In resolution, it can be explainedוְיֵשׁ לוֹמַר,
that our Sages’ statement, “Does it make a difference to the Holy One, blessed be He?...”שֶׁזֶּה שֶׁאָמְרוּ רַזַ''ל וְכִי מָה אִכְפַּת לֵיהּ לְהַקָּדוֹשׁ בָּרוּךְ הוּא כוּ',
refers to man’s Divine service itselfקָאֵי עַל הָעֲבוֹדָה עַצְמָהּ
(i.e., the particular activities that constitute his Divine service). That, in and of itself, is not of consequence to G‑d.(דְּהַיְינוּ פְּרָטֵי הָעֲבוֹדָה),
In contrast, the outcome of man’s Divine service,אֲבָל הַתּוֹצָאָה שֶׁל הָעֲבוֹדָה
“the refinement of the created beings,” is significant to the Essence of the Ein Sof.שֶׁעַל יָדָהּ נַעֲשֶׂה צֵרוּף הַבְּרִיּוֹת,
I.e., the particular deeds that a person performs in his Divine service are not significant in and of themselves. The ultimate intent and effect of man’s service – the refinement of the material world – is, however, significant to Him, as explained below.
The term “created beings” refers to lowly entities, beings whose only redeeming virtue is that they were created by G‑d.1שֶׁגַּם בַּבְּרִיּוֹת בְּעָלְמָא, בְּרִיאָה פְּחוּתָה,
They too become refined and purified.נַעֲשֶׂה צֵרוּף וְזִכּוּךְ,
This involves the transformation of yesh, an entity with a consciousness of self, into ayin, nothingness –שֶׁזֶּהוּ עִנְיַן הָאִתְהַפְּכָא מִיֵּשׁ לְאַיִן,
HaYom Yom states:2 “G‑d creates materiality (gashmiyus) out of spirituality (ruchniyus), and the people of Israel make spirituality out of materiality.”
To explain: G‑d created the world because He desired a dwelling in the lower realms;3 that is, He desired His Presence to be manifest in this physical world. To accomplish this, two steps are necessary: the material world must be created (yesh me’ayin), and then its corporeality must be transformed into spirituality (the transformation of yesh to ayin). The first step was accomplished by G‑d; the second, He entrusted to His partner, the Jewish people.
The partnership is an equal one, for G‑d brings the world into being, something from nothing. And the Divine service of Jews transforms yesh, the self-centered perspective that pervades our material world, into ayin, G‑dliness.
Both tasks transcend the natural order, and they are only possible because of G‑d’s essential power. And He implanted this essential power within His people to enable them to accomplish their mission.4
– this is significant even to the Essence of the Ein Sof.הִנֵּה זֶה נוֹגֵעַ גַּם בִּבְחִינַת הָעַצְמוּת.
Since we are speaking about types of created beings that possess no redeeming virtues other than the fact that G‑d created them, there is no logical reason why their refinement is important to Him. Not only is He perfect in and of Himself and therefore in no need of their refinement, there is no quality within these created beings in and of themselves that is of significance to Him.
Why then is their refinement significant? Because He desired a dwelling in the lower realms; i.e., that this physical world which is characterized by self-concern and materialistic desires should be refined and made into a medium to reveal G‑dliness.
To explain: There are rational explanations for the refinement of the world. Since G‑d’s creative process involved the revealed dimensions of His light, man has come into being feeling that the world should not be a jungle, that we should all do what is necessary to improve our fellow men and the environment in which we live. As man proceeds and develops himself – and surely as he grows in Torah – he finds deeper and more comprehensive rationales why the refinement of man and the world is desirable. Nevertheless, on an ultimate scale, when viewed from the perspective of G‑d’s Essence, the validity of all these reasons falls short. Since the world is utterly insignificant in and of itself, what difference does it make to G‑d whether it is refined or not?
Although the validity of this question is inescapable, G‑d did desire a dwelling in the lower realms – i.e., that there be a material world and through man’s efforts, it be refined and made into a medium for G‑dliness. We cannot explain this desire. Indeed, the use of the term “desire” implies that there is no reason or logical rationale. And as a result of this desire, the refinement of the world is significant.5
This is the intent of the verse: “And you shall serve G‑d your L-rd… and I shall remove sickness from your midst.”וְעַל זֶה נֶאֱמַר "וַעֲבַדְתֶּם אֵת הֲוָיָ׳ אֱלֹקֵיכֶם גוֹ' וַהֲסִרֹתִי" גוֹ',
“I” refers to the Essence of the Ein Sof.עַצְמוּת וּמַהוּת אֵין סוֹף בָּרוּךְ הוּא דַּוְקָא.
On this basis, a distinction can be made between this phrase, “I shall remove sickness from your midst,”וּבָזֶה יוּבַן מַה שֶּׁנֶּאֱמַר כָּאן "וַהֲסִרֹתִי מַחֲלָה מִקִּרְבֶּךָ",
and a preceding verse,6 “All of the sickness with which I afflicted Egypt, I will not place upon you.”וְלֹא כְּמוֹ שֶׁנֶּאֱמַר לִפְנֵי זֶה "כָּל הַמַּחֲלָה אֲשֶׁר שַׂמְתִּי בְמִצְרַיִם לֹא אָשִׂים עָלֶיךָ" גוֹ',
The verse: “All of the sickness… I will not place…” refers to the possibility of sickness;כִּי, בַּפָּסוּק "כָּל הַמַּחֲלָה גוֹ' לֹא אָשִׂים" גוֹ', מְדֻבָּר רַק אוֹדוֹת אֶפְשָׁרוּת לְמַחֲלָה,
G‑d’s blessing is that the sickness will not actually come about.וְהַבְּרָכָה הִיא שֶׁאֶפְשָׁרוּת זוֹ לֹא תָּבוֹא לַפֹּעַל.
The verse “I shall remove sickness from your midst,” by contrast, speaks of a new development of a greater nature:אֲבָל בְּפָסוּק "וַהֲסִרֹתִי מַחֲלָה" גוֹ' יֵשׁ חִדּוּשׁ גָּדוֹל יוֹתֵר,
Even when sickness (not only the possibility of sickness) exists,שֶׁגַּם כְּשֶׁיֶּשְׁנָהּ מַחֲלָה בְּפֹעַל (לֹא רַק אֶפְשָׁרוּת לְמַחֲלָה),
G‑d will remove it.תִּהְיֶה הֲסָרַת הַמַּחֲלָה.
Now, to remove sickness that already exists, a higher power is required.וּבִשְׁבִיל הֲסָרַת הַמַּחֲלָה שֶׁכְּבָר יֶשְׁנָהּ בְּפֹעַל יֵשׁ צֹרֶךְ בְּכֹחַ עֶלְיוֹן יוֹתֵר,
Hence, the verse uses the first person, “I will remove,”וְעַל זֶה נֶאֱמַר וַהֲסִרֹתִי בִּלְשׁוֹן נוֹכֵחַ,
referring to the Essence of the Ein Sof.שֶׁקָּאֵי עַל עַצְמוּת וּמַהוּת אֵין סוֹף בָּרוּךְ הוּא.

Summary

In resolution, it can be explained that our Sages’ statement, “Does it make a difference to the Holy One, blessed be He?...” refers to man’s Divine service itself (i.e., the particular activities that constitute his Divine service). In contrast, the outcome of man’s Divine service, “the refinement of the created beings,” is significant to the Essence of the Ein Sof, for G‑d desired a dwelling in the lower worlds, i.e., that a world in need of refinement (hence, the term “lower”) be created, and it be refined through man’s Divine service. When that refinement is carried out, blessings that could only be brought about by G‑d’s Essence become manifest.