At least 46 million Americans are uninsured and 25 million more are underinsured or unable to cover the full cost of their medical needs with their current coverage. Moment’s senior editor Nonna Gorilovskaya talks to Noam Zohar, chair of the department of philosophy and director of the graduate program in bioethics at Israel’s Bar-Ilan University, about the Jewish position on access to health care and what Israelis make of the U.S. health care debate.

What is the Jewish perspective on making health care available to all?
Judaism is a tradition with many voices and opinions, and on almost no subject is it responsible to say what “the Jewish view” is. But, in fact, on this issue there is almost wall-to-wall agreement that the Jewish tradition and religious perspective require any society to make basic health care available to everyone.

What Jewish concept sheds light on the health care debate in the U.S.?
The Hebrew term tzedakah is often translated as charity. But tzedakah, which is derived from a root that means justice, is distinctly different from notions of mere charity. Tzedakah aims to meet the same kind of needs that charity and alms-giving aim to meet, but it includes a strong notion of a duty that translates into the authority of the community to tax people to meet the needs of the poor. Indeed, Jewish communities throughout the Middle Ages were well known for having so-called tzedakah funds or welfare arrangements.

What happens if providing health care for everyone is extremely expensive?
There is a question of how much the community can demand of its members in terms of taxes. But the truth is that all other developed countries have a national health care program of one kind or another, and they are able to provide it in a way that does not tax people in an unacceptable way. They do it by reining in costs and making arrangements so that medical personnel don’t charge too much. Part of the problem in the U.S. is that the fee-for-service system encourages doctors to recommend treatments that are more expensive but not necessarily more effective.

What does the Jewish tradition say about preventive care?
The society’s responsibility includes preventive medicine or public health. But that doesn’t mean that society can do anything and everything. Sometimes, there are financial and health costs for doing certain things in excess.

Is profit-making on health care kosher in the Jewish tradition?
We can’t do the same things prescribed by Maimonides in the 12th century in regards to the trading of goods essential to life. However, we can look at the current arrangements and ask: How can we avoid profiteering? For example, prohibiting for-profit health care is one way to go. And drug companies should be able to make a decent profit and return off their investments but not leverage that into unreasonable profit or monopolistic control.

What kind of health care system does Israel have?
From the beginning, Israel had so-called sick funds that were mostly connected to labor unions. These came to provide coverage for about 95 percent of the population, but we did have five percent uninsured. In order to rectify this, Israel instituted national health coverage in the early 1990s, joining the family of enlightened nations—including all of the Western European countries—which regard it as a basic social commitment to provide requisite health care to everyone.

How does Israel’s system work?
Health care is funded by the government and is based on a flat-rate tax, which is collected from everyone above a certain level of income. Any legal resident of Israel is entitled to to be served by one of the four sick funds. The sick funds are not owned by the government but are prohibited from being for-profit [though they can market supplemental insurance]. So they are competing against each other: Each fund wants people to switch to its coverage and each one works to keep its current members. The funds do this by offering better quality, better service, better access and so on.

What do the Israelis make of the U.S. health care debate?
It’s very hard to understand how there can be such a debate. Why is something that is so clear to every other country in the developed world such a challenge to Americans? The phrases we hear are “fear of socialized medicine” or “keep the government out of this” or “I won’t get the kind of service I’m used to if it becomes something organized or mandated by the federal government.” All of these things sound strange. You have tens of millions uninsured and tens of millions of underinsured in the United States. People are afraid to shift jobs because they’re going to lose coverage, employers worry about hiring people because they cannot afford the burden of coverage. It’s very, very hard to explain this to Israelis. It’s really almost beyond belief.

Is there anything good about health care in the United States?
There are particular things in U.S. health care delivery, for example, innovation, that are good. The FDA doesn’t always do a perfect job, but I think it’s getting better at making sure that drugs are safe and effective. Certainly many U.S. doctors are admirable. Learning from them and from particular institutions and hospitals is something that Israelis and people from other countries do all the time. But I don’t think these things depend on the way that health care delivery as a whole is organized—or rather has failed to be organized in the U.S. The U.S. doesn’t really have a system. It has a non-system.