I stayed up late the other night to watch the US House of Representatives’ historic vote to bring health care to all citizens. I kept thinking, as the votes were counted, that it is about time that the United States joined the rest of the civilized world in providing affordable health care to all. It was quite a political/historical moment. Usually I don’t like to comment on political issues. There are many people who are paid lots of money to speak intelligently on political issues. I am a pulpit Rabbi and my main concern is the well being of the members of my congregation. So my political opinions are all my own and subject to change when I have the chance to do some more research on the facts.
But Health Care is not just a political issue, it is also a moral issue. Judaism has had a long standing concern for the most vulnerable in society. The poor and oppressed have, since the time of the Torah, been singled out as needed to be defended by those in power in society. The list from the Torah is long. We are forbidden to oppress the orphan and widow. We have to let a slave go free if we injure his body. When we free a slave, we have to make sure that he has what he needs to start life over. We need to set aside the corners of our fields to be reaped by the poor. If we drop something while we are harvesting, it is left for the poor to glean. Land can’t be sold forever; it must return to its original owners at the beginning of the Jubilee year. Indentured servants are freed every seven years. There is a tithe that is set aside for the Levites and for the poor. We are commanded to lend without interest, cancel those debts in the sabbatical year and not refrain from lending when the sabbatical year is pending. This is not an exhaustive list but it is still impressive.
The Talmud even tries to legislate exactly how much we should invest in charity depending on if we want to be stingy, moderate or generous. One should not give too much or too little. It was forbidden to live in a city that did not have a community fund for the poor, a soup kitchen and a doctor among other necessities. All of this points to a social need to care for those who were at the bottom of society. To bury the indigent, to provide for poor brides, to care for the elderly, all of these were an essential part of communal responsibilities.
What we have here is Judaism trying to adjust capitalism to be fair to all those in society. It is one thing when society encourages and promotes those who work hard and earn a living. If one works hard enough and is smart, one could also become quite wealthy. Acquiring wealth is the main goal of a capitalistic economy. Judaism is not comfortable with the reality however, that while some people will rise to the top, there will also be those who sink to the bottom. Therefore, Judaism teaches that we have responsibilities to those who have not succeeded. Rambam declares that there are eight different levels of support for those who are in need. Some levels speak to the motivations of the giver. Some protect the dignity of the poor. The highest level is to help a person get back to work so that they can, eventually, support themselves and their families and no longer be in need of support.
Health Care is a part of this system. Since it is well known that health issues can bring an individual and a family to poverty, we have an interest in preventing this kind of poverty. Since the poor get sick and don’t have the means to visit a doctor, there is a potential that serious disease could be spread throughout the community. We are not permitted to do something that could endanger life, and health care is one way we prevent loss of life. Remember also, it is forbidden to live in a town that does not have a doctor. It is not a stretch to say that if the health care is not affordable, then what use is the doctor to the poor in the town?
There is a story of the “good citizens of Chelm” who had a dangerous road leading to the city and people would fall off the cliff and get hurt. After deliberations the citizens of Chelm decided to build a hospital at the base of the cliff. While building a hospital in that location could certainly save lives, how many more lives could be saved by investing in a proper “guard rail” at the edge of the road? When I heard so many representatives, opposed to health care crying out that government was interfering in people’s lives, I thought of that guard rail. It was as if they were saying: “Why should we interfere with people who are not careful on the road? What right do we have to declare that one stretch of road is dangerous and another is not?” Yet, Judaism insists that we have a moral responsibility to look out for each other, by building guardrails, promoting preventative medicine and by providing, for everyone, affordable health care. What good is Medicaid if it does not prevent families from having to lose virtually all their savings and resources before they can access health care? Real health care is care that applies to all members of society according to their ability to pay.
The free market philosophy is that, over time, the best services at the best prices will become available to everyone in society. The problem is that this philosophy can only work if all the service providers are committed to offering the best service at the best price. To prevent collusion between providers and to prevent agreements that subvert the free market to the benefit of the service providers, government needs to step in and foil those who would attempt to profit from the system in a corrupt way by creating an unfair advantage. We have seen how insurance companies all too often, move to protect their own interests rather than the health needs of the community. We hear stories of the abuses; the cancelled policies, the refused coverage, the exorbitant renewal premiums that make sure that those who are well, can get affordable coverage, but if one should have a condition that makes it impossible to get a new policy, the rates are adjusted to be so high that the policy becomes unaffordable and the sick must go without coverage. Regulation of insurance companies will guarantee that the best coverage will be offered at the best price and consumers will not be afraid to access their coverage due to fear of sudden cancellation.
I am sure that there will be many unscrupulous people who will try and defraud this new system as they have done with Medicare and Medicaid. I am sure that there will be provisions that will need to be adjusted, added or repealed. We are imperfect human beings and our ability to evade the law is great if we have the desire to do so. I have no doubt that we will be making changes in this Health Program for many years to come.
I can’t speak about if the Health Plan approved the other night will pay for itself. If it will or will not reduce the federal deficit. Whether or not it is good for the states that must provide the pooled coverage. Whether or not it will promote or kill jobs, or whether or not it will harm the economy. I will leave those questions to those who study this bill. I only know that we have a moral responsibility to see to it that every member of society has appropriate access to health care, so we all are able to live not only productive lives, but healthy lives as well.