When I told my daughter about the luxurious facilities at Memorial Sloan-Kettering Hospital, she sighed. A palliative care social worker at a small hospital in Brooklyn that serves mainly the poor, she told me that Sloan-Kettering was out of reach of most of her patients. “Why?” I asked her. Not all Medicaid Managed Care plans provide coverage for services at Sloan-Kettering, she told me, and even if they did, and even if co-payments were not a problem for her patients, most of them have never heard of the hospital.
I was surprised by what she said and then I was ashamed at my surprise. Almost all the patients I had seen during my three visits to Sloan-Kettering facilities appeared to be at least middle class. Those sitting in Sloan-Kettering’s waiting rooms, outfitted like boutique hotel lobbies, resembled not at all the mix of passengers one sees in the subway or the variety of pedestrians one encounters on the streets. From what I’ve seen, Sloan-Kettering serves mainly the narrow upper levels of the socioeconomic pyramid. I was ashamed because I hadn’t noticed.
We touched on this tendency to be impervious to the suffering of the poor in our Torah study group last Shabbat, which was led by Shira Koch-Epstein, our associate rabbi at Congregation Beth Elohim. Part of that week’s portion concerned the establishment of cities of refuge, where a person could flee after killing another unintentionally. There the killer would be safe from the blood revenge that the victim's family could otherwise exact.
In Rabbi Koch-Epstein’s handout was a quotation from the French philosopher Emmanuel Levinas (1906-1995), who asked if the more fortunate among us don’t live in Cities of Refuge. “Do these murders, committed without the murderers’ volition, occur in other ways than by the axe-head leaving the handle and coming to strike the passer-by?” In our socially unequal society, he asked, don’t the advantages enjoyed by the rich in relation to the poor lead in one way or another to the distress of others and therefore to the anger of the disadvantaged toward the more privileged? If so, then we live in cities of refuge because the protection they offer make us safe from the vengeance of the poor.
Social stratification is virtually universal in human societies. Some members of a society tend to have more of what money and position can obtain - education, health, wealth, opportunity - than do others. One is reminded of the spiritual, All My Trials, “If religion were a thing that money could buy, you know the rich would live and the poor would die.” We’re not going to end stratification, but we can try to reduce the disparities, growing larger by the decade in America, between rich and poor, between those born with every advantage and those born in poverty.
So what are my obligations towards those less fortunate than myself? Transferring from Sloan-Kettering to a hospital serving the poor would help no one, even if I were selfless enough to do so. My responsibility, it seems to me, is first of all to be present to the suffering of others. Only by being conscious of it, awake to it, can I do anything to help. And second of all? What can I do, beyond contributing to programs, either financially or as a volunteer, that improve the circumstances of the disadvantaged? I have no answer at present. But thanks to my conversation with my daughter and the suggestion posed by Levinas in Rabbi Koch-Epstein's handout, I will be more alive to the opportunities that present themselves.
I used to have a record in which Joan Baez sings the spiritual to which you refer. But as I remember it, she sings, "if living were something that money could buy, you know the rich would live, and the poor would die."
ReplyDeleteAs I remember it, she sings "living," not "religion."
In this country living IS something that money does buy. If you can afford good medical care, you do tend to live longer. Your chance of healing improves with your bank balance. That this is so is, in my opinion, obscene.
It's a moral issue, and, in this country, a political one.
Levinas' comments are provocative. Those of us who live in gated communities, or who have a doorman in their lobby, or who, like me, simply live a relatively discouraging (though not completely prohibitive) distance from the "inner city" do, in effect, live in cities of refuge where we hope to be safe from "crime" -- which, Levinas would suggest, is the vengeance exacted on us by the poor for having worsened their distress.
ReplyDeleteWe can worsen the distress of the poor, or benefit from that distress, without ever laying eyes on the poor.
We can see an example of this in the siting of power plants in or near neighborhoods with too little political clout to prohibit it. The electricity from these plants may travel far to power the many upscale conveniences of users so removed from the plant that they don't realize that their electric rates are only part of the cost of the power. The hidden cost is the disease suffered by those who live near, or downwind of, the plant.
What can we do? For starters, we can, as Anchises suggests,"be more alive to the opportunities that present themselves" to correct these problems.
That's what I remember too, but on another version it's religion. Either way, the poor get the short end of the stick, which is the meaning of social stratification. I agree that the health care situation in the country is a scandal, especially when compared to less expensive systems in other countries, like Canada and Israel, that have better results on the average.
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