By Ruth B. Balser
Elliot Dorff and Aaron Mackler conclude that Jewish law and ethics require a collective re-sponse to the health care crisis in the United States. I share their perception of a crisis. The large numbers of uninsured and underinsured - along with a provider community that is struggling with failing enterprises and administrative obstacles to providing quality care - are evidence of the current crisis in health care. As a legislator, my focus is on the failure of government to respond effectively to this problem. As Dorff and Mackler point out, this failure has meaning from a Jewish ethical point of view, which suggests that the Jewish community might support political efforts to respond to this crisis.
In 1948, the United Nations declared in its Universal Declaration of Human Rights that:
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care….”
Although the United States is a signatory, it stands alone among industrialized nations in failing to provide health care to all its citizens. Apologists acknowledge that access is a problem but claim excellence in quality. That claim is disputed by the June 2000 World Health Organization’s first ever analysis of the world’s health systems. Using five indicators to measure health systems in 191 member states, WHO ranked the United States 37th. WHO’s director of global programs stated,
“The U. S. is really three Americas. The top 10 percent here are the healthiest in the world. The middle bulk does mediocre. But it’s the bottom 5 or 10 percent, … that is a third America. They have health conditions as bad as those in sub-Saharan Africa.”
The United States has not yet embraced the idea that access to quality health care is a human right. Our patchwork system leaves many without access, health institutions struggling, and quality of care inconsistent. Many Americans receive health insurance as an employment benefit. The government provides insurance for the elderly (Medicare) and for the poor and disabled (Medicaid). While some others are able to purchase insurance privately, many - primarily the working poor - remain uninsured.
When economic times are tough or when the cost of health care increases, payers eliminate benefits or drop coverage altogether. Further, because of inadequate reimbursements to providers by both public and private payers, there is a financial crisis for health care institutions, making it hard for them to provide free care to those without insurance. Finally, cost-cutting strategies sometimes result in diminished quality even for those with insurance.
There has been a debate within the health care advocacy community about how to focus political efforts to solve the problems, whether by increments or by mounting a campaign for a system of universal coverage. As a State Representative, I have co-sponsored a bill that would establish a health care entity charged with implementing a single payer health care delivery system in Massachusetts. The health care trust fund would also be charged with determining a funding mechanism. All residents of the Commonwealth would be covered and protections would be in place to ensure quality of care and adequate reimbursement to providers.
Education was not always considered a “right.” Universal access to education was established gradually, state by state. It may take a similar process before our society accepts the U.N. resolution and the Jewish principle that health care is a right. It will happen only by sustained lobbying on the part of a committed public. Dorff and Mackler provide the basis for the Jewish community to participate in that effort.
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