Government-Mandated Healthcare: Halakha and Social Policy

By Chaim Apfel, J.D.

This article was printed in Volume 3 of Verapo Yerape. Republished with permission.

I. Introduction

The role that governments have played in caring for the level of public health has changed dramatically over the course of the twentieth century worldwide. In the United States this role has recently undergone a dramatic change with the passage of the Patient Protection and Affordable Care Act as well as the Healthcare and Education Affordability Act. With all of these changes, many of the policies that were debated touched upon legal issues that have existed for thousands of years across many civilizations. It would be useful to compare how these issues were treated according to Jewish laws and values. The purpose of this paper is to explain what ethical rules should govern a government healthcare plan and to explain how such a plan should be implemented.

II. Two Distinct Biblical Commandments for Charity

Arguably, the most fundamental ethical issue that the statute addresses is to what extent individuals can be compelled to provide for their poor. The Biblical law mandating charity can be found in two locations. The first section addresses society’s reaction to abject poverty. Continue Reading –> 

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2 Comments

Filed under Halacha / Jewish Law, Health & Medicine

2 responses to “Government-Mandated Healthcare: Halakha and Social Policy

  1. CA

    A few comments:

    1. Of all the leaps of logic found in this article, this is probably the greatest in my opinion:

    “Applying this ruling leads to the conclusion that once a person is part of a community, there is a broad scope of public services that a community can compel its citizens to pay for. However, it would seem that the communal funds must be gathered for the purpose of meeting a public need.

    It would be easy to imagine that public medical insurance could meet this definition. Medical care is a service that everybody needs at one point or another and if a town decides to create a communal insurance system to address the issue, the town would presumably have the right to set
    up such a system.”

    I can include almost every aspect of everyday life under the logic of the last sentence and then (following the logic of the quoted passage) include it under “a need of the community” that needs to be provided for by the government through compelled taxation.

    For instance, cell phone service. Everybody in modern society, at one point or another, needs to make a call.

    Food. Shoes. Clothes. Computers. Cars. Chairs. Housing. Etc.

    This logic leads straight to socialism — all the property of the populace is transferred to a secular (or religious) “beis din” and then redistributed back according to the political or social calculations of the beis din.

    Meanwhile, socialization of medicine leads to real decrease in the quality of services provided. Israel is a good example of how a potentially good medical system can be ruined by socialization.

    2. The author of the article does not define a “thieving government”. My perusal of various Halachic sources suggests that the US government may very likely fall under this category.

    3. Is there a source extending the rights of a Jewish king to eminent domain to a secular king (a king who is not a Jew or a Noahide gentile)? The article does not provide one.

    4. I found this footnote curious: “19 Ad loc sv mahu; also see Rashi sv vayatzilah holding that it is forbidden to save oneself with the money of one’s friend” (p. 102 in the text).

    The system of society that the Americans have established in the Thirteen Colonies during and after the American Revolution is not that of monarchy. This is not a trivial point. According to the philosophy of the Founding Fathers (explicit in the Declaration of the Independence, Federalist Papers, the Constitution, etc.), American government does not own the people. The people are not its subjects, and the government is not a sovereign.

    The people are the government’s clients. The people are considered to possess certain natural rights to their property and livelihood, and they hire the government to protect those rights. They delegate their rights to the government. Thus, for instance, if I have a right to defend myself, I can delegate that right to the government.

    That is the relationship between the people and the government. Now, if you follow Rashi’s stated opinion, if I may not compel you to save my life with your property (or use your property by force to save my life), I should not be able to use a company that I hired as my representative to do the same.

  2. CA

    This is all ignoring the question of even if it permissible for the current governments to tax people for whatever transfer-of-property scheme, whether it is a good idea for us to allow it.

    I.e., just because something is halachically permissible, does not mean it is a good idea pragmatically. (One could even say that it does not necessarily mean it is moral.)

    One point is the one I already raised in the following post: allowing the government to manage any kind of industry (from shoe making to television to roads to medical care) basically ruins that industry. The best way that the decisions about direction of capital in an industry can happen is through free market — competition and cooperation between service-providers and the customers. The government (or any other single monopoloy) does not have necessary foresight to manage the resources most effectively. This argument is known as “economic calculation problem” and was presented by Jewish-Austrian libertarian economist Ludwig von Mises: http://en.wikipedia.org/wiki/Economic_calculation_problem

    The other problem with government-provided medical care is that it violates people’s “natural rights” through taxation (the taxation is potentially justified only when the one taxed receives some products or services in return). Now, a frum Jew may not be worried about “natural rights” as presented by the Western philosophers of 18th-19th centuries, but, unfortunately, the practice has shown that once you allow the government to violate natural rights for the supposed “common good”, you open the door for it to violate many different kinds of rights and interfere in personal lives — including Jews’ religious personal lives (not to mention their livelihoods).

    All the regimes that constricted Jews’ freedom of religion have done so under the premises of “common good”. Indeed, if you follow their logic, they were doing Jews a favor by forcibly converting them to Christianity, not allowing their children to learn Torah, forcing them to send kids to secular governmental schools, etc. In our times, there have been a proposal to ban bris in San Francisco. It was rejected — but in many European countries, shechita and bris are banned. Homeschooling is banned. (So, if there are no private Jewish schools available in one’s area, one has to send kids to a public school or have them taken away by the state. Chabad shluchim in Sweden are currently facing this problem.) The list, from the past, the present and the potential future goes on.

    Even in Israel, frum Jews are forced to listen to kol isha in the army, because a posek in the army has declared that it’s muttar. Well, these Jews’ poskim disagree, but the opinion of this, more meikel, posek is imposed upon them by the state. We see that Jewish governments and frum elements within them can be just as tyrannical.

    Therefore, it seems to me that even if the government may have a number of powers granted to it by Halacha (which I personally do not necessarily agree with), it may still be a bad idea for us to support a government that exercises these rights. Until Moshiach comes, the government that governs least governs best.

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