Today, Senate Republicans unveiled their so-called healthcare plan—the Better Care Reconciliation Act—conceived in secret and designed to deprive millions of people access to affordable health care, while cynically giving tax breaks to the wealthiest Americans. These Senate Republicans, who so-often like to flaunt their spiritual credentials, would do well to remember the obligation to pay for the cure of a person who has a life-threatening illness: “From the straightforward reading of Sanhedrin 73a, we see that one is obligated to do everything to save him, and if not, one transgresses the negative commandment: ‘Do not stand idly by the blood of your neighbor’” (R. Shlomo Zalman Auerbach, Minchat Shlomo, V.2, 86:4).
In our contemporary climate, we easily see this concept expanded to include medical care: "The Torah has given permission to doctors to heal. And it is a mitzvah. And it is included in 'saving a life.' And if a doctor refrains from healing it is as if he spilled blood," (Shulhan Arukh Yoreh De'ah 336:1). We see historical evidence that the Jewish communities in Europe retained these values over centuries. Even as early as the Middle Ages, there were Jewish communities that supplied free medical care. About a thousand years ago, the Jewish community in Cologne had a hospital (hekdesh), primarily for travelers, and communities throughout central Europe followed in succeeding centuries.
Let’s recall modern history around ensuring healthcare coverage. Whereas Europe implemented a variety of methods for universal coverage, America struggles to find a balance between methods that would be most effective to cover every citizen. The first modern call for health insurance in the United States came in 1906 from the American Association of Labor Legislation (AALL). In 1915, the AALL developed a bill to give health insurance to poor workers, supported by payments from the workers, their employers, and the government. At the time, medical groups, even labor (due to fears the bill would undermine some of the benefits it gave members), opposed the bill; it faded by the time of World War I.
A political generation later, Franklin D. Roosevelt pushed New Deal initiatives that would spur the economy and protect the majority of those affected by the Great Depression. While the New Deal engendered significant progress for certain forms of economic safety—think Social Security—it did not directly propose national health insurance. The Wagner-Murray-Dingell bill, which would have created a national insurance plan financed by a payroll tax, did not gain traction in Congress when introduced in 1943 and the United States’ involvement in World War II would further stymie discussion of national coverage, though the labor shortage during the war spurred employers to attach health insurance options to employment packages.
The first major push for national health care came in 1945, shortly after the war ended. President Harry S. Truman proposed a national health insurance plan, to be paid by a tax on workers, that would provide adequate medical care to all Americans. President Truman understood that affordability was the chief problem, that Americans "cannot afford to pay…on an individual basis at the time they need it." This applied not only to the poor, but also "for a large proportion of normally self-supporting persons." While the President stressed that he was not proposing a government takeover of medical care, he faced an uphill battle. It attracted strong opposition from the American Medical Association (AMA), which called the Truman administration "followers of the Moscow party line" with "socialized medicine." Truman shot back to the AMA whether it was "un-American to visit the sick, aid the afflicted or comfort the dying?" However, President Truman could never overcome the strong opposition to the plan.
While Truman struggled to find a path forward with national healthcare, internationally, other nations were strengthening their internal health care systems. In 1948, the Labour government in the United Kingdom established the National Health Service, which established universal health care (free at the point of use except for prescriptions and optical and dental services) for all people, who are taxed based on income. Today, the National Health Service provides care for 65 million people. Likewise, Canada established universal hospital and doctor care for all by 1971.
It wasn’t until 1965, during Lyndon B. Johnson’s tenure as President, that universal forms of healthcare coverage were revisited. As part of Johnson’s Great Society initiative, Medicare and Medicaid were enacted into law, providing health care for the elderly and many poor Americans (former President Harry Truman was issued the first Medicare card). But though there was some progress, national health insurance still proved elusive.
Decades passed with little movement for healthcare progress. While President Bill Clinton presented his 1993 health care plan, tepid support from key Democrats could not overcome hostile opposition from Republicans who forcefully killed the prospects for national healthcare. Between the scandals of the Clinton Administration and the focus to combat terror from the second Bush Administration, healthcare moved to the recesses of the national consciousness. Yet, people continued to languish in an endlessly complex, expensive, and often unfair, web of actuarial bureaucracy and ambiguity from health insurance companies.
Finally, after years of stagnation, Congress passed President Barack Obama's imperfect, but workable, Patient Protection and Affordable Care Act, in 2010. Seeking to eliminate many egregious health insurance practices such as excluding consumers who had pre-existing medical conditions (about half of Americans have them), annual or lifetime limits on coverage, having consumers pay for preventive tests, and canceling policies when consumers became chronically ill. Part of the underlying logic to the ACA was its mandate that every person was required to have insurance. This mechanism was achieved in part by expanding Medicaid and creating exchanges where consumers could buy more affordable insurance than before, since the ACA levied a tax on insurance companies, medical device companies, and individuals making more than $250,000 annually. The hope was that this would reduce the 46 million people who lacked insurance.
Yet, despite the many compromises and backroom deals to keep the legislation alive, no Republican voted for the ACA. In the ensuing years the Republican-dominated House voted more than 50 times to repeal the ACA without offering a viable alternative. When Republicans won a partial court victory in 2012, when the Supreme Court ruled that states did not have to expand Medicaid, nineteen Republican governors declined to expand Medicaid in their states. A Kaiser Family Foundation study from 2016 showed more than three million Americans were prevented from going on Medicaid due to their state's refusal to expand Medicare. On the other hand, Kaiser Family Foundation study found that as of 2016, nearly 11.2 million people had enrolled in Medicaid (there more than 73 million people currently on Medicaid) due to the expansion in 31 states and the District of Columbia.
During his campaign for the presidency, Donald Trump promised an instant repeal and replace of the ACA, with lower premiums and better coverage for all Americans, and no cuts in Medicaid. Since President Trump’s inauguration, the proposed Republican health plans reverse all these promises. According to the Congressional Budget Office (CBO), the Republican House and Senate bills would reduce the number of insured Americans by 23 million and 22 million, respectively; cut Medicaid by $834 billion and $761 billion, respectively; and by 2026, raise the percentage of uninsured Americans to 19 percent and 18 percent, respectively (versus 10 percent if the ACA were left in place).
Both Republican plans eliminate the mandate for individuals to have health insurance, would enable individual states to allow insurers to impose annual and lifetime benefit caps, would allow states to eliminate covered mandates such as maternity care (and defund Planned Parenthood), and would expose older Americans to rates five times greater than younger Americans. As a result, older Americans, and those with lower incomes, would pay much higher premiums.
The litany of groups opposing the new legislation in congress is staggering. The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, American Psychiatric Association, American Hospital Association, American Association of Medical Colleges, National Association of Medicaid Directors, Federation of American Hospitals, American Association of Retired People (AARP), the American Heart Association, American Lung Association, the American Cancer Society Action Network, the National Center on Addiction and Substance Abuse, the American Nurses Association, and the American Congress of Obstetricians and Gynecologists all oppose the proposed bill. American Medical Association (AMA) President Dr. David Barbe spoke for many when he said: "Does it improve coverage? No. Does it improve affordability? No. Does it stabilize the safety net? Medicaid? No."
Republicans developed their plans without hearings. In June 2017, Majority Leader Mitch McConnell refused to meet with many of the medical groups mentioned above to discuss the Senate health care bill that was being written; no one knew what was in the bill or how it would affect the nation. He ignored the scores of protesters, many in wheelchairs, who staged sit-ins near the Senate offices of Republicans, out of fear for losing their Medicaid.
Such a desire to put profits over people is a disturbing trend in our modern political discourse. The behavior of certain elected representative who would rather stand ideologically against the most vulnerable in order to provide more benefits to the prosperous is an abdication of moral obligation. The amount of avarice, mendacity, and myopic material gain is antithetical to the ideals of pursuing an ethical and compassionate nation.
And indeed, the Jewish people are taught to elevate discourse and be compassionate to those from all walks of life. When Abraham met the angels in disguise at his tent, he didn’t shun them even though they were strangers (Genesis 18:1). He didn’t shun them even though it could have appeared they were a burden to him. Instead, Abraham gave them the most attention, preparing for them drinks and food and attending to their needs. When we are reminded in Jewish religious thought of the sanctity of human life, we are taught that “…the first human being was created alone to teach that all who destroy a single life are as though they destroyed an entire universe, and those who save a single life are as if they had saved an entire universe" (Jerusalem Talmud Sanhedrin 4:22).
Congress would do well to heed these words. Ensuring that every person is given the same access to healthcare professionals and practices is a moral objective not limited to the political realm. Should we fail to seek a remedy to the catastrophe of repealing and replacing the Affordable Care Act, then who is to say that we have let the blood of our neighbor be spilled in vain? Universal healthcare, though an enormous undertaking, is an imperative, not only for the physical health of our nation, but its spiritual health. May we only have the foresight and perspicacity to see this dream to honor human dignity made tangible for the countless people who struggle every day to fulfill their potential in this world.
Rabbi Dr. Shmuly Yanklowitz is the President & Dean of the Valley Beit Midrash, the Founder & President of Uri L’Tzedek, the Founder and CEO of The Shamayim V’Aretz Institute and the author of ten books on Jewish ethics. Newsweek named Rav Shmuly one of the top 50 rabbis in America and the Forward named him one of the 50 most influential Jews.
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