Friday, June 29, 2012

Healthcare: A Jewish Response

Maimonides Oath for the Physician

The highest court of the land upheld the Affordable Care Act, often referred to as Obamacare.  Attached is an excerpt from my sermon dealing with the issue of Judaism’s views on healthcare.  “The central crux of this issue as I see it is the question of: does community have an obligation towards providing healthcare to its members? 

To begin to find our answer, we must once again return to the world of the Talmud.  The Talmud states there are ten specific items a community must provide for its members, “It has been taught a scholar should not reside in a city where any of the following ten are missing: (1) a court of justice … (2) a charity fund … (3) a synagogue; (4) public baths; (5) toilet facilities; (6) a moyel; (7) a surgeon; (8) a notary; (9) a shochet (ritual slaughterer); (10) a schoolmaster” (BT Sanhedrin 127b).

It is interesting to note how many of these have to do with public health and healthcare.  In this passage communities are required to have proper facilities with public baths and toilets as well as proper medical personnel such as surgeons and moyels, yes moyels are considered proper medical personnel. Thus we learn from this passage: the state of communal healthcare can and should be a vital concern of the Jewish community.

I would hope that we would all be in agreement that the healthcare system in our country is fundamentally flawed in many ways.  It is outrageously expensive.  Patients often have to wait long hours to receive treatment, and when they do, they are often charged ridiculous amounts for it.  Doctors, who spent years in training, now have to see more patients than ever just to pay their bills, because they receive less and less remuneration for their skills.  Almost no other place in our society are individuals not paid for what they charge.  While at the same time our society as a whole is becoming unhealthier in a lot of ways especially as a result of our expanding waist lines.  Our healthcare system is sick.  We are left wondering is our healthcare system in a terminal state?  Or is there a cure?

Advocates have argued that there appear to be only two solutions to this fundamental problem, which is really at the heart of our current debate.  The first is a nationalized system, which is often referred to as socialized medicine.  Those in favor describe how a system maintained by the government will cure most of our ills.  Those against describe a national healthcare system as being one step closer to communism at best or the French at worst.  It is a system of complete government oversight, which opponents argue will prevent innovation, instead resulting in long waits for important medical procedures. 

However, at least in theory, this sort of system should help keep costs down because it spreads the impact on the entire population.  More than that, it is also quite probable the amounts we pay in insurance premiums are still more than we would pay in taxes for such a system.

A purely capitalist system on the other hand, is focused primarily on profits first and then treatment second.  When a policy holder becomes unprofitable, either their procedures are denied, or they are dropped from the program due to that dreaded pre-existing condition.  You are left asking such foolish questions as how many stitches constitute a case of urgent care versus a true medical emergency.  If you guess wrong, your insurance is likely not to cover this procedure. This system does encourage innovation, but at what cost we often wonder.

So which system, as Jews, should we be supporting?  To find the answer I suggest we again turn back to tradition.  There is a ruling in the Shulchan Aruch which states, “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.  Even though this source is about redeeming the captive, for the rabbis the principle remains the same, we as individuals have a financial obligation to take care of ourselves. 

But at the same time our tradition also argues that each community is not only supposed to provide the proper medical personnel, but it also “must pay for the healthcare of those who cannot afford it as part of its provision for the poor” (Dorff, Elliot, Matters of Life and Death: A Jewish Approach to Modern Medical Ethics, 1998, page 307).

Thus our tradition proposes setting up a system with both communal and personal elements to it.  Judaism argues it should be a system built both upon personal responsibility as well as communal obligation.”

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