Many state Attorneys General are fighting the thing in court, but I have the sinking feeling that they will not prevail. And so, we must live with this thing as the law of the land. Make no mistake, H.R.3590 - The Patient Protection and Affordable Care Act, is not about helping a poor child or a sick homeless person. No, it is a power-grab by the Social Democrats, a narcissistic romp over the Constitution by our President and Comrade Pelosi, hoping to etch a name for themselves in history as the next FDR, a triumph by the Left as a path toward socialized medicine, and Socialism in general. You won't convince me otherwise. More on this below.
Supporters of the bill fall into two camps: those who honestly (and naively) believe in its virtues, and those who cynically hide behind the purported good it will do to further their political aims and ambitions. I am, however, having a moral dilemma concerning the supposed improvements that are found in the bill, such as the elimination of preexisting conditions as an impediment to being insured, the (feeble) attempt to cover more Americans (whether they want such coverage or not), and so forth. Should I therefore close my eyes to the power grab and embrace the bill? For ethical guidance, I have spent much of my spare moments these past few days trying to find the answers in the Jewish moral and ethical traditions. Frankly, I'm still confused, but we have to start somewhere.
Helping those who need help certainly falls under the auspices of charity, and Jewish law discusses charity in detail. Tzedakah ( צדקה) is the common Hebrew term, although the more literal translation of tzedakah involves righteousness rather than charity per se. Depending upon the source, we are to give 10 percent of our income (most say after tax, some say before tax, a few say tax might even be included in the calculus of giving). However, one is not to give until it hurts, since
. . . (N)o one should give so much that he would become a public burden, nor more than twenty percent of his assets even if he would not become a public burden.Rabbi Moses Maimonides was a great Jewish scholar and physician who lived in Spain and then Egypt in the 12th Century. He is often referred to as the Rambam, an acronym of his Hebrew name. In addition to writing one of the preeminent commentaries on the Bible, the Rambam was known for his philosophical and ethical teachings. His comments about the eight levels of charity are apropos here (I should note that the Rambam was speaking of charity from one Jew to another, but I think the ethical principles apply to the more general situation):
There are eight levels of charity, each greater than the next.The Democrats clearly envision themselves at level two at the least, and would place the rest of us at level eight, having to be forced (by them) to give.
 The greatest level, above which there is no greater, is to support a fellow Jew by endowing him with a gift or loan, or entering into a partnership with him, or finding employment for him, in order to strengthen his hand until he need no longer be dependent upon others...
 A lesser level of charity than this is to give to the poor without knowing to whom one gives, and without the recipient knowing from who he received. For this is performing a mitzvah solely for the sake of Heaven. This is like the "anonymous fund" that was in the Holy Temple [in Jerusalem]. There the righteous gave in secret, and the good poor profited in secret. Giving to a charity fund is similar to this mode of charity, though one should not contribute to a charity fund unless one knows that the person appointed over the fund is trustworthy and wise and a proper administrator.
 A lesser level of charity than this is when one knows to whom one gives, but the recipient does not know his benefactor. The greatest sages used to walk about in secret and put coins in the doors of the poor. It is worthy and truly good to do this if those who are responsible for distributing charity are not trustworthy.
 A lesser level of charity than this is when one does not know to whom one gives, but the poor person does know his benefactor. The greatest sages used to tie coins into their robes and throw them behind their backs, and the poor would come up and pick the coins out of their robes so that they would not be ashamed.
 A lesser level than this is when one gives to the poor person directly into his hand, but gives before being asked.
 A lesser level than this is when one gives to the poor person after being asked.
 A lesser level than this is when one gives inadequately, but gives gladly and with a smile.
 A lesser level than this is when one gives unwillingly.
Providing health care for those in need is one form of charity. Some of the sages believe that health care must be offered to all in the community for free, but Rabbi Yossi Grossman of Houston says:
(T)he Talmud clearly states that if I jump into a river to save someone and lose my shirt, then I can subsequently charge them for my losses incurred through the act of kindness. That means there’s no obligation to provide universal healthcare. The obligation is to help indigent people. But if the indigent can afford to pay something, then they are obligated to do so. Healthcare is not an automatic right to everyone who lives in the community.Judaism, being practical on many things, realizes that there might be fraud in the acceptance of charity, and healthcare would certainly be included, as those of us in the business know all too well:
Judaism acknowledges that many people who ask for charity have no genuine need. In fact, the Talmud suggests that this is a good thing: if all people who asked for charity were in genuine need, we would be subject to punishment (from G-d) for refusing anyone who asked. The existence of frauds diminishes our liability for failing to give to all who ask, because we have some legitimate basis for doubting the beggar's sincerity. It is permissible to investigate the legitimacy of a charity before donating to it.And further, giving when you know you're being deceived doesn't do anyone any good:
The NIMUKEI YOSEF in Bava Kama (6b of the pages of the Rif) cites the RAMAH who explains that a person who gives charity to one who is undeserving will still receive reward only when the giver is not aware that the recipient is undeserving. When the giver is aware that the recipient is undeserving, then he does not receive any reward for his act. (I. Alsheich)Now, can Tzedakah be confiscated from someone who doesn't want to give? Well. . . this passage says yes. . .
We have already noted that the courts can enforce payment of tzedakah. . . Rabbenu Tam claimed that only verbal pressure could be used . . . Consequently, the Rashba felt that actual physical pressure could be applied. . . However, the Rambam and the Ran both maintained that Beit Din could actually confiscate property. This would appear to go beyond the normal parameters of enforcing mitzvot.BUT the following puts this in a very contemporary light:
This concept of "the debt of tzedakah" requires elucidation. It runs counter to our intuitive perception of charity as a moral category, voluntary in nature. Yahadut, however, has a different understanding of tzedakah. The Rambam already noted that the term "tzedakah" is derived from the root "tzedek" - justice, and not from "chesed" - lovingkindness. However, it is clear that tzedakah cannot be understood as a clear-cut monetary debt. . .
In the capitalistic system individual ownership is absolute; charity, therefore, is voluntary. I have no obligation to give charity. I owe the poor nothing. Due to my generous nature or sense of moral obligation, I, by my own volition, decide to offer something of mine to the poor. Within this system it is obvious that categorizing charity as a debt is absurd.
Socialism, on the other hand, would be very sympathetic to such a concept. Even if private property is recognized, the individual as part of society is responsible to society’s demands. He is therefore monetarily obligated to fund society’s causes, which include the support of the needy. Hence we can understand the justice which creates the debt of tzedakah. . .
Although aware that Hashem (literally, The Name, i.e. God, the Lord) granted man private ownership, he nevertheless understood that human legal rights were subject to Hashem’s demands. From the fusion of these two ideas sprang the Jewish concept of tzedakah - tzedek he. From a technical legal perspective one man is giving of his private property to another to whom he owes nothing. However from a more profound perspective the first man actually owns nothing, and is merely granted possession subject to the will of a moral and loving God. It was these ideas that Avraham (Abraham) discovered and taught to his children. It is this understanding of tzedakah that is unique to the Jewish experience, and is unparalleled in secular universal culture. Furthermore, the appreciation and internalization of these ideas are characteristic of the Jewish people, and are critical in their covenantal march through history. Therefore, the fulfillment of this mitzvah is instrumental in the realization of Jewish destiny.
This socialistic interpretation is not really mainstream, and proper Socialists would be very upset to learn that God in Heaven owns everything rather than the State. Still, it is an interesting perspective. Fortunately, Judaism does not have a problem with wealth, as long as it is used for good:
The Jewish attitude towards wealth is quite positive. In fact, wealth, peace, and/or long life are rewards from God for obeying God's laws (Leviticus 26: 3-13; Deuteronomy 11: 13-16; Deuteronomy 25:15; Proverbs 22:4). Those that use their wealth to help the poor will be blessed by God (Deuteronomy 15:10; Isaiah 1:17-19; Proverbs 19:17) .
The Talmud (Babylonian Talmud, Taanis 9a) also sees wealth as a reward from God. In a wordplay on the verse (Deuteronomy 14: 22): "You shall surely tithe," the Talmud advises that one should tithe in order to become rich (the Hebrew word that means to tithe is very similar to the word that means to become rich). The verse (Proverbs 11:24), "There is one who scatters and yet is given more" is interpreted by many of the commentators (e.g., Rashi and Ibn Ezra) as referring to one who spends his money on the needy. The question of what a person should do to become rich is discussed in the Talmud; one answer is to engage in much business and deal honestly (Babylonian Talmud, Niddah 70b). Wealth is seen as "comely to the righteous and comely to the world" (Babylonian Talmud, Avot 6:8), and affluent people who used their possessions to help others were respected by the Talmudic sages (Babylonian Talmud, Eruvin 86a).And, the Talmud tells us not to be jealous of others' success:
The rabbis decried envy and jealousy, in which a person, out of discontent with his portion, begrudges the good fortune that has come to others. Envy and hatred of one's fellow-man were cited by the rabbis as vices that "take a man from the world." One of the rabbis was accustomed to offer a daily prayer: "May it be acceptable before Thee O Lord my God and God of my fathers, that no hatred against us may enter the heart of any man, that no hatred of any man enter our heart, that no envy of us enter the heart of any man, nor the envy of any man enter our heart …"Judaism also is a strong advocate for preservation of life. So what about our obligation to save someone? How far must we go? From Rabbi Chaim Steinmetz:
The Talmud (Bava Metzia 62a) discusses the case of two people who are traveling the desert and only one of them has sufficient water to survive. Ben Petura is of the opinion that it is better that they divide the water and both die, rather than have one watch the death of the other. Rabbi Akiva is of the opinion that "your life comes first", that the owner of the water must save his life first, even if the other person will die. Rabbi Akiva's opinion has become the Halachic (Orthodox Jewish law) consensus. While it is clear that one may not sacrifice his life to save the life of another, there is some debate if there is an obligation to save lives when it will endanger the bystander. The Hagahot Maimoni (Rotzeach 1:14) is of the opinion that it is obligatory for the bystander to place himself in uncertain danger in order to save the victim from certain danger. Others argue that it is forbidden to do so, and that the principle of "your life comes first" applies to uncertain danger as well (Radvaz in Pitchei Teshuva YD 157:15). Based on this opinion, some authorities forbid a donor from giving a kidney to dying patient if it will place the donor in some danger (Tzitz Eliezer 13:101; Minchat Yitzchak 6:103). Rabbi Moshe Feinstein takes a middle point of view. It is not obligatory to place yourself in a situation of questionable danger to save another person's life; However, you may choose to take this risk in order to save a life. Therefore, he rules it is permitted to donate kidneys, even if there is some danger to the donor. (YD 2:174)Life is precious, and is to be preserved, but how does Judaism deal with the sad fact that our means to do so on a very wide scale are limited? From a 1993 position paper by the United Synagogue of Conservative Judaism:
The Talmud (Sanhedrin 73a) requires the bystander to spend money in order to save lives. If the victim has money, he must repay those who save him (Rosh Sanhedrin 8:1). However, the bystander has an obligation to spend money even when the victim cannot repay. The Chofetz Chaim rules that the bystander is obligated to spend all of his money (Ahavat Chesed 2:20). One reason he gives is that when the Rabbi Akiva states "your life comes first" it implies that only your life comes first; your money does not. Rabbi Yoseph Shalom Elyashev disagrees, and says that the bystander does not have to give more than a fifth of his wealth to save a life (Quoted in Nishmat Avraham V, CM 426:1). He interprets Rabbi Akiva's statement differently, and argues that Jewish sources consider a loss of wealth as a partial "death". Therefore, the donor would not be obligated to impoverish himself to save the lives of others.
Distribution of Scarce Resources -- We have seen that Judaism places a premium on human life and health and mandates the creation of structures to provide every member of society with access to adequate health care. In situations of scarcity, Jewish insistence on the intrinsic and fundamentally precious value of human life makes triage decisions difficult. Consequently, the rationing of scarce resources in the classical texts is often decided on procedural grounds (e.g., first-come-first-served) rather than substantive considerations (e.g., who is worthier of being saved). [Maimonides, Hilkhot Yesodei HaTorah 5:5-7; Bava Metziah 62a]
Recently, Jewish scholars have begun to argue that the cases in the classical sources, which deal with distribution issues among a small number of people, may not be appropriate models for decisions about our society's overall health care system. While individuals are bidden to make all efforts to save human life and forbidden to engage in evaluation of whose life is more worthy to save, Jewish law does recognize limits to the community's capabilities and offers possible models for the limitation of extraordinary expenditures that threaten to impoverish society.
One such model is discussed in the Talmud in regard to how much a community is required to spend to redeem captives. The Shulhan Arukh states that "There is no greater positive commandment than the redemption of captives" (Yoreh Deah 252:1). Nevertheless, the rabbis decreed that captives should not be redeemed for excessive ransoms, "to prevent abuses" (Gittin 45a). At least one opinion in the Talmud suggests that this decree was made in response to the extreme financial burden placed on the community. . .As an aside, the article notes:
In these circumstances, we are at least permitted, if not commanded, by the sources on siege to desist from aggressively treating those whose lives we have little chance to save (specifically, the terminally ill) so that we can turn our energies and resources to saving those we can. Specifically, if we were to order our health priorities according to the Jewish demand to afford health to as many of society as possible, the order of services a community should provide would probably be something like this, in descending order of importance: (1) sufficient food, clothing, and shelter for everyone; (2) preventive care in the form of immunizations and health education; (3) treatment of acute and life-threatening, but reversible illnesses; (4) medical care for illnesses, whether acute or chronic, which are treatable and not life-threatening; and, finally, (5) treatment of irreversible, life-threatening illnesses.
It is not fair to ask physicians to make these decisions; they must focus on benefitting the individual patients for whom they are responsible. Moreover, the burden of giving up access to scarce therapies cannot legitimately be put on the shoulders of individual patients; society as a whole must determine when it will provide a given type of medical care and when not. Indeed, Jewish sources indicate that while individuals may devote all of their own resources to an attempt to save their lives, however unlikely the chances of success, a community must be more circumspect in its allocations, taking into account the welfare of all of its members ....
(W)e must face the fact that we are not God, but human beings, with limited medical abilities and limited resources.
While physicians are not required to provide their services for free ("A physician who takes nothing is worth nothing" -- Baba Kamma 85a), communal subsidies matched by reduced rates for poor patients have been the norm. [Shulhan Arukh, Yoreh Deah 249:16; see also Responsa Ramat Rahel of Rabbi Eliezer Y. Waldenberg, sections 24-25]
Finally, a word about personal responsibility from the Jewish perspective. Rabbi Hillel, who lived in Jerusalem around the time of King Herod, tells us in one of his most famous tracts (Avoth 1:14):
"If I am not for myself who will be for me? Yet, if I am for myself only, what am I? And if not now, when?"There are many ways to interpret this, but it seems to represent a balanced approach to life. We must be for ourselves, we must take care of ourselves, we must rely upon ourselves. But we must not think only of ourselves.
With that preamble, it's time for me to try to figure it all out. Judaism does clearly call for helping those in need, especially the sick, and all are commanded to provide tzedakah to fund the effort, according to their means. I could stop there, throw up my hands, and give in to the inevitable, assuming that the Democrats/Leftists are guiding (forcing) me to do my duty to my fellow man. (I might as well start loving Big Brother in the process.) But I think there is a little more to it than that.
Few know all of what is in the health care bill. I've tried to read it, but the legalese is so dense as to render the Abomination completely uninterpretable. We have been told it will somehow obtain insurance for 30 million Americans, while decreasing the deficit. I think it is incredibly likely that this is a stepping stone to a single-payer, government run system, which will be put in place on an emergency basis when the current plan falls flat on its face.
I have a number of problems with where we are headed.
First, of course, is the fact (and it is a fact) that this bill has no intention of helping anyone but the Social Democrats, who know that once government controls health care, it quite literally controls the lives of its constituents. You can stand on your head and whistle Dixie until the cows come home, and you won't change my mind on this. The Sunday Night Massacre is just the beginning. Liberal columnist Ezra Klein gloats over this certainty and Leftist victory:
But the fact of it is that this bill represents an enormous leftward shift for American social policy. It is not, in my view, a sufficient leftward shift, but it is unmatched by anything that has passed into law in recent decades. Progressives have lost some very hard battles but are on the cusp of winning an incredibly important war. For all its imperfections, health-care reform itself is deeply, deeply progressive. And if you don't believe me, just ask the conservatives who have made opposing it their top priority.
I am very uncomfortable with the targeted, confiscatory nature of the taxes that supposedly fund this little exercise. While we are all commanded to give tzedakah, the targeting of the "rich" is clearly designed to share the wealth, and not the responsibility. This is totally counter to the spirit of tzedakah as described. Of course, those who think they are immune from the costs of the abomination are in for a rude awakening. A T and T, for example, has claimed a $1 Billion charge in the first quarter of 2010 to pay for its share of the new health care costs. Do you think for a minute that won't be passed on to the consumer? You folks out there who are celebrating Mr. Obama's "gift" of "free" health care are about to get a big surprise, courtesy of the Law of Unintended Consequences.
In addition, we are commanded not to impoverish ourselves so as to give charity. Because I have been a little frugal, and saved something over the years, the slashing of my income and raising of my taxes won't impoverish me or send me onto the public dole, but I can't say that for others. But again, the goal of all this is redistribution of wealth, and I suppose many out there would be happy if we could all be equally miserable.
The concept of personal responsibility is defeated by the ultimate goal of the Patient Protection and Affordable Care Act. Maimonides told us that the greatest level of charity is that which "strengthen(s) his hand until he need no longer be dependent upon others." This bill has just the opposite in mind. Ultimately, this offers a "hand-out" and not a "hand up". The Left, Democrats or not (and not all Democrats are Leftists), has a significant degree of antipathy toward personal responsibility. In their Utopia, everyone would be able to do their own thing without regard for the consequences thereof. Don't believe me? Read the words of Comrade Pelosi herself:
Think of an economy where people could be an artist or a photographer or, eh, a writer without worrying about keeping their day job in order to have health insurance, or that people could start a business and be entrepreneurial and take risk but not [be] job-locked because a child has asthma or someone in the family is bipolar. You name it. Any condition is job-blocking.
This certainly sounds magnanimous, doesn't it? . Going a bit deeper (and I'm going to make a lot of you angry with this one), this reveals the deeper desire to decouple results from actions and intentions. The Left does this well. Having indiscriminate, unprotected sex? Let's have abortion on demand to fix the potential result (an attitude you will recognize no matter what side of that debate you are on). Your child doesn't want to work hard in school? He should get an "A" anyway for simply showing up to school, or maybe grades should be eliminated altogether so little Fauntleroy doesn't feel bad about himself. You would rather spend your money on an Escalade (or payments thereof), $200 tennis shoes, and an iPhone with $100/month service than insurance? No problem, we'll take the money from the "rich" to pay for your health care. Oh, and by the way, feel free to smoke, drink, take illicit drugs, participate in dangerous sex practices, and so forth, even though that might affect your health. This is clearly counter to the self-reliance taught by our Sages. And don't forget, we are not to give charity to those who are undeserving.
Let's remember the words of the Rambam once more, ". . .(O)ne should not contribute to a charity fund unless one knows that the person appointed over the fund is trustworthy and wise and a proper administrator . . ." Do we really trust the government to oversee this massive entitlement program? Do we really trust Comrade Pelosi and Big Brother and a sea of nameless, faceless bureaucrats to make our health care decisions for us? Keep in mind, there WILL be rationing of some sort, as this bill will have unsustainable costs. Believe it, even in spite of the lies about its being revenue neutral or even deficit-reducing. That myth is borne of some budgetary sleight-of-hand which shifts dollars away from the massive Medicare entitlement we already have. Someone has to pay, and that will be us, patients and physicians. I submit that the free market, properly regulated, would do a better job. Customers would flock to the insurance policies that give them the best coverage for the most reasonable, if proper regulation allowed them to do so. The scope of this already too-long post does not allow an adequate discussion of what needs to be done with and to the insurance companies. Suffice it to say that I find them neither friend nor enemy. They are in business to make a profit, and the laws must guide them toward doing so in the manner that benefits their customers, the patients, to the greatest extent. That does not mean hamstringing and gutting them so they will go out of business, "forcing" the government to take over completely.
And what of our duty to the poor? We must take that very, very seriously. But wait, most physicians already do. My group, for example, eats millions of dollars in "Self-Pay" coverage, and if you didn't know, "Self-Pay" generally means "No-Pay". This is a cost of doing business at the big hospitals, true, but it is the right thing to do. Why do we never hear about the generosity of the average doc in the media? Because that wouldn't further the Leftist agenda, now would it? Forcing physicians' fees through the floor as well as boosting our taxes carries the likelihood of driving many of us out of business, if not into poverty outright. We are commanded against giving until it hurts in this manner.
Finally, as I have described in an earlier post, artificially fixing the prices on health care will stifle innovation. This will certainly harm many patients in the name of "helping" others, again counter to tradition. The CBO actually agrees with me to a significant extent:
Given the central role of medical technology in the growth of health care spending, reducing or slowing that spending over the long term will probably require decreasing the pace of adopting new treatments and procedures or limiting the breadth of their application. Such changes need not involve explicit rationing but could occur as a result of market mechanisms or policy changes that affect the incentives to develop and adopt more costly treatments.
The vast majority of my Jewish brethren voted for Mr. Obama, and favor the abomination of a bill. Dennis Prager, in his article, "Jews and Big Government," helps us to understand this:
But the reason for their support goes deeper than a desire to see more Americans insured. Those of us who opposed this plan also want to see more Americans insured.
The deeper issue, as President Obama has acknowledged, is the size of government. On CBS’ “Face the Nation” last fall, Obama said, “What’s driving passions right now is that health care has become a proxy for a broader set of issues about how much government should be involved in the economy.”
Exactly right. Jews and other Americans on the left believe deeply in the state as the greatest single force for good in society. Those of us not on the left fear the state’s growth.
Why Jews believe so deeply in the state is a real puzzle. It is not as if the powerful state has been a friend of the Jews. If Jews were often persecuted and killed by religion in the Middle Ages, they — not to mention many millions of Chinese, Koreans, Cambodians and Rwandans — were persecuted and slaughtered en masse by the (secular) state in the 20th century. . .
But none of this matters to most American Jews who hold liberal/left views as strongly as believing Christians hold Christian beliefs or Orthodox Jews hold their beliefs.
Do read the whole thing.
Norman Podhoretz, in his new book, Why Are Jews Liberals? says the same thing, noting that today's Leftist Jews have replaced the Torah with liberal doctrine.
The first half of the book reviews centuries of history and acknowledges that Jews learned that oppression and danger tend to come from the political right. The second half focuses on the shift Podhoretz believes has occurred, particularly since 1967, with the Right becoming more supportive of Israel and of Jewish interests, while the Jews refuse to follow their own self-interest, financial or otherwise.Jews thought, correctly for the time period, that liberal policies, ultimately including Socialism and Communism, would knock down old barriers placed by Christian monarchies and empires, allowing them (us) to be equal citizens at last. This may have been briefly true, but perhaps no one ever envisioned a place like America where there is no monarchy, no discrimination (OK, that probably isn't true even yet, but we're getting there, and discrimination is totally illegal), and at least in theory, equal opportunity for everyone. Jews have thrived and prospered here in America more we have anywhere else and at any other time in history. But we are now hoist by our own petard for our leftist leanings. In the process of researching this article, I landed upon dozens of White Supremacy sites, whose disgusting content I won't legitimatize by providing links, which blame Jews exclusively for Socialism and Communism, and even the Sunday Night Massacre. Oy vey. . .
And it’s not just that Jews are not voting with their pocketbooks, he said, as other immigrant groups tended to do after they “made it” — Jews are also not voting for their own security, particularly with respect to Israel.
“After ’67,” Podhoretz said, “the Left became more and more hospitable to ideas hostile to Jews, particularly on the issue of Israel. It grew more and more anti-Zionist and as time went on, the anti-Zionism became less and less possible to distinguish from old fashioned anti-Semitism.
“But American Jews refused to recognize this great change,” he said.
After all this, I'm convinced of a few things, though I still have a number of misgivings on all sides of the issue. I know deep in my soul that Washington's approach to health care is morally wrong. It is a power-grab, a plot to redistribute wealth, a scheme that will ultimately fail and take the economy of the nation with it, and possibly nation itself as well. Based on Jewish teachings, we DO have the moral imperative of caring for the sick, and we do accomplish that. I certainly acknowledge that those of us in health care, as well as the average man and woman, can do far better, as far as helping more and giving more. Keep in mind, though, the recipient has a duty as well, to care for himself, to take responsibility for his actions.
Our statist-oriented, Left-leaning government, does not seek any moral, ethical solution to this (or any other) problem, they simply want more control and more power over us. And in your hearts, you know I'm right.