Elections 2012 - A Jewish Perspective
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The Healthcare Debate:
The Mandate and Jewish Law
Elections 2012 - A Jewish Perspective
The Healthcare Debate:
The Mandate and Jewish Law
Student’sIntroducƟon
NowherearethelinesbetweentheparƟesdrawnmoresharply
thanontheissueofhealthcare.TheHealthCareReformAct–
“Obamacare”–waspassedonstrictpartylinesintheHouseand
theSenate.OpposiƟontothelawsparkedadeeppopularrevolt
that resulted in one of the greatest Congressional elecƟon
swingsinAmericanhistory.AndwhiletheSupremeCourtruling
on the issue may clarify for a Ɵme the consƟtuƟonal issues
involved, the policy issues sƟll remain without eīecƟve
consensus.
ThisclassaskssomebasicquesƟons.Whoseresponsibilityisour
healthcare?AreothersresponsibleformeandamIresponsible
for others? Is health care insurance a contradicƟon to trust in
GͲd?Doesacommunityhavearighttorequireitsmembersto
buyhealthinsurance?Whatistheroleofourownfreechoicein
solvinghealthcareproblems?
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OpeningquesƟon:
Who is most responsible for paying for my healthcare ͲͲ the
government,myemployer,ormyself?
Ranktheirlevelofresponsibility:Įrst,secondorthird.
SecƟonI
ObligaƟontoseekhealing
1a. IfyouwilltrulylistentothevoiceofGͲdyourGͲd,do
that which is upright in His eyes, listen to His
commandmentsandguardallHislaws,thenIwillnotaŋict
you with any of the sickness with which I aŋicted Egypt,
becauseIamGͲd,yourHealer.
Exodus15:26
1b. Ifheshouldgetupfromhissickbedandwalkabout
outside,evenwithacane,thenhemustpayhimfortheidle
Ɵmeandtomakesureheishealed.
Exodus21:19
Make sure he is healed—As the Aramaic translaƟon reads
this:“Andheshallpaythedoctor’sfee.”
CommentaryofRashi,adloc
2a.
TheSchoolofRabbiIshmaeltaught:Makesureheis
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Elections 2012 - A Jewish Perspective
healed (verapo yerapei) – From this doubling of the verb,
we learn that divine permission has been given to the
doctortoheal.
BabaKama85a
2b. DivinepermissionhasbeengivenͲͲOnemightraise
thequesƟonthatthiscouldhavebeenlearned,withoutthe
doubling, as the simple meaning of ‘healing’. The answer
would be that the simple meaning covers only an injury
causedbyanotherhuman,butthatwewouldsƟllnothave
permissions to heal illnesses and injuries coming from
heaven, for it would seem as if we were contradicƟng the
decree of the King. This doubling, therefore, teaches that
thisisnotso.
Tosafotadloc
3a.
ButforyourownlifebloodIwillrequireareckoning.
Genesis9:5
3b.
Alllivesaremine.
Ezekiel18:4
3c. Aperson’slifeis not his or her ownpossession,but
thepossessionoftheblessedHolyOne.
RidvazonRambam,HilchotSanhedrin18:6
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Elections 2012 - A Jewish Perspective
3d. Itisforbiddentostrikeone’sfellow.Evenifhegives
permission to strike him, no person has any such authority
overhisownbodyastoallowittobestruck.
R.SchneurZalmanofLiadi,HilchotNizkeiGufVanefesh,Chap.4
4a. Chamira sakanta me’isura ͲͲ– Physical danger is a
graverissuethanmereprohibiƟon.
Chulin10a
4b. AŌer Rabbah had let blood, they chopped up a
footstoolforĮrewoodtowarmhim.AbbayesaidtoRabbah:
“But is the master not violaƟng the prohibiƟon of bal
tashchit?!”
Rabbah answered: “Bal tashchit applies even more to my
body[thantothefootstool].”
Shabbat129a
4c. It is a posiƟve Torah command to remove any
stumblingblockthatposes a danger to life, tobe watchful
of it and be extremely careful of it, as it is said: Be very
carefulandguardyourlife(nafshecha)…[Deuteronomy4:9]
Rambam,HilchotRotseachUshemiratHanefesh11:3
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ClassQuesƟon:
Whoisbeingaddressedbythesecommandsof:Guard your life
(lenafshoteichem) very carefully andBe very careful and guard
your life (nafshecha)?
Who is being given the responsibility to do this – the
individual,thecommunity,orboth?
5a. A scholar is forbidden to liveinany town that does
not have these ten things: a court, a charity fund, a
synagogue,abathhouse,alatrine,adoctor,abloodͲleƩer,
ascribe,akosherbutcherandateacherofchildren.
Sanhedrin17b
5b. Since maintaining a healthy and sound body is
among the ways of GͲd Ͳ for one cannot understand or
haveanyknowledgeoftheCreator,ifheisillͲtherefore,he
must avoid that which harms the body and accustom
himself to that which is healthful and helps the body
becomestronger.
Maimonides,HilchotDe’ot4:1
ClassQuesƟon:
Have these readings changed your mind or reinforced your
earlierthoughts?
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SecƟonII
MyBrothersKeeper
ClassQuesƟon:
Are we obligated to heal others or help them care for their
health?
6a. Youshouldnotwatchyourbrother’soxorsheepstray
andturnablindeye—returnthemtoyourbrother.Butifyour
brother is not near to you or if you do not know him, you
shouldbringitintoyourhouseanditshouldremainwithyou
unƟlyourbrotherseeksitoutandthenreturnittohim.
Deuteronomy22:1Ͳ2
6b. Andthenreturnittohim—Evenhehimselfyoushould
return.
Sifrei,KiTeitsei223
7a.
Donotstandidlybyyourneighbor’sblood.
LeviƟcus19:16
7b. Donotstandidlybyyourneighbor’sblood—andwatch
himdiewhenyouareabletosavehim.
CommentaryofRashi,adloc
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8a. From where do we know that if one sees one’s
fellowdrowninginariverorawildbeastravaginghimor
bandits coming to aƩack him that he is obliged to save
him?Scripturestates:Donotstandidlybyyourneighbor’s
bloodbutrathersavehimfromdeath.
Butisitindeedfromherethatthislawisderived?Surely
not! The law is derived from a verse in this other place:
The Torah clearly states that a lost object must be
returned to its owner, but from where do we know that
wemustreturnalostbodyi.e.thatifthelifeofafellow
Jew is in danger, there is an obligaƟon to save him?
Scripturestates:Andthenreturnittohim.
Now,ifthisverseteachesthatonemustsavehisfellow’s
life, then why would the verse Do not stand idly by your
neighbor’sbloodbeteachingthesamething?
If wehadlearned this law fromthere, then I wouldhave
said that obligaƟon is only when he himself can save his
fellow’s life, but if he could only save his life by hiring a
rescuer,thenIwouldsaythatoneisnotrequiredtodoso.
Therefore,thisverseDonotstandidlybyyourneighbor’s
bloodcomestoteachusthathemustevenhiresomeone
torescuesomeoneindanger.
Sanhedrin73a
8b. TheverseAndthenreturnittohimteachesusthat
onemustreturnhisbodytohim.
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TheverseDonotstandidlybyyourneighbor’sbloodmeans
don’t stand by yourself but pursue every possibility so that
yourneighbor’sbloodnotbelost.
CommentaryofRashi,adloc
ClassQuesƟon:
WhoisresponsibleforpayingformyhealthcareͲͲthesociety,
myemployer,ormyself?
Foreach,rankitslevelofobligaƟon:Įrst,secondorthird.
9.
Onewhoseeshisfellowdrowningintheseaorbeing
setuponbygangstersͲͲifhecansavehimpersonallyorby
hiringotherstosavehim,thenheisobligatedtogotothe
trouble to hire people to save him. He may aŌerwards
require reimbursement for his expenses if [the one saved]
has the money. If not, he should nonetheless not refrain
from saving; if he does refrain, he is guilty of violaƟng the
prohibiƟonof“Donotstandidlybyyourneighbor’sblood.”
RabbiSchneurZalmanofLiadi,HilchotNizkeiGufVanefesh7
ClassQuesƟon:
Does the mitzvah that obliges us to save another oblige us as
individuals or only as a group? Is the responsibility to help
othersprimarilyapersonalobligaƟonorisitprimarilysocietal?
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Elections 2012 - A Jewish Perspective
10. [HalachaspeciĮesthatifthereisonlyonedoctor,he
is required to heal those who cannot pay and rather than
expendpublicchariƟes,wemaylegallycompelthedoctorto
healwithoutpay.]However,ifthereismorethanonedoctor
in a place, then it is impossible to cast the burden of
providingmedicalcarewithoutfeeononedoctormorethan
onanother...
Accordingly, the right thing to do is either for the
congregaƟon to pay the fee from tsedaka funds or to take
up a collecƟon for the required amount or for the
congregaƟon and its bet din to set up a rotaƟon during
whicheachdoctorwillcoverforfreeaccordingtotheneed,
each in his turn. And when the congregaƟon has greater
ability,thebestwayisforittosetupasetmonthlywagefor
a doctor who will take on at no charge the poor of the
congregaƟonwhowillcomewithdocumentaƟonidenƟfying
himassomeonewhoisunabletopay.
And how good and Įne are those sickͲcare funds in their
widely varying sorts which we have here in our Holy Land.
They symbolize in a united way the three great traits by
which our people are disƟnguished and by which we are
idenƟĮed:compassion,humilityandpracƟcalbenevolence.
RabbiEliezerWaldenberg,TzitzEliezer19:1
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Elections 2012 - A Jewish Perspective
ClassQuesƟon:
WhoisresponsibleforpayingformyhealthcareͲͲthesociety,
myemployer,ormyself?
Foreach,ranktheirlevelofobligaƟon:Įrst,secondorthird.
SecƟonIII
MyLife,MyChoice?
ClassquesƟon:
Should we be responsible for someone who was negligent
about his own healthcare? What about someone who says, “I
wanttodie,don’ttrytosaveme?”
11a. Ifyouseeyourneighbor’sdonkeycollapsingunderits
burdenshouldyouhesitatetohelphim?!Youmustcertainly
helpalongwithhim!
Exodus23:5
11b. Ifyourneighborgoesandsitsdownandsaystoyou,
“It’s you who are commanded to help,” then you may
unload the donkey or not, as you wish. For Scripture says,
“Alongwithhim.”
MechiltadeRabbiShimonbarYochai23:5
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Elections 2012 - A Jewish Perspective
11c. It would seem that if someone were to aƩempt
suicide and someone else would be able to rescue him, he
mightnotbeboundbytheprohibiƟonof“Donotstandidly
byyourneighbor’sblood;”andhowmuchthelesswouldhe
be bound by the posiƟve command of returning a lost
object.
MinchatChinuch,KometzMincha,Mitzva237
12a. Itisforbiddentostrikeone’sfellow.Evenifhegives
permission to strike him, no person has any such authority
overhisownbodytohaveitstruck.
R.SchneurZalmanofLiadi,HilchotNizkeiGufVanefesh,Chap.4
12b. EvenifapaƟentbroughtillnessuponhimselfthrough
negligence,theSabbathmustbedesecratedonhisbehalf.
Fred Rosner, “Rabbi Moshe Feinstein’s InŇuence on Medical
Halacha,”TheJournalofHalacha,No.20,p.49
13. IfasƟngyrichmanstarveshimself,eventhoughwe
shouldfeelnocharityobligaƟontowardshimandweallow
himtogoaboutinhisfoolishness,itseemstomethatifhe
becomesillfromhishunger,wedofeedhimandforcehim
topay.
Rabbi Yechiel Michel Epstein, Aruch Hashulchan, Yoreh Deah,
HilchotTsedaka253
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ClassQuesƟon:
WhoisresponsibleforpayingformyhealthcareͲͲthesociety,
myemployer,ormyself?
Foreach,ranktheirlevelofobligaƟon:Įrst,secondorthird.
14. IfIamnotformyself,thenwhowillbeforme?Butif
Iamformyselfonly,thenwhatkindofapersonamI?Andif
notnow,when?
Avot1:14
SecƟonIV
Insurance
15a. CastyourburdensonGͲd;Hewillsustainyou;Hewill
neverallowtherighteoustostumble.
Psalms55:
15b. If one does not trust in GͲd, then one is trusƟng in
somethingelse.Andonewhotrustsinsomethingotherthan
GͲdremovesGͲd’sprotecƟvegovernancefromhimself,and
isabandonedtothethinginwhichheputhistrust.
RabbiBachyaibnPakuda,DuƟesoftheHeart,TheGateofTrust,
beginning
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15c. Doesinsuranceinallitsformsnotrepresentalackof
trustinGͲd?TheprophetJeremiahsaid:“Cursedistheman
whoputshistrustinman,makingŇeshhismight,andpulls
backhisheartfromGͲd.”Ifso,whenIplacemytrustinthe
insurance company, perhaps this is a lack of faith in the
blessedHolyOne?
Chief Rabbi Yona Metzger, Miyam Hahalacha, 85, “The RelaƟon
ofHalachatoInsurance”
Class QuesƟon:
Areweallowedtohaveinsurancealtogether?Ifweliveourlife
anƟcipaƟngtheworst,isthatnotalackoftrustinGͲdthatgoes
a long way to opening the possibility for evil to happen, GͲd
forbid?
16. GͲdwillblessyou[Deut.15:18]–Youmightthinkthis
would be so even if one were to sit and do nothing.
Thereforethetextadds,…inallthatyoudo[ibid.].
Sifrei,adloc
17.
Donkey drivers can say that whenever someone’s
donkeydies,allwillcollecƟvelybuyhimanewdonkey.
ToseŌa,BabaMetsi’a11:25
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18a. Apersonshouldneverconsecrateordevoteallofhis
possessions. He who does the reverse acts contrary to the
intenƟon of Scripture…Such an act is not piety but folly,
since he forfeits all his valuables and makes himself
dependentuponotherpeoplewhomayshownopitytohim.
Maimonides,HilchotArachin8:13
18b. Amanshouldalwaysexerthimselfandshouldsooner
endurehardshipthanthrowhimselfasadependentonthe
community. The sages admonished: “Makeyour Shabbata
weekdayratherthanbecomedependent.”Evenonewhois
learned and honored should, if impoverished work at
various trades, even very lowly ones, rather than accept
dependency.
Maimonides,HilchotMatnotAniyim10:18
19. RegardingthequesƟonofwhetherthereisanyworry
that it is forbidden to take out an insurance policy, as it
might consƟtute (GͲd forbid) a lack of faith in GͲd… In my
humble opinion, there is not a bit of lack of faith in GͲd in
this,foritislikeanyotherbusinessmaƩerinwhichaperson
isnotonlyallowedbutrequiredtoengageincommerceand
work for his livelihood and it is forbidden for him to say,
“EvenifIdonothing,GͲdwillsustainmeinsomeway.”
RabbiMosheFeinstein,IggrotMoshe,OrachChayim,2:111
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Discussion:
Seeing that provision for the future through a Įnancial
instrument is allowed under Jewish law, can a case be made
thatanindividualshouldbuyhealthinsurance?
ClassQuesƟon:
What do you think provides a more powerful reason for
purchasing insurance: (1) the community’s right to protect
itself,sinceitisonthehookfortheperson’streatmentevenif
he is negligent; or (2) a person’s selfͲinterest in protecƟng
himselffromalifeƟmeofpayingoīmedicaldebt?
20. A community can restrict, enact laws, and make
agreementsastheyseeĮt.ThesehavethestrengthofTorah
laws.TheycanĮneandpunishanyonethatviolatesanyof
theircollecƟveagreements… RabbiShlomobenAderet,Responsa4:185
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