Torah Values, Right – Wing Politics, and Health Reform

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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 8 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 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.

Reb Yid
2 years 8 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 9 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
2 years 9 months 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 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

YM
2 years 9 months 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.