Perhaps the fact that the announcement was made on the second day of Rosh HaShanah said it all: “The North Shore-Long Island Jewish Health System … is being renamed Northwell Health as the 21-hospital network prepares to launch a rebranding and marketing campaign in 2016 to distinguish it in a crowded metropolitan market.” Another Jewish hospital has disappeared and its managers were unconcerned that the announcement was made on the Jewish New Year.
Some historians trace the origins of Jewish hospitals in the United States to 1654, when the Sainte Catherine, a French frigate, sailed into New Amsterdam with 23 Jewish refugees from Brazil. Peter Stuyvesant, director-general of the colony, requested permission from his superiors at the Dutch West India Company in Amsterdam to refuse entry to the “deceitful,” “very repugnant,” and “hateful enemies and blasphemers of the name of Christ.” His directors reminded him that some of the company’s shareholders were Jews and ordered him to admit the refugees provided they pledge that “the poor among them shall not become a burden to the company or to the community, but be supported by their own nation.” This “Stuyvesant Pledge” is the foundation of American Jewish communal institutions. The formation of Jewish hospitals in the U.S. was a continuation of the community’s creation of a social network designed to assure that Jews would never be a societal burden.
American Jews created approximately 113 Jewish hospitals. German-Jewish immigrants fostered the first wave of construction with the establishment of the Jewish Hospital Association of Cincinnati in 1854. By 1868 there were Jewish hospitals in Baltimore, Chicago, and Philadelphia. The second wave of construction, from 1880 to 1945, was fostered by East European Jewish immigrants. In the last wave of construction, which was fueled by the Hill-Burton Act between 1945 and 1960, the number of beds in Jewish hospitals increased from 13,800 to 18,283. Eighteen hospital names contained the word Jewish, and five contained the word Hebrew. Fourteen were named Mount Sinai or Sinai, eight were named Beth Abraham, Beth David, Beth El, or Beth Israel, three were named Montefiore, and two were named Menorah.
Why did Jews build hospitals? First, to spare themselves the indignity of Christians’ attempts to convert them as they lay on their deathbeds. Second, Jewish hospitals respected Jewish faith with kosher food, a synagogue, a rabbi on the staff, a mezuzah on the door, Sabbath needs and the reduction autopsies perceived as unnecessary. Third, they were a response to medical anti-Semitism. In the 20th century most medical schools and hospitals had restrictive quota systems to deny medical school admission to Jews, restrict the access of Jews to internship and residency training, and deny Jews hospital staff privileges. Jewish hospitals provided workplaces for Jewish physicians who were excluded from employment at other hospitals.
There are three reasons why these hospitals have disappeared: economics, a decline in anti-Semitism, and demographic changes that affect philanthropy.
Jewish hospitals are subject to the same marketplace pressures as their non-Jewish counterparts. Changes in Medicare, the rise of health maintenance organizations, and advances in medical technology prompted a wave of hospital acquisitions and mergers. Jewish hospitals have been swept up in these changes.
Second, anti-Semitic quotas designed to restrict Jews’ access to medical school, internship and residency, and hospital staff privileges are now socially unacceptable and illegal. The need for Jewish hospitals as a response to anti-Semitism has largely disappeared.
Finally, the population of self-identifying Jews is shrinking as a proportion of the U.S. population. Jewish hospitals in urban Jewish neighborhoods saw their constituencies move to the suburbs. Often, the Jewish hospitals that were “left behind” have disappeared, although there are a few exceptions that either have carved out a market niche or have persisted because of urban Orthodox Jews.
Jews used to donate almost exclusively to Jewish causes. However, the frequency of wealthy American Jews focusing on Jewish communal organizations for their philanthropy has fallen from near 100 percent to 33 percent. Jewish federation support to hospitals has also fallen. After the creation of Medicare and Medicaid, hospitals derived their income from these sources and insurance payers. But Jews reassessed the rationale for Jewish hospitals and continued Jewish federation financing of hospitals. However, there has been a rise in the acceptance of Jews into upper-class social circles associated with philanthropy. As a result more Jewish donations are being directed to secular universities, opera companies, symphonies, museums, and non-Jewish hospitals and medical schools.
Does the disappearance of Jewish hospitals matter? It is to the detriment of Jewish commitments to education, to the provision of health care to the poor, and is a loss to the extent that Jewish hospitals are a “public face” of the Jews. Most American Jews do not insist that hospitals provide kosher food, Sabbath elevators, and a synagogue. Many of the remaining “Jewish hospitals” are bricks and mortar with Jewish plaques and signs that no longer meet criteria that define them as Jewish. The hospital marketplace and cultural changes have combined to make the Jewish hospital an endangered species. These disappearing hospitals succeeded so profoundly in abetting the success of the American Jews that they became unnecessary.
Dr. Edward C. Halperin is chancellor and CEO of New York Medical College.