Community Magazine April 2012

A Talmudic Perspective on A s the campaign for president heats up, one of the central issues is that of “healthcare reform.” The government has been spending more money on Medicare and Medicaid than it had anticipated it would, consuming more and more of the federal budget each year. Two years ago, President Obama made healthcare reform a signature part of his first term, forcing highly unpopular legislation through Congress. The goal of that bill was to make sure every American had health insurance, and at the same time try to contain healthcare costs without compromising current healthcare, objectives which seem inherently contradictory. The main features of “Obamacare,” as it has been called, have yet to go into effect, and will again be a focus of attention over the next few months. Last month, the U.S. Supreme Court heard opening arguments for a case that could decide whether or not the Federal government can compel individuals to purchase health insurance. At its core the controversy surrounding Obamacare revolves around the question of how limited resources should be distributed. If the federal government had unlimited funds to pay for healthcare, the concept of universal healthcare would be universally accepted and this wouldn’t be a politically charged issue. Clearly this is not the case and so, at the center of the debate is the question of how to allocate the limited available healthcare resources fairly among the citizenry. For insights on the subject, we turn to several Talmudic sources cited in Jewish- medical halachic literature that relate to the issue of limited resources. One of the sources addresses the issue on an individual level, whereas two others deal with the communal level. Rationing Water in the Desert The most famous of the Talmudic discussions of this subject is the debate between Rabbi Akiva and Ben Petura regarding two travelers with a single jug of water. The Talmud in Baba Messia (62a) quotes the following beraita 1 : Two individuals were traveling, and one of them had a jug of water. If they would both drink, they would both die, but if one of them would drink from it, then that one would make it to the next settlement. Ben Petura ruled that it is preferable that they both drink from the same jug and die, rather then one of them see the other die. Along came Rabbi Akiva 1 A beraita is tradition in the Jewish oral law not incorporated in the Mishnah. and taught, “ …and your brother should live with you ” (Vayikra 25:36), your life takes precedence over the life of your friend. What is the precise point of argument between the Ben Petura and Rabbi Akiva? The Hazon Ish 2 explains that these sages debate the question of whether we should focus on haye sha’a (sustaining life in the short term) or haye olam (prolonging life for the future). Ben Petura understands that one may not assume that his life is more valuable than that of his fellow, as the Talmud in Sanhedrin (74a) states, “Who says that your blood is redder? Perhaps the blood of the other is redder.” Therefore, for the present time, when it comes to haye sha’a, sustaining life in the short term, the two lives are equal. However, according to Rabbi Akiva, the issue at hand is not one person’s haye sha’a weighed against the haya sha’a of another, but rather the haye olam of one and the haye sha’a of both of them. If drinking the jug will allow one person to achieve prolonged life, then this takes precedence over the short term life that they could both receive by sharing the limited ration of water. Rabbi Akiva infers this principle from the verse, “and your brother should live with you.” The Maharsha, commenting on Baba Messia 62a, explains that according to Rabbi Akiva, 2 Collection of Hazon Ish on Baba Messia, 20 JASON ESSES M.D. Obamacare” “ 22 COMMUNITY MAGAZINE