Judaism and Health Care Reform

April 1993

The Commission on Social Action and Public Policy of the United Synagogue of Conservative Judaism is pleased to present this publication on Judaism and Health Care Reform. Today more than 35 million Americans have no health insurance, millions more have inadequate coverage, and health care costs continue to rise rapidly. Reform of America's health care system has become an urgent national issue.

The Jewish community, with its long and proud heritage of involvement in the medical professions and a tradition profoundly concerned with the preservation of human life, can make an important contribution to the current debate over health care reform. On May 1, the President will bring the results of the White House Task Force on Health Care Reform to Congress in the form of legislation. By uniting with other religious groups and concerned citizens, Jews can ensure that the process of deliberation over and evaluation of this legislation is seen not as a purely practical matter, but as a moral imperative as well.

Jewish values demand that we work to create a society where no one is denied proper medical care. We are all created b'tzelem Elohim -- in the image of God -- health is not a luxury, and it should not be the sole possession of a privileged few. Elderly people should not be required to impoverish themselves in order to receive medical coverage. As one of the oldest demographic groups in America -- with nearly one third more elderly members than the general population -- Jews must work to change the status quo where nursing home care is unaffordable for over 80% of elderly Americans. The health care crisis touches nearly every one of us. It is time for us to act.

The material included in this packet is intended to help you and your congregation become advocates for a just and adequate health care reform plan. We have included educational materials, suggestions for action, information about health care reform organizations and other resources for program planning. We hope that you will use these to inform and mobilize your congregation around the issue of health care reform.

If you would like further information, contact the Commission on Social Action and Public Policy of The United Synagogue.

Commission on Social Action and Public Policy
The United Synagogue of Conservative Judaism
Rapaport House
155 Fifth Avenue
New York, NY 10010
212-533-7800, ext. 2207

Conservative Movement Resolutions on Health Care

Universal Health Care (United Synagogue, 1991)

WHEREAS Judaism mandates the maintenance of the health of the body; and

WHEREAS the high cost and restricted access to adequate health care in the United States have virtually eliminated a significant and growing percentage of Americans from the crucial benefits of adequate health care; and

WHEREAS serious gaps in coverage are appearing even for those Americans who are insured;

NOW, THEREFORE, BE IT RESOLVED that the UNITED SYNAGOGUE OF CONSERVATIVE JUDAISM urges Congress and the Administration to develop a comprehensive national health care plan that ensures adequate coverage for all Americans; and

BE IT FURTHER RESOLVED that the UNITED SYNAGOGUE OF CONSERVATIVE JUDAISM supports efforts to ensure that such a health plan contains a long term care program for the elderly and adequate insurance coverage for catastrophic care.

National Health Care (Leadership Council of Conservative Judaism, 1992)

The Jewish tradition considers the sanctity of all human life as an overriding principle in developing theological and legal guidelines. Consequently, talmudical academies included in their curriculum medical studies, and scholars, according to the Talmud, were forbidden to live in a community that did not boast a physician and a surgeon.

In addition, so important was life and health that delivery of health care superseded all sabbath restrictions and the concept of pikuah nefesh (i.e., danger to one's life) and the prevention of disease were religious values clearly articulated in Jewish sources demanding society's intervention. Therefore, physicians were called upon to minister to all the sick regardless of religion or ethnicity, and men, women and children were given access to daily prayer and medical treatment. As the Talmud observed, a healthy body must come before a healthy soul.

As citizens of the United States, we look upon the crisis in our health care system through the eyes of our tradition and share the profound concerns of other religious groups embodied by the National Interreligious Health Care Consultation in developing and encouraging the establishment of a new health care delivery system which will benefit all people. We concur with the "Proposed Summary of Working Principles" adopted by the National Interreligious Health Care Consultation at William Bay, Wisconsin in April, 1991.

We strongly urge the Congress of the United States and other responsible agencies to develop a national health care system which will cover all our citizens. Human beings created in the image of God deserve medical care that reflects our belief in the sanctity of life.

Health Care in Jewish Law: Concepts and Sources

While Judaism's concern for the preservation of health is quite clear, it is also clear that our sources did not consider the provision of health care in terms of the enormous scale and level of complexity of America's present health care system. Therefore, a straightforward application of the source material to the American scene would be out of place. Nevertheless, Jewish views on the importance of health and on the distribution of scarce resources add a valuable dimension to current debates on health care reform. Below is a brief glossary of legal and theological concepts, with references to the sources in which they can be found.

Hatzalat Nefashot -- The Saving of Human Life: It is a positive commandment to save the life of a person in danger from illness. This duty falls under the general obligation of saving life, which is grounded in a number of biblical verses, including "Thou shalt not stand idly by the blood of your fellow," (Lev. 19:16) "And your fellow shall live by your side," (Lev. 25:36), and "You shall restore it [in this case, life] to him" (Deut. 22:2). So great is the mitzvah of saving life, that nearly all other religious obligations are subordinated to it: we violate the Sabbath to save a person's life (Pikuah nefesh doha et ha-shabbat, Yoma 85b), and there is a general principle in Jewish law that danger to life and health is of greater religious concern than ritual matters (Hamirah sakanta mi'issura, Hullin 10a). [See Encyclopedia Talmudit, Vol. 10, s.v. Hatzalat Nefashot, pp. 242-251; Shulhan Arukh, Yoreh Deah sec. 336 and Maimonides, commentary to Mishnah Nedarim 4:4]

Shemirat Ha-briut -- Preventative Care: In addition to requiring a response to illnesses when they occur, Jewish law also requires that we make all attempts to stay well. In Deuteronomy, God tells the Jewish people, "take utmost care and watch yourselves scrupulously." The Talmud derives from these verses th at a person must scrupulously guard his physical health (Berakhot 32b), and this ruling was codified by Maimonides (Hilkhot Rotzeah 11:4) and the Shulhan Arukh (Hoshen Mishpat 427:8). Maimonides understands this obligation to include both positive aspects, such as regular exercise and the seeking out of proper medical care, as well as negative ones, such as refraining from damaging of one's body through the consumption of harmful foods or drugs. [Hilkhot Deot, 4:1ff; see also Rabbi David Golinkin's ruling that smoking is prohibited by Jewish law in Moment Magazine, Oct. 1991, pp. 14-15]

Tzedaka -- Communal Obligations to Meeting Basic Human Needs: Just as the Jewish community recognizes an obligation to provide for such basic needs as food, clothing, and shelter through the collection and distribution of communal funds, so, too, have Jews insisted that no person be denied access to health care on account of inability to pay.

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]

Bikkur Holim -- Visiting the Sick: Judaism recognizes that illness affects the whole person, presenting threats not only to the body, but also to one's mental state and financial stability. Bikkur holim -- the mitzvah of visiting the sick -- ensures that the needs of the sick are attended to in all of these areas, creating a communal support system to complement the work of medical doctors. [Shulhan Arukh, Yoreh Deah 235-238; Maimonides, Hilkhot Eivel 14:4-5; Berakhot 5b, Nedarim 39b-40a, and Sotah 14a]

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. [See "Judaism, Justice, and Access to Health Care", listed in the next section.]

A Guide to Jewish Views on Health Care Reform

The materials listed below give a fuller explication of Jewish views on issues related to health care reform. The first two items may be ordered directly from the United Synagogue Department of Youth Activities, 155 Fifth Avenue, New York, NY 10010; tel. (212) 533-7800.

"Triage -- Choosing Who Lives and Who Dies" in When Life Is in the Balance: Life and Death Decisions in Light of the Jewish Tradition, by Barry D. Cytron and Earl Schwartz, pp. 43-74.
"Visiting the Sick: Bikkur Holim" in Community and Responsibility in the Jewish Tradition: A Study and Action Program, by Barbara Fortgang Summers, pp. 27-41.
"Judaism, Justice, and Access to Health Care" by Aaron Mackler, Kennedy Institute of Ethics Journal, June 1991, pp. 143-161.
"Judaism and the Health Care Crisis" by Barry Freundel and J. David Bleich, "Health Care Costs, Malpractice and Tikkun" in Sh'ma, 22/434 (May 15, 1992).
"The Allocation of Scarce Medical Resources", in Modern Medicine and Jewish Ethics (2nd ed.) by Fred Rosner (Hoboken, NJ: Ktav, 1991), pp.375-390.
"Medical Care: Communal and Individual Obligations", in With All Your Possessions: Jewish Ethics and Economic Life, by Meir Tamari (New York: Free Press, 1897), pp.301-306.

The Interreligious Health Care Access Campaign

In January of 1991, the Interreligious Health Care Access Campaign was launched to give America's churches and synagogues a voice in the emerging debate on national health care reform. The Campaign works to bring basic principles for health care reform to the attention of legislators and policy makers. These principles were agreed upon by dozens of religious groups over the course of two years of interreligious consultation; they require that any proposal for reform must:

Provide quality, comprehensive care -- from preventative care to long-term care -- to everyone living in the United States
Generate funding for health care in the most efficient and least costly manner, using a progressive financing system to distribute costs fairly
Obtain significant savings by eliminating administrative waste
Assure consumers the freedom to choose their own health care professionals

In January, a delegation of national religious leaders met with officials of the Clinton administration to present the Campaign's principles as well as thousands of letters from people of faith across the country. The Campaign works to coordinate the health care advocacy efforts of religious groups, to build grassroots coalitions, and to keep congregations informed of emerging health care legislation.

More information about the Campaign, including a full explanation of the principles for health care reform and suggestions for how your congregation can connect with local and national advocacy efforts, can be obtained from The Interreligious Health Care Access Campaign, 110 Maryland Avenue, NW Washington, DC 20002; tel. (202) 543-5878.

Additional Resource Agencies

The American Medical Association -- The nation's leading professional organization for physicians. Contact: Brenda Laukaitis, Director of Governmental Affairs; tel. (202) 789-7447.
The Children's Defense Fund -- The foremost advocacy group for children's welfare issues. Contact: Health Division, 25 E St., NW Washington, DC 20001; tel. (202) 628-8787.
Families USA -- A non-profit consumer group focusing on health care reform issues, especially the increasing cost of long-term care. Contact: Judy Waxman, Director of Governmental Affairs, 1334 G St., NW Washington, DC 20005; tel. (202) 623-3030.
National Jewish Community Relations Advisory Council -- The source for information on public policy views of the organized American Jewish community. Contact: Diana Aviv, Director for Domestic Affairs, 443 Park Avenue South, New York, New York 10016-7332; tel. (212) 684-6950.

Congregational Involvement in Health Care Reform

The crisis in health care affects both the interests and the values of American Jews. With the Presidents support for reform of the country's health care system, the question has become not whether there will be change, but what the nature of that changew ill be. Conservative Jews can add a distinctive voice to the current debate, and, if response among Conservative congregations to this issue is high, that voice will be influential.

Below is a series of suggestions for congregational involvement in health care reform issues. These suggestions are intended to help your synagogue implement the Universal Health Care resolution passed by the United Synagogue of Conservative Judaism in 1991. As with any issue of this complexity, the first step will be education. But Jewish tradition requires that we turn our learning into action. As Rabban Shimon ben Gamaliel says, "Not study, but action is the main thing" (Pirkei Avot 1:17).

Become Informed

Use the synagogue as a place to understand both the facts and the values behind different proposals for health care reform. In part, the question of how to reform the health care system is a question about how we think about ourselves as a society: Should access to basic health care be a right? Are we willing to make sacrifices in quality of care for greater access: The synagogue community and the Jewish tradition can be important tools in helping congregants to identify and examine these crucial issues. Make education about health care reform a part of your synagogue's agenda. Here's how:

Hold a congregational forum on health care reform and invite doctors, rabbis, health insurance professionals and other experts to address the issue. Perhaps this can be a topic for an oneg shabbat.
Encourage the rabbi to devote sermon time to discussing health care reform.
Add a class on Jewish perspectives on health care to your adult education program.
Include articles on health care reform in your synagogue bulletin.
Form a health care committee to coordinate these activites for the congregation.

Become Advocates

Once informed, use your congregational strengths to let legislators and policy makers know that you support health care reform and that you have recommendations about what a plan for reform must include. Public opinion has brought health care to the top of the legislative agenda, and only public opinion will keep the legislative process on track. To keep health care reform high on the national agenda, your congregation can:

Organize a letter and telephone campaign to your state and federal representatives, urging them to support comprehensive reform leading to universal access to basic health care.
Send a delegation from your congregation to the local offices of your Senators and Congress members to discuss health care reform. Bring a written statement of the congregation's concerns or letters written by congregants.
Join the Interreligious Health Care Advocacy Campaign and connect with other congregations to increase the power of your message.