Does Jewish law mandate universal health care?

The short answer is “yes” -- but the details are a bit complicated.

 

First, let me acknowledge that, in answering this question, I am indebted to the work of Rabbi Jill Jacobs, who devotes an entire chapter of her book, There Shall Be No Needy: Pursuing Social Justice Through Jewish Law & Tradition (Jewish Lights: 2009) to Jewish perspectives toward the provision of health care. 

 

Second, let me issue a qualification: Jewish law arose in an age long before antibiotics, modern surgical procedures, … and health insurance. It is always difficult to apply specific rulings from the past to present circumstances, and the law in this area is no different. What we can do, though, is to examine the values underlying the relevant Jewish texts, and apply those values to the contemporary reality in which we live.  

 

When we do that, it seems clear to me that Jewish law would support requiring everyone to obtain health insurance.

 

Here’s why: Judaism imposes an obligation on each and every one of us to care for the others among whom we live. If they are poor, we are obligated to provide them with food, clothing, and shelter. That much is clear, and uncontroversial. 

 

But we are also obliged to provide the poor with medical care. 

 

Where does that obligation come from? Some say it comes from the mitzvah (Jewish religious obligation) not to “stand idly by the blood of your neighbor” (Leviticus 19:16); others derive it from the mitzvah (stated in Deuteronomy 22:1-3) to return lost property. We are told that we are obligated to return not only a person’s donkey or garment, but “anything belonging to your fellow human being which he has lost and you have found.”  (Deut. 22:3, emphasis added)  That word “anything” is interpreted to obligate us to restore even a person’s health -- should it be possible for us to do so.

 

Moreover, not only individuals, but the community as a whole has this obligation. “Jewish legal texts impose on the community an obligation to provide financial and other resources for the ill.” (Jacobs, p. 171) A prominent 20^th century Israeli legal authority, Rabbi Eliezer Waldenberg, stated the following: 

 

It has been enacted that in every place in which Jews live, the community sets aside a fund for care of the sick. When poor people are ill and cannot afford medical expenses, the community sends them a doctor to visit them, and the medicine is paid for by the communal fund. The community gives them food appropriate for the ill, day by day, according to the directions of the doctor. (Tzitz Eliezer 5:4) (quoting Rabbi Rafael Mordechai Malchi; Jacobs, p. 171-172) 

 

And the poor who are to be cared for are not just the Jewish poor. A medieval authority, Rabbi Nissim of Gerona (Barcelona, 1320-1380) noted that health care funds are specifically designated for the “poor of the world” and not only for the “poor of the city.” Thus, when it comes to providing health care for the indigent, a community must offer help to all who are in need, regardless of their ethnicity, religion, or nationality. 

 

Therefore, we can say that if a government today were to care for its citizens in accordance with Jewish law, it would be required to provide health care to all – regardless of their ability to pay.

 

The U.S. federal government has recently chosen to do that by means of the insurance system that the vast majority of Americans use to pay for their medical expenses. By mandating (i.e., requiring) universal coverage, the government hopes to distribute the cost among everyone of providing medical care for the poor. The government could have chosen a different approach to fund universal coverage, but I see nothing in this approach inconsistent with Jewish law.

 

To conclude, Jewish law imposes on us as individuals and on the society in which we live the obligation to provide medical care to all. One acceptable means of doing this is to mandate all of us to purchase health insurance, thereby distributing the cost of this communal burden among the entire population.

There are three Biblical statements that bear directly on the health care issue.    The Torah tells us “Lo Taamod Ahl Dam Reiechah”, “Do not stand idly by while your friend’s life is in danger”.   This would imply that if I see a person in a life threatening situation, I am required to help, provided I do not gravely endanger my own life.   Furthermore, we have a requirement of “Rapoe Yirapeh”, “you shall certainly pursue full medical healing”.   This verse originally required someone who had injured another to pay for medical costs, but has been extended to obligate everyone to pursue medical care from the most expert physicians in situations of injury or sickness.   Now, one could make the argument based on these two verses that if a community has the financial wherewithal to provide healthcare for everyone, it is obligated to do so.    However, the verse of “do not stand by” is majorly referring to an immediate situation of mortal danger, and the verse about healing in its extension is referring to the obligation of the sick person, not the community.   Therefore, I believe that Jewish Law does not mandate universal health care, but rather encourages it under the rubric of Tzedakah, charity (for those who cannot afford it), and aiding people to fulfill the Mitzvah of “Tishmore et Nafshoteichem” “You must guard your health” (the third Biblical statement to which I was referring), for those who can afford health care, but need encouragement to pursue preventative medicine.

The debate over whether the United States should mandate universal health care has occupied the attention of the nation for much of the past year. As President Obama has noted, it has been part of the political conversation in the country for decades. 

 

The Reform Movement went on record with a resolution in 1976, supporting the Kennedy-Corman bill, saying

WHEREAS our tradition teaches concern for all people, especially the poor and the elderly, and WHEREAS all Americans should have the right to adequate health care, and WHEREAS the high cost of medical care makes it virtually impossible for large segments of our population to receive it,

BE IT THEREFORE RESOLVED that we call on Congress to enact a comprehensive national health insurance program such as the Kennedy-Corman bill to cover prevention, treatment and rehabilitation in all areas of health care.

That position has been reaffirmed multiple times since. 

 

There are many traditions that support this position. I would recommend a reading of the document produced by the Conservative Movement’s Committee on Law and Standards, “Responsibilities for the Provision of Health Care” by Rabbis Elliot N. Dorff and Aaron L. Mackler, which is referenced and available on the Jewish Values Online site under the category of Health Care System. 

 

In a chapter devoted to this question Rabbi Jill Jacobs, in her book There Shall Be No Needy, cites the decisions of Israeli rabbinic authorities confronting similar questions in the State of Israel. Their decisions, while not direct responses to this question, suggest that we do bear a positive obligation to provide universal healthcare. 

 

Rabbi Eliezer Waldenberg, in 1985, addressed the question of how to deal with a patient who did not have the funds to pay for treatment. He concluded that a Bet Din, a religious court, could compel a doctor to offer treatment. He suggested several ways to cover the cost of that treatment, including pro bono care from the doctors, the use of communal charity funds, or the establishment of a public fund that would cover such expenses. At base his ruling argued that health care is an obligation that rests on the community, including the state, as a whole. 

 

Rabbi Shlomo Goren, once the Chief Ashkenazi Rabbi of Israel, was asked about the status of a doctor’s strike in Israel. His ruling concluded that just as the civil authorities bear a responsibility for maintaining roads and caring for the infrastructure of the community as a whole, so they bear responsibility for the delivery of health care to the population. Rabbi Goren wrote: “The government may not excuse itself from its responsibility toward the sick since the government is responsible for the health of the people.” His opinion is echoed by Rabbi Chaim David Halevy, Sephardic Chief Rabbi of Tel Aviv/Jaffo, who wrote “every advanced nation should provide health care to its residents.”

 

Once we recognize that such an obligation exists, and I believe it does, then we need to find a way to make it happen in the real world.