- This topic has 36 replies, 9 voices, and was last updated 15 years ago by .
-
Posts
-
In light of the health care debate underway in the Senate, I wanted to pose the question as to whether coffe room members feel that the charedi world should be more involved in the debate.
After all the potential bill includes many end of life situations which can lead to situations of Pikuach Nefesh.
It may be a chiyuv on the community to provide health care for all — Rabbi Dr. Moshe Tendler (yes, he is a modern orthodox Zionist but he is also a leading posek for medical matters) gave a pretty convincing proof to this a few years ago and I’ve seen no counterargument. (Is there *any* rabbi who says that we are permitted to stand by and let someone die because they can’t pay for medical treatment? It happens, more often then people believe.) Most developed countries in the world, including Israel, do this.
End of life care isn’t going to be affected much (either expanded or restricted) by the various proposals in Congress, except that if we do manage to get universal coverage after that it will become more possible to provide halachically acceptable end of life care without bankrupting a family with no or inadequate insurance. This alone would seem to make health insurance reform a good thing. Whether it is done through public or private plans would not seem to matter. (I can’t understand why people are so upset about a “public option” or lack of one.) I will add that my wife is a physician who treats Medicaid patients and she tells me that in the four plus years she has done this in New York they have never denied coverage for treatment she has recommended.
Let’s agree that it’s a chiyuv on the community to provide health care for all. (If it isn’t, it should be.) But is is a chiyuv on the community to provide health care for non-Jews? Any option that requires citizens to have insurance, be it public or private, is requiring them to fund health care for non-Jews.
That means providing maternity coverage for every 16-year-old who chooses to get pregnant. Or alternatively, providing abortions for those same people. (There are some proposals that would not cover abortions.)
It means providing health care for those who have, through various lifestyle choices, endangered their health unnecessarily.
Do we, as a community, have a chiyuv to provide for everybody else?
This reminds me of a similar situation in 1974 (I think). The government of Israel offered to fund the Yeshivas (education is something else the community has a chiyuv to provide). Rav Schach was instrumental in convincing the Yeshivas not to accept the government’s proposal. He felt, based on an opinion of the Chofetz Chaim, that when the government takes over the responsibility for funding, people get out of the habit of supporting those institutions that need our support.
Instead of asking the government to fund health care, wouldn’t it be nicer if we could take the tax money we would save and give it to Jewish social service agencies that help provide health care for poor people?
Dear Charliehall,
In light of your comment, and being that I believe you are an intelligent individual, I would like to address a question to you:
My income is slightly above the income limits for government insurance (JerseyCare, etc). I purchase insurance, and therefore go without things that I consider luxuries, such as vacations, nice cars, high-end electronics, etc. I personally have no interest in “help” from the government for this, particularly the specter of the public option. I know families from both the UK and Canada who have come to the USA for more timely medical testing and treatment, and pitied them for the apparent deficits in their respective countries that necessitated them making such a trip when in ill health. Regardless, I am thankful I can purchase insurance, and don’t think the government should be sponsoring my health care so that I can have enough left over to buy a nice car, high-end electronics, or eat out.
Anyone making a bit less than me is eligible for government health care assistance, such as JerseyCare (I know the numbers for eligibility). So why would I advocate for the government to sponsor health care for people who are not poor enough to be eligible for JerseyCare (or similar in other States)? Why would I want my taxes to sponsor health care so that people in my position can take trips abroad, spiff up their homes, buy a nicer car, eat out at restaurants, or purchase more expensive clothing? Insurance is a necessity, the above items are not. Why should taxes go to help people pay for non-essentials?
If someone opts to purchase a flat-screen TV, nice car, go to fast-food joints frequently instead of cheaper homemade food, take nice little vacations, etc, that is their choice. My taxes should pay for their choice? As I said, the truly poor are already eligible for the health care programs.
Can you shed some light onto why I should want taxes to sponsor individuals’ choices?
charliehall:
I agree, with a number of caveats. There is a limit as to how much one must spend to “do a mitzva”. I’m not sure (much to my own chagrin) that there is a mitzva to spend money to help an Aino Yehudi, and it may very well be assur to do so with no payment/as a gift (If Rabbi Tendler spoke about this as well, please tell me). In addition, the idea of the country going bankrupt & under the influence of China (who does not allow religion to be taught to those under the age of 18!) is a factor that must come into play.
More so, there is no chiuv to have “punitive damages” when a doctor makes an honest mistake. If the President would add real tort reform to the proposed law (or push for it from the Oval Office), I would think this is more about health & less about ideology.
Last (and greatest), anyone can walk into a hospital’s ER and get treated, and can not be forced to leave until stablized (which in extreme cases, can take over a year). So this does not seem to be a direct point of Pikuach Nefesh in either case. It may only prove what Chazal say regarding “Bechol Meodecha”; There are those who favor their money over their life.
Senator Nelson who’s vote is needed to ensure no filibuster and passage of any compromised bill has added an amendment preventing ANY public (government) plans from paying for abortions. This is a religious stance and something the frum community should applaud him for doing. He has committed to walk away from the entire OBAMAnible Health Care Bill if his amendment doesn’t pass.
After speaking with Senator Durbin it appears that the amendment will not pass and the entire negotiations on health care may be tabled. His opinion is, unless a compromise is agreed to by end of business on Friday the entire discussion will be moot.
My head is spinning from all the discussions of the day but for Obama Care opponents like me today is a good day. Obama Care is wrong for the country and ethically challenged.
Does universal health care automatically = rationing? Are we headed there anyway?
Witness the controversy over the new screening recommendations for women.
What also concerns me is how little awareness there is of everything that’s in there. One democrat said that he didn’t have two days and help to read this, he was going to vote anyway. President Clinton spoke to a group of politicians urging them to vote for the bill even though it was rough as that’s what amendments are for (not sure if the amendment line was from him or someone else).
Here is my summary of Rabbi Dr. Tendler’s comments, from a shiur given September 10, 2006. The original is online at YU’s Torah site. (YWN does not permit outside links, even to other Torah sites.) Translations from 1917 JPS (in public domain). All errors are mine.
Exodus 21:18-19.
?? ?????-???????? ?????????–????? ???-????? ???-???????, ???????? ??? ?????????; ????? ??????, ??????? ???????????
And if men contend, and one smite the other with a stone, or with his fist, and he die not, but keep his bed;
?? ???-?????? ????????????? ???????, ???-???????????& #1493;?–???????? ?????????: ??? ????????? ??????, ???????? ????????
if he rise again, and walk abroad upon his staff, then shall he that smote him be quit; only he shall pay for the loss of his time, and shall cause him to be thoroughly healed.
— This means that we are supposed to get real healing from real doctors, and not just accept illness as God’s will.
Deuteronomy 22:2
? ?????-??? ?????? ??????? ???????, ????? ??????????–???? ????????, ???-?????? ????????, ??????? ??????? ??? ??????? ??????? ?????, ???????????? ???
And if thy brother be not nigh unto thee, and thou know him not, then thou shalt bring it home to thy house, and it shall be with thee until thy brother require it, and thou shalt restore it to him.
This means that if someone can heal someone else, one must try to do so.
Leviticus 19:16.
?? ???-?????? ?????? ???????????, ??? ??????? ???-???? ??????: ?????, ??????
Thou shalt not go up and down as a talebearer among thy people; neither shalt thou stand idly by the blood of thy neighbour: I am the LORD.
This means that even if you can’t heal the sick person, you must find someone else who can rather than standing idly by — even paying for the healing. In other words, we have to provide healthcare for all!
haifagirl,
Rabbi Dr. Tendler didn’t distinguish between Jews and non-Jews, but it would be reasonable that the chiyuv would be on Jews to provide healthcare to all other Jews. So far our community leaders have not done anything about this, in fact, they are busy trying to get the mostly non-Jewish population to provide funding for Jewish schools in America. I can’t see how we can afford to provide health insurance when we can’t pay for our schools.
Bemused,
There is no need for the government to sponsor health insurance for anyone other than those who can’t get it themselves, such as the poor who can’t afford it, those with pre-existing conditions for whom no sane insurer would ever issue a policy, or the elderly whom no sane insurer would ever insure. France and Israel cover everyone with no government programs (although the government does subsidize the cost and regulate the coverage).
Gavra,
You are correct about the desirability of tort reform; there is certainly a Torah right to actual damages but I’ve seen nothing about punative damages. My wife is a practicing physician and she would love to see tort reform! But it is desireable independent of universal coverage, and won’t solve any of the many other problems in our health care system. Texas enacted the most dramatic tort reforms ever but today it has the most dysfunctional health care system in America, with fewer people covered by insurance than any other state. Also, the federal government may have no constitutional authority to regulate damage suits in state courts. You are also incorrect about the lack of pikuach nefesh. While it is true that everyone is entitled to emergency care, people regularly die from chronic conditions because they can’t get non-emergency treatment or medications. It is a shonda that this happens in one of the wealthiest societies in history. And another problem is that someone has to pay for that emergency care, and generally it is those of us with insurance.
Ben Levi,
Health care for the elderly in the US is almost entirely paid for by a government health insurer and has been for 44 years. This will not change under any plan under consideration. Thus your concern about end of life care is not necessary. And yes, it would be cheaper to replace private health insurance with a government plan, even for congressmen — Medicare is the most efficient health insurer in America and Medicaid is second — but that isn’t going to happen.
tzippi,
Health care is and has been “rationed” ever since the first health insurance plans were created about 70 years ago. The question is, how should it be rationed. Right now, if you don’t have insurance, you have been rationed to almost no care except immediate life threatening emergencies. Private health plans and Medicare deny coverage all the time. (My wife, a family physician, tells me that NY Medicaid has never denied coverage for any treatment she has recommended, so maybe that should be the model for coverage? But NY Medicaid is very costly.) The issue of mammography is about using the best scientific evidence for medical decision making, and unfortunately there has never been any evidence to support mammography screening in the general population for women under the age of 50. The US Preventive Services Task Force should never have recommended it when they did, and they were absolutely correct in changing it to something more sensible. (The best studies don’t even show that mammography screening saves life in women *over* 50; I can post the evidence if there is interest.) The situation for prostate cancer in men is about as disappointing. The situation is very depressing but we can’t allow politics to interfere here as some pro-screening advocates want to do.
The issue of abortion in health care reform is a red herring. Most private health care policies cover elective abortions and don’t charge less if abortion coverage is excluded. Abortions are inexpensive (particularly the early trimester medical abortions done with methotrexate or mifepristone which might well not even have halachic problems), and certainly are less expensive to an insurer than prenatal care, labor and delivery. All the proposals currently under consideration prohibit federal government funds from paying for abortions. (It should be noted that New York Medicaid pays for abortions for any reason to anyone it covers.)
charliehall?
I saw you posted on the main page tonight; are you able to provide any answers on this topic?
One more thing on abortion: the country with the lowest abortion rates in the world among countries with reliable statistics is The Netherlands — about half the rate in the US. Yet abortions are free to citizens through their national health insurance program. The culture there abhors abortion while promoting contraception and responsibilty. Interestingly, its teen birth rate is about one tenth that of the US. If you want to stop abortions, forget about laws and insurance — change the culture!
BS”D
charliehall:
Good point on the chronic illness, that is why in many states there is specific HIV drug coverage (which is well paid for).
As for lawsuits, the Feds can withhold funding for these programs to states that don’t pass reform, just like they did with highway money & the speed limit.
Third, the USA is made up of multiple cultures, and (I know you may not like this if you are a “liberal”, but its how I feel and think is true) certain cultures view certain “bad” things, such as dependency, fraud, and single parenthood / WIC babies as acceptable. The country as a whole is moving closer to the average citizen (let alone inhabitant) becoming more willing to accepting these as the norm. And if you attempt to change the culture, the “race” or “ethnicity” card is played.
The “public option” is feared (see the Joe Lieberman interview in the WSJ) to be the first step to single payer/canadian type system, in which doctors must follow the guidelines and are not allowed to work outside the system. In addition, the “proposed minimum coverage” will (correct me if I am wrong) disallow HSA plans with high deductibles, which is the only real “insurance” product out there (the rest are coverage).
Also, we talk about “the wealthiest society”. America is split by culture, and many of our citizens/cultures are not in that “wealthy society”, but are stll counted in the average (which throws it off). When a ceratin group is known to have a large percentage of its male youths in prison, they are not part (for worse, and it is not a good thing) of “the wealthiest society”.
Last, who says what type of care will be offered (or should be)? as the President said, take the pill and not the surgery, but how about pain? Why should we, as the taxpayers, pay for a drug for someone else with fewer side effects? AND WHO SHOULD DECIDE?
If part of the bill would be that only generic drugs (not more expensive versions) are covered (with the excption of illnesses where there is no generic that does ANYTHING), then that would also help. Why cover Lipitor if Zocor works 95% of the time just as well?
I have my own ideas on how Universal HC should be done (a VA/Kaiser Permanente type system), but that is well off.
I look forward to your response.
i was listening to WABC today and Mark Simone made a good point. we already have several forms of government healthcare in place. nameley…medicare…medicade…veterans health…among others. the infrastructure is in place, why not extend the program and its funding?
“Bemused,
There is no need for the government to sponsor health insurance for anyone other than those who can’t get it themselves, such as the poor who can’t afford it, those with pre-existing conditions for whom no sane insurer would ever issue a policy, or the elderly whom no sane insurer would ever insure. France and Israel cover everyone with no government programs (although the government does subsidize the cost and regulate the coverage).”
Charliehall,
Perhaps there were too many comments for you to have time to read mine through. I stated quite clearly that I know the numbers, and people making slightly below mine are mostly eligible for health care programs we already have in place. Anyone above those income levels, such as myself, is making choices about purchasing insurance versus purchasing a better lifestyle.
Your response did not answer my query at all. You either did not have time to read my question, or there really IS no answer, and it’s all about politics, not about health care for those who “can’t afford” it. Can I trouble you to reread my initial comment in order to specifically address the question?
bombmaniac:
That is my bottom line as well. The VA does the best job of the three, since they do not pay-per procedure (possibly the main reason for health care inflation), and has a strict, evidenced based formulary.
exactly. cut out the middle man, i.e. the government working through insurance companies, and bang! you just saved a bundle. (of course i just saved a bundle by switching to geico:D a fifteen minute call can save you fifteen percent on car insurance. geico. :D:D:D lol)
As it stands now, the Senate bill eliminated the Public Option. This bill calls for the expansion of Medicare down to 55 for those without insurance. Medicaid will remain the same.
This will blow up in the House. The House voted by 2 (two) measly votes to let the bill see the light of day, ONLY on the strength of the “Vibrant” Public Option. Now that has been effectively eliminated, it appears that hopefully ObamaCare is dead too. It’s good to fail on his Signature Issue. As he fell on this issue, he should fail on all his other ideas as well.
Now Socialist Obama can focus more on stimulating jobs by FORCING businesses who to hire. A total loon, he is!!
lol indeed! you know if he wanted to force businesses to expand, he should have financed them. all businesses. not just the barely solvent car companies. instead of spending a trillion dollars on nothing, and now proposing stimulus 2.0…he could have given that money to individual businesses…thus enabling them to expand, which would create new jobs.
Bemused,
You have just made the argument for a single payer system that will cover everyone. There really isn’t any justification to have you slightly above a threshold and getting nothing. But since we aren’t willing to have a single payer system, you are stuck.
gavra_at_work,
You are completely misinformed about the Canadian system. Most physicians in Canada are actually self-employed. My wife and I met a Canadian family physician last winter and the picture he painted of the Canadian system was so favorable we investigated emigrating there. Basically, he NEVER has an insurance company deny coverage for something he recommends, he NEVER has to worry about not getting paid, he NEVER has to worry about his patients being able to afford the treatments he recommends, and he doesn’t have to worry about getting sued, either!
Ben Levi,
Have you ever spoken with a posek about abortion? My wife asked one whether it was permissible for her to teach medical residents how to perform an abortion. To her surprise (mine, too) the answer was yes, because some abortions are mandatory under halachah and therefore we must train physicians in how to perform them.
The fact is, the vast majority of poskim do not consider abortion to be murder. (IIRC, Rabbi Moshe Feinstein was a daat yachid here.) For Jews it is not a capital offense even when prohibited. Some poskim even permit aborting a child with a chromosomal defect; Rabbi Eliezer Waldenberg z’tz’l was as prominent a posek in Eretz Yisrael as Rav Moshe and he permitted aborting a Tay-Sachs fetus and recently Rabbi Shlomo Aviner permitted aborting a Down’s syndrome fetus. For non-Jews it can be a capital offense but so too theft of less than a pruta! Our religion does not view abortion the same way as the Catholic church which treats a fertilized ovum as a full human (hence their opposition to the assisted reproductive technologies we frum folks support) not the same way as the mainline Protestants who do not see abortion as inherently evil at all.
Furthermore most administrations of capital punishment in the US would likely be murder because the administration of death penalties here does not meet even the minimum Noachide standards, such as the requirement for an eyewitness. Do you object to your tax dollars going to prosecutions?
gavra_at_work,
Regarding your question of “who should decide”, most decisions on health care coverage today are maid by for profit companies whose first responsibility must be to their stockholder-owners. Most actually do try to do the right thing but it is a very difficult system. I knew a medical director of an insurer who decided he couldn’t cover smoking cessation despite the huge medical benefits because they would not save the company money for decades. He just couldn’t demand that the stockholders foot the bill. A government plan, or government regulations, can eliminate this terrible situation.
charliehall,
I’m sorry that you were unable to address my question directly; that was what I was afraid of. I’m even more sure of my position on this than before, in recognition that this is indeed, a partisan “issue” rather than a humanitarian one. I wish it weren’t true, but this thread, and the lack of direct response is very revealing.
Es chatai ani mazkir, but I listen to liberal radio. It is clear that the public option is simply a stepping stone for single payer; that IS the ultimate goal.
Right now I just heard an interview on an Air America program with Marlo Thomas, focusing on her work with St. Jude Hospital. The hostess gushed, look at the success rates with childhood cancer they have – see what happens when no one is turned away and money is spent! If it weren’t erev Shabbos I would call in – all that money is from private funding and philanthropy, isn’t it? What comes from the government? Can someone crunch the numbers and see what would happen if they would rely on government funding?
Health care for the elderly in the US is almost entirely paid for by a government health insurer and has been for 44 years. This will not change under any plan under consideration. Thus your concern about end of life care is not necessary.
My father was on Medicare. If you think there are no concerns about end-of-life care, than I think you need to do some more research. I had to be extremely vigilant whenever he was in the hospital to make sure they didn’t issue a DNR. There was a time I walked into his room and saw that someone had issued a DNR in my absence.
The VA does the best job of the three, since they do not pay-per procedure (possibly the main reason for health care inflation), and has a strict, evidenced based formulary.
I had a friend who received his health care through the VA. He has since passed away. He used to receive his supply of insulin through the mail. The VA decided it would be cheaper to send it in padded envelopes rather than insulated containers. Do you know what happens to insulin when it sits in a metal mailbox in Alabama in the summer? It becomes worthless. But the VA managed to save money. They also wouldn’t give him the proper amount of heart medication because it was too expensive. So if we are using the VA as a model for health care, Heaven help us.
haifagirl, end-of-life care is an issue for those on private insurance too. When my father was in the ICU, the hospital staff kept trying to take him off the ventilator for “apnea testing” and then “forgetting” to put him back on. My siblings and I took turns staying by his bed to keep this from recurring.
Also, most private insurance companies have lifetime limits, generally of about $1 million. They will not cover any expenses incurred beyond this amount.
Regarding Medicaid, the physicians I’ve spoken too say that there’s a significant difference in coverage between Medicaid plans managed by private HMOs and those managed by Medicaid itself. Generally the latter type offers better coverage.
I do agree with you about the VA. People I know who’ve worked at VA hospitals tell me that the treatment there is not very good. Really our veterans deserve better than that.
Ben Levi, my point is that the hospital was refusing to treat my father, who was on private insurance. They were also trying to take him off the ventilator in the guise of “apnea testing”, and probably would have succeeded in doing so if not for the fact that one of his visitors was a physician who knew what was going on. Whether this was legal or not I cannot say; all I know is that this is what happened.
- You must be logged in to reply to this topic.