Torah Values, Right – Wing Politics, and Health Reform
by Micah Segelman
Socially conservative principles and strong rhetorical support for Israel, among other factors, attract many in the Orthodox world to the GOP. While in of itself this is perfectly reasonable it’s a serious mistake, too often made, to conflate Torah values with right wing politics as a whole.
While the right shares some of our values they betray others. Admittedly, with the Republican Party’s current disarray following the election and years of infighting it’s difficult to define a coherent Republican platform to evaluate. But it seems that one of the defining positions of the GOP since Obama’s 2008 election – their stark opposition to health reform in 2009 – 2010 – is inconsistent with our principles.
A Jewish society run according to Jewish law would be required to provide health care for those who can’t afford it. This is apparent from the Chofetz Chaim in Ahavas Chesed (3:3) and the Tzitz Eliezer (15:40:17). The Tzitz Eliezer writes that, “…the government, which must be concerned with the health of the population as one of its top priorities, must set aside funds …” (for more background see Noam Solomon’s “Concierge Medicine in Halacha”). The degree to which someone must sacrifice in order to help someone else and the ethics of distributing scarce resources are complex subjects and are beyond the scope of this article. Yet it is clear that the community / government should play a role in providing resources for healthcare.
Non – Jews are bound only by the 7 Noachide Mitzvos and not by the rest of Jewish law. Yet, the Torah looks favorably on Noachides keeping additional mitzvos (aside from specific ones like Shabbos and learning Torah – see the Rambam Hilchos Melachim 10:10). It should follow that the Torah would look more favorably upon those societies that provide healthcare for their poor and less favorably upon those that don’t. That charity of non – Jews is considered virtuous can also be seen from Daniel’s advice to Nebuchadnezer (Daniel 4:24) and from the Ramban in Vayera (19:5) who says that the most egregious sin of Sodom was that they didn’t help the poor – “all of the nations perform charity on behalf of their neighbors and those among them who are impoverished – there were no other nation as cruel as Sodom.”
Millions of Americans, typically lower income working people, lack health coverage because they can’t afford it. Anyone with any understanding of the American healthcare system knows that being uninsured means you lack adequate access to healthcare – at least until you are acutely ill and in need of immediate help (the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) guarantees it in this case) – and then it might be too late. This is documented in the Institute of Medicine’s 2002 report, “Care Without Coverage: Too Little, Too Late.” Although it’s an oversimplification to condense the health reform debates of 2009 – 2010 into a sound bite, the following is fairly accurate: liberals believed that the existence of so many uninsured Americans required government intervention while conservatives didn’t. Conservatives maintained that people should figure out a way to solve this problem themselves.
Granted there are many possible concerns with an expansion of government run social welfare programs. These include the impact on deficits, costs to taxpayers, likely inefficiencies of large bureaucracies, potential for big governments to abuse their power, and the fear of disincentivizing work. There is also the fear that those who currently “have” will become worse off if more is provided to the “have nots.” It’s beyond the scope of this article to objectively consider to what degree these issues actually apply to the Patient Protection and Affordable Care Act (PPACA aka “Obamacare”) or to the 2006 Massachusetts reforms under Mitt Romney that paved the way for it. But debating the merits of the law misses a crucial point. That key point is that the political right doesn’t accept the premise that providing coverage for the uninsured is a priority at all.
This critical fact is apparent from the fact that Republicans didn’t offer an alternative proposal to cover the uninsured while mitigating those parts of “liberal sponsored” health reform that they opposed. On the contrary, the right went to war against reform in favor of the status quo as described authoritatively in Paul Starr’s “Remedy and Reaction.” GOP efforts to “repeal Obamacare” don’t attempt to find an alternative way of helping the uninsured. The result, according to a July 2012 letter from the CBO director Douglas Elmendorf to House Speaker John Boehner, would be 30 million more uninsured Americans than under “Obamacare.” Admittedly, there have been Republican ideas of how to help the uninsured – from Nixon’s in 1974 through Romney’s in 2006 (many of which were incorporated in the PPACA). But Republicans over the past number of decades have for the most part avoided addressing this issue while Democrats have championed it. And after failing dramatically under Clinton (and a number of times before that) they succeeded under Obama.
The difference between right and left on this issue can be further seen in the way the “red” and “blue” states currently deal with it. Red states tend to define eligibility for Medicaid more narrowly while blue states define it more broadly. In Texas, for example, parents in a family of 3 who earn more than $4818 per year have too much income to qualify for Medicaid. In New York State the cutoff is $27,795. It’s no coincidence that Texas has the highest rate of uninsured in the US with 24% of its population without health coverage. In New York State 14% lack coverage, slightly below the national average of 16% (most recent available data from the Kaiser Family Foundation).
Lest anyone with a more insular mindset think that it’s only “others” that need help buying health insurance I point to the large number of those in our own community – including many mechanchim – who rely on these programs. Imagine the costs some yeshivos would face if they needed to pay for health insurance for their faculty’s families rather than relying (as some yeshivos along with many other employers, both Jewish and non – Jewish, do) on the various programs which exist to cover them (such as Child Health Plus in New York State).
I don’t claim here that the Torah’s concept of tzedaka is equivalent to the contemporary notion of social justice which provides a philosophical basis to some on the left in pressing for universal coverage. It’s that despite whatever differences we may have with liberals – we’re closer to them than we are to conservatives on this issue. Yet we are undoubtedly closer, though also not identical, with the right on a number of other issues.
As Torah Jews we don’t have the luxury of blindly following either right or left wing orthodoxy in applying our timeless values to contemporary dilemmas. Our Torah values are above being reduced to either of these simplistic formulations.
Rabbi Micah Segelman learned in Yeshiva Chofetz Chaim in Rochester and in Queens, has an MA in Statistics from the University of Rochester. He is currently pursuing a doctorate in Health Services Research and Policy at the University of Rochester.
This article reminds me a lot of the charge made by Democrats against President Bush, that he opposed stem cell research, when actually, what he opposed was government sponsored stem cell research. The false assumption is being made that the government is the only way to provide social services to needy individuals. However, not only is the government not the only way to provide humanitarian aid such as health care, but it is actually the worst way to provide it. Once the government controls health care, it has not only has a monopoly on health care, but a monopoly that is enforced by the law. And any time there is a monopoly over any venture, there is no more incentive to provide the best product for the least cost. What is produced instead is the exact opposite: poor service for the highest cost. We see that in public school education, which for all intents and purposes has a monopoly on our educational system, resulting in ever increasing costs for education that produces worse and worse results in student learning. While there is no guarantee that everybody in our entire nation will ever have access to health care, the optimal way to approach that goal would be to take the government completely out of it, and let the free enterprise system compete for patients. Prices would plummet, and the quality of service would soar. It is important to for our nation to be kind, but we must be smart about our approach, too.
The degree to which someone must sacrifice in order to help someone else and the ethics of distributing scarce resources are complex subjects and are beyond the scope of this article.
They may be beyond the scope of the article but they are at the heart of the issue. IMHO a vast majority of the population agrees government should play some role, the question is how much? Let me suggest two thought experiments:
1. The government of Israel determines it can increase the basket of basic services if each able bodied non working (including those in kollel) able bodied adult volunteered 2 days a month at an IDF logistics center. How would torah values inform on the response?
2. A government has $x to spend and can either improve national health dramatically by cleaning up sanitary conditions in its slums or use those $ for lower income educational services.How would torah values inform on the response?
I have a big problem with some of the major commentators in the “American Chareidi”(whatever that means), media. I note a lot of sarcasm and “bitul” put down of those who have other points of view.To write article after article about how stupid all of us are, how all the black people voted against their own interests,etc. to quote the idea that those of us who believe in social justice are “goodists’ ( I just renewed my Agudist membership, but how do I become a goodist) smacks of elitism and snobbery. Those who think that the majority of voters are just plain stupid, that they don’t understand that they are harming themselves and leading America to ruin by voting for anyone but a conservative Republican is stupid. It is so much more complex. Why do these otherwise intelligent people dominate the media of the frum press and blogosphere? Is there something in keeping mitzvos that makes one rigid and inflexible and seeking simplistic answers to complex problems. Is there any connection between the Torah and one branch of one political party? It is not a question of voting for Obama vs Romney, that is dependent on a lot of factors of these two people and the race is over, it is a matter of basic hashkafa. I do not like being told that my deeply held bveliefs about tzedek and veohavto l’reiacho komocha are stupid. That lowers the argument to the gutter.
The salvation of the Jewish People in this land is multi-culturalism, in the sense that our derech is considered just as kosher as another derech. We don’t live in a Protestant Christian White Anglo Saxaon America any more, we live in a diverse and tolerant society. Sure, that allows for things that you or I don’t agree with, but it also allows shomer shabbos workers to take off for their holidays as a matter of law. It is a trade off. Judaism can flourish in 21st century America because of the diversity and tolerance that some decry.
This does not mean that I or anyone else with brains is a robot following the party line. That is not the Judaism or Americanism that I believe in (although it is the norm in much of our frum world). The Democrats have many ideas that need to be tweaked,but having your heart in the right place is healthy, not stupid.
To go even further: many of these same “red” states want nothing to do with setting up health insurance exchanges, even though states like Texas surely have many who desperately need them. They would rather let the Feds deal with it–surely not their standard operating practice in most other matters–than prioritize this important issue for their constituents.
The onus should really be on America as to why it is the ONLY developed country without health insurance coverage, even as health care costs in the US are by far larger than in any other developed country. Everyone else has it–including Israel (a country that devotes so much of its budget to defense still provides for its citizens in this way…why can’t we?).
I am glad the author mentioned some of the effects on the Jewish community. Even if one does not agree with all of the provisions of the Affordable Care Act, it is embarrassing that “Obamacare” was treated as an epithet for so long, including by some in the Jewish community.
In applying our timeless values to legislation in our time, we need to consider the nature of the organizations and personnel that will put the enacted legislation into practice. All laws, including (or, maybe, especially) laws thousands of pages long, leave much to the interpretation and discretion of our bureaucracy. This means that the self-interests, political inclinations, general competence, and moral backbone of the bureaucrats are critically important. This becomes all the more so when they are granted sweeping powers, and their actions are poorly monitored and corrected by the legislature and courts.
There is a lot of room for skepticism that loudly proclaimed good intentions will play out as corruption and oppression. Once the Constitution is shoved aside, as is often done now by all branches of government, who knows what can happen?
Excellent, excellent article.
I’m always amazed at how many in our communities bow down to the altar of Rush Limbaugh without properly analyzing if those values are consistent with the Torah.
Even if many of us chose at the end to vote for Romney, there should be at least a recognition that not all Republican values are Jewish values. We’re so careful not to allow outside influences in our homes, but somehow the republican diatribes have penetrated the thickest ghetto walls…
Another area where Republican and Torah values clash is immigration. The Ramban on Vayera that you quoted provides a clear picture of how Sodom deserved to be destroyed primarily due to their anti-immigration policies and belief that poor people moving to your country will take away the wealth from them. Yes, perhaps it needs to be done in an orderly fashion, but the way that immigration is enforced in the US (not allowing any legal way for a hardworking non-college graduate foreigner to come in) is certainly not the Torah way.
There is support across the political spectrum — including the religious parties — in Israel for that country’s universal health insurance program, which is adminstered through four highly regulated not for profit organizations.
Rabbi Dr. Moshe D. Tendler stated publicly a number of years ago that providing universal health care is a chiyuv from the Torah. I have see no rabbi of similar stature refute him on this.
In addition, Ze’ev Jabotinsky, while not a religious person, included health care in his “five mems” that society should provide to all. In many respects, including this one, the Israeli “Right” is far to the left of the Democratic party in the US.
Those who wonder why American Jews — including Orthodox American Jews — continue to vote Democratic might want to consider these issues.
If this post fails to elicit many responses it wont be for lack of simple rejoinders, but only because people tire of pointing out the obvious so many times. Altogether now, for the 1,000th time – what the Torah teaches about compassion for the widow and the orphan is completely irrelvant to mammoth pieces of social legislation for a 1)non-Jewish, 2)non-homogenous society, 3) forced unwillingly on a populance under threat of fines and prosecution, and 4) funded by taxes 5) not borne equally by everyone.
Let Rabbi Seligman tell the whole world why he thinks Obamacare is so great. Its his opinion, and even though the majority of the country doesnt share it, he’s entitled to it. Just please quit with the patronizing and (to an educated orthodox audience especially) silly claims that the “the Torah is in favor of Obamacare.”
The differences between the torah’s notion of tzedaka and today’s notion of social justice is bigger than night and day. As your own Rosh Yeshiva (Rabbi G) put it: In a communist state there is no tzedaka; there is no ability to give, and no ability to receive.
But that is not the point of your post. The point of your post is you think that one of the things society must force each other to pay for, is its indigents’ health care.
The most basic response, is that of course I’d like to see their health care paid for and I’d even like to see the rich people decide as a group to force one another to pay for it. I just don’t define “health care” as a specific good the way you do.
What is adequate health care that should be provided? Is it the least level that will avoid tort liability on the part of the doctor? Is it the level that most people have access to?
Do you get to see a specialist or only a GP? How long do you wait for that specialist? Do you get an MRI when the doctor says you certainly need one, or when the doctor says you should get one, or when it might be helpful, or when the doctor is afraid you will sue if you don’t get it? Do you get surgery the week it is decided you needed it? Or the next week? Or within 3 months? There are a billion things which affect the quality and cost of healthcare, and are the difference between the quality of care we have here (for the next few months-years) and the quality of care they have in Canada, England, and the other populist countries.
Look how silly the left’s position is on this. We don’t say you need to give poor people food in the quality that the average person has, and certainly not in the quality that would satisfy a contract claim in a contract for “food”. We define a minimum level of dei machsoro, and that is it.
You want to know why there is no alternative proposed? Well, because it would have to look like exactly what I am proposing. That the level of care stop being “standardized” in tort law, and allowed to reflect market conditions similar to the food market and the housing market. And we all know how that would play in the polls (“they want to give you third world country health care”).
Meanwhile, the effect of your solution is to give all of us “second world country” health care, and that is not a price I am willing or mechuyav to pay. Because that is literally the only way to give everyone health care while controlling the cost, since the cost of health care will always go up as a result of new technologies. The only way it can happen is if we simply deny everyone the new technologies.
(This will of course also mean the new technologies will not be developed since there are no payers, at great social waste.)
The left’s basic mehalech is that there is more utility in equality than in a greater sum of social good. And that is why they think this is a good idea.
This first paragraph is certainly true to at least some extent. It would certainly be worthwhile to have a serious discussion ofhow various “conservative” values do and/or do not fit well with a Torah outlook, and how Orthodox Jews can apply Torah values to the American political system. Unfortunately, this article does not provide anything of the sort. Not only is the article largely based on a “straw-man” version of American conservatism, but the article also makes overly simplistic equivalences between the requirements of a Jewish government run according to Torah law and a non-Jewish secular state, and makes the commonplace error of assuming that since many Orthodox Jews are forced to make use of various government services, it therefore follows that these government services are an inherently good thing.
“Conservatives maintained that people should figure out a way to solve this problem themselves.”
This is blatantly false and shows a complete, total ignorance of and disdain for a huge body of intellectual conservative writings on the issue.
How is redistributive economics (and certainly redistributive rhetoric) not a codification of violating the 10th Commandment against coveting another’s property? When left wing politicians refer to property being theirs, rail against the “rich”, or openly consider the prospect of nationalizing industries, how is that not advocating theft?
Egalitarian inclinations always seem to have “egal” as their idol and inevitably seek totalitarian means to make sure nobody has more than another. And when the legislation egalitarians seek invariably destroy private sector jobs, they eliminate the highest form of assistance specified by the Rambam: enabling someone to become employed.
Instead of 30% of a nation employed by the state, 12% are unemployed and many others are receiving assistance, isn’t the sign of a healthier economy one where under 10% work for the state and there is under 5% unemployment? Of course, such a scenario is a nightmare for unions and government workers who perceive the economic pie as finite and fight for leverage over slicing it.
Given that there is an estimated $40B in annual Medicare fraud, wouldn’t going after that and redistributing that handle much of the medical care needed for those in a safety net?
I think the Chofetz Chaim’s “required to provide health care for those who can’t afford it” and Rabbi Tendler’s arguments for universal health care have been ripped out of context. What isn’t addressed is how much? Is the poorest entitled to receive no less than the richest? Do we all deserve the same care that the President of the United States gets or do we drag everyone down to the lowest common denominator? And what is the public responsibility to pay for the costs of treating high-risk behavior? And what can society do to individuals who refuse to exercise, to eat well, to wear seat belts, etc.? And once we mandate universal health care, why not universal food and housing?
What we’ve seen in Europe is that socialism has transformed a continent into charity-averse narcissists who think “I gave at the tax board” and we get France who let tens of thousands of seniors die during a summer heatwave because nobody wanted to curtail the right to vacation time.
Lastly, there’s the math of an entitlement state. If ALL the assets of the top 20% of Americans were simply seized by the state it wouldn’t pay for what’s been promised. It’s long overdue to have legislators videotaped annually to prove they understand 7th grade math (exceeding what our present POTUS admits he knows) and, perhaps, some fundamental economic theory. If we REALLY wanted to get honest debate, we’d compel all government employees, their spouses, dependents and staffs to use ONLY government healthcare and ONLY government education at the cost of losing their jobs and all retirement benefits if they ever go out of network. It’s long overdue to deprive the elitists of their being “more equal than others”.
Has there been a direct relationship between the growth of the welfare state and the growth of Hamas? For wasn’t the first “hamas” in the story of the flood not a form of unprosecutable redistribution of property? If a majority can democratically vote to seize the assets of a minority, how is that not theft?
“and makes the commonplace error of assuming that since many Orthodox Jews are forced to make use of various government services, it therefore follows that these government services are an inherently good thing.”
Lets call a spade a spade. No one “forces” anyone to make use of the government services we are discussing. Some Yidden make a lifestyle choice (which may or may not be Halachic) to have more children and work less than they can afford to do. That is not “forcing”, and no different (even though it is for better reasons) than the bum who chooses not to work and watch TV all day, knowing he/she can collect food stamps, section 8 & Medicaid.
There are two questions in the healthcare debate: the practical, and the philosophical.
The American political Right holds, essentially, that government should be minimized because the more money government forcefully takes from its citizens, the less freedom those citizens have, which is in and of itself bad. That is a purely philosophical argument.
Many on the Right (and Left) also make various practical arguments about whether or not universal health care (in one form or another) will work in this country’s specific context. There is no question that those who hold a specific view for philosophical reasons are often prone to fudging the practical arguments, but the practical arguments still exist.
As Torah Jews, we should ignore the secularly-based philosophical arguments.
Responses to Comments 1 – 10:
Raymond – Economists know that the free market works well for some things and not for others – the “tragedy of the commons” is a famous example of where it doesn’t work well. Having a preference for free market solutions is fine – but you need to understand the limitations of the free market as well. Almost no one would suggest as you do that government should be “completely out of it.”
DF – Read my article more carefully – I made a more nuanced argument than you’re giving me credit for. I never said anything remotely close to “the Torah is in favor of Obamacare.”
Daniel – I don’t necessarily disagree with you. In fact, Medicaid beneficiaries do in some sense already get a lower level care than others. They have far fewer doctors to choose from and may be denied certain treatments – for example Arizona recently said they won’t pay for some organ transplants for Medicaid beneficiaries. On the other hand in some ways Medicaid beneficiaries get more than “paying customers” because they generally have no cost sharing (ie copays) and this may encourage overutilization. It may be perfectly reasonable for society to define what a minimal level of care should be even though wealthier people get more. However, I think that before we decide to save money by denying care to poor people that we have an obligation to exhaust all the other options for reducing medical costs in this country in ways that don’t reduce quality of care (for wealthy, middle class, or poor people). And we haven’t done even close to enough in this regard. I could provide plenty of “marei mekomos” on ways to do this but I don’t think CC is the place for a long, purely health policy discussion.
Eliezer – I don’t think I’m portraying a “straw man” version of conservatism. I think that because of their feeling that the problem of the uninsured wasn’t that important to begin with (and because of their various concerns about government social welfare programs and because they wanted to hurt Obama politically) the Republicans decided to reject health reform rather than try to shape reform in such a way as to mitigate legitimate concerns with it. I fully understand that it’s possible to have a nuanced conservative position – but I don’t think the recent Republican opposition to health reform was particularly nuanced.
The poor already have medical coverage- Medicaid. The not-by-choice uninsured are lower middle class and I think a better solution for them is more free markets in health care to lower costs and tort reform.
Anyone objecting to the imperfections of such an approach should consider that every health system stays in business by denying some treatments to some customers. Socialized medicine rations and responds slowly to clients, and Obamacare has negative consequences for the already insured and is a disincentive to hire workers. The point is to figure out which system produces the most overall good and does the least harm.
There is really nothing compassionate at all about spending other people’s money, forcing people to pay, through their hard-earned tax dollars, for causes they may nor may not believe in. There is nothing Jewish about the government forcing us to pay for things like the killing of the helpless unborn, or for the certificates of homosexual marriages. Nor is it exactly kosher to set up a system whereby the government decides, based on their resources, who shall live, and who shall die. Whoever controls the money, controls those supposedly benefiting from that money. The more control over our lives that we hand over to the government, the less free we are, and the more we are like slaves subjected to the government which is increasingly controlled by special interest groups. G-d liberated us from the slavery of Egypt so many thousands of years ago, but apparently there are some Jews who wish to be enslaved by our Government. Some of us Jews are like those Jews in the Sinai Desert, who longed to return to Egypt with its leeks and onions.
And as for multiculturalism, there is no force in existence today that is more eroding the unique greatness that has been this country ever since its beginnings. Once it is proclaimed that one culture is no better than another, then there is no reason why our Constitution with its guarantees of individual freedoms, will not be eroded by a foreign culture within this country that has managed to collect enough votes. And that, sadly, is exactly what is happening to this country, as our freedoms are being ever increasingly surrendered to the forces of socialist tyranny.
reflecting the view of the late prof. katz, perhaps we should question anyone quoting halakha as mandating a particular detailed position. more accurately halakha can help control excess in any direction. as should be obvious, few experts, let alone rabbis, possess the necessary perspective.
I think Rabbis Segelman and Oberstein unfortunately miss an important point. Many, many Orthodox Jews such as myself were opposed to ACA specifically because we think many people, including the less well-off, will be much worse off than under other reforms.
The social science of economics is complex enough to allow people to be sincerely wrong in their underwstimation of the unintended negative consequences without being particularly stupid, so that accusation is a little inappropriate for this forum. Nevertheless, it is still very likely that: a) boosting the demand for health care without changing the supply will raise the cost of health care, b) some employers will choose to employ fewer people and/or employ them for fewer hours to avoid various thresholds, and c) the ultimate reduction in health care provider compensation will dissuade some people from a career in health care, which itself ultimately leads to lower-quality health care.
Setting aside the weak argument asserting that a bad plan is better than no plan, Rabbi Segelman is also quite wrong in claiming that there were no “right-wing” proposals for reforming our clearly broken system. It would take all of five seconds of Google-ing time to find suggestions and position papers from any number of conservative or libertarian organizations.
Even though i believe they are mistaken in their assumed consequences, I firmly believe that the vast majority of people that support the ACA did so with the best of intentions. An unfortunate few (hopefully excluding Rabbi Segelman, and certainly excluding Rabbi Oberstein, whom i know personally) are incapable of reciprocating that favorable assumption, and instead impute any informed opposition to selfishness and the like. That imputation says far more about them than about Orthodox Republicans and libertarians.
Responses to Comments 1 – 10 (cont):
Joel Rich – You’re making a good point. I think that what I responded to Daniel that there are ways to lower costs without reducing quality applies to your comment as well. Also – my overriding point is that the basic impulse to want to solve this problem seems to me to be a correct hargasha and the right didn’t demonstrate that hargasha. Of course once you actually get into the details things get complicated.
Dan, Charlie Hall – Thank you and your points are interesting.
“This is blatantly false and shows a complete, total ignorance of and disdain for a huge body of intellectual conservative writings on the issue.”
One might argue as to whether secular conservative writings should trump Torah principles. Nevertheless, while there are indeed many intellectual conservative writings on the issue, the Republicans made use of none of them during the 2009-2010 health care debate. Unlike the 1970s and 1990s, they came up with absolutely no alternative proposals. In fact, the one Republican who seriously tried to negotiate a proposal with the Democrats, Robert Bennett of Utah, was rewarded for his efforts with a primary defeat.
Universal health insurance originated as a conservative idea — Otto von Bismarck was a bitter enemy of both liberals and socialists yet he was the person who got Germany its universal health insurance system. Decades later Theodore Roosevelt supported it in the US, as would Richard Nixon, Gerald Ford, and Bob Dole even more recently.
The arguments that private charity should provide take no account of the massive cost of health care for the poor in the US: The total cost of Medicaid is approximately equal to the total amount contributed to every single charitable organization in America put together. And that doesn’t even count the many poor elderly and disabled persons who receive Medicare. Private charity will also be far less efficient, lacking the huge economies of scale in the government programs. Do you really want to shut down every United Way agency, every Jewish Federation agency, every synagogue and day school, every church, every university, every voluntary social service organization?
I will conclude with the comments of two conservative intellectuals, one non-Jew, and one Jew. First, the non-Jew, Friedrich Hayek:
“There is no reason why, in a society which has reached the general level of wealth ours has, the first kind of security should not be guaranteed to all without endangering general freedom; that is: some minimum of food, shelter and clothing, sufficient to preserve health. Nor is there any reason why the state should not help to organize a comprehensive system of social insurance in providing for those common hazards of life against which few can make adequate provision.”
And the Jew, Ze’ev Jabotinsky, the intellectual father of the Zionist Right, alluded to in my earlier comment:
“The basic needs of a human being, which today a person must fight for and request the right to earn a living and cause a commotion when this right is not afforded him, comprise in essence five elements: food, housing, clothing, the possibility of educating one`s children and the possibility of receiving medical attention in the event of illness. In Hebrew, these five elements may be arranged according to initials: Mazon (food), Ma`on (housing), Malbush (clothing), Moreh, (education) and Marpeh (medical care). The `five M`s`.
With regard to all these elements, there exists in every country and in every period a certain conception of the required minimum. And the duty of the state, in my conception, must be to provide these to any citizen who declares that he is in need of them. This is the first of my `laws.` From this, it must be ensured that the state possesses the possibility to provide these `five M`s` to all those citizens in need of them. How will the state acquire this? The answer to this is my second `law`. The state will acquire this possibility by obligation from the nation, as today it imposes other taxes and requires that young people serve in the military.
In my conception, the government will, each year, calculate the number of individuals to whom the `five M`s` will need to be provided over the coming period. That is, there will be a need for such and such tons of food, such and such housing units etc. And to provide this, there will be a need for such and such money and such and such working hours. And the state will impose on the citizenry each year the appropriate level of taxation, or will employ the use of a particular number of private concerns, or recruit the appropriate number of young people for `social service`. While I am not a great statistician, I am sure that this will cost much less than for example the maintenance of an army today costs. Thus the social question will be adequately addressed.”
The fact that people are uninsured and then walk into hospitals and get free care shows the system is broken.
What we need is a system that gives basic care, especially for children, at a low cost (which we already have for the poor), and then the extras – like organ transplants, name-brand meds, etc. – should be covered by private insurance – not employer-based, because people lose their jobs or have part-time jobs with no benefits. For those who begin the new system with past health problems such as cancer, the insurance companies should be required to cover them, but everyone else can take their chances, just as they do with flood insurance, that an insurance company will cover them later.
Basic care costs – like a pediatrician visit, a throat culture – should be paid in cash, thus lowering the costs of paperwork and medical records (doctors would make more if they didn’t need as much office help to deal with insurance companies and wouldn’t charge $200 a visit), while expensive treatments would go through insurance companies.
I don’t buy the idea that Halacha requires universal or free health insurance for those who are unwilling or unable to purchase health insurance, even in a Jewish society. It may require universal emergency care, but not beyond that.
Responses to Comments 11 – 20:
Toby Katz and Moishe Potemkin – I am aware of a lot of conservative thought which would contribute to addressing this issue and I even referred to some of it in the article and explicitly wrote, “Admittedly there have been Republican ideas of how to help the uninsured…” A good example is the work of the (conservative leaning) Heritage Foundation which was incorporated in Romney’s Massachusetts reforms (referred to in Chapter 6 of the Starr book I referenced).
But ideas and actions are not the same thing. My point was that when it came to making a decision of how to respond to the President’s healthcare agenda the Republicans seemed to reject it entirely (reflecting at least somewhat a lack of interest in solving the problem) rather than responding with a proposal which would solve the problem in a better way. Furthermore, no Republican President or Congress (to the best of my knowledge) seriously sought to solve this problem since Nixon in 1974 (and he had one foot out the door due to the Watergate scandal at the time) and many Democratic ones did.
In writing this article I should have been more careful to emphasize that I’m not defending PPACA per se. There may be many ways that conservative principles could have improved it – for example vis a vis PPACA’s policies towards consumer directed health plans (see Michael Tanner of the (libertarian leaning) Cato Institute’s “Bad Medicine A Guide to the Real Costs and Consequences of the New Health Care Law”). My concern is with the right’s not seriously trying to find a solution.
Aaron – see my response to Daniel above
There’s one inescapable point that hasn’t been raised in this discussion. If Obamacare is such a great idea, why did Congress exempt themselves from it? If it’s good enough for us, it should be good enough for them. By granting members of Congress an exemption, it confirmed our worst fears about it.
To David F:
Please stop believing the lies from Rush and other slanted media about the Affordable Care Act.
If you go to the Affordable Care Act government website, the timeline clearly shows that starting in 2014 members of Congress will be getting their healthcare from the Affordable Insurance Exchanges.
My concern is with the right’s not seriously trying to find a solution.
Who is “the right” that is not seriously trying to find a solution? You’re moving fairly quickly from the legitimate observation that millions of Americans lack health insurance to the questionable assertion of a crisis (when illegal immigrants and the voluntarily uninsured are excluded, the numbers are far less distressing) to the grossly inaccurate imputation of nefarious motivations to about half the country because of the actions of a small number of politicians.
One could equally inaccurately, and equally unpleasantly, accuse “the left” of utter indifference to life because Democratic politicians refuse to consider any reasonable constraints to abortion (the false choice presented is always between unfettered abortion and, for no discernible reason, the preferences of the Roman Catholic Church). Such accusations add little to public discourse.