The Sanctity of Human Life

Chapter 2. A JEWISH ARGUMENT FOR SOCIALIZED MEDICINE

C H A P T E R 2 A JEWISH ARGUMENT FOR SOCIALIZED MEDICINE UNIVERSAL HEALTH CARE: CANADA AND THE UNITED STATES My concern with the question of socialized medicine, or universal health care, and a Jewish approach to it has been greatly heightened by my experience in Canada during the past ten years. I now hold citizenship in Canada as well as the U.S. citizenship conferred upon me by my birth in the United States. I proudly retain my U.S. citizenship because of what the United States has done for me and my family, going back several generations. I have not ceased to be an American, but as a Canadian I have a new basis for comparison of morally significant phenomena in my two countries. As most readers know, Canada provides health care for all of its citizens and residents. Equally well known is that the United States does not provide universal health care. Approximately 40 million Americans are without any regular health care; these people must depend on the arbitrary charity of public and private institutions. That sad fact came home to me almost twenty years ago, when I had to take my wife to a hospital emergency room in New York City. There I saw the large number of poor people who had to use that emergency room as their primary health care facility—after the staff there could take time away from the paying patients. Many 91 of their more serious health problems had to wait for treatment until my wife’s less serious problem was treated—because she had health insurance and they did not. Either they never had any health insurance, or they had had it and lost it because it came with a job they had lost. Despite all the problems Canadian health care services entail— such as having to wait almost a year for elective surgery, as I once did—I firmly believe that health care delivery in Canada is fundamentally just, and health care delivery in the United States is fundamentally unjust. As an American and a Canadian, the question I must address is why this belief is rationally justified. More important , however, as a Jew I must base this belief on the authoritative sources of the living Jewish tradition. MORAL AND THEOLOGICAL PROBLEMS WITH THE PRACTICE OF MEDICINE I begin by looking at a shocking rabbinic text that has embarrassed many Jews, especially because of the long Jewish involvement in medicine. The Mishnah states that Rabbi Judah said in the name of Abba Gurya, a man of Sidon,“The best of the physicians belongs in hell [tov she-ba-rof’im le-gehinnom].”1 In his Talmud commentary, Rashi, the great eleventh-century French commentator, gives four reasons for this seemingly harsh judgment.2 First, physicians are not apprehensive about disease and let sick people eat food that is only fit for healthy people. Second, physicians do not pray (literally , “break their hearts”) to God. Third, physicians sometimes kill humans. Fourth, physicians have the power to heal poor persons yet often refuse to do so. Each of these reasons for a harsh indictment of ancient medicine could be applied to modern medicine as well. PREVENTIVE MEDICINE With regard to the first reason, Rashi is dealing with what one might consider preventive medicine. In ancient times, this practice was a much greater factor in medicine than it has been in modern 92 A Jewish Argument for Socialized Medicine times. Although Rashi was a medieval thinker, he was much closer to the ancient world than to the modern world, so he could identify with the situation of medicine in the ancient world that was assumed in the Mishnah more easily than we can identify with it.3 In the ancient world, physicians probably focused as much (and perhaps more) on prescribing healthy living to their patients as on treating the bad effects of their patients’ often unhealthy lives.4 Today, except for the annual physical examination that most of us who are more than fifty years old get from our private physicians— or that insurance companies occasionally require us to undergo— most of us deal with physicians on a crisis basis. Rashi reminds us that physicians ought to be our teachers even before they are our rescuers. If preventive medicine was wanting in his day, how much more so is it in our day—when U...