August 26, 2009
Why We Must Support Universal Health Care
(Page 4 - Previous Page)
Of course, those who have no resources to pay for health care may accept public assistance to procure it. In fact, they must do so, for to refuse needed care is to endanger their lives, which is, for Jewish law, tantamount to committing suicide. Still, the Shulchan Arukh strongly condemns those who use public funds for their health care when they do not need to do so, and it appreciates those who postpone calling upon the public purse for as long as possible: “Whoever cannot live unless he takes charity — for example, an elderly person or a sick person or a suffering person — but he forces himself not to take [communal funds] is like one who sheds blood [namely, his own] and he is liable for his own life, and his pain is only the product of sin and transgression. But anyone who needs to take [charity] but puts himself instead into a position of pain and pushes off the time [when he takes charity] and lives a life of pain so that he will not burden the community will not die until he sustains others, and about him Scripture says, ‘Blessed is the man who trusts in God.’”
Conversely, unless a given drug or medical procedure is so scarce that the government has put limits on who may obtain it even with their own money, individual patients who have the money to afford something that the government or their private plan does not provide may decide to pay for the drug or procedure privately. Individuals are free to spend as much of their own funds as they wish to redeem themselves or their relatives: “We do not redeem captives for more than their worth out of considerations of fixing the world, so that the enemies will not dedicate themselves to take them [Jews] captive. An individual, however, may redeem himself for as much as he would like….”
This could seem unfair, but it is only the unfairness built into any capitalist system. Jewish sources do not require that Jews use socialism as their form of government or their rule for distributing and charging goods.
Applying the Tradition to Contemporary America
On the basis of these Jewish sources, the entire community is responsible to ensure that all its members receive the health care they need. This does not mean that everyone should get every possible treatment, no matter how remote its possibility of benefit or how high its cost. The community has both the right and the duty to make considered decisions about how it will allocate its resources among its various responsibilities.
Those who can benefit most from the procedure must come first, and then first-come, first-served, regardless of social position, wealth, or relationships to the health care personnel involved. Jewish principles justify concern for the people of one’s own nation first in such procedures as the supply of organs for transplant and of rare, new drugs, unless international agreements can be reached to provide medical services, for example, to the citizens of any nation visiting another or in the organ transplant supply based on need, not nationality. It is only absent such agreements that concern for one’s own can legitimately come first.
The Jewish demand that everyone have access to health care does not necessarily mandate a particular form of delivery, such as socialized medicine or government-sponsored health insurance for those who cannot afford private plans. Any delivery system that provides basic needs will meet these Jewish standards. Thus, while President Obama’s original proposal for government-sponsored health insurance for those who cannot obtain or afford private insurance would surely fit Jewish criteria for meeting communal responsibility, so too would any other mechanism that provides basic minimum health care to everyone.
The fact, however, that more than 40 million Americans have no health insurance is, from a Jewish point of view, an intolerable dereliction of society’s moral duty. The Torah, the Prophets, and the Rabbis of our tradition all loudly proclaim that God commands us to take care of the poor, the starving and the sick. Given the current costs of health care, almost all of us fall into that category. On both moral and religious grounds, then, we simply cannot let the present condition continue; we are duty-bound to find a way to afford health care for all American citizens.
A pragmatic concern also requires that we act now. The fact that some of those people will ultimately get health care in the most expensive way possible — namely, in the emergency room, usually when they are sickest — means that the United States is currently neglecting its fiduciary responsibility to spend its communal resources wisely. We Americans spend about 15 percent of the gross national product on health care; our Canadian, Western European and Israeli friends spend about half that — 8 percent. Yet their morbidity and mortality rates are much lower than ours. Yes, they give up some of their autonomy in their health care, but the vast majority of Americans have very little choice now. We get what our employer provides — no more, no less.
It is time that we carry out our Jewish duty to manage our resources wisely as well as our obligation to provide health care for everyone. How we do that is a legitimate topic for debate, but we simply must do it.
Rabbi Elliot N. Dorff is the Distinguished Professor of Philosophy at American Jewish University and chair of the Conservative movement’s Committee on Jewish Law and Standards.