Second in a series
Halakha (Jewish law) is a normative legal system: It is primarily about good order and governance (what scholars of law call “municipal law”). I teach the halakha of chaplaincy, which is found in some 30 chapters of the section Yoreh Deah [YD] of the Shulhan Arukh, a 16th century digest of halakha so superlative that it is only surpassed by the much fuller treatments found in modern halakhic compendia.
The halakha of chaplaincy is also the halakha of health care. The price of medication, for example, must be standardised. This means a pharmacist cannot create a market for medication by restricting its
availability. It also means that a pharmacist cannot increase the retail price of medication unless the wholesale cost of the meds also increases. The dispensing fee must be in accord with the fees charged by other pharmacists, for this would be the standard.
YD 336:1 states –
Torah permits physicians to heal. This is a mitzva. The general principle is saving a life. One who makes no effort to save a life is a manslaughterer. This is so even if someone else may do so, on the premise that his or her skills are the ones needed to save the life in question.
A I>mitzva< is what G!d Wants us to do. Halakha is how the Rabbinic tradition wants us to do it. This mitzva, however, poses some serious questions:
*What if there are no physicians available to heal?
*What if there are many physicians, each so busy already healing others that no time is available to heal me?
*How much time is it reasonable to wait before healing is available?
*Is it reasonable to impose restrictions on where physicians can work so as to provide reasonable access to health care in small or northern communities?
These questions occur from the inefficiencies of the Canadian singe-payer health care system. The inefficiencies are well-known to anyone living in Ontario, as almost 40% of Canadians (including me) do, because a Conservative provincial government brought with it a L>Common Sense Revolution< that destroyed health care here and devastated also the educational system.
But it was not just a right-wing government provincial government more interested in saving money than saving lives that caused the mess Canadians now face. The federal government had a huge role to play when it went into its deficit reduction mode — and this government was Liberal, which transitioned from centre-left to centre-right. Canadian health care suffered because federal transfer payments to the provinces were reduced by 50%.
It was much easier to refuse funding than to impose fiscal discipline, so the money stopped.
Medical students, however, kept graduating — and the tuition remained low. The current tuition is $21,000 to train a physician at McGill University in Montreal — over four years. The four year tuition at Columbia: $200,000.
This simple math eluded both the federal and Ontario governments. Medical education is 90% less expensive in Canada. The educational standards meet or surpass those in the USA. Canadian medical graduates can write American board exams.
Our top medical students are doing residencies throughout the United States. They’re not always returning. Compounding this issue: the reticence of provincial licensing bodies to make licensure attainable for physicians trained outside North America.
Implicit to the halakha of health care is the assumption of a free market. The halakha, however, also regulates the market — something that was long ago proposed in Canada for medicare and rejected. Price controls were rejected until pharmacare was introduced.
Pharmacare is by no means universal, which is to say that some provinces and territories are more generous with their pharma benefits than others.
An unscientific study suggests to me that Quebec’s pharma program is the most generous in Canada. The only qualification for membership in Quebec’s program is lack of group insurance. I think I paid $9 for a three month supply of ADD medication.
The halakha of health care is too complex for a single post. I’ll continue with it tomorrow
Second in a series
Halakha (Jewish law) is a normative legal system: It is primarily about good order and governance (what scholars of law call “municipal law”).
I teach the halakha of chaplaincy. The halakha of chaplaincy is also the halakha of health care. The price of medication, for example, must be standardised.
Rabbis mostly rely on a digest of halakha called Shulhan Arukh, which in turn is divied into four sections. The section that deals with health care and chaplaincy is called Yoreh Day’a (YD).
In YD 336:3 we learn a pharmacist cannot create a market for medication by restricting its availability. Nor can a pharmacist increase the retail price of medication unless the wholesale cost also increases.
The dispensing fee must be in accord with the fees charged by other pharmacists, for this would be the standard.
YD 336:1 states –
Torah permits physicians to heal. This is a mitzva. The general principle is saving a life. One who makes no effort to save a life is a manslaughterer. This is so even if someone else may do so, on the premise that his or her skills are the ones needed to save the life in question.
A mitzva is what G!d Wants us to do. Halakha is how the Rabbinic tradition wants us to do it. This mitzva, however, poses some serious questions:
- What if there are no physicians available to heal?
- What if there are many physicians, each so busy already healing others that no time is available to heal me?
- How much time is it reasonable to wait before healing is available?
- Are restrictions on where physicians can work reasonable so as to provide health care in rural communities?
These questions occur from the inefficiencies of the Canadian singe-payer health care system. The inefficiencies are well-known to anyone living in Ontario, as almost 40% of Canadians (including me) do, because a Conservative provincial government brought with it a L>Common Sense Revolution< that destroyed health care here and devastated also the educational system.
But it was not just a right-wing government provincial government more interested in saving money than saving lives that caused the mess Canadians now face. The federal government had a huge role to play when it went into its deficit reduction mode — and this government was Liberal, which transitioned from centre-left to centre-right. Canadian health care suffered because federal transfer payments to the provinces were reduced by 50%.
It was much easier to refuse funding than to impose fiscal discipline, so the money stopped.
Medical students, however, kept graduating — and the tuition remained low. The current tuition is $21,000 to train a physician at McGill University in Montreal — over four years. The four year tuition at Columbia: $200,000.
These questions occur from the inefficiencies of the Canadian singe-payer health care system. The inefficiencies are well-known to anyone living in Ontario, as almost 40% of Canadians (including me) do, because a neoconservative provincial government in 1995 brought with it a Common Sense Revolution that destroyed health care here and devastated also the educational system.
A right-wing provincial government more interested in saving money than saving lives caused only some of the mess Canadian health care now faces.
The federal government had a huge role to play when it decided to reduce the federal deficit — and this government was Liberal, which transitioned from centre-left to centre-right.
Canadian health care suffered because federal transfer payments to the provinces were reduced by 50%.It was much easier to refuse funding than to impose fiscal discipline, so the money stopped.
Medical students, however, kept graduating — and the tuition remained (and remains) low. The current four year tuition is $21,000 to train a physician at McGill University in Montreal. The four year tuition at Columbia: $285,000.
This simple math eluded both the federal and Ontario governments:Medical education at a Tier-1 school is 95% less expensive in Canada.
The educational standards meet or surpass those in the USA. Canadian medical graduates can write American board exams.
Our top medical students are doing residencies throughout the United States. They’re not always returning.
Compounding this issue: the reticence of provincial licensing bodies to make licensure attainable for physicians trained outside North America.
Implicit to the halakha of health care is the assumption of a free market. The halakha, however, also regulates the market — something that was long ago proposed in Canada for medicare and rejected. Price controls were rejected until pharmacare was introduced.
Pharmacare is by no means universal, which is to say that some provinces and territories are more generous with their pharma benefits than others.
An unscientific study done today at drugcoverage.ca suggests to me that Quebec’s pharma program is the most generous in Canada. I think I paid $9 for a three month supply of ADD medication when I lived in Montreal.
The halakha of health care is too complex for a single post. I’ll continue with it tomorrow in Part 3, Medicating in Montreal.
