What G-d said about healthcare reform

By Malka Eisenberg

Using slides, cartoons and humorous quips, Rabbi Dr. Aaron Glatt presented the halachic (Jewish legal) perspective on healthcare reform at the Young Israel of Woodmere on Sunday.

“Universal Healthcare: What Does the Halacha Say in this Public Health Debate?” was to be a shiur, a lesson in Jewish law, he noted. It would have no “agenda,” no polemics, would be apolitical and — here he apologized — would be “non-controversial.”  The goal of the talk, which was sponsored by the Orthodox Union, was to “see if we can come to a conclusion of what Halacha, what Hakadosh Baruch Hu (the Holy One, Blessed be He), has to say,” Rabbi Glatt explained. He is the assistant to the rabbi of the Young Israel of Woodmere, as well as President and CEO of New Island Hospital and Professor of Clinical Medicine at New York Medical College,

Clearly, he stressed, from a Jewish perspective, we “want every one to have all the health care they could possibly get, but what do you do when you can’t do everything?”

After building a case based on individual and communal requirements of Jewish law, Rabbi Glatt concluded that “there is no halachic obligation to provide every citizen with equal universal healthcare but there is also no halachic prohibition to provide every citizen with equal universal healthcare,” since the government may use its funds as it sees fit and has the right to spend money. “Jewish law looks favorably at healthcare reform that is economically feasible, just and fair,” he stated.

Pointing out that President Obama has called his health care plan a “moral obligation,” according to the New York Times, Rabbi Glatt emphasized that “nothing in Halacha is based on secular morals.”  The President held a conference call with a thousand rabbis, Rabbi Glatt said, asking that they assist in the ‘mitzvah’ of healthcare and saying, “We are G-d’s partners in matters of life and death.”  On the other hand, Rabbi Glatt said, Republican members of Congress consider it “morally objectionable to vote for” the President’s plan.

Judaism’s Reform movement appears to support generic healthcare reform citing ‘tikun olam’ (repairing the world) and holds that it “should be the primary focus of Judaism,” Rabbi Glatt said, and “many secular Jewish organizations have the same approach.”

Glatt also quoted the position of Agudath Israel of America, as outlined in a letter sent to President Obama, Congressional leaders and Health and Human Services Secretary Kathleen Sebelius. “Universal coverage” is a “worthy goal,” the letter said, but expressed concern that health care reform may pose a challenge regarding religious rights when cost-benefit ratios clash with quality of life issues.

“Matters of life and death cannot be measured solely in dollars and cents,” said Rabbi Chaim Dovid Zwiebel, executive vice president of Agudath Israel, in a press release, but “need to be considered through the prism of religion and morality.”

In a recent Op-Ed in The Jewish Star, Shmuly Yanklowitz of the liberal Orthodox organization Uri L’tzedek cited halachic and rabbinic sources to support his contention that universal health care is an Orthodox Jewish imperative.

“The true Jewish perspective on any issue,” said Rabbi Glatt, is determined “only after the scholarly review of authentic source material, the Torah, the Talmud, Responsa, the Shulchan Aruch and contemporary poskim; not by vote or majority opinion.”

“The Torah says that you have to guard your life,” he continued, explaining that one is therefore not allowed to overeat, smoke or drink to excess; and euthanasia, suicide and “risky behavior” are prohibited.

Rabbi Glatt, a medical doctor and infectious disease specialist, noted that a physician is required to heal by the halachic dictate of hashavat avaydah — returning a lost item — and has the right to charge for healing. If he is the only doctor in town, he may be required to treat without pay, though Rabbi Glatt noted that there is a “big machloket (difference of opinion)” on that point among halachic authorities. If there are many doctors in a town, “Society has to determine what to do with patients who can’t pay. The gemara praises doctors who provide service for free, but may not have the obligation if other doctors can do so.”

Quoting the late posek [halachic decisor] of Shaare Tzedek Hospital, Rabbi Eliezer Waldenberg zt”l, known as the Tzitz Eliezer, the “community should provide money to treat poor patients or divide the burden upon all doctors in the area, as a communal responsibility.”  However, Halacha doesn’t specify the monetary amount or percentage to be set aside or how much should come from the government, Rabbi Glatt said.

The legal source of the Jewish communal obligation regarding healthcare is the commandment of Bikur Cholim, visiting the sick, said Rabbi Glatt. “One of the critical obligations is to daven [pray] for the choleh [sick] at the bedside,” but also to be sure that all the patient’s needs — medical, physical, social, emotional, spiritual — are met.

A secular government’s obligation under Jewish law falls under the requirement to set up a just legal system, one of the seven Noahide commandments. Since the US has a “fair and just system of rules and is non-discriminating, Jewish citizens must observe such laws including taxation, public health laws and universal healthcare, that must be economically fair and feasible, since dina d’malchuta dina, [the law of the government is the law].” He further explained that a government has the right to tax its citizens to provide benefits and allow usage to its citizens, such as roads and bridges, and can thus allocate funds to where it sees fit, as in health care.

“The potential areas of concern, however, are end of life, beginning of life and reproductive issues, triage hierarchies and resource usage,” Rabbi Glatt cautioned.  He pointed out a recent article on dialysis in a medical journal. It implied that the cost of dialysis is great, but the life expectancy in older patents is not, and called into question the use of that treatment in older patients who are likely to soon die of other causes anyway and, if on dialysis, are more likely die in a hospital instead of at home or in a hospice.

Currently there is no clear definition of what constitutes universal healthcare, Rabbi Glatt noted, since there are many possibilities being debated, but said that the government needs the input of appropriate specialists in how to divide the funding.

Using slides, cartoons and humorous quips, Rabbi Dr. Aaron Glatt presented the halachic (Jewish legal) perspective on healthcare reform at the Young Israel of Woodmere on Sunday.

“Universal Healthcare: What Does the Halacha Say in this Public Health Debate?” was to be a shiur, a lesson in Jewish law, he noted. It would have no “agenda,” no polemics, would be apolitical and — here he apologized — would be “non-controversial.”  The goal of the talk, which was sponsored by the Orthodox Union, was to “see if we can come to a conclusion of what Halacha, what Hakadosh Baruch Hu (the Holy One, Blessed be He), has to say,” Rabbi Glatt explained. He is the assistant to the rabbi of the Young Israel of Woodmere, as well as President and CEO of New Island Hospital and Professor of Clinical Medicine at New York Medical College.

Clearly, he stressed, from a Jewish perspective, we “want every one to have all the health care they could possibly get, but what do you do when you can’t do everything?”

After building a case based on individual and communal requirements of Jewish law, Rabbi Glatt concluded that “there is no halachic obligation to provide every citizen with equal universal healthcare but there is also no halachic prohibition to provide every citizen with equal universal healthcare,” since the government may use its funds as it sees fit and has the right to spend money. “Jewish law looks favorably at healthcare reform that is economically feasible, just and fair,” he stated.

Pointing out that President Obama has called his health care plan a “moral obligation,” according to the New York Times, Rabbi Glatt emphasized that “nothing in Halacha is based on secular morals.”  The President held a conference call with a thousand rabbis, Rabbi Glatt said, asking that they assist in the ‘mitzvah’ of healthcare and saying, “We are G-d’s partners in matters of life and death.”  On the other hand, Rabbi Glatt said, Republican members of Congress consider it “morally objectionable to vote for” the President’s plan.

Judaism’s Reform movement appears to support generic healthcare reform citing ‘tikun olam’ (repairing the world) and holds that it “should be the primary focus of Judaism,” Rabbi Glatt said, and “many secular Jewish organizations have the same approach.”

Glatt also quoted the position of Agudath Israel of America, as outlined in a letter sent to President Obama, Congressional leaders and Health and Human Services Secretary Kathleen Sebelius. “Universal coverage” is a “worthy goal,” the letter said, but expressed concern that health care reform may pose a challenge regarding religious rights when cost-benefit ratios clash with quality of life issues.

“Matters of life and death cannot be measured solely in dollars and cents,” said Rabbi Chaim Dovid Zwiebel, executive vice president of Agudath Israel, in a press release, but “need to be considered through the prism of religion and morality.”

In a recent Op-Ed in The Jewish Star, Shmuly Yanklowitz of the liberal Orthodox organization Uri L’tzedek cited halachic and rabbinic sources to support his contention that universal health care is an Orthodox Jewish imperative.

“The true Jewish perspective on any issue,” said Rabbi Glatt, is determined “only after the scholarly review of authentic source material, the Torah, the Talmud, Responsa, the Shulchan Aruch and contemporary poskim; not by vote or majority opinion.”

“The Torah says that you have to guard your life,” he continued, explaining that one is therefore not allowed to overeat, smoke or drink to excess; and euthanasia, suicide and “risky behavior” are prohibited.

Rabbi Glatt, a medical doctor and infectious disease specialist, noted that a physician is required to heal by the halachic dictate of hashavat avaydah — returning a lost item — and has the right to charge for healing. If he is the only doctor in town, he may be required to treat without pay, though Rabbi Glatt noted that there is a “big machloket (difference of opinion)” on that point among halachic authorities. If there are many doctors in a town, “Society has to determine what to do with patients who can’t pay. The gemara praises doctors who provide service for free, but may not have the obligation if other doctors can do so.”

Quoting the late posek [halachic decisor] of Shaare Tzedek Hospital, Rabbi Eliezer Waldenberg zt”l, known as the Tzitz Eliezer, the “community should provide money to treat poor patients or divide the burden upon all doctors in the area, as a communal responsibility.”  However, Halacha doesn’t specify the monetary amount or percentage to be set aside or how much should come from the government, Rabbi Glatt said.

The legal source of the Jewish communal obligation regarding healthcare is the commandment of Bikur Cholim, visiting the sick, said Rabbi Glatt. “One of the critical obligations is to daven [pray] for the choleh [sick] at the bedside,” but also to be sure that all the patient’s needs — medical, physical, social, emotional, spiritual — are met.

A secular government’s obligation under Jewish law falls under the requirement to set up a just legal system, one of the seven Noahide commandments. Since the US has a “fair and just system of rules and is non-discriminating, Jewish citizens must observe such laws including taxation, public health laws and universal healthcare, that must be economically fair and feasible, since dina d’malchuta dina, [the law of the government is the law].” He further explained that a government has the right to tax its citizens to provide benefits and allow usage to its citizens, such as roads and bridges, and can thus allocate funds to where it sees fit, as in health care.

“The potential areas of concern, however, are end of life, beginning of life and reproductive issues, triage hierarchies and resource usage,” Rabbi Glatt cautioned.  He pointed out a recent article on dialysis in a medical journal. It implied that the cost of dialysis is great, but the life expectancy in older patents is not, and called into question the use of that treatment in older patients who are likely to soon die of other causes anyway and, if on dialysis, are more likely die in a hospital instead of at home or in a hospice.

Currently there is no clear definition of what constitutes universal healthcare, Rabbi Glatt noted, since there are many possibilities being debated, but said that the government needs the input of appropriate specialists in how to divide the funding.