Wednesday, February 15, 2012

Halachic basis for Medicare?


(George Washington, asking G-d whether he should socialize horse fodder production)

The Jewish Law blog, to which I am subscribed, linked to the following article in its recent post. You can read the article yourself, but basically, it argues that Halacha supports or even mandates some sort of socialized healthcare provided by the government through taxpayers' money. I urge you to read the article.

These are my two responses to it. The first one is rather brief and does not address my view of Dina D'Malchusa Dina fully, for I did not (nor do now) have time and all the necessary sources at my disposal for a full answer. This is my limited answer then:

First part:
A few comments: 
1. Of all the leaps of logic found in this article, this is probably the greatest in my opinion: 
“Applying this ruling leads to the conclusion that once a person is part of a community, there is a broad scope of public services that a community can compel its citizens to pay for. However, it would seem that the communal funds must be gathered for the purpose of meeting a public need.

It would be easy to imagine that public medical insurance could meet this definition. Medical care is a service that everybody needs at one point or another and if a town decides to create a communal insurance system to address the issue, the town would presumably have the right to set up such a system.”

I can include almost every aspect of everyday life under the logic of the last sentence and then (following the logic of the quoted passage) include it under “a need of the community” that needs to be provided for by the government through compelled taxation.

For instance, cell phone service. Everybody in modern society, at one point or another, needs to make a call.

Food. Shoes. Clothes. Computers. Cars. Chairs. Housing. Etc.

This logic leads straight to socialism — all the property of the populace is transferred to a secular (or religious) “beis din” and then redistributed back according to the political or social calculations of the beis din.

Meanwhile, socialization of medicine leads to real decrease in the quality of services provided. Israel is a good example of how a potentially good medical system can be ruined by socialization.

2. The author of the article does not define a “thieving government”. My perusal of various Halachic sources suggests that the US government may very likely fall under this category.

3. Is there a source extending the rights of a Jewish king to eminent domain to a secular king (a king who is not a Jew or a Noahide gentile)? The article does not provide one.

4. I found this footnote curious: “19 Ad loc sv mahu; also see Rashi sv vayatzilah holding that it is forbidden to save oneself with the money of one’s friend” (p. 102 in the text).

The system of society that the Americans have established in the Thirteen Colonies during and after the American Revolution is not that of monarchy. This is not a trivial point. According to the philosophy of the Founding Fathers (explicit in the Declaration of the Independence, Federalist Papers, the Constitution, etc.), American government does not own the people. The people are not its subjects, and the government is not a sovereign.

The people are the government’s clients. The people are considered to possess certain natural rights to their property and livelihood, and they hire the government to protect those rights. They delegate their rights to the government. Thus, for instance, if I have a right to defend myself, I can delegate that right to the government.

That is the relationship between the people and the government. Now, if you follow Rashi’s stated opinion, if I may not compel you to save my life with your property (or use your property by force to save my life), I should not be able to use a company that I hired as my representative to do the same.

Second part:
This is all ignoring the question of even if it permissible for the current governments to tax people for whatever transfer-of-property scheme, whether it is a good idea for us to allow it. I.e., just because something is halachically permissible, does not mean it is a good idea pragmatically. (One could even say that it does not necessarily mean it is moral.) One can find halachic sources allowing beating one's wife if she did not cook the dinner...

One point is the one I already raised in the [previous] post: allowing the government to manage any kind of industry (from shoe making to television to roads to medical care) basically ruins that industry. The best way that the decisions about direction of capital in an industry can happen is through free market — competition and cooperation between service-providers for the customers' business (and competition between the customers for the products and services in the cases when the latter are scarce). 
The government (or any other monopoly) does not have the necessary foresight to manage the resources most effectively. This argument is known as “economic calculation problem” and was presented by Jewish-Austrian libertarian economist Ludwig von Mises.

The other problem with government-provided medical care is that it violates people’s “natural rights” through taxation (the taxation is potentially justified from natural rights perspective only when the one taxed receives some products or services in return). Now, a frum Jew may not be worried about “natural rights” as presented by the Western philosophers of the 18th-19th centuries, but, unfortunately, the history has shown that once you allow the government to violate natural rights for the supposed “common good”, you open the door for it to violate many different kinds of rights and interfere in personal lives — including Jews’ religious personal lives (not to mention their livelihoods).

All the regimes that constricted Jews’ freedom of religion have done so under the premises of “common good”. Indeed, if you follow their logic, they were doing Jews a favor by forcibly converting them to Christianity, not allowing their children to learn Torah, forcing them to send kids to secular governmental schools, etc. In our times, there has been a proposal to ban bris in San Francisco. It was rejected — but in many European countries, shechita and bris are banned. Homeschooling is banned. (So, if there are no private Jewish schools available in one’s area, one has to send kids to a public school or have them taken away by the state. Chabad shluchim in Sweden are currently facing this problem.) The list, from the past, the present and the potential future goes on.

Even in Israel, frum Jews are forced to listen to kol isha in the army, because a posek in the army has declared that it’s muttar. Well, these Jews’ poskim disagree, but the opinion of this, more meikel, posek is imposed upon them by the state. We see that Jewish governments and frum elements within them can be just as tyrannical.

Therefore, it seems to me that even if the government may have a number of powers granted to it by Halacha (a statement that I personally do not necessarily agree with), it may still be a bad idea for us to support a government that exercises these rights. Until Moshiach comes, the government that governs least governs best.

8 comments:

e said...

Whatever people want, they'll say Judaism supports it. Did not Shakespeare say, "The devil can cite scripture for his own purpose"?

Certified Ashkenazi said...

Well, as Frierdiker Rebbe said, every idea can find its source in Torah. Because every idea has good and bad in it, and Torah is the source of all good, you can justify every idea with Torah.

It can also mean that when Torah was given, Hashem's wisdom penetrated the world. As a result, if people will want to seek truth, they will be automatically drawn to it. Unfortunately, since they have a lot of imperfections, the truth they arrive at will be distorted.

So, it's our job to separate the truth from the falsehood.

I really think that if you take what Torah says in the most straightforward way, you can show that the two systems of the government that Judaism supports the most are fascism and socialism. Yet, Jews suffered the most under these two regimes in the recent times.

William of Ockham said...

Instead of saying that Torah is the source for everything and that Torah penetrated the world and all that jazz, why don't you just say that torah contains lots of ideas from lots of different times and places, so it's easy to extract any idea you want from it.

Certified Ashkenazi said...

Because I think that Torah comes from a singular source and was written at one point of time.

It's true that that source includes in Himself all the ideas (including, actually, even bad ones), but Torah is the revelation of the good of the Source.

When Frierdiker Rebbe said that Torah contains all good, he was not saying that because he was able to identify elements of a lot of good ideas in Torah. That would be circular reasoning. He knew that Torah has all the good in it because it comes from G-d.

Michael said...

CA Said: "This logic leads straight to socialism — all the property of the populace is transferred to a secular (or religious) “beis din” and then redistributed back according to the political or social calculations of the beis din."

How does arguing that something is socialism, or that it leads straight to socialism prove that it can't be Halachic? Maybe, in this situation, Halacha is socialist.


CA said: "Meanwhile, socialization of medicine leads to real decrease in the quality of services provided. Israel is a good example of how a potentially good medical system can be ruined by socialization."

You can't look at one person's experience in Israel, and extrapolate from that. The fact is that, on average, Americans spend far more money on health care and don't have a commensurate benefit in any measure of health.
In fact, Health Care is a great example of an industry that likely confounds the free market.
Consider: For thousands of years, health care operated with free market principles. Yet, there was very little relationship between the amount of money spent on a treatment and its efficacy. This is because health care providers have something I like to call a "Confuse-opoly".
The product they are selling requires a lot of specialized knowledge to detect quality. As a result, customers have a very hard time making rational market decisions. The best treatments fail to work many times, and patients often recover without any medical care, so it is super-hard to separate out the value of the care being offered.

It is very hard to imagine an effective free-market in health care.

Certified Ashkenazi said...

> How does arguing that something is socialism, or that it leads straight to socialism prove that it can't be Halachic? Maybe, in this situation, Halacha is socialist.

This should be part of the second response. I am assuming that an educated person should know that people live worse under socialism.

But also, it sounds that the author is singling out medicine as something that turns out to be a common good. But you can make this argument for anything at all...

> You can't look at one person's experience in Israel, and extrapolate from that.

I am looking at only four members of my family alone. Five members if you count my cousin's father-in-law who had an experience similar to that of my family members. And a few friends (including my mom's former employers) who had similar experiences. And statistics. Basically, unless one is blown up, the medical care in Israel is very sub-par.

> The fact is that, on average, Americans spend far more money on health care and don't have a commensurate benefit in any measure of health.

The fact is that American government is involved in every single area of American health system. This is a quote from a forum on Mises.org:

"They actually set a limit on the number of medical students per year. Furthermore, even if you go to school overseas, the law requires you to perform a residency here. The taxpayers are forced to fund the vast majority of these residencies, and so the doctor must either pay for his own residency (several hundred thousand dollars) or be selected by a bureaucrat. There is a bunch of other stuff, but since I spend 12 hours a day producing goods for people who have legal tender, I cant remember."

This is another quote from him:

"We have two cadillac insurance plans and medicare (because the federal govt required her to purchase medicare when her kidneys got bad enough to go on dialysis) and we cannot seem to get any kind of quality of service because, ironically, we have insurance. Because they have separated the patient from the purse, we have no leverage when it comes to dealing with the medical professionals and so we are at their mercy. And this is all perfectly legal because the law prevents people from practicing medicine without government approval."

> In fact, Health Care is a great example of an industry that likely confounds the free market.

I will answer this ridiculous argument in a separate post which I am going to write shortly, iyH.

Michael said...

I can hardly wait - email me when the post is up...

Certified Ashkenazi said...

Also, regarding the rising costs of healthcare, look at this figure: http://www.ncpa.org/images/1247.jpg

Guess which healthcare industry is the one least regulated by the government?