Monday, July 20, 2009

Repeal "Don't Ask, Don't Tell"


LT Dan Choi as a Cadet at West Point, from his website
When I was an Air Force chaplain, I tended to be more than a little ‘evangelical’ about talking up the military chaplaincy as a vocational path with other Reform rabbis and with rabbinical students. In the military service, most of the Jewish chaplains are Orthodox rabbis. This is not to disparage the great work my Orthodox colleagues do in the military chaplaincy, but I believe that since the non-Orthodox movements (Reform and Conservative, and to a lesser extent the small Reconstructionist Movement) claim the largest number of affiliations of American Jews, then members of our rabbinates should be willing to step up and serve with the troops in uniform wherever the go. To explain why there is a dearth of non-Orthodox rabbis in the chaplaincy is complex and beyond the scope of this post. But over the years one attitude I encountered over and over among my civilian colleagues, cited as a reason to not even consider the military chaplaincy, was the ‘Don’t Ask Don’t Tell’ (henceforth DADT) law that prohibits gay men and lesbians from serving openly in the military. Since the military ‘discriminates’ against GLBT people, the reasoning goes, one who upholds civil rights for all Americans should not even consider serving in the military. And I know that this attitude is not limited to the Reform rabbinate; I know that there are periodic protests against military presence on college campuses over the issue.

With a new, liberal administration in Washington, there is a new call brewing to repeal DADT.

I want to go on record by saying that I oppose DADT and think it should be repealed on both an ideological and practical basis.

Ideologically, I don’t think it is right to eliminate from the opportunity to serve their country, any group without a compelling benefit to the military from their exclusion. Although where gays and lesbians are concerned, we’re still waiting for scientific proof that sexual orientation as something that’s organic to the individual, there is plenty of anecdotal evidence of homosexuality as being more than a behavior ‘disorder’ to give gays and lesbians the benefit of the doubt that most of them arrived at their sexual orientation by a number of factors beyond their control. Because of this widespread and generally-accepted principle, gays and lesbians today find few barriers – to employment, education, housing, etc – based on their known sexual orientation. If it could be proven that excluding them from the military service provided some benefit adding to the fighting readiness of the armed forces, then perhaps there would be grounds to exclude them in the way that those with criminal records and without high school diplomas are (at least, partly) excluded. But I believe that case has not been made.

The pragmatic case for repealing DADT is primarily that, in an era of shrinking manpower pools, it would make available talented individuals of homosexual orientation who desire to serve. For example, the well-known case of LT Dan Choi, a graduate of West Point who is a fluent Arabic speaker and served with distinction as a commander in Iraq, who was recently mustered out of the National Guard after he ‘came out.’ As observers like to point out, other countries allow gays and lesbians to serve openly in their military services with no loss of fighting effectiveness; the usual examples given are the UK, Australia, and Israel.

But let’s back up and ask ourselves: what exactly is the origin of DADT? How was it enacted in the first place?

In 1981, the Department of Defense enacted a policy declaring homosexuality to be incompatible with military service. Although there were various challenges to this policy over the years, it stood until 1993 when newly-elected President Bill Clinton issued an executive order repealing it. Under the order, gays and lesbians were to be allowed forthwith to serve openly, period. In issuing it, Clinton was making good on a campaign promise to the gay community.

But the Clinton order raised a firestorm of outrage, not only in the military itself but among groups of parents of young adults in the military service, for example. In reality, what killed the new policy was opposition to it by another constituency that Clinton owed for his election: African-Americans.

In advocating for the new policy, many gays and their supporters drew parallels to President Truman signing an executive order dropping all discrimination in the military against Blacks, integrating the military completely. Black Americans largely objected to the comparison; most Blacks have conservative Christian social values, and the idea that homosexuality is a characteristic that is organic to a person’s makeup is anathema to them.

Clinton backpedaled on the executive order and asked congress to sit down with military leaders to produce a compromise that he could sign into law. The result was the Don’t Ask Don’t Tell Law – not Policy! – part of the fiscal year 1994 Defense Appropriations Bill that Clinton signed into law.

DADT is, therefore, beyond the power of any military leadership or even president to repeal, unless the US Supreme Court were to strike it down as unconstitutional – and the Supreme Court has never even considered hearing such a case. The solution, then would be for congress to enact legislation to repeal it, or attach such language to the current defense appropriations bill, and that is not something that is under serious consideration. Why not? Because President Obama has not advocated such action.

DADT can be repealed, at least during the session of the 111th US Congress, if the President will publicly ask congress to do so, saying unambiguously that he will sign such legislation into law should it reach his desk. But Obama is yet to make such an unambiguous declaration. Perhaps he does not personally favor repealing it – after all, he is known to hold socially conservative views with regard to, for example, gay marriage. Perhaps, alternatively, he realizes it will cause an intense fight over what he considers a not-very-important issue, a ‘tempest in a teapot,’ potentially getting in the way of other elements of his legislative agenda. The latter is what I suspect; although the Administration has a great amount of influence in both houses of congress due to Democratic majorities and the widely-held belief that many Democratic members rode into office on Obama’s coattails, there is increasing breaking of ranks by Democratic representatives over various legislative priorities and perhaps Obama doesn’t want DADT to further spoil his chances of, for example, Health Care Reform. But regardless of whatever his reason might be, Obama’s not publicly advocating for the repeal of DADT is the main obstacle keeping the unpopular law in place.

Sunday, July 19, 2009

The Healthcare Conudrum



Like many conservatives and middle-of-the-roaders, I find the idea of a unified, nationalized health care system, which many analysts predict will be the only possible outcome of the legislation that President Obama is pushing congress to pass this summer, frightening.

Like many Americans, I have watched elderly parents struggle with the Medicare system. Medicare patients are forced, if they are unable to pay for supplemental insurance policies or to ante up out of their own pockets for costs not covered by standard Medicare Part A and B coverage, to enroll in Medicare Advantage Plans – HMOs which are set up specifically for, or which accept Medicare patients at a set fee by the federal government – and thus have an incentive to cut costs in every way possible to make a profit of the business of providing health care for their elderly patients.

When my father, of blessed memory, was sick, every decision by his MAP created a nightmare of a clash of wills between my brother and me on one hand, and the MAP’s care director on the other.

The push-and-pull we had to engage in, as bad as it was, would have been impossible had we not had one trump card on our side; we could have pulled Dad out of that MAP and put him in standard Medicare Part A and B coverage. Therefore, while the MAP seemed intent on saving money on Dad’s back, they could be swayed on some decisions out of fear of ultimately losing an enrollee. But as Dad became sicker and sicker, that trump card became next to worthless.

(Lest one think that I am attacking indiscriminately all MAPs, after a geographic shift we enrolled Dad in one in the new state and its care decisions were mostly quite reasonable.)

With a nationalized health care system, for which there would be no alternative, one loses that trump card altogether; all decisions concerning provision of care would be in the hands of faceless bureaucrats who could stand behind their offices and would have no compulsion to even reveal their names to disgruntled patients.

I experienced this in a smaller way recently with my son’s care. As a military retiree, my family and I are covered under Tricare, the Department of Defense’s managed care system. Retirees and their families, and the families of active duty personnel, have two options: Tricare Standard and Tricare Prime. Tricare Standard works something like Medicare Part A and B – one makes one’s own care decisions but has to pay a large part of the costs – while Tricare Prime works like an HMO or MAP. Just as with Medicare patients, those without supplemental insurance plans or extensive cash resourced to cover out-of-pocket expenses, choose Tricare Prime for the additional coverage for a reasonable annual premium. The system is divided into regions, with a different contractor managing the care of patients in each region for the government.

Eyal needed to see a certain type of specialist for several visits, but we had a hard time finding such a specialist ‘on-network’ close enough to his school that he could be taken to his appointments. The Tricare Prime standard is that, if an on-network specialist can be found within a specific radius of one’s zip code, then the contractor does not need to cover a visit to an off-network specialist. The radius is, if I am not mistaken, 80 miles. If Eyal were home, I would drive him that far to get the care he needed without question. But he is half a continent away, and he is a fourteen-year-old boy who cannot drive himself. But those facts would not move the contractor, and they were under not compulsion under the terms of the contract to provide me with redress other than to go off-network in which case Tricare Standard reimbursement rates (and deductibles) would apply; in other words, I would have paid mostly out of pocket for the specialty care. So I’ve already had a ‘taste’ of the challenge we all would face under a nationalized health care plan, and believe me it does not look enticing.

I have been stationed abroad in four different countries, each of which has nationalized health care: The UK, Germany, Greece, and Turkey. These are four very different countries, and the quality of care varies greatly between them. As an American family stationed in these places, we did not find the prospect of being referred to the local system for care as frightening in the UK or Germany as in Greece or Turkey. The language issue was only part of the frightening aspect; we also knew that mortality rates in those countries’ systems were considerably higher than in the American system, with all its problems.

We hear horror stories all the time of higher mortality rates in ‘the best’ of the nationalized systems (e.g. Canada) due to advanced procedures being severely rationed and advanced drugs being unavailable. These stories are not just anecdotal; hard statistics back them up. Survival rates from various cancers and other illnesses are markedly higher in the US than in any of these countries. Surgeries that we take for granted as being available, surgeries that prolong life or improve quality of life, are severely rationed in these other countries.

Most Americans, knowing these statistics and stories, do not want a nationalized health care system that will make us imitate the experiences of our neighbors in Canada, or our European cousins. And President Obama, in his campaign for office last fall, promised that his health care program would only provide a ‘government option’ and not interfere one iota with the coverage of Americans who are happy with their present care and coverage – which is to say, that of most Americans.

The concern of detractors is only in part that, whatever the government’s intentions, a government ‘option’ will ultimately kill competition in the marketplace and we’ll end up with a Canadian/European-style system with no options. Add to that, the President’s own recent backpedaling on the campaign rhetoric to open admission that – under his plan – many Americans will see changes to their health care. And finally, the President’s intense pressure on congress to pass legislation according to an artificial and rushed timetable – and the willingness of many Democratic legislators to be pressured out of loyalty to Obama – raises fears that, at the very least, the congress will pass sweeping, complex, game-changing legislation that will be signed into law without even having time to consider the many aspects of what they’re approving, not to mention unintended consequences thereof.

I agree that fears of a nationalized, ‘single payer’ health care system are not irrational; I believe that unintended and intended consequences of this rush to produce legislation that the President will sign, will conspire to give us a system along the lines of the Canadian/European system that will satisfy no one, except perhaps those who have no insurance coverage now.

The last time such a sweeping change in our health care system was attempted, by President Bill and Hillary Clinton, it failed because of a groundswell of public opinion against it. President Obama seems to be taking as the lesson of that failure, that the quicker he can ram through the legislation and sign it into law, the greater his chances of success in enacting this legislation that most Americans, given time to chew on it and consider, would tell their representatives to reject.

Instead, I and other sceptics would prefer the President take a much different lesson from the experience of the Clintons: he should instead work for a reform of the present system to fix its shortcomings and make better insurance coverage available to those who fall through the cracks now. Our fear is that America has elected a ‘Hard Left’ President who is so enamored of the idea that Government is the Answer to All Our Problems, that he is not really concerned about what most Americans think.

All Americans who know people who have experienced nightmares in getting health care under Medicare and other government programs such as Medicaid and Tricare and whatever, should ask themselves: Do I want the government providing my health care? If the answer is no, please do two things: send your congressman and senators e-mails telling them to reject the legislation currently underway on Capitol Hill, and sign the petition found at http://www.freeourhealthcarenow.com/.

Wednesday, July 15, 2009

To Circ or not to Circ?



Recently, a correspondent asked me about Reform Judaism's position toward circumcision. He pointed out that some of the early reformists - particularly in Europe in the 19th century - had advocated against dropping the pressure for circumcision along with other reforms they were pushing. His question was: Is this still the position of Reform Judaism, or has there been some 'backsliding' on this point?

I'm not sure that the early reformists ever did abandon circumcision along with other rituals and ceremonies that may have struck them as outdated. I do know that many couples affiliated with Reform Judaism choose for their newborn sons a circumcision performed by a physician in a clinical setting rather than by a traditional mohel at home. If a Jewish physician can be found and utilized, so much the better but even when it must be a non-Jewish doctor it does get done. When a rabbi or learned lay person can be present at the procedure to say the traditional blessings, that is usually desired - I have personally served in this way, saying the ceremony while the doctor did the circumcision, quite a few times. In recent years in Reform Judaism in the United States, a network of Reform mohalim (the plural of mohel) and even mohalot (that's the feminine plural), all of whom are doctors, has been developed for those Jewish couples who would prefer a practitioner who can perform the sacred rite, but still perform the procedure according to modern medical practice.

So, at least in the USA, my observation is that Reform Jews do circumcise their sons, with an accompanying Jewish ceremony when possible, in a clinical setting when possible. Some prefer to use a traditional mohel, but the majority do not. When my son was born, Clara and I engaged a traditional mohel. (I'll explain below.)

In countries other than the USA and Israel, current practice is a mixed bag. In Europe, for example many Jewish families who are not Orthodox choose not to circumcise their sons. This reflects a very different bias in the medical communities in Europe.

In America, it is very ingrained that male babies are circumcised. The vast majority of white infant males - somewhere in the 90's percentage-wise - are circumcised at birth in the hospital. Although the practice of circumcision has always been considerably less universal among a number of non-white groups, statistics show that among African-American and Latino males the rates are going up. Anecdotally, it seems that the rise in the circumcision rate of infant males in these groups is directly related to the fact that more babies are being born in the hospital as opposed to at home. But in any case, circumcision rates for non-white baby boys have been on the rise.

American doctors and their patients generally support the notion that circumcision is a useful prophylaxis for a number of diseases and conditions. This, despite the fact that the American Academy of Pediatrics has repeatedly published statements that disapprove of the practice of routinely performing neonatal circumcisions. The most recent statement, published in 1999, conceded that there may be potential benefits of infant circumcision but that the AAP does not recommend the practice given the potential risks. Despite this position, parents looking for a doctor to circumcise their baby sons generally have no trouble finding one, and medical insurance usually pays for the procedure.

In Europe generally, the situation is the opposite; it is often impossible for parents to obtain the services of a doctor to circumcise their sons within the existing nationalized health services. Sometimes, a traditional religious practitioner is the only alternative available. Instead of the nuanced position of the AAP, European medical societies oppose circumcision outright.

I personally believe that the American position is more correct; the argument that there are great potential benefits, particularly to women whose male sexual partners are circumcised, is convincing. Here's a place where information on this position can be found: http://www.circinfo.net/index.html. And to be fair, I'm also including an information site that tries to make the opposite case: http://www.nocirc.org/.

So why did Clara and I choose a traditional mohel rather than a physician or a Reform physician/mohel? First, I want to make it clear that the Reform movement's efforts to create a cadre of mohalim/ot using clinical methods and also being friendly to Reform-affiliated families who have sensitivities about such issues as separating men and women at a circumcision (sometimes, but not always demanded by a traditional mohel), are a wonderful service. Many Reform-affiliated families also feel more comfortable with a practitioner with medical training. Finally, for couples consisting of a Jewish man and a non-Jewish woman, many traditional mohalim will not even agree to provide the service. But after having been present for dozens of circumcisions both by traditional mohalim and by physicians, we felt more comfortable using a traditional mohel who came with very glowing recommendations. It happened he was also a licensed medical doctor and a surgeon, but he used the traditional mohel's methods when performing brit milah.

I'm convinced that, for Jewish parents, a skilled and experienced mohel using the traditional methods is superior to a physician using modern clinical practice. First of all, the traditional practitioner's method makes the procedure go very quickly which surely reduces the trauma for the infant (not to mention those witnessing the rite!). Despite the abundant jokes about mistakes by mohalim, they do one thing repeatedly, and they usually become quite proficient at it. In contrast, physicians who perform circumcisions do them in addition to many other procedures - they simply don't do as many, day in and day out, as a traditional mohel. And the protocols they follow make the procedure take a long time - as long as ten minutes, while a traditional mohel generally completes the procedure part of the circumcision in less than a minute total.

But what about adult circumcision? Adult males who convert to Judaism are traditionally required to submit to circumcision. If they were circumcised hygienically at birth, an Orthodox or Conservative rabbi generally requires a ceremony called hatafat dam brit - the taking of a drop of blood as a symbolic compliance with the covenant.

I have never supervised the conversion of an adult male who was not circumcised at birth, reflecting the prevalence of the practice of neonatal circumcision in the USA. I have met male Jews-by-Choice who did get circumcised as adults, as inpatients at hospitals, and they did not seem traumatized by the experience. Although it is a far more complicated procedure on an adult than on a newborn, it is not unheard of. Years ago, when I was in the US Navy I saw many crewmembers on an aircraft carrier (which has a full hospital, including surgical theater, onboard) get circumcised while on an extended cruise on the orders of their wives (whose concerns were hygienic, not religious). For conversion candidates I do not require it personally, although I would counsel the candidate that uncircumcised his status might not be accepted in all sectors of the Jewish community. On the other hand, since Jewish males are not routinely asked to drop their pants to prove their bonafides...they could probably get away without doing it!

I do not require hatafat dam brit when I supervise a male conversion where the candidate was circumcised at birth. I offer it as a possibility and can attest, having witnessed the procedure, that it takes a nanosecond and is entirely trauma-free. Nevertheless, I believe that requiring it represents a stringency that I don't feel comfortable requiring. A man without a foreskin is a circumcised man, regardless of whether it was done for hygienic or religious reasons.

On a number of occasions I've discussed the subject of adult circumcision, not for converts but for Jewish males who were born in the Soviet Union where circumcision was not done in the medical system and it was not available as a religious rite either. Russian Jewish men who have resettled in the USA have often been pressured by Orthodox organizations to get circumcised. Those organizations sometimes even have funds to pay for the procedures. While I believe that these organizations are well-meaning, I understand that grown men are often squeamish about having any elective procedure done to their sexual organs. Although there are anecdotes about uncircumcised Jewish men being denied interment in Jewish ceremonies, or of burial societies performing the procedure on the deceased without telling the family, I don't believe that these phenomena are widespread. Therefore, if a Jewish man was not circumcised at birth and asks me if he should have it done now, I will counsel him to consider it but will fully accept him as part of my community if he decides not to.

Tuesday, July 14, 2009

Honduras in Turmoil



It has been almost ignored by the major media outlets in the focus on Michael Jackson's memorial service and Sarah Palin's resignation (last week); and the Senate confirmation hearings for nominee to the US Supreme Court Sonia Sotomayor and the fight over health care reform (this week). I'm talking about the struggle of a small and poor country in Central America, Honduras, to maintain its democracy. The world's reaction to events in Honduras is unhelpful, but in particular the reaction of our US government is upsetting.

President Manuel Zelaya was overthrown June 28th by the counry's Congress, Supreme Court and military acting together. The charges were that he was working to undermine the country's constitution and make himself president with an open-ended tenure. At the time of the overthrow, his approval rating was about 10 percent of the populace. Zelaya is, however quite popular with the hemisphere's most brutal dictators, namely Hugo Chavez and Raul Castro. Daniel Ortega is a strong supporter as well. As always, whom a person chooses as his friends can be very telling.

In the past, our country in her desire to see the 'lesser of evils' in power, has pragmatically backed some unsavory strongmen. Of course, the words 'military coup' are enough to make us reflexively distance ourselves from any regime installed in that way. But the interim government in Honduras is not a Pinochet, a Somoza, or a Marcos. Once the army had spirited Zelaya out of the country safely - no harm was done to him and he was not imprisoned or detained - an interim government led by Roberto Micheletti, the president of congress and a member of Zelaya's Liberal Party, was installed. Micheletti has promised that his government will only serve out the remaining six months of Zelaya's term, and that elections will be held when planned or even earlier. There has been no violence as a consequence of the takeover; there have been peaceful protests in the streets, both for and against the interim government.

Unfortunately, most of the world has condemned the Micheletti government and called for Zelaya's reinstatement. Chavez of Venezuela, a supporter of Zelaya, is making bellicose threats of dire consequences if his friend is not soon returned to power. The US State Department is playing a lower-key role; Secretary Clinton has asked Costa Rican President and Nobel Peace Prize winner Oscar Arias to mediate the crisis. Even so, for our government the desireable outcome is quite clear; State Dept. spokesman Ian Kelly has called "on all parties, particularly President Zelaya and the de facto regime to work together and come to a peaceful resolution that restores the democratic order," meaning "the restoration of the democratically elected president." It is distressing to hear our administration agreeing with the likes of Chavez, Castro and Ortega; would be refreshing to hear President Obama or Secretary of State Clinton instead express hope for the upholding of the liberty and the constitution of Honduras rather than worry about the 'rights' of a would-be tyrant.

Sunday, July 12, 2009

Hiking on Shabbat


On Saturday morning I took a hike on the Monument Rock Loop in Pike National Forest. Joined by seven others, a mix of Temple Beit Torah members and others, we hiked about a mile until we came to the Monument Rock, a striking formation located at the foot of Mount Herman. The formation, called the Dawson Arkose, consists of jumbled bits of quartz and feldspar pressed together to form the rock and was molded from eroding bits of the ancestral Rockies that washed onto the plain about 55 million years ago. There are other, similar formations in the Monument-Air Force Academy area and of course, the reddish rock formations of Garden of the Gods and other areas along the Front Range.

In the rock's shadow, we conducted a short Shabbat morning service before hiking back via a different route. I'm very much enjoying these Shabbat hikes; I wish more folks would take advantage of them, but anything new takes a while to catch on. New for my congregation, that is; he whole idea is not original to me and has been done on a somewhat larger scale by my colleague Jamie Korngold, the 'Advenure Rabbi' who is based in Boulder. The idea of combining a hike with an outdoor service is wonderful; out in the wild I feel that the prayers speak to me much more consistently than in the synagogue. Why not worship the Creator in the beauty of creation? I'm looking forward to several more of these hikes before summer's end.

Wednesday, July 8, 2009

Getting Started

I'm starting this Blog to record any random thoughts or accounts of mis-adventures that I might want to share with my congregation, friends and family. Watch this space to see where I might take you.

I'll be talking about Judaism, the Outdoors, and most notably politics - a subject I have studiously avoided in the past. Why have I avoided it? Because as an active duty military member I was in effect working for the Exacutive Branch, and I was often based overseas. And in my first year as a congregational rabbi I also avoided the subject; with national elections going on, the subject was simply too hot and I didn't want to be seen as telling people how to vote. But now it is time for me to comment on public policy issues, and you'll see posts on the subject creeping into my Blog.

I'm not allowing the posting of comments because in my experience, they can very quickly get nasty, ad hominem and inappropriate. But if you'd like to respond thoughtfully to any of my posts, please feel free to e-mail me and I would love to have a dialogue with you. Likewise, if there's a subject that you'd like to see me write about please feel free to let me know. Otherwise, enjoy!