall of Damascus and the Philistines, at the hands of Edom, and Edom at the hands of an unnamed aggressor, and the Ammonites, and the Moabites, and Judah. All for being militant and violent, or practicing harlotry, or valuing money over justice, or having unjust laws and courts, or for exploiting the poor. If you were a congressional lobbyist or a top executive for big oil or big pharma or the tobacco companies, this weeks haftarah makes for exceedingly uncomfortable reading.
And aye, theres the rub. A lot of Americans rejoiced at the killing of the CEO of United Healthcare, and a lot of other Americans recoiled at the rejoicing. And oddly, both were wrong, and both were right. There’s something wrong in America when the price of insulin or the cost of a life-saving surgery requires a second job or third mortgage. Every day in this country we sell for silver those whose cause is just. Many of you know my wife is a physical therapist, and every week she sees patients whose best course of treatment would be ten visits with her over ten weeks. But their insurance will only pay for four. So she does what she can and gives them exercises to do at home and hopes for the best.
All of these complaints about the health care industry, by the way, ignore a lot of the strides we’ve made as a society and the improvements that have come over time. A hundred years ago, everyone paid out of pocket to see a doctor, or they were poor and they didn’t see a doctor at all. Then came medicare for the elderly, and then medicaid for the poor, and health insurance from your employer, and then very rapidly in this country the majority of persons was covered. In 2000, 86% of Americans had health insurance. But after the great recession from 2008 to 2011, the number of uninsured Americans ballooned to over 40 million. And so we had healthcare reforms, and now the number of uninsured Americans is at its lowest level in history - a reported 8.1%. And yet. And yet we are still talking about this system, because the system itself has huge flaws and gaps, and still means that many people have to work longer hours to cover medical procedures, or start a go fund me campaign to cover their out of pocket maximums, or have to ration certain expensive medications because of the price. I’ll also add that making UPMC the villain in this story at the outset was a touch disingenuous - UPMC lost almost $300 million in fiscal year 2023. Something is profoundly broken in our national healthcare system, and there’s no one simple answer or easy victim here. But you and I both know that other countries than ours, with fewer resources, have done a better job than the United States.
This sermon is not meant to analyze the problems in the healthcare marketplace and give solutions. Lord knows I’m not qualified to do that, and lord knows there are literally thousands of people who have the right answer that could get us closer to an equitable and fair system. A classic end to a rabbis sermon is to either tell you what you can do - get up and call your congressman, yada yada yada, or to cut to the quick and say ‘so my prayer for us all today’ yada yada yada and then kind of proclaim some hope. I’m saying something different today. I’m saying this: You should feel uncomfortable, like I did on December 4th when Brian Thompson was killed. You should feel angry at United Healthcare and our entire healthcare system, and that anger for me manifested as righteous indignation at a man who earned a salary of $10 million a year working for a company with an infamous reputation for systematically denying health care claims to generate profit. And you should feel shame, like I felt shame for laughing at internet jokes about a murder.
In our parsha today there is a moment that I’d never fully considered. Joseph’s brothers throw him in a pit and then begin plotting his murder. Reuben comes along and says ‘don’t murder him!’ and everyone ignores him. Judah comes along and says ‘let’s sell him instead.’ Until this year, I had always read Judah’s actions as the actions of a man seeking a moral compromise to spare Joseph’s life: with his brothers baying for blood, he was thinking on his feet and came up with a quick solution to spare his life. But a commentary our hassidut class learned on Wednesday from the Mei HaShiloach, Rabbi Mordechai Yosef Leiner of Ishbitz, went in a totally different direction. It suggested that Judah exclaimed ‘lets sell Joseph into slavery’ not to spare his life, but because Judah saw an opportunity to turn a profit. The Mei HaShiloach, based on a line in the Talmud, suggests that Judah was applying relative morality to the situation - a sort of moral version of ‘in the land of the blind, the one eyed man is king.’ The Mei HaShiloach suggests to us that this degree of moral compromise is a cop out. What Judah probably should have done is stand up and say to his younger siblings ‘what you are doing is wrong. If you want to kill Joseph, or sell him, you’ll have to do it over my dead body.’
It is an understanding that Judaism is not a religion of lesser evils or of inconvenient compromises. We aren’t the people who are supposed to say ‘a little poverty, a little homelessness, an 8% uninsured rate, and the occasional medical bankruptcy, oh well, close enough.’ We feel uncomfortable feeling momentarily joyous that Brian Thompson was killed because we know the system that he operates under is unjust and we ought to do better. The feeling of internal conflict we have is because we know we are a little like Judah here - murder is wrong, the healthcare system is deeply flawed, and we’re supposed to pick a side. But it can be both. We know violence in this case, and really in any case, is not an effective agent of change. So my prayer for us I guess is: be uncomfortable. Don’t lose your humanity, but don’t remain complacent in the face of injustice. Shabbat Shalom.
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