August 26, 2009
Why We Must Support Universal Health Care
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A hierarchy of need. Yet a fourth possible criterion in Jewish sources is that health care should be provided to the ones who need it most. Thus the Shulchan Arukh includes the following: “We redeem a woman before a man. If, however, the captors are used to engaging in sodomy, we redeem a man before a woman.”
This ruling is clearly based on the author’s judgment of the relative needs of women and men in captivity. Since male captors would be more likely to rape female captives than to sodomize males, we must redeem women first, for they need to be saved not only from slave labor, but from sexual violation. If, on the other hand, the captors are known to sodomize male captives, we must redeem men first, for sodomy is, in this author’s estimation at any rate, an even greater threat to the captive’s life and dignity than rape is. Whether one agrees with that assessment or not, it is clear that the attempt of this ruling is to base the priority of recipients on who needs help most.
Equality: First come, first serve. Finally, a fifth strain in Jewish thought and law objects to any hierarchy, whether governed by social position, family ties, communal duties, or even relative needs of the specific individuals involved in the choice; instead, it emphasizes the equality of everyone, as each of us is created in the image of God.
Although this guideline for the distribution of health care evokes warm, universalistic feelings and stems from deep theological roots in our common origins as the creations of God, it suffers from the hard, pragmatic realities that prevent societies from giving all things to all people. These egalitarian principles, though, must have a call on all Jews who take their Jewish identity seriously.
The Cost of Medical Care
Who should pay for medical care? The Jewish tradition divides that responsibility among the physician, the individual, family members and the community.
Normally, Jewish law permits physicians to charge a fee for their services. Indeed, the Talmud opines that “A physician who charges nothing is worth nothing!” At the same time, there is great concern that the poor should have access to medical services. The Talmud thus approvingly sets forth the example of Abba, the bleeder, who “placed a box outside his office where his fees were to be deposited. Whoever had money put it in, but those who had none could come in without feeling embarrassed. When he saw a person who was in no position to pay, he would offer him some money, saying to him, “Go, strengthen yourself [after the bleeding operation].”
There are similar examples among medieval Jewish physicians, and the ethic must have been quite powerful because it is not until the 19th century that a rabbi rules that the communal court should force physicians to give free services to the poor if they do not do so voluntarily.
Today, not just the poor, but most people simply cannot pay for some of the new procedures, no matter how much money they have or can borrow. The size of the problem makes even conscientious and morally sensitive physicians think that any individual effort on their part to resolve this issue is useless. Moreover, the enormous costs of gaining a modern medical education must somehow be compensated for — to say nothing of ongoing malpractice insurance, overhead for their offices and for the hospitals in which they practice, staff, etc.
Indeed, like everyone, doctors have a right to earn a living, and Jewish law imposes a limit on them no less than on other Jews as to the percent of their income that they may donate to charity — specifically, 20 percent of their income. So although physicians have some responsibility to care for others gratis or at reduced rates, they alone cannot be expected to bear the burden of financing health care.
Individuals also bear some of the responsibility for paying for their own medical care, as they do for their ransom: “If someone is taken captive and he has property but does not want to redeem himself, we redeem him [with the money his property will bring] against his will.”
Although this source speaks of redemption from captivity and not health care, the duty to redeem captives is based on the danger to their lives in captivity, and thus this is a reasonable source for determining that an individual has a financial responsibility for his or her own health care. Moreover, one must pay for one’s own health care before one pays for anyone else’s, for saving one’s own life takes precedence over saving anyone else’s.
