Funny Jokes and Serious Matters

Note: This is a guest post by my husband, Gary Bakst, M.D. While I may question whether the jokes are funny (Gary didn’t write them!), I don’t question the seriousness of the subject he addresses. Thank you, Gary.

Jewish Humor – here are some jokes that have been around longer than I have:

  1. Why don’t Jews drink? It interferes with their suffering.
  2. My wife will buy anything that’s marked down. Yesterday she brought home two dresses and an escalator.
  3. A man can’t find a lawyer. He picks up the Yellow Pages and picks out a law firm-Schwartz, Schwartz, Schwartz and Schwartz. He calls up and says, “Is Mr. Schwartz there?  A guy says, “No, he’s out playing golf.” The man says, “All right, then let me speak to Mr. Schwartz.”  “He’s not with the firm anymore.”“Then let me talk to Mr. Schwartz.”  “He’s away in Detroit.  He won’t be back for a month.”“Ok, then let me talk to Mr. Schwartz.”  “Speaking.”
  4. I’d like to help you out. Which way did you come in?
  5. In New York’s Garment District, a little, old man is hit by a car. While he is waiting for an ambulance, a police officer tucks a blanket under his chin and asks him, “Are you comfortable?”  The man responds, “I make a living.”

It is that final joke that I am thinking about as I write this essay.  I grew up in a middle-class family and in a middle-class neighborhood. I remember when Linda and I struggled to make ends meet.  I realize that we are more comfortable today, but I still like to think that I am connected to the struggle of the average person/average family.  The reality is, every so often a patient says something that reminds me that I am not as connected as I’d like to believe.

They will tell me about the cost of an item – perhaps $10 – that is a big deal in their lives.  They are living on fixed incomes or small paychecks.  They have worked their whole lives but cannot afford things that I would take for granted.  While every expense is important, the one that we are most often speaking about is the cost of their medication.

This is a problem that has been mentioned often in the media.  But I don’t think that the real impact on so many people has been adequately discussed.  The stories I see in the news are about the most extraordinary examples.  They don’t convey the reality that I see people face numerous times every day.  The reality is, especially in the world of diabetes care, that we are in a time when there are great medications that can change people’s lives.  They can safely lower their glucose levels, protect their hearts and their kidneys, prolong their lives.

On the other hand, I have never seen a time in which so many people just couldn’t afford their medications.  It was not that long ago that medications were prescribed by doctors and filled at pharmacies and patients picked them up for no copay or small ($5-10) copays.  Now, the doctor writes the prescription and it goes to maybe a pharmacy, maybe a gigantic mail order facility.  The insurance company rejects the charge but doesn’t tell either the doctor or the patient why the med was rejected or what alternative would be covered.

Our staff spends enormous, frustrating hours, expensive hours, working on getting medications approved.  When a medication is approved – not necessarily the medication we had ordered but some theoretically similar drug – the patient is still left with frequently gigantic out of pocket expenses.

Some of this is related to the fact that medications are so much more expensive than they used to be.  The pharmaceutical industry is entitled to make their profits and needs substantial income in order to invest in the next generation of medications.  But too much of that profit comes from the US (as compared to overseas markets) and it seems like the average American is carrying a financial burden that is breaking their back.

On top of this, the insurance companies routinely reject claims, use intentionally opaque methods to keep us and our patients in the dark about what they need in order to approve those claims and even when they cover the medications, they leave too much of the charge on the shoulders of the patient.

Insurance companies typically use ever increasing premiums to herd patients into high deductible plans.  This means that you pay your premiums, but the insurance company may never spend anything on your care.  The situation is similar for those who receive their insurance through the Affordable Care Act (Obamacare).  While it is great that there is insurance that people can access, the insurance is often expensive and comes with high deductibles.  And, for those who get their insurance through Medicare, the development of prescription drug coverage (during the George W. Bush administration) is a great step forward but the coverage comes with that so called “donut hole” which means that you have to pay thousands of dollars out of pocket and then you can get back to where the coverage helps you out.

In the end, we are at a time of crisis in health care affordability and especially medication affordability.  Recognizing that I have no expertise in this topic beyond what I see every day in my office, I would make several suggestions that I do not hear from our politicians of either party.

  1. I would end the policy of not allowing Medicare to negotiate with pharmaceutical companies regarding the price of medications. Medicare needs that tool.
  2. Congress needs to pass a law limiting how much more any medication can cost in the US as opposed to the rest of the developed world. Perhaps up to 20% more but not the 300% more that we often see.
  3. I would outlaw deductibles over $1000
  4. I would limit how terrible any insurance policy can be and still be legal to sell in the US. If you are marketing your policy as insurance, it has to be helpful to people when they get sick or injured.
  5. I would require insurance policies to offer adequate reimbursements to hospitals such that they can hire enough nurses to truly take care of patients. Patient to nurse ratios are becoming dangerous and patients will be harmed.
  6. I would increase reimbursement to doctors and other health care providers for primary care services. This would continue the trend of reduced reimbursement for procedures and presumably make more doctors consider careers in primary care – not enough doctors are going into primary care.
  7. I would require insurance companies to make public how much money they spend on items other than patient care and to make public their procedures for approval of tests such as PET scans and for medications and expensive treatments. It is time to remove the curtain and give doctors and patients a fighting chance to get patients the care they deserve.
  8. Medicare is more efficient in translating money into care and I would require private insurance companies to make strides towards that benchmark in order to operate in the US.

There it is. That is my little manifesto.  The rantings of a comfortable doctor on behalf of his uncomfortable patients.  Now one last Jewish joke:  A Jewish grandfather takes his grandson to the beach when, suddenly, a gigantic wave sweeps the boy away.  Panicked, the grandfather looks up and prays to God, “Oh God, please bring him back.  Let him live.”  Just then, an even larger wave deposits the boy back on the beach unharmed.  The grandfather looks up and says, “He had a hat.”

Laura Bakst: A Granddaughter’s Journey

Note: One of the greatest sources of pride and joy for Paula and David are their four grandchildren, each accomplished in their own right. Laura, third oldest and the daughter of Gary’s brother, was kind enough to contribute this piece. 

Nearly five years ago, I made my way across rural Germany to visit my great-grandfather’s grave. While the trip itself took only a few days the process started months earlier in New York, when my Poppy (grandfather) presented me with a disintegrating photograph of his father’s tombstone and the knowledge that it was located in a Jewish cemetery near Kassel, Germany.  I could tell that at the age of ninety Poppy was still haunted by not knowing what came of the grave that he last saw over sixty years ago. I also knew that given my upcoming travels to Israel and Europe it was likely the only opportunity I’d have to locate the grave in the near future, and possibly in his lifetime.

Over the next few months I sifted through archives, including multiple visits to Yad Vashem (Israel’s holocaust museum), attempting to find records on my great-grandfather.  Eventually I stumbled upon a German database of abandoned Jewish cemeteries. With the aid of Google Translate, I managed to obtain location information for a gravestone that appeared identical to the one in my grandfather’s photograph. It was in a cemetery in Hofgeismar, a small town in Northern Germany.

Fortunately, it was relatively easy to tack on a detour to Hofgeismar between trips with friends to Berlin and Amsterdam. Nevertheless, I was still nervous to be traveling across Germany on my own; I was the first in my family to return to the country since WWII, did not speak the language, and was traveling in areas not frequented by tourists. Fortunately, the kindness of others made the process a bit easier: I had made a few German friends while I was studying in Dublin who helped me book trains. Julia, a woman who volunteered at the Jewish Museum in Hofgeismar, was generous enough to not only respond to my cold-email inquiring about the cemetery, but also coordinate my entire itinerary for the day in Hofgeismar (unfortunately I was not able to meet her in person as she was traveling for a conference in Israel at the time).

Around 6:45am on a brisk October morning, I left my friends in Berlin and anxiously entered a metro station. True to Germany’s reputation, the four separate trains I took were impressively prompt. After making it to Hofgeismar, I met Mr. Burmeister, the Jewish Museum’s director, who drove me to the cemetery.

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I didn’t really know what to expect, but I recall being surprised by the beauty of the place. Though obviously aged by the elements, the gravestone was completely intact, with the inscription still easily readable.

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The small cemetery was in a lovely location, overlooking gorgeous valleys and blanketed by colorful leaves.

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Following the Jewish tradition, I left several stones on behalf of my family on the gravestone. Across from my great-grandfather’s grave there was a small hill, below which a number of stones from the 1800s once stood. Unfortunately, they were destroyed during WWII (the cemetery houses Jews from after the war and pre-1936), so Mr. Burmeister showed me the memorial stone erected in their memory the prior year (2012).

Mr. Burmeister gave me a tour of the small but substantial Jewish museum, in which we had an interesting conversation about the Jewish history in Hofgeismar and his interest in the subject as a non-Jew. While there are no longer any Jews in Hofgeismar, before the War it was home to one of the highest percentages of Jews in Germany (10%).

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Julia’s friend, Gabriele also showed me around Hofgeismar. We walked down to where the community temple once stood, now destroyed. We also drove through where the displaced persons camp used to be, the same camp that my grandfather stayed in after my great-grandfather died from surgical complications. The grounds are now being used for a school and police station.  The town center was exactly as I’d have pictured it, with lovely sculptures and traditional German buildings.

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Gabrielle pointed out some of the homes where Jews once lived, in front of which small metal squares note their names, dates of birth and death, and what occurred to them during the war. I remembered seeing similar stones in Berlin, and Julia explained that they are becoming more common as people are more open to uncovering that their homes may have been taken from Jews.

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While the entire trip was extremely meaningful, what struck me the most was how seriously modern-Germany takes addressing its history. Unlike in America, it’s illegal to deny the Holocaust, display Nazi symbols, or otherwise incite hatred based on religion or ethnicity. All schools deeply educate students about the Holocaust, leaving my German peers more knowledgeable about it than me. People like Mr. Burmeister and Julia chose to dedicate their time to preserving the Jewish history in a small, now Jew-less town. Mr. Burmeister’s parents had no familial connection to Judaism, but rather his interest in the subject was peaked as a schoolboy studying German history. A teacher from a neighboring town told me how she believed it was important to expose her students to Jewish culture early on, bringing her class of 8-10 year olds to the Hofgeismar Jewish cemetery and Museum for a three-day workshop. Through tears she explained that she educates others about Nazism because her daughter has a disability and likely would have been killed had she been living during WWII.

Note: Laura is quite correct in saying that David was haunted by never having gone back to see his father’s grave. In going through the effort of locating and visiting the site, Laura did a mitzvah (good deed) that brought her grandfather comfort. Thank you, Laura, for doing that and for sharing this story on my blog.