The issue of heath care, specifically the economics of health care, has taken a central role recently both here and south of the border. Like it or hate it the new health care bill in the United States is undoubtedly one of the most important pieces of legislation in years, one that will permanently change the face of America. And just this past week, in a move that caught many by surprise, the Ontario government announced that generic drug companies will no longer be allowed to pay pharmacies to carry their products. That announcement alone shaved close to 10% off the price of Shoppers drug mart stock.
Paying for essential services has sparked debate from time immemorial. Should the community at large bear the burden of such expenses, with the wealthy being taxed at much higher rates, or should the primary model be one based on some form of user fee. This debate plays out in such issues as the funding of education (where society at large sees this as an essential service that all must contribute too, whereas the Jewish community operates with a user fee approach), salaries for religious functionaries and synagogue building funds.
While the payment for the above services are discussed rather extensively in our classic sources, to the best of my knowledge the same can not be said regarding the funding of health care. Living under foreign domination the broad issues of health care were apparently less pertinent to the Jewish community. The “private” nature of health care during Talmudic times can be seen in the following ruling. Included in the obligation to support a wife was the obligation to pay for her medical bills. Yet the husband is within his legal (if not moral) rights to divorce his wife, pay her the value of her Ketuba (an ancient form of alimony) and free himself from the need to continue paying her medical fees. Presumably health care was just one of many needs that the individual was expected to pay for – and those who lacked funds would turn to charitable sources.
As an essential service Jewish law does regulate the cost of health care. In theory Doctors are not allowed to receive payment for treating patients. One is not allowed to receive payment for performing any mitzvah and preserving health is a (the?) primary mitzvah of Judaism. Of course our Sages realized that such a system could not work in practice and allowed one to receive payment for his efforts and the opportunity cost of foregoing other forms of gainful employment. Furthermore no recourse was available against a doctor who did in fact charge, or even overcharge, for his or her diagnosis, as “he sold his wisdom which is priceless”.
The same is not true regarding pharmaceuticals. In order to ensure availability for all, prices must be kept at an affordable rate even if that means limiting the profits of drug companies. Whether that would include the disallowing of payment to pharmacies for carrying products is much less clear. One would need to examine not only the price impact but also the effect on drug availability and even corporate profits before reaching any conclusions.
Our sages well understood the power of and the need for a profit motive as an inducement to meet market demand. This is especially true regarding pharmaceuticals where the investment needed to find new drugs can be quite substantial and such investment would only be carried out if there were potential for solid profits. Thus Jewish= laws recognizes both some sort of patent protection for drug companies and the right of generic companies to compete at the proper time. Finding the proper balance between these competing needs requires constant vigilance, monitoring and tweaking.
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