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.

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Moishe Potemkin
2 years 11 months ago

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… Read more »

Reb Yid
2 years 11 months ago

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.

David F.
2 years 11 months ago

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.

Micah Segelman
3 years 6 hours ago

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… Read more »

3 years 6 hours ago

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.

3 years 8 hours ago

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,… Read more »

Charles Hall
3 years 9 hours ago

“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… Read more »

Micah Segelman
3 years 1 day ago

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.

Moishe Potemkin
3 years 1 day ago

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… Read more »

dr. bill
3 years 1 day ago

excellent article

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.

3 years 1 day ago

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… Read more »

ben dov
3 years 2 days ago

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… Read more »

Micah Segelman
3 years 2 days ago

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… Read more »

3 years 2 days ago

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… Read more »

3 years 2 days ago

“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… Read more »

3 years 2 days ago

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. … Read more »

Toby Katz
3 years 2 days ago

“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.

Eliezer C. Abrahamson
3 years 3 days ago

“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.”

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… Read more »

3 years 3 days ago

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… Read more »

3 years 3 days ago

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.… Read more »

Charlie Hall
3 years 3 days ago

Well said.

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… Read more »

3 years 3 days ago

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… Read more »

Bob Miller
3 years 3 days ago

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… Read more »

Reb Yid
3 years 3 days ago

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… Read more »

L. Oberstein
3 years 3 days ago

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… Read more »

joel rich
3 years 3 days ago

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… Read more »

3 years 3 days ago

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… Read more »