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Watch This Space

I really will write about the current situation, although you could probably go back to the earliest posts of this blog from 2006 and note that the more things change the more they stay the same, but I've been very busy with my new, and colicky, grandson.  Feeding him tends to take at least 2 of the three hours before we have to begin all over again, and my daughter is just a tad tired these days.

I promise I will soon bring the blog up to date!

A Page of "Talmud" -- Hilchot Xmas

This has been sitting in my files ever since 2002. I post it, completely at the wrong time of year, because a good laugh never hurt anyone.  [Explaining all the allusions would take forever, so I expect non-Jewish readers to be somewhat baffled in places.  However, the Jews reading this ought to have no problem.  If you do, you need to enroll in a Jewish studies program --Antigonos]

Have you ever wondered what Xmas would be like if it were a Jewish Holiday?.... Please note: We hope that our readers understand that as a religious holiday, Christmas is totally incompatible with Judaism, and the very thought of it being a Jewish holiday is ludicrous. Therefore, we have avoided all references to the religious aspects of the holiday, and tried to focus only on those aspects which have pervaded American culture. Our intention has been to provide a good-natured, humorous parody, to use those cultural aspects of Christmas to illustrate some of the methodology and details of Jewish law. It is a very fine line we are treading, but we hope that we have insulted neither the Torah, nor our Christian friends.
 ã1998 Akiva and Ilene Miller. Permission is granted to copy and recirculate, but only for free, and only if we get the credit (or blame!)

 LAWS OF XMAS (version 2.1)
 Letter of Approbation from the Kringler Rav {I omit a long letter in Hebrew -- Antigonos]

 1. PREPARING FOR XMAS
 1. PREPARATIONS FOR XMAS MUST NOT BEGIN1 BEFORE2 THANKSGIVING.3 THIS APPLIES TO PREPARATIONS WHICH AFFECT THE HOLIDAY MOOD, 4 BUT NOT THOSE WHICH ARE DONE IN PRIVATE. 5
   1 This contrasts sharply with Shabbos, for the mitzva of honoring Shabbos applies all week long. For example, if one finds a particularly good food during the week, one should save it for Shabbos even though it is now only Sunday and Shabbos is a week away. However, Xmas preparations may not begin too far in advance, in order to fulfill the dictum, "It's beginning to look a lot like Xmas."
   2This is because of the principle that two festive occasions should not be mixed into each other. Note the decree of the great R.H. Macy, who established that Santa Claus may not appear in the Thanksgiving Day parade until after all the other floats have passed.
   3 There are some who begin preparing for Xmas as early as Halloween. This is wrong, and they will be called upon to account for their evil ways.
   4 Such as setting up the Xmas tree (some say even buying one,) or playing holiday music on the Muzak.
    5 Such as buying gifts or buying the Xmas dinner turkey. Cooking the turkey may not be done before Thanksgiving because it will appear to be a Thanksgiving turkey.
2. SOME HOLD THAT THE TREE SHOULD BE DECORATED IMMEDIATELY AFTER THANKSGIVING,6 BUT OTHERS PREFER TO DECORATE IT AS CLOSE TO XMAS AS POSSIBLE.7
   6 For the mitzva of "adding to the yom tov" by beginning the Xmas season early.
    7 As it is said, "Do not put off for tomorrow, that which can be put off for the day after tomorrow."

 2. THE TREE 1. ANY SPECIES OF TREE IS KOSHER FOR USE AS A XMAS TREE, PROVIDED THAT IT HAS NEEDLES AND NOT LEAVES. IN OUR LANDS IT IS CUSTOMARY TO USE A FIR TREE.8 IT SHOULD BE REASONABLY FRESH, BUT NOT TOO FRESH, IN ACCORDANCE WITH THE PRINCIPLE "A XMAS TREE WITH NO FALLEN NEEDLES IS LIKE A SUKKAH WITH NO BUZZING BEES." 8 If the lady of the house already has a fur, then any evergreen may be used. 2. THE TREE SHOULD BE CHOPPED DOWN SPECIFICALLY FOR USE AS A XMAS TREE; IF IT HAD BEEN CUT FOR LUMBER IT IS INVALID. IF THE TREE WAS CUT FOR GENERAL DECORATIVE PURPOSES, BUT NOT SPECIFICALLY AS A XMAS TREE, SOME AUTHORITIES ALLOW IT WHILE OTHERS ARE STRICT. A STOLEN TREE IS NOT VALID FOR THE MITZVAH.9 FORTUNATE IS ONE WHO IS ABLE TO CHOP HIS OWN TREE HIMSELF.10 9 One who cuts his own tree must make sure that he has permission from the landowner to do so. Ideally, cut only from one's own backyard. A tree taken from a reshus harabim, such as the county park (which is actually a carmelis, not a reshus harabim,) is considered as stolen and invalid. 10 One who is unable to cut his own tree should make sure to purchase it from a reputable dealer, or one who is certified by a national kashrus organization.

 3. DURING THE SHMITTA YEAR, A JEW MAY NOT CUT THE TREE DOWN, BUT IT SHOULD BE DONE BY A GENTILE. HOWEVER, SINCE THE TREE IS INEDIBLE, THE PROBLEMS OF "KEDUSHAS SHVIIS" WHICH APPLY TO THE ESROG DO NOT APPLY TO THE XMAS TREE. 4. THE TREE MUST BE BRIGHT GREEN. BRIGHT RED, or a mixture of green and red, IS ALSO ACCEPTABLE FOR A XMAS TREE,11 BUT BROWN IS NOT. THERE MAY BE ONE BROWN SPOT NEAR THE BOTTOM OF THE TREE,12 BUT IN THE TOP HALF OF THE TREE, EVEN ONE BROWN SPOT WILL INVALIDATE THE TREE. A TRULY PIOUS PERSON WILL MAKE SURE TO BRING ALONG A XMAS TREE EXPERT WHEN HE GOES TO LOOK FOR HIS TREE.13 11 Because such trees do not grow red naturally, many Sefaradim adorn the tree with red poinsettia flowers. Ashkenazim prefer poinsettas. 12 Or even two, provided they are on opposite sides so they cannot be both seen at the same time. 13 But it is more macho to pretend to be an expert and pick the tree out himself. 5. THE REQUIRED HEIGHT OF THE TREE IS SUBJECT TO MANY RULES. AN INDOOR TREE MUST BE TALL ENOUGH SO THAT IT REACHES WITHIN 3 HANDBREADTHS OF THE CEILING.14 AN OUTDOOR TREE MUST BE AT LEAST 20 CUBITS TALL. 14 Where local fire codes prohibit the use of such large trees, a smaller tree - even a bonsai - may be used, provided it has toy people around it who will make it appear tall.

6. THE LAW IS "ETZ ISH U'BEITO" - "ONE TREE FOR A MAN AND HIS HOME". THIS TEACHES THAT INDIVIDUALS MUST HAVE A XMAS TREE AT THEIR HOME, AND THAT THE MAIN FUNCTION OF THE TREE IS FOR THE BENEFIT OF THE FAMILY, but public places are exempt. IF ONE WISHES TO PLACE HIS PERSONAL TREE IN A PUBLIC LOCATION HE MAY DO SO, BUT HE WILL NOT HAVE FULFILLED HIS OBLIGATION UNLESS IT IS TRULY SEEN BY THE PUBLIC. IN THIS CASE, "SEEN BY THE PUBLIC" MEANS THAT THE TREE IS LARGE ENOUGH THAT IT IS SHOWN ON THE LOCAL TV NEWS REPORTS.15
   15 This is the origin of the custom of the great tree in Rockefeller Center, where a shaliach from Lubavitch lights the tree just before sunset on Erev Xmas, and is then returned to Crown Heights by an NYPD helicopter in time for the dinner meal.

 7. IN RECENT YEARS, THERE HAS BEEN A GREAT CONTROVERSY OVER THE USE OF MANUFACTURED TREES. IN THEORY, SOME HOLD THEY ARE INVALID,16 WHILE OTHER AUTHORITIES HOLD THEY ARE VALID.17 IN PRACTICE, HOWEVER, EVEN THE LENIENT OPINIONS HOLD THAT ARTIFICIAL TREES ARE TOO TACKY, AND THUS VIOLATE THE PRINCIPLE OF "HADAR". But if one has already met his obligation by displaying at least one kosher Xmas tree, he may have additional trees of any kind, natural or not.18 16 Based on the verse "Etz chayim hee" ("A tree is alive"), teaching that even if it looks like a tree, it still cannot be a tree unless it was alive at some point. 17 Based on the verse "Etz chayim hee" ("It is a tree of life"), teaching that some trees have life, and others do not necessarily have life. 18 Similarly, manufactured trees are acceptable in malls, offices, and other exempt public places.

8. ORIGINALLY, THE LAW WAS THAT THE TREE MUST BE DISPLAYED SO THAT IT WOULD BE VISIBLE TO PASSERS-BY OUTSIDE THE HOME. OVER THE CENTURIES, AS PERSECUTIONS INCREASED, THE PEOPLE INSIDE THE HOME BECAME THE MAIN AUDIENCE. EVEN SO, IT SHOULD BE DISPLAYED IN A PROMINENT AREA OF THE HOUSE, TO SHOW RESPECT FOR THIS MITZVAH. WHEN POSSIBLE, IT SHOULD PREFERABLY BE BY A WINDOW WHERE IT COULD BE VIEWED FROM THE STREET, TO CONTINUE THE ORIGINAL PRACTICE. 3. DECORATING THE TREE 1. AS WITH ALL MITZVOS, THE TREE SHOULD BE TASTEFULLY19 DECORATED. POPCORN TASTES EXCELLENT, AND SOME STRING POPCORN TOGETHER (WITH NEEDLE AND THREAD)20 TO MAKE LONG CHAINS WHICH ARE WRAPPED AROUND THE TREE. 19 In order to keep children actively interested and participating in all the goings-on, "tasteful" is defined by the youngest person in the household. This generally results in displaying all sorts of holiday projects in school, no matter how tacky or amateurishly done, giving great prominence to "artwork" which is normally allowed nowhere but the refrigerator door. 20 To remind us of the verse, "We're all connected." (Nynex)

 2. THE MAIN DECORATION FOR THE TREE IS STRINGS21 OF COLORED22 LIGHTS. The circuitry of the lights is arranged with parallel23 wires, not in serial. A certified24 electrician should inspect each set of lights. 21 The numerical value of the word "orot" (lights) is 613, similar to the value of the word "tzitzit". 22 The lights may be of 5 colors (corresponding to the knots in each tzitzit) or of 8 colors (corresponding to the 8 strings in each tzitzit). Where these combinations are unavailable, all the lights must be white. (Some use all white lights, with each eighth light being blue.) 23 Just as the eight strings of the tzitzis are tied in two parallel groups of four strings to help keep them kosher in the event a string breaks, similarly, arranging the lights in parallel will keep the other lights lit even if one light goes out. 24 By mutual consent, certification of Xmas lights is handled not by the OU but by the UL.

 3. ADDITIONAL LIGHTS ARE SET UP AROUND THE OUTSIDE OF THE HOME,25 EACH ACCORDING TO HIS OWN ABILITY. THE MORE LIGHTS and other decorations26 ONE SETS UP, THE MORE PRAISEWORTHY HE IS. 25 The minimum which one should strive for is the outline of one window which faces the street, and this is sufficient for apartment dwellers. 26 Those who have a front yard or lawn put all sorts of decorations up, whether lit by lights or not. Some say that if a snowman was built before Xmas, and by New Year's it still has not melted, it is a sign of blessing for the home for the coming year.

4. THE LIGHTS MUST STAY LIT27 UNTIL28 MOST PEOPLE CAN BE PRESUMED TO BE IN BED29 OR ASLEEP. 27 One may use a timer to turn the lights off each night automatically, but not on Shabbos. Because of the public nature of the lights, they must stay lit lest anyone think that they were turned off manually, which would be a violation of the holy Shabbos. 28 11:35 pm Eastern, 10:35 Central/Mountain time. 29 Watching Leno or Letterman.

 5. TREE DECORATIONS ARE CONSIDERED "MUKTZA L'MITZVASA", "SET ASIDE FOR ITS MITZVAH", AND MAY NOT BE USED FOR ANY PERSONAL USE UNTIL AFTER XMAS IS OVER.30 FOR EXAMPLE, EDIBLE DECORATIONS MAY NOT BE EATEN UNTIL AFTER XMAS. SIMILARLY, SINCE THEY MAY NOT BE USED FOR PERSONAL USE, ANY DECORATIONS WHICH FALL FROM THE TREE ON SHABBOS OR ON YOM TOV MAY NOT BE REPLACED31 UNTIL AFTER SHABBOS OR YOM TOV. 30 See Siman 9 below for opinons regarding when Xmas actually ends. 31 Or even handled.

6. IF THE LIGHTS WERE NOT32 PUT AWAY AFTER XMAS, THEN IN THE FOLLOWING YEAR EACH33 BULB MUST BE REMOVED34 FROM THE WIRING AND REATTACHED. 32 But if they were put away properly, then the act of restringing them the following year suffices for the mitzva. It is only where they stayed up all year that the lights must be renewed by removing and reattaching them. 33 If is enough if this is done for the majority of bulbs. 34 The bulb does not need to be totally removed, but it is adequate if the bulb is so loose that the electricity will not flow to it to light it.

 4. GIFTS 1. ONE IS OBLIGATED TO BUY PRESENTS, REGARDLESS OF HIS INCOME LEVEL, FOR EVERY PERSON THAT HE HAS EVER SPOKEN TO IN HIS ENTIRE LIFE and their immediate family members. ONE MAY GO INTO SERIOUS DEBT IN ORDER TO CARRY OUT THIS MITZVAH. PRESENTS MAY BE EXCHANGED AT ANY CONVENIENT TIME DURING DECEMBER UP UNTIL THE 25TH. 2. REGARDING A CHILD WHOSE BIRTHDAY OCCURS ON OR AROUND XMAS, SOME SAY TO GIVE HIM A DOUBLE PORTION OF GIFTS,35 AND OTHERS SAY TO GIVE HIM A SINGLE PORTION.36 SOME RESOLVE THIS BY GETTING HIM A NORMAL NUMBER OF GIFTS, BUT THEY WOULD BE DOUBLE IN SIZE OR VALUE.37 35 Which may cause others to feel cheated. 36 Which will surely cause him to feel cheated. 37 Another idea has been to celebrate "Xmas in August". See Rabbi Edward's opinion below, in section 9:2.

 5. THE OFFICE PARTY 1. "WHEN DECEMBER ARRIVES, OFFICE PRODUCTIVITY DECREASES."38 BEGINNING AT 9:00 AM ON THE MONDAY PRIOR TO XMAS, ALL REAL OFFICE WORK STOPS.39 IN ORDER TO MAINTAIN THE ILLUSION OF DOING REAL WORK, EMPLOYEES BUSY THEMSELVES WITH TASKS SUCH AS THE COMPANY NEWSLETTER, OR PLANNING THE OFFICE "HOLIDAY PARTY". 38 As it is said, "It's a slow time of year." 39 When that Monday is Erev Xmas itself, this work stoppage is moved up to the preceding Monday.

2. IT IS A REQUIREMENT THAT ALL COMPANIES CONDUCT AN ANNUAL "HOLIDAY PARTY" EACH YEAR. THIS HAD BEEN CALLED A "XMAS PARTY" UNTIL 1972, WHEN THE SUPREME COURT RULED IT TO BE A DISCRIMINATORY NAME. THE TERM "HOLIDAY PARTY" WAS ENACTED SO THAT NATIVE AMERICANS, ASIANS, AND MUSLIMS40 WILL ALL FEEL EQUALLY UN-AMERICAN. 40 When Ramadan is not in December. 3. THE "HOLIDAY PARTY", IN ORDER TO BE DONE PROPERLY, REQUIRES A GREAT DEAL OF RITUAL DRINKING AND DEBAUCHERY. "AD'LOYADA" - ONE MUST DRINK AND CONTINUE DRINKING UP TO41 THE POINT HE CANNOT TELL THE DIFFERENCE BETWEEN HIS FAT DUMPY WIFE AND HIS GORGEOUS 22 YEAR-OLD BLOND SECRETARY.42 41 In this case, "up to" means "ad v'lo ad b'clal" - "up to but NOT including" the point when he cannot tell the difference. Once one has reached this point he is excused from further drinking. See next note for more details. 42 The example above presumes that he is a male, and his secretary is a female. However, if his secretary is male, and he has reached the point where he cannot tell the difference between his fat dumpy wife and his handsome 22 year-old blond male secretary, then he is forbidden to drink any more alcohol until Purim.

4. ALL BANKS AND OFFICES MUST CLOSE AT NOON43 ON THE 24TH OF DECEMBER SO THAT EVERYONE MAY BE ABLE TO GET HOME IN TIME TO TAKE CARE OF THE LAST MINUTE PREPARATIONS. 43 Retail establishments remain open until 4 PM on Erev Xmas, and restaurants a bit later. There is a popular saying that "Denny's never closes," leading many people to ask, "So why are there locks on the doors?" The answer is that until recently, Denny's restaurants had been non Xmas-observant, and in fact did not have locks on the doors. Locks were installed only a few years ago when Denny's became Xmas-observant and began closing for the holiday.

 6. THE FESTIVE MEAL 1. IN THE EVENING, AFTER THREE STARS APPEAR IN THE SKY, THE FAMILY GATHERS TOGETHER FOR THE EREV XMAS MEAL. THERE ARE VARIOUS OPINIONS AS TO WHAT IS TO BE EATEN AT THIS MEAL. ONLY FISH IS TO BE EATEN AT THE EREV XMAS MEAL.44 In our lands, the custom is to eat 12 fishes45 at this meal corresponding to the 12 days of Xmas. 44 When Erev Xmas is on Friday, and the dinner coincides with the first Shabbos meal, only gefilte fish may be used. 45 Even on Shabbos, one can easily reach 12 different kinds of gefilte fish: How can we show that four different fishes can make twelve different dishes? Because we ate four different fishes in Egypt, (whitefish, pike, carp, and whitefish-pike,) but we are now able to buy them three different ways. We can buy them ready-to-eat in jars, frozen in loaves, or ground raw at the fish store. Now, it follows that if there were four different species made three different ways, then there are 12 different gefilte fishes. How can we show that each of the twelve fishes is actually eight dishes? Because they can be made with or without salt, with or without sugar, and with or without matzo meal, and there are eight combinations of those three options. Thus, if there are twelve fishes that can be prepared eight ways, then there are a total of 96 dishes! How can we show that each of the twelve fishes is actually sixteen dishes? Because each of the eight recipes can be made either cooked or baked. Thus, if there are twelve fishes that can be prepared sixteen ways, then there are a total of 192 dishes!

 2. ONCE THE MEAL IS COMPLETE, THE FAMILY GATHERS IN THE ROOM WITH THE TREE WHERE THEY SING ZEMIROS AND DRINK EGGNOG.46 AT MIDNIGHT THE FAMILY HEADS TO SHUL FOR TIKKUN CHATZOS. Some say that Tikkun Chatzos can be said as early as 8:00 PM,47 but it is good to be stringent on oneself. 46 Eggnog being a milchig drink, some hold that this is the real reason for eating fish instead of meat. 47 So that the children will be awake.

 7. SANTA CLAUS 1. FOR MANY YEARS, THE EXISTENCE OF SANTA CLAUS WAS A SUBJECT OF INTENSE DISPUTE IN THE ADULT COMMUNITY. IN 1897, A TEAM OF INVESTIGATIVE REPORTERS WAS COMMISSIONED BY ONE VIRGINIA O'HANLON TO RESOLVE THE QUESTION. THEIR FINDINGS CONCLUDED "YES, VIRGINIA, THERE IS A SANTA CLAUS."48 THIS WAS REAFFIRMED SEVERAL DECADES LATER IN A COURT CASE BROUGHT IN NEW YORK COUNTY SUPREME COURT.49 48 New York Sun, September 21, 1897. (not in December as one might think) 49 Testimony from the United States Post Office proved to be crucial in deciding this case, as documented in Miracle on 34th Street, 1947.

 2. IT IS ABSOLUTELY FORBIDDEN TO LIGHT ANY KIND OF FIRE IN THE FIREPLACE ON THIS EVENING.50 THOSE WHO WANT TO ROAST CHESTNUTS ON AN OPEN FIRE SHOULD USE A BARBECUE. 50 DUH! (But see also below, note 39) 3. TO DEMONSTRATE OUR FAITH51 IN SANTA, EACH YEAR WE LEAVE HIM A PLATE OF DONUTS OR COOKIES ON A TABLE NEAR THE TREE, WITH A GLASS OF MILK TO DRINK. SOON AFTER THIS PRACTICE BEGAN, CHILDREN BEGAN TO QUESTION WHY THE MILK WAS STILL ON THE TABLE THE FOLLOWING MORNING, SO THEIR PARENTS ADOPTED THE CUSTOM OF DRINKING THE MILK AFTER THE CHILDREN WENT TO BED. HOWEVER, JUST THREE YEARS AGO,52 WHILE DELIVERING HIS GIFTS, SANTA ACCIDENTALLY REVEALED TO A YOUNG GIRL THAT HE SUFFERED FROM LACTOSE INTOLERANCE, AND THAT THIS IS WHY THE MILK HAD BEEN LEFT UNDRUNK ALL THOSE YEARS. THE FOLLOWING YEAR, SHE LEFT HIM A GLASS OF PAREVE SOYBEAN "MILK", AND THIS PRACTICE HAS SPREAD FAR AND WIDE SINCE THEN. (IN COMMUNITIES WHICH ACCEPT THE USE OF GOVERNMENT SUPERVISED MILK IN LIEU OF RABBINIC CHOLOV YISROEL, LACTAID™ MILK IS USED INSTEAD.) 51 "I believe with complete faith that he knows if you've been bad or good, so be good for goodness sake." Ani Maamin #11, daily siddur. 52 The Santa Clause, by Tim Allen, produced by Walter Disney, 1994. This film also showed Santa's new fire-resistant suit which was developed just that year. Nevertheless, the principle is that a protective measure is not abandoned even if the reason no longer exists, and so the ban on lighting fireplace fires remains in full force.

 8. OTHER CUSTOMS 
 1. ONE IS TO RISE EARLY ON THE MORNING OF THE 25TH IN ORDER TO OPEN THE PRESENTS. THERE IS A RITUAL MEAL WHICH MUST BE COMPLETED BEFORE SUNSET. 2. MEAT AND WINE MUST BE SERVED AT THIS MEAL. LOTS ARE DRAWN TO CHOOSE A DESIGNATED DRIVER WHO MAY NOT HAVE ANY WINE. 3. THE MEAT MAY ONLY BE ROASTED. ONE MAY NOT EAT ANY BOILED OR BROILED MEAT AT THIS MEAL. 4. AFTER THE MEAL, MANY HAVE THE CUSTOM TO RETIRE TO THE FAMILY ROOM TO WATCH SPORTS ON T.V. 5. KIDDUSH IS NOT RECITED ON XMAS, BUT HOLLY IS REQUIRED. 9. HAVDALA 1. THERE ARE MANY OPINIONS REGARDING WHEN THE XMAS SEASON IS OVER.53 SOME HOLD THAT XMAS IS OVER WHEN THE LAST ITEM IN THE AFTER-XMAS SALE HAS BEEN SOLD. OTHERS ARE STRICT AND HOLD THAT XMAS IS OVER IMMEDIATELY AT THE CONCLUSION OF THE FOOTBALL GAME. The last opinion is the main one. 53

 Many are confused by the term "twelve days of Xmas", implying that the Xmas continues until and including January 5. Today, this view is accepted only by the Eastern Orthodox, who hold that December 26 through January 5 constitute Chol Hamoed Xmas. This view is opposed by both the Modern Orthodox and the Ultra Orthodox (and even the Non Orthodox) who hold that Xmas is only one day long, and any context which seems otherwise actually refers to the Xmas season.

 2. WALLED CITES CONTINUE XMAS UNTIL THE END OF THE WINNING TEAM'S TICKER-TAPE PARADE. A RECENT AUTHORITY, RABBI EDWARD, CELEBRATED XMAS IN AUGUST. For this he became known as "Crazy Eddie".

 HAGADA FOR XMAS
 This is the fruitcake of our affliction, which our ancestors baked 400 years ago. All who are in need, come and celebrate Xmas with us. All who are hungry, come and partake of this 400-year-old fruitcake, as it is written, "Let them eat cake!" This year we watch football in the living room, next year may the Super Bowl come to our city! Some have the custom to place the gift-wrapped presents under the tree so that they will pique the curiosity of the children so that they will ask the Four essential questions: How come I have presents and Santa Claus didn't come yet? Why do we drive on the parkway and park in the driveway? How much is that gorilla in the window? Why did the chicken cross the road? We were slaves to our employers, working seven days a week with no benefits, and then the Unions were organized, and decreed a five-day workweek and many holidays in the end of the year. Now if the Unions had not gotten their act together, then we, and our sons, and even our grandsons, would still have to work on Labor Day, Thanksgiving, Xmas, and New Years. But our daughters and granddaughters still await their salvation.

 There are four types of children who ask questions on Xmas: the wise one, the bad one, the simple one, and the one who does not know to ask. - What does the wise one ask? I don't know; I couldn't understand him either. Him you must send to a school for gifted children. - What does the bad one ask? He says, "What is this holiday to you?" Because he excludes himself from the community, you must exclude him from your table, and he will go back to his employer and get paid double-time and a half for working on Xmas day. - What does the simple one ask? He simply asks, "What is this?" You will say to him, "This is dinner." - As for the one who does not know to ask, you must go to his room, wake him up and say, "Next year, come to dinner on time!"

 If we would have a beautiful tree, but not have stockings hanging from the fireplace, it would have been enough. If we would have stockings hanging from the fireplace, but not get today off from work, it would have been enough. If we would get today off from work, and not get off on Erev Xmas as well, it would have been enough. If we would get off on Erev Xmas as well, but not get presents, it would have been enough. If we would get presents, but not a delicious dinner, it would have been enough. If we would have a delicious dinner and no dessert, it would have been enough. If we would have dessert, but not watch the football game, it would have been enough. If we would watch the football game, but not see our team win, it would have been enough. If we would see our team win, and have a hangover the next morning, it would have been enough. (Pick up the eggnog and say:) But we do have a beautiful tree, and we have stockings hanging from the fireplace, and we got today off from work, and we got off on Erev Xmas as well, and we got presents, a delicious dinner, and dessert, and we watched the football game, and saw our team win, and so we will now toast our team, and pray that we do not get a hangover tomorrow morning: "Yay team!" Next year is Purim!

ZEMIROS Who knows one? I know one! One is a partridge in a pear tree. Who knows two? I know two! Two are the turtledoves, and One is a partridge in a pear tree. Who knows three? I know three! Three are the French hens! Two are the turtledoves, and One is a partridge in a pear tree. ... ... Who knows four? I know four! Four are the calling birds! ... Who knows five? I know five! Five are the gold rings! ... Who knows six? I know six! Six are the geese a-laying! ... Who knows seven? I know seven! Seven are the swans a-swimming! ... Who knows eight? I know eight! Eight are the maids a-milking! ... Who knows nine? I know nine! Nine are the drummers drumming! ... Who knows ten? I know ten! Ten are the pipers piping! ... Who knows eleven! I know eleven! Eleven are the ladies dancing! ... Who knows twelve? I know twelve! Twelve are the lords a-leaping! Eleven are the ladies dancing Ten are the pipers piping Nine are the drummers drumming Eight are the maids a-milking Seven are the swans a-swimming Six are the geese a-laying Five are the gold rings Four are the calling birds Three are the French hens Two are the turtle doves and One is a partridge in a pear tree. -------------------

 One little reindeer, one little reindeer, My father bought for two zuzim. One little reindeer, one little reindeer. Then came a cat and ate the reindeer My father bought for two zuzim. One little reindeer, one little reindeer. Then came a dog and bit the cat, That ate the reindeer, My father bought for two zuzim. One little reindeer, one little reindeer. Then came a stick and beat the dog, That bit the cat that ate the reindeer My father bought for two zuzim. One little reindeer, one little reindeer. Then came a fire and burned the stick, ... Then came the water and quenched the fire, ... Then came an ox and drank the water, ... Then came a shochet and slaughtered the ox, ... Then came the angel of death and killed the shochet, ... Then He came and slew the angel of death, That killed the shochet that slaughtered the ox That drank the water that quenched the fire That burned the stick that beat the dog That bit the cat that ate the reindeer My father bought for two zuzim. One little reindeer, one little reindeer.

APPENDIX The authors are proud to have been students of Yeshivat Ohr Somayach (Akiva in 1976-80) and Neve Yerushalayim (Ilene in 1979-80) in Jerusalem, Israel. Akiva has written and published some serious Torah on the Internet over the past few years, but it has not gotten the wide and speedy distribution enjoyed by "The Laws of Xmas." (The reason for this is simple: The Guinness Book of World Records used to list "lashon hara" under the heading "fastest known form of communication", but this changed in 1996 when "funny e-mails" moved into first place.)

The Current State of US Negotiations with Iran [Thanks, Obama!]

(click here to view)

Paul Combs Tribune Media Services Jul 15, 2014 EditorialCartoonists.com

No Comment Needed

(click here to view)

Mike Smith Las Vegas Sun Jul 15, 2014 EditorialCartoonists.com

The Clock is...Ticking?

(click here to view)

John Cole Scranton Times/Tribune Jun 27, 2014 EditorialCartoonists.com

Proud to be a "Hog"!

(click here to view)

A.F.Branco Freelance/Self-syndicated Jun 19, 2014 EditorialCartoonists.com

Don't mess with my team! [There aren't any Amerinds in the DC vicinity anyway; the name comes from the Boston Redskins, which they were originally.] Frankly, using a bunch of caricatured dancing leprechauns for the "Fighting Irish" of Notre Dame is more offensive to "Little People", IMHO.

Happy 66th Independence Day, Israel!

(click here to view)

Gary Varvel Indianapolis Star May 5, 2014 EditorialCartoonists.com

Maybe we'll be able to end the war of independence in 50 years or so...

Midterm Election Strategy Explained

(click here to view)

Bob Gorrell Creators Syndicate Inc. Apr 16, 2014 EditorialCartoonists.com

In other words, basically the same strategy as 2008, 2010, and 2012.

I Wouldn't Hold My Breath If I Were You

(click here to view)

Randy Bish Pittsburgh Tribune-Review Mar 6, 2014 EditorialCartoonists.com

"You May Well Think It, But I Couldn't Possibly Comment" [Francis Urquart, "House of Cards"]

(click here to view)

Bob Gorrell Creators Syndicate Inc. Mar 3, 2014 EditorialCartoonists.com

Hadassah and Hubris Part 7

From Haaretz -- the argument for nationalization:

Thank you for your money ladies, and good-bye

By Anshel Pfeffer | Feb. 21, 2014 | 12:00 PM

Hadassah, The Women's Zionist Organization of America laid the foundations for modern medicine in Israel, but the medical center’s crisis is a signal that Israelis must take responsibility for themselves 

 

There is probably not one Israeli today who has not benefitted at some point in life from Hadassah University Hospital, was born or had a child enter life there, received treatment or underwent an operation. Even if they and their family members never entered one of the Jerusalem hospitals at Ein Karem or on Mount Scopus, they were certainly treated by doctors and other medical practitioners who graduated from Israel’s oldest and arguably still most prestigious medical school.

And yet only a small minority of Israelis and not even most Jerusalemites were aware until a few weeks ago of the fact that the hospital they regard as a national institute and constant fixture in their lives is actually owned by a group of Jewish philanthropists in America, Hadassah, The Women’s Zionist Organization of America. In its 102 years of existence, Hadassah may have laid the foundations for modern medicine in Israel but that is of little relevance to Israelis today. The organization’s founder, Henrietta Szold, deserves to be remembered as one of the great pioneers of Zionism, but there was little room for her in the masculine pantheon of fighters, generals and politicians. Founding hospitals and nursing schools was never going to be as sexy as leading men in battle, and Szold did herself no favors by supporting Brit Shalom with its belief in a binational state and Jewish-Arab cooperation. After her death in 1945, Hadassah Women continued to prosper for decades as one of the most influential Jewish organizations in the U.S., famed for its fund-raising, while Israelis just got used to having the hospitals.

Now, all of a sudden, they have been thrust into the spotlight as an ugly battle of blame is being fought out in full media glare over responsibility for the 1.3 billion shekel deficit that has left the medical center, the biggest private employer in Jerusalem, incapable of paying salaries and forced to appeal to the courts to get the creditors of its back. There’s a long list of culprits − senior management who hid the full figures, the government which failed to regulate, the health maintenance organizations which forced Hadassah into disadvantageous arrangements, wealthy doctors who used the hospital as their base for private treatments, unions who gouged preferential terms for favored members and the good women from overseas bequeathed Hadassah an archaic ownership structure and a $360 million 14-story new hospital tower that the hospital cannot afford to operate.

Nothing is holy in this very Israeli mud-fight, and no one is coming out well. The media have been inundated with wild figures of senior doctors’ and executives’ salaries, the details of former executive director Professor Shlomo Mor-Yosef’s golden parachute, how respected members of the board looked the other way and sordid stories of how Hadassah women lost much of their investment fund in the Madoff scandal. They tried to remain above the fray, preferring instead to use PR people and direct the blame elsewhere, and really, why should they be blamed? All they did over the years was to donate hundreds of millions and ensure that the people of Jerusalem enjoyed a first-class level of medical treatment, but they have been forced to fight back because now they are being faced with the ultimate humiliation: nationalization of the medical center that will wrest control over its affairs from their hands. How could the people of Israel be so ungrateful after all we have done for them?

There is no question that Hadassah should be nationalized. An organization that has created for itself a 1.3 billion shekel deficit and can only be saved by a massive government bailout has no alternative but to cede ownership and effective control to the state. Or else go under. Arguing that the funds Hadassah provided over the decades should grant the organization perpetual private ownership disregards the fact that even before the looming bailout, it was in reality a public medical center, with the lion’s share of its budget always coming from the Israeli taxpayer. There are other ways to recognize Hadassah women’s contribution than clinging to a historical anomaly that contributed, at least in part, to the current crisis.

The arguments made by Hadassah President Marcie Natan and Israel Director Audrey Shimron against nationalization make as much sense as the Rothschild family issuing a demand that since it funded much of the construction costs of the Knesset and Supreme Court buildings in Jerusalem, they also get to appoint the MKs and justices. If there were six or seven other general hospitals serving the capital then maybe it would make sense, but Hadassah operates two out of Jerusalem’s three main general hospitals.

Conceivably, if they had the necessary funds to dig Hadassah out of its hole, they may be allowed to retain some control, but the most they are capable of offering is $25 million from their depleted investment fund, less than 10 percent of what the hospitals’ need to ensure their long-term survival.
The government will of course bail out Hadassah and the mandarins of the treasury’s budget department − the most powerful civil servants in Israel − will make sure that effective control of the medical center’s financial affairs is transferred to the government. There is no other way they will agree to fork out what will be at least a billion shekels over the next few years. Hadassah women will never again have much of a say in the decision-making. While to all purposes this will be de-facto nationalization, it will probably be called something else. Prime Minister Benjamin Netanyahu, facing considerable pressure from the Obama administration on the Palestinian and Iranian issues, is too fearful of adding to his troubles a potential showdown with the old American Jewish establishment.

Hadassah women may have lost much of their stature due to generational changes and the shifting landscape of Jewish philanthropy, and are no longer a central pivot of American Zionism as they were a generation ago, but they still wield considerable influence. What they lack in fund-raising prowess and financial acumen, they still have in lobbying clout. Israel Director Shimron is married to one of Netanyahu’s oldest childhood friends and personal lawyer. The Women’s Zionist Organization of America would become a nonentity overnight if it is forced to abandon its connection to the Jerusalem hospitals. Netanyahu won’t do that to them. They will retain their titles, be allowed to continue fund-raising on the medical center’s behalf in North America, hold their galas, cut ribbons, fete each other and make passionate speeches, but that’s all.

The Hadassah debacle has provided a valuable lesson to both Israelis and American Jews. While the financial assistance of the Diaspora was extremely valuable, perhaps crucial, to Israel in its early years, continuing to rely on the generosity of kind women in America can lead to bankruptcy, as it has in Hadassah. Israelis have to take ownership of their own social issues, just as they must do with all their other challenges. This doesn’t mean we are ungrateful in any way, only that we have to grow up. We’re still friends and if you want to continue donating, that’s great, but if not, well then, thank you ladies for your money and good-bye.

Hadassah and Hubris Part 6

From Haaretz, Feb. 21:

 Hadassah: Medical excellence, management malpractice The world renowned hospital is controlled by the women’s organization, but runs as poorly as a government institution.
 By Meirav Arlosoroff
 Feb. 21, 2014 | 8:23 AM

  In the middle of 2012, Hadassah Medical Center’s board of directors received a damning report on its two Jerusalem hospitals -- which have over 5,000 employees and annual revenues of some 2 billion shekels ($568 million).

 The report revealed that a major medical center that plays a key role in the health of Israel’s biggest city was not being properly managed on the most fundamental level. The center had no financial targets for increasing revenue or market share. There was no cost accounting for procedures done by doctors -- no one knew if the medical treatments were profitable or lost money -- and by how much. There was no breakdown of expenditures by department, and department heads did not know whether their units were in fact making or losing money. But they also didn’t feel they were being deprived of useful information because none had ever received management training.

There were no work plans, no data collection, no supervision of the hospitals’ financial management or of manpower costs.

 The report, which was prepared as Hadassah Director General Prof. Shlomo Mor-Yosef was stepping down as was the medical center’s comptroller and chief financial officer, was the start of the snowball that ended with the Hadassah receiving protection from its creditors in court a week ago.

Over the past 18 months, not a stone has been left unturned in Hadassah by its new director general, Avigdor Kaplan, and the board. And under every stone more and more failures have been found. All together they add up to a financial and management fiasco at a world renowned medical center.

 Everywhere you look, there seems to have been a glaring lack of management at the medical center. For example, doctors have been paid overtime for working in the afternoon to help reduce long lines for appointments. The extra hours are a part of the regular operations of the hospital - not part of the private medical services (Sharap) it offers. Shortly after Mor Yosef’s departures, Hadassah’s new management began exploring way to tackle a deficit that by the end of 2012 had reached 850 million shekels. What they discovered was that in many specializations the number of procedures carried out in the morning hours was suspiciously low. Instead, most were performed in the afternoon when the doctors received overtime pay.

 This kind of featherbedding reached its peak when the private medical services were involved. The doctors performed procedures on a private basis also in the afternoon, the same time they were supposed to be providing services under the hospital’s public health service requirements. In practice, a few of the highest wage earners at Hadassah were doctors who received salaries for the public healthcare services they provided, but in practice worked only in the private services. Hospital management seems to have known and done nothing.

 Artificially long waits

Management never supervised the hours of the private healthcare services, or the scope of services provided. By creating impossibly long waits for receiving treatments and appointments in the public health system, doctors were easily able to maneuver patients toward private care. Research conducted at Hadassah a year ago showed that the average wait was 55 days for treatment in the public system and only seven days for exactly the same treatment, by the same doctor and in the same hospital in the private system.

 It was of course not particularly complicated to prevent this. All that had to be done was to set quotas between the two systems: No department could offer private medical care beyond a certain percentage that must be dedicated to public services, and no doctor could receive patients privately if he did not provide a certain number of the same treatments in the public framework.

 Similarly, Hadassah could have linked waiting times for public and private medicine, for instance by creating a rule that a private appointment would always be one day longer than in the public system. Creating such a linkage would give the doctors an incentive to increase the quota of their activities on the public side and reduce as much as possible the waits for treatments for the government-subsidized patients.

 The lack of management supervision was also evident in the odd contracts governing the operation of the private healthcare services. These were historic contracts signed decades ago -- it seems even as much as 50 years ago -- and have never been changed out of a fear of upsetting the hospital’s labor relations. The contracts state that the hospital receives only 22% of the doctor’s gross revenues from the private services -- for net revenues of just 16%. This is a ludicrous amount considering that the entire expense of providing private medical services is absorbed by the hospital. Moreover, private services were so popular in the first place because of Hadassah’s reputation as a leading medical institution. Hadassah management must have certainly known that such a contract was problematic for the hospital itself, but management was afraid of angering the doctors.

Research vs treatment

The problem of managerial neglect was compounded by Hadassah’s role as a university teaching hospital. The division between healthcare, which earns money, and research, which is a pure expense, was never made, or monitored. Many doctors spent more of their time on research than they did treating patients. In some cases, it turns out that the doctors continued their research projects even after their research grants ran out - while the hospital continued to fund the projects out of its own pocket.

 The lack of oversight over research activities is common at state-owned hospitals in Israel as well, the report says. It is a major waste of resources and takes away from doctors’ time treating patients. But at government hospitals there are limits on research activities and a doctors need to win external grants to finance their research.

 What is shocking is that Hadassah was supposed to be much better run than the government-owned hospitals. Hadassah, after all, is controlled by Hadassah, the Women’s Zionist Organization of America. It has an active board of directors that is supposed to oversee management -- this, in contrast to the outrageous situation in state-owned hospitals, which have no boards at all.

 But it turns out a corporate governance structure is no guarantee of sound management. The weakness of the Hadassah board, as evidenced by the absence of any managerial goals, seems to stems from the unhealthy involvement of the Hadassah women’s organization.

 In practice, the organization weakened the board by maintaining its own direct relations with the hospital’s director general. In such a situation, it should be no surprise that the director generals never really paid much attention to the boards they were supposed to be reporting to.

 The Hadassah organization and its members are well-meaning Zionists who have also donated hundreds of millions of dollars to the medical center over the years. But most of the organization's leaders lack business and managerial experience. The only director from Hadassah who was considered to have significant business knowledge, Judy Swartz, one of the owners of the footwear and apparel manufacturer Timberland, resigned from the board a short time before the crisis erupted.

 Hospital’s DNA

 In their great generosity, the Hadassah women created the framework that allowed the hospital to deteriorate because management and staff acted with the knowledge that there would always be someone to cover the cost of high salaries, and deficits.

“The organization’s DNA was deep pockets. There would always be someone to pay -- the Hadassah women or the government -- and therefore no one had an incentive to ever become more efficient,” a senior official in the health system told me.

 This DNA is embedded deeply in Hadassah, as evidenced by the fact that it employees are refusing, even when the hospital is collapsing around them, to agree to any cuts in their salaries. Employees of a private organization would never take such a stance if their employer was in such jeopardy. Management and staff could likewise take comfort in knowing their institution was too big and too high profile to fail. Management paid employees, mostly the doctors, whatever they asked for in exchange for peace. Employees, in particular the doctors, demanded more and more even if it was evident that it would be financially detrimental to the hospital.

 Another indication that the supposedly privately run Hadassah was in practice a public institution was its practice of paying noncontributory pensions, even in the case of voluntary early retirements that were part of various recovery plans instituted at the medical center over the years. This meant that the employee contributed nothing toward his pension, which is paid entirely out of the institution’s budget.

 The very generous retirement package Hadassah gave to Mor-Yosef, including a bridging pension of 75,000 shekels a month until he reaches the official retirement age, is in practice a budgetary pension in every way. Bridging pensions were paid by Hadassah regularly, which is one of the reasons why the recovery plans formulated by Hadassah over the past five years failed. Whatever savings were made by laying off staff were easily eaten up by paying pensions to those who left.

This DNA is also what prevented management from healing Hadassah. They had no partner who would agree to lend a hand to save the organization. Therefore, the only way to impose a recovery plan is to force it on the employees via the courts. Instead of acting through the Labor Court, in agreement with the workers, Hadassah management chose to petition the Jerusalem District Court as a way of coercing the employees. All sides will lose in this case.

 But it is, of course, the government that made the decisive contribution to Hadassah’s managerial failure by exempting itself from overseeing the hospitals in Ein Karem and on Mount Scopus, since they are supposedly private. The Health Ministry claimed it had no legal authority to do so.

 But let us remember that Hadassah also operates under the wage agreements set by the state; and under limitations on its scope of operations, set by the state; and under rate schedules, set by the state; under limitations on the number of inpatient beds it can have, set by the state; and of course under the state’s “too big to fail” insurance.

The claim then that Hadassah is a medical center that does not need to be supervised by the state is baseless. Given that the Health Ministry lives just fine with the fact that the hospitals it owns operate without boards of directors and without internal auditors, makes it easy to believe that the ministry didn’t think it had to supervise Hadassah either.

 The treasury is no less at fault

The government’s other arm involved in the affair, the Finance Ministry, contributed no less to the management failure at Hadassah. The treasury placed severe limitations on hospital budgets. The portion of the state budget intended for health services was eroded within a decade form 5.2 percent of GDP to only 4.5% of GDP, and this was during a period when health costs only rose. This prolonged shrinking of the health care budget led to serious deficits in the system: Every hospital, except for Sheba Medical Center at Tel Hashomer, and every health maintenance organization are in debt; but at least the public bodies receive compensation via grants from the treasury to close their deficits.

 These equalization grants for the HMOs and the subsidies for the hospitals are paid out regularly. The hospital subsidies have reached 720 million shekels a year. Hadassah, because it is seemingly a privately owned institution, was not eligible for these subsidies, and so its situation became worse than that of the other hospitals.

This is the chronic disease of failure that makes one tempted to say it was foreseeable. Since the government did not supervise and was not interested in supervising, Hadassah's colossal failure came as a big surprise. Now it will cost all of us at least half a billion shekels to fix the mess.

NHS, Anyone?*

(click here to view)

Bruce Plante Tulsa World Feb 23, 2014 EditorialCartoonists.com

See here: *There's nothing wrong with the concept of the NHS, or indeed the concept that health care in the US needs radical reform. The devil is in the details. Populations grow, often at unpredictable rates. Doctors, nurses, and all other varieties of health care providers and facilities do not automatically expand [or contract] to match the needs of populations. A fact so simple only a child can understand it.

Gee Whiz, It's 10 Years Already!

Searching for a particular post, I suddenly realized I've had this blog for 10 years now.  Haven't begun to write all I've wanted to say, but maybe [!?] the next 10 years will be better.

As the saying goes, "to be continued"...

Hadassah and Hubris Part 5: Accountability at Hadassah

From Haaretz: editorial Feb. 13, 2014

Accountability at Hadassah, not just a bailout

The anarchy, irresponsibility and administrative failure at Hadassah Medical Center surprised the public. No one, even in the health or finance ministries, knew just how deep was the hole in which Jerusalem’s two Hadassah hospitals had sunk: annual losses of 300 million shekels ($85 million) and an accumulated deficit of 1.3 billion shekels. 

It is clear that a recovery plan is needed to bring Hadassah into the black and allow the medical center to continue to operate. The Finance Minister – in other words the Israeli public – will put up hundreds of millions of shekels, and employees will have to do their share. That means layoffs, wage cuts, a complete overhaul of terms of employment and of the center’s private medical services (known by the Hebrew acronym Sharap). 

But it’s not enough to address the future; an accounting of past actions is also needed. It is inconceivable for labor to pay the price, while management goes scot-free. The focus must be on 2001 to 2011, when Prof. Shlomo Mor Yosef was director general of Hadassah Medical Center. In this period the center’s deficit swelled due to the failures of the management, which sought only to appease labor through unconditional surrender to their demands. It was in this period that the magnificent and megalomaniacal Sarah Wetsman Davidson Tower, which costs 30 million shekels a year to operate, was built. 

In light of this mismanagement, Mor Yosef’s employment terms were unwarranted. As head of Hadassah Medical Center he earned 140,000 shekels a month, plus “appreciation bonuses” equal between two and four months’ salary. His retirement conditions, too, are outrageous: a bridging pension of 75,000 shekels a month until he reaches the official retirement age of 67, several million shekels in severance pay, redemption of his leftover sick pay and vacation days, and continuing contributions to his pension and other savings plans, even though he no longer works for Hadassah. 

Hadassah’s board of directors also failed to meet its responsibilities. From the minutes of its meetings it is clear the board did not stand up to management, making do with gentle criticism that was not acted on. Thus, the conduct of the chairmen during this period should also be scrutinized: David Brodet, Yossi Nitzani and Yossi Rosen. 

In order to get to the bottom of these weighty issues, the cabinet should appoint a commission of inquiry that will examine the reasons for the financial collapse, the conduct of the director general and all the gatekeepers – the directors, accountants, internal auditors, the Registrar of Nonprofit Organizations and the health and finance ministries. Only an investigative commission with teeth will make it clear that administrative failure in the public sector incurs a personal cost rather than, for example, being hired to head the National Insurance Institute, at a monthly salary of 60,000 shekels.

Hadassah and Hubris Part 4: The New Tower

 Health sources: New Hadassah tower helped drive hospital to near-bankruptcy 

Haaretz, Feb. 13, 2014

The new tower at Hadassah University Hospital, Ein Karem is one of the main causes of the near-bankruptcy of Hadassah Medical Organization. 

The 19-floor Sarah Wetsman Davidson Tower contains high-tech operating theaters and private rooms. While the hospital did need these new facilities, the building’s upkeep is so expensive that it rapidly worsened the hospital’s already shaky financial situation. 

Yet there is almost no mention of the new tower in Hadassah Medical Organization’s application for protection from creditors, which was granted by the Jerusalem District Court on Tuesday. The petition, which presumes to list all the causes of the medical center’s financial collapse, mentions salary distortions, a surplus of employees, problematic agreements with Hebrew University and outsized discounts to Israel’s health maintenance organizations. The tower is mentioned only as an asset. 

Most of the funding for the tower – 800 million shekels ($227 million) - came from the New York-based Hadassah, the Women’s Zionist Organization of America, which operates Hadassah Medical Organization, even though its budget deficit was growing rapidly during that time. The state contributed another 197 million shekels. 

During those years, despite the huge influx of cash for the tower’s construction, the medical organization, which also includes Hadassah University Hospital, Mt. Scopus, was scrambling for money. One tactic, revealed recently, was to pull money out of the doctors’ private funds, unbeknownst to the doctors themselves. 

Health sector sources said they had no doubt that paying for the tower’s upkeep was a major burden for the hospital. The new facilities were necessary, as the hospital had been overcrowded and patients’ rooms had been substandard. 

The new tower has 19 floors, including five below ground, and contains 100,000 meters of space, nearly double that of the old building. It could be considered Israel’s best hospital facility, with 500 beds in private or double rooms. By comparison, the Sami Ofer Building at Tel Aviv’s Ichilov Hospital has double and triple rooms, and not one single room. 

The tower’s cost -- $360 million, including $318 million for construction and another $42 million for equipment – was tens of millions of dollars beyond the original budget. 

Since the new building opened, it has increased the hospital’s operating expenses by 30 million shekels a year, sources told TheMarker. Hadassah said that figure is incorrect. 

Some 85% of the new building’s operating budget comes from donations, as is the case with many of the newest hospital facilities in Israel. All of that money is raised by the Hadassah women’s organization. 

Still, the hospital very likely could have sufficed with new facilities that cost less to maintain.
“It’s killing their operating budget,” said a senior official in Israel’s health sector. “A bloated project, ostentatious and wasteful, that doesn’t suit the standards in Israel. One or two patients per room? Someone needs to fund that.” 

Another health sector source suggested that the women’s organization’s promotion of such a building showed it was out of touch with the economics of hospitalization in Israel. 

“The Hadassah women live in the United States, where people pay thousands of dollars for a day of hospitalization. In Israel it costs a few hundred dollars. You can’t maintain the same standard,” he said. 

Audrey Shimron, head of the Hadassah women’s organization in Israel, said building a tower of this standard was a matter of foresight. The tower was built to last 50 to 70 years, she said. 

Meanwhile, former Hadassah Medical Organization director Shlomo Mor-Yosef said yesterday that he is being unfairly blamed for the hospitals’ financial problems. Taken to task for the large salary bonuses he received in his former job, Mor-Yosef, now director general of the National Insurance Institute, refused to take the blame for the Jerusalem hospital’s dire financial straits, saying that the Finance Ministry and the Hadassah women’s organization knew about its financial decline but failed to do anything about it. 

Mor-Yosef was speaking at a session of the Knesset Finance Committee, which he was attending as NII director general. He had initially been asked to attend to discuss imbalances in the NII’s own cash flow. However, Knesset members demanded that he respond to a report in Wednesday's Yedioth Ahronoth newspaper about salary bonuses he received from Hadassah during a period in which the hospital accumulated a huge deficit. 

Hadassah Medical Organization filed for protection from creditors on Friday, and only paid staff at the hospital’s two Jerusalem locations half their salaries at the beginning of the month. The hospital has also been wracked with labor unrest over the past several days. 

Hadassah employees continued with their labor sanctions on Wednesday, as the hospitals continued to offer only life-saving treatment. 

The hospitals are expected to receive a cash infusion of 22 million shekels on Thursday or tomorrow from the Hadassah women’s organization, which would be used to pay salaries, said hospital sources.
The hospitals are also months behind in their payments to workers’ pension and provident funds.
Meanwhile, the halls of the hospitals were nearly empty on Wednesday. Many patients came to Jerusalem’s Shaarei Zedek hospital instead, which appeared significantly busier than usual.

 

Hadassah and Hubris Part 3: The Underlying Problem

Haaretz: Feb. 13, 2014

Why Hadassah is a perfect example of an institution that's too big to fail

Health Ministry Director General Roni Gamzu told a session of the Knesset’s Labor, Welfare and Health Committee this week devoted to the crisis at Jerusalem’s Hadassah University Hospital that he has not been monitoring what has been happening at the crisis-mired medical center because it is a private hospital and he has no oversight authority there. 

The cash-strapped hospital, which consists of two Jerusalem hospital campuses sponsored by the U.S.-based Hadassah women’s organization, filed for protection against creditors last Friday. Privately-owned hospitals, Gamzu said, don’t want to be regulated, “but when they’re in trouble they come and ask for assistance from the state.” 

There are other similarly troubled private hospitals in Israel, Gamzu noted, most of which, unlike Hadassah, are very small. 

Hadassah is actually one of the largest hospitals in the country, with revenues in 2012 of close to 2 billion shekels ($569 million).  It is the major hospital service provider in Israel’s capital. The vast majority of its revenues are paid to Hadassah Hospital by the country’s four health maintenance organizations (kupot holim). The HMOs pay for regular services rendered through the public health system and also through their supplemental insurance plans for medical care provided by doctors at Hadassah on a private basis − sharap services, as they are known by their Hebrew acronym. All in all therefore, the hospital is supported almost entirely from public funds. And in addition, Hadassah’s revenues are limited by the state, as part of government curbs at all the country’s hospitals, in an effort to rein in healthcare spending. 

When Hadassah became mired in its current financial problems, it came running to the state to be rescued. The state is considering injecting half a billion shekels into the hospital even without taking it over. The hospital is a classic example of an institution that is too big to fail, meaning that the public is being relied upon to ensure its continued operation. Even though it is owned by the Hadassah women’s organization rather than the State of Israel, it is a public hospital for all intents and purposes. But if that’s the case, why isn’t it under the state’s oversight? 

The Health Ministry’s response is that it has no legal mandate to impose oversight, which is true from a technical standpoint. The ministry’s supervision of hospitals − all hospitals, including government ones − is based on a 1940 order of the pre-state British Mandatory government. Written at another time by another government authority, you won’t find mention of financial oversight in the order, or in fact the issue of oversight itself. 

Paradoxically enough, the Justice Ministry is the agency that provides oversight of the medical system here, but it lacks legal teeth. In the case of private hospitals, it has never occurred to anyone at the Health Ministry in the 66 years of Israel’s existence to address this absurd legal vacuum. The ministry’s failure to create even a legal foundation for such regulation became apparent at hearings by a committee headed by Health Minister Yael German that is trying in part to address the inherent conflict of interest at her ministry among the hospitals, custodial nursing care insurers, providers of services such as mental health care or equipment, the supervisor of hospitals and the HMOs. But the Health Ministry has no intention to provide oversight, so why knock oneself out to enact modern legislation over its authority? 

Among the evidence presented to the committee was testimony that the subjects of the ministry’s oversight, meaning hospital directors, the most prominent of whom have been on the job for 10 to 20 years, show contempt for requests the ministry makes of them. When it comes to government-owned hospitals, the Health Ministry has authority and actually owns the facilities, but that doesn’t mean it has genuine authority over the hospital directors − so it learns to live with them. 

Private fiefdoms

The ministry deals with the contempt shown by the hospital heads by cornering the hospitals when the time is ripe. When the hospitals make a request of the ministry, it in turn conditions a positive response on getting missing data. In short, the overseer makes a deal with the overseen to get information that the law requires the hospitals to provide in any event.

Zeev Rotstein, the powerful head of the Sheba Medical Center at Tel Hashomer east of Tel Aviv, even built a helicopter landing pad at his facility and hid the project from the health and finance ministries. Rafael Beyar, the director of Haifa’s Rambam Medical Center, has also been on a collision course with the government after media reports disclosed his plan to build a private hospital within the confines of his public one. He wants to build a hospital tower funded by private contributions that will not be owned by the hospital itself. 

The country’s government hospitals are like private fiefdoms under the absolute rule of their directors general, who are appointed for life and do whatever they please. Supervision by the Health Ministry there is more in the nature of a recommendation. And paradoxically, the fact that these are public hospitals even enhances the hospital directors’ absolute power, because the state has nowhere to go to purchase the most advanced kinds of medical care for the public other than the large public hospitals. 

If you want to get advanced care on an immediate basis at these places, it’s available only through connections − and the best connection is directly to the hospital head. And since everyone is potentially in need of these connections, it’s no wonder that the directors of the country’s public hospitals are among the most powerful people in Israel. 

The problem is larger than Hadassah

So Hadassah is a privately-owned example of a much more public problem. If the Health Ministry exerted no oversight over Hadassah, it’s not just because it’s a private facility but because it doesn’t really supervise any of the hospitals, even the ones it owns. And there is no chance that it will impose supervision on any hospital if it continues to tremble in fear before the hospitals’ directors. The fact that the Health Ministry’s own directors general have historically been senior physicians has only buttressed the ministry’s distaste for the prospect of going head-to-head with the hospital heads. 

It’s doubtful that the Health Ministry’s attitude will change for the better as long as the power of the country’s senior doctors, first and foremost the hospital directors, is not curbed. This major confluence of power among a handful of people exceeds that of any corporate tycoon or any consortium of financial firms. 

The healthcare system cannot be improved as long as this concentration of power is not broken up through the most basic administrative action: term limits for hospital directors. No one in such a position needs to be there for life. That’s true in the public sector in general, and all the more so when it comes to something as sensitive as the lives of members of the public. It’s not right as a matter of proper management. It’s also ethically flawed and it’s a major source of inequality in Israeli society. Those with pull get more of a chance to stay alive just because they have a hospital director’s personal cellphone number. The time has come to put an end to this situation and limit the terms of the hospital directors.

 

Hadassah and Hubris Part 2: Background

  Haaretz, Feb. 11, 2014

If Jerusalem’s Hadassah hospitals are so great, why are they so sick?

Everything you didn’t know you needed to know about the financial crisis jeopardizing the medical center your mothers and grandmothers helped build and run.

How did Hadassah Medical Center get into the mess it’s in today, with the threat of closure hanging over its two hospitals in Jerusalem, staff on strike and debt of around $370 million?
To answer the big question, some background is essential. The center, which today comprises the Hadassah University Hospital on Mt. Scopus and its newer counterpart outside Ein Karem, was founded by Hadassah, the Women’s Zionist Organization of America, and is still operated and funded by the charity.
Between 2005 and the first half of 2013, for example, the organization contributed some 2 billion shekels (about $568 million by current exchange rates) to the center, for both current and capital expenditures.
But the women’s organization is itself in trouble, partly the result of losing millions of dollars due to the Madoff scandal. According to a former consultant to Hadassah, the organization has drastically cut its regular funding to the Jerusalem hospitals, to about $19 million a year from what had been upward of $40 million.
To this must be added the high costs of a major expansion project on the Ein Karem campus, excessively high salaries paid to some staff members and discounts given to Israel’s health insurers.
In January 2013, Prof. Ehud Kokia stepped down as director of Hadassah Medical Center over the debt crisis, after less than two years on the job, and the center tried to launch a financial recovery program that would include contributions from the Israeli government. 

So how big is Hadassah Medical Center’s debt?
The center carries debt of 1.3 billion shekels, plus an annual deficit of 250 million shekels to 300 million shekels. 

How does management plan to reduce its debts?
By firing 300 employees, cutting salaries and benefits, and increasing the medical center’s share of the revenue from private medical services provided by physicians using its facilities. The center has reached an agreement with the Finance Ministry and with Hadassah over allocations of a total of 100 million shekels over the next three months to keep the hospitals open. On Tuesday a Jerusalem court gave it a three-month respite from creditors, after it sought protection from lender banks. 

Is Hadassah Medical Center private or public?
The center straddles the line between public and private. Its hospitals are not owned by the government; it is Hadassah, from its New York headquarters, that hires the center’s CEO and board of directors, and they provides private medical services, paid out of pocket, with private health insurance or with supplementary coverage provided by Israel’s four health maintenance organizations (kupat holim). But the center’s hospitals and outpatient clinics are also part of the national health care system, under which every resident belongs to one of the HMOs.
The possibility of nationalizing Hadassah Medical Center as part of the Finance Ministry’s bailout package has been raised – Health Ministry director general Ronni Gamzu, for one, supports the idea – but for now it’s not on the table. 

What set off the current strike, or go-slow, by hospital employees?
Due to its large budget deficit and accumulated debt, workers received just half of their January salaries. After management sought to cut doctors’ salaries, instead of agreeing to reduce immediate wage costs by converting part of their salary into loans to the medical center, physicians initiated work sanctions on February 4. The hospitals were placed on weekend and holiday footing, providing urgent treatment only, and new patients are only being admitted in event of an emergency.
On Sunday, hundreds of doctors demonstrated outside the Jerusalem offices of Prime Minister Benjamin Netanyahu, urging him to intervene in the dispute. On Monday, the remaining hospital staffers joined the strike and colleagues at other hospitals held a two-hour solidarity strike. 

How big is Hadassah Medical Center?
Between them, the two hospitals have more than 1,000 beds, 31 operating theaters and nine intensive care units. There are six schools for health professionals, operated jointly with Hebrew University. The 19-story Sarah Wetsman Davidson Tower, completed in 2012 and costing $363 million, added 500 more beds and 20 operating rooms. By its own estimate, Hadassah Medical Center treats approximately one million patients a year. It employs 6,000 medical professionals and support staff, some of them part-time. According to the center’s website, there are 800 doctors in its employ. More than half – 488, to be exact – provide private treatment. 

What’s the difference between private and regular medical services at Hadassah?
For one, an average waiting period to receive treatment of seven days for the former, versus 55 days for the latter. Beyond that, surgeons operate on public patients in the morning and on private patients after 12:00 P.M. Similarly, private consults on hospital premises are after 3:30 P.M. only. 

How much does the medical center make from private medicine?
Hadassah Medical Center’s net income from private medicine amounts to just 16% of the hospitals’ revenue from private medicine, or around 40 million shekels a year. The center’s physicians earn a total of 128 million shekels a year from private care. For the sake of comparison, the combined annual salaries of all the center’s physicians (including doctors who do not offer private services) for public medicine come to 600 million shekels.
Most Hadassah doctors aren’t making millions. Of the 488 of the center’s physicians who do offer their services privately through the hospitals, some 85% gross less than 50,000 shekels a month. Only between two and three dozen Hadassah doctors earn more than $1 million a year for their work at the medical center.

Hadassah and Hubris, part 1

Abroad, the two Hadassah hospitals at Mt. Scopus and Ein Karem are generally regarded by American Jews as being tremendously good institutions, as is only right since "everyone" knows that Jewish doctors are the best, and Israel, of course, is a "light unto the nations".

Well, it is all coming apart at the seams.  Hadassah Medical Organization is bankrupt, with debts currently estimated at close to $400 million, and probably a lot more.

What happened?  And why do I care?

My husband's family has been a kind of mini-Mafia in Hadassah.  At one time my husband and four of his brothers all worked for it, my husband at Mt. Scopus, and the others in Ein Karem.  Now, only one does [two left when they reached pensionable age, my husband and one other brother left for other reasons].  So we know a lot of the stuff that doesn't reach the newspapers.

Hadassah, like all the hospitals in Jerusalem, is a private hospital, although it accepts patients from all the kupot holim, and only patients [foreigners and/or Palestinians] who don't have insurance have to pay cash. [This, incidentally, is why Hadassah's patient population is more than half non-Israeli. The kupot can take over a year to pay a bill; cash is paid in advance or soon after discharge].  See Part 3 for an analysis of what this means.  In previous years, compared to other Israeli hospitals, the two Hadassahs were awash with money, and Israelis perceived the nice American Hadassah ladies as rather gullible, and so the internal politics of Hadassah were always rather more cutthroat than in other hospitals: it could pay very well to stick the knife in someone's back to step up the ladder.  I've worked in US, UK, and other Israeli hospitals and while there is always intrigue, I never experienced anything as ruthless as what went on in Hadassah, btw.  Even when my husband worked there [1973-1985], contracts for maintenance and renovation were let without any real oversight, money passed under the table, and the resulting work was often shoddy.  There was a lot of waste.  But the sums provided by the American donors were enough to hide most of it.

In 2001, after years of mismanagement and outright theft, the small, mostly maternity hospital where I worked, Misgav Ladach, went belly-up.  Also private, the collection of men who constituted the governing body [amuta] were indifferent to the machinations of the hired administration. Once yearly, they'd meet with the Administrator, ask if everything was OK, and when, without providing any documentation about the financial state of the hospital, he said it was, they would leave, satisfied.  Meanwhile, he, and his deputy [who was also his nephew] was siphoning off as much as they could, including the money in the employees' pension funds [which is why, today, I have no pension]. This only came to light when an outside investigator was appointed by the receiver.  Many people I talked to were shocked: "But there are laws!"  And, yes, there are laws.  But the bottom line is, no money, no one gets paid anything.  Misgav Ladach's debts were estimated at $120 million; the building and equipment was eventually sold for $10 million.  The suppliers never received anything more than a fraction of their bills, and the workers, after 6 years of court wrangling, received partial compensation from the National Insurance Institute [Bituach Leumi]

What is happening now at Hadassah is what happened at Misgav Ladach, and currently also in the still-functioning Bikur Holim Hospital, another private Jerusalem hospital [all hospitals in Jerusalem are private; Shaare Tzedek is currently administering BH]  Only, ML had 180 employees, not 6000, and it wasn't a teaching hospital.  My brother-in-law, in what could be described as "middle management" of a particular department of Hadassah, will almost certainly lose his job in any restructuring; hopefully his pension is safe [Hadassah uses a different sort of pension fund from my old hospital], but at this point no one really knows.  He's never worked at any other place, and his job cannot be replicated outside of the medical world, so, at age 50 or so, he is likely to be permanently unemployable if fired.  His wife, who he met at Hadassah, is a skilled radiation therapy technician, so her job is probably safer, but she has so much seniority that she could be pushed out for a new graduate who is much cheaper.  In Israel, all sorts of workers in hospitals, apart from the doctors, are covered by collective wage agreements which are almost impossible to break unless the position a worker fills is eliminated [doctors work on individual contract, which is why they are being pressured to make "voluntary" contributions of large parts of their salaries]

In subsequent parts of this post, I've quoted articles from Haaretz, which are all very good.  The reason I'm reproducing them in full is because they can't be accessed without membership or subscription, and I think they need to be widely disseminated for the public good.  While it's true that today's "Hadassah ladies" are a pale shadow of their mothers and grandmothers, they still work hard, and for an excellent cause, and don't really deserve to have their efforts wasted as they have been -- but the time has come for a really hard look at the way hospitals are managed in Israel.  The free lunch has ended.  But the tragedy is not that an institution might fail, but that 6000 families, as well as the patients the hospital has served will pay a much higher price than the donors who created and maintained Hadassah.

Honesty, Obama-style

(click here to view)

Nate Beeler The Columbus Dispatch Feb 13, 2014 EditorialCartoonists.com

At least, HE believes what he says. I doubt the Supreme Court does, nor the American public, any more.