As the battle for the future of American health care rages in Washington, I find myself eager to understand what the Jewish tradition has to say on the subject. Does our ancient tradition offer any wisdom that might shed some light on this complicated subject? Do Jewish values point us in one direction or the other?
On the surface, the answer might appear to be no. After all, most of the foundational texts of the Jewish tradition were composed in the ancient and medieval era, while many of the issues regarding health care in the modern context — like access and affordability — were unthinkable even half a century ago. Before the 19th century, medical procedures were more likely to be life-threatening than life-saving. No wonder the Mishnah, codified in the 2nd century, remarks, “The best of physicians should go to hell” (Kiddushin 4:14).
At the same time, the Jewish tradition advances powerful teachings — central to virtually every authority’s understanding of Jewish values — about the sanctity and value of human life, and the obligation to save life whenever and wherever possible. We must do whatever we can to protect our own lives (Deuteronomy 4:9), make choices that preserve our lives and our health (30:19), and also save the lives of others, refusing to “stand idly by the blood of our fellow” (Leviticus 19:16). In fact, Jewish law understands the requirement to preserve life — pikuah nefesh — as a primary religious imperative, taking precedence over virtually every other biblical and rabbinic command. For example, if a Jew is faced with the choice of upholding the laws of the Sabbath or saving a life (whether their own or that of someone else), she or he would be obligated to violate the Sabbath and save the life.
In classical Jewish law, these obligations are understood to extend beyond the responsibility of the individual to that of the community at large. After all, I may not be in a position to save my own life or that of someone else whenever a need arises. Ultimately, we form communities so that I can rely on others to do those things I am unable to do by and for myself, and so others can rely on me for those things they are unable to do by and for themselves. That reality does not absolve me of my basic responsibilities to others. My obligation remains the same. It means that I don’t have to do it myself, but I must do my part to ensure that it is done. So, while I may not have the skills myself to heal the sick, I am nevertheless required to contribute so that the sick are cared for.
This principle is enshrined in classical Jewish law. Members of a community are required to contribute to a communal welfare fund, which is utilized to provide for the needs of the poor. While the Hebrew term for this contribution, tzedakah, is commonly understood as “charity,” it is not meant, in Jewish law, to refer to a voluntary gift stemming from the goodness of one’s heart. Rather, it is an obligatory payment; a tax, for all sakes and purposes. The authorities can enforce this tax through corporal punishment and even the seizure of property (Shulhan Arukh, Yoreh De’ah 248:1-2).
This fund, consisting of the forced contributions of everyone in the community (including the poor themselves, so long as they have already provided for their own needs), is designed to be used for many things, like sustaining religious institutions, educating youth, and feeding the hungry. Helping those in need is thus not merely a matter for private charity, laudable though such deeds may be. Rather, it is a shared responsibility, incumbent upon a community charged by its most sacred text with caring for all its members and striving toward an eradication of poverty (Deuteronomy 15:4).
Priority for how the fund is to be used is given to urgency of need. So, for example, feeding the hungry takes precedence over clothing the naked, presumably because hunger is more life-threatening than exposure (Shulhan Arukh Yoreh De’ah 251:7-9). And those who are more vulnerable take precedence over those who are less vulnerable. The highest priority for the use of communal funds is redeeming captives, that is, saving the lives of community members who are presumed to be in imminent mortal danger (Shulhan Arukh Yoreh De’ah 252:3). Redeeming captives takes precedence over every other need, and tradition admonishes those communities who refrain from fulfilling this responsibility in the strongest of terms, arguing that not redeeming captives violates many biblical precepts (252:2). A community must reallocate resources towards redeeming captives, even if those resources had already been dedicated toward other worthy endeavors (252:1).
Jewish law holds that healthcare is a communal obligation. A community is responsible for the welfare of all its members, including and especially those whose lives are threatened. Members of a community must pool resources to provide for the needs of everyone within the community, especially the neediest and most vulnerable. And the first priority for the use of those resources is towards saving the lives of community members in mortal danger.
In our time, our country is our community. Our government’s budget, our communal fund. Our tax dollars, the tzedakah we are obligated to contribute to that fund. Captives, those whose lives are imperiled and who could be saved through our intervention, like the sick and the injured. In other words, Jewish tradition teaches that the government in fact has an essential role to play in ensuring all its citizens receive adequate health care.
From the Jewish perspective, then, the fact that millions of Americans cannot afford adequate health care is unconscionable. Our current healthcare system should indeed be amended, but in such a way that ensures that every single American can afford adequate health care, even if such care is at the expense of the taxpayer, as is the case with systems like Medicare and Medicaid. Any proposal that would put affordable care out of the reach of any person ought to be seen as immoral, a dereliction of our responsibilities toward each other. Similarly, a proposal that would force tens of millions of Americans to lose health insurance is, from the Jewish point of view, morally outrageous. No person in our society should be permitted to be without the protection of the community, even if such protection comes at the expense of the taxpayer.
The Jewish tradition obligates us to save lives. That obligation falls on individuals as well as communities. From the Jewish perspective, this is not an act of mercy. It’s a divine imperative.