I often feel a bit let down when people accept the status quo or the orthodoxy of any given field. Each and every thinking person should analyze for themselves if things are being done in the best possible manner to induce the best possible results. Humans are inherently imperfect so obviously the actions which humans take are merely reflections of themselves and are thus sometimes going to be imperfect.
I want to now depart from a direct discussion about healthcare for a moment to bring out an idea about a philosophy about life (to which I zealously subscribe).
I have had the very lucky merit to have been a student of Rabbi Ahron Soloveichik before he passed away and continue to merit to be a student of his son Rav Moshe Soloveichik. Many people have fine teachers, mentors, clergy, and leaders. What is so special about these two giants among men? They continue in the glorious path of their illustrious progenitor Rav Chaim Soloveichik who was the Chief Rabbi of Brisk in Lithuania. So what was so unique about Rav Chaim?
When a person analyzes any problem, they can be overwhelmed by the apparent challenges, contradictions, and roadblocks presented by the obstacle and they can be overwhelmed and become dispirited and give up on attempting to solve the given challenge...or, even worse, a person may not even attempt to solve the problem. They can become slaves to the status quo.
Rav Chaim brought to the world of Torah scholarship in particular, (as well as to the world of acts of chesed or loving kindness more generally) a new brazen weltanschauung that every problem can be solved with a deep analysis of the given texts of Talmud or passages of Maimonides (or social ills) and therefore harmony can be created from apparent contradiction and chaos. He rejected the status quo and strove to attempt to mold the world into a more perfect state (by decreasing the number of apparent contradictions which exist) by being the innovator par excellance.
Rav Chaim applied his innovative approach to the sphere of acts of loving kindness as well. One such example is from well known occurrences in Brisk where Jewish and even non-Jewish young mothers who had their children out of wedlock would drop their babies at Rav Chaim's doorstep at all hours of the night and that he would arrange for the best care for these babies and he would continue to look after them until they were married off.
Rav Chaim didn't see problems. He didn't see challenges. Instead of focusing on the problems and challenges of every social situation or Rabbinic textual difficulty, Rav Chaim would focus on the solution to the problem. Now, Rav Chaim wasn't naive. With his great and legendary power of incisive analysis, he understood how difficult it would be to raise children born out of wedlock (especially in those days when there was certainly a much stronger stigma attached to these children). He understood that there had been apparent contradictions in Maimonides that scholars had struggled to understand for 800 years.
But Rav Chaim understood that to solve problems you cannot be constrained by the past, by social pressure, or by the accepted norms of the intelligentsia of the era. In fact, when Rav Chaim was innovating his new approach of textual analysis, he was often scorned and derided by the "old-guard" of Rabbinic leadership who derided him as "the chemist."
Basically, Rav Chaim applied the logic of the scientific method to Torah learning. If you have two phenomenon with apparently the same inputs but you obtain two different outputs, logic told Rav Chaim that obviously you don't have the same inputs as you originally thought. So Rav Chaim labored to analyze, and, if he was successful, he was able to detect the differences between the two inputs. While it might have appeared at first glance that the 2 cases had the same inputs, Rav Chaim with the precision akin to that of the precision needed by a neurosurgeon, was able to realize the differences and answer the apparent contradictions. If 2 given passages of Maimonides or Talmud contradicted themselves, or if Maimonides
apparently contradicted the Talmud (which is theoretically impossible because Maimonides codified and organized the various halahkhic (AKA Jewish Law) holdings and precedents of the Talmud), Rav Chaim would read the texts extraordinarily closely to discern which passage had an extra phrase or was missing a certain passage to harmonize the apparent contradictions.
Rav Chaim saw that which everyone thought wasn't there. It took tremendous fortitude to change the style of Torah learning. Rav Chaim innovated. He applied the logic of the scientific method to Torah study. Rav Chaim had such a strong belief in the inherent harmony of the Torah,the Talmud, and of Maimonides'es writings, that he was able to "solve" contradictions that had been unexplained or poorly explained for around 1400 years from when the Talmud was finished being organized.
Implications for healthcare policy:
Constant experimentation, questioning of "accepting truths", insistence on comparative effectiveness research not just for the entire populations but for as many unique sub-populations as possible, which interventions lead to actual provable increased life expectancy and quality of life, etc.
Don't forget, surgeons though until not very long ago (~70 years) that a heart should never be cut into....the dictum of "don't touch the heart." There was nothing wrong with this approach...this was true for the level of medical technology and progress that existed at that time. But it wasn't an immutable law. It was an accepted norm based on the reality at that time. Times change. Innovation spreads. Medical progress marches on. Alfred Blalock and Vivien Thomas at Johns Hopkins dared to think differently about the dictum of "don't touch the heart." Since then, millions of heart procedures have been done in the world saving countless lives of humans of every age, creed, and color.
There are always manners to improve the world in general and the healthcare environment (both the clinical and financial aspects) in particular. Do we accept the imperfect status quo or do we strive to innovate and improve the healthcare environment? The legendary example of Rav Chaim Brisker instructs us how to proceed.
To be continued...
