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The Jewish Ethicist  - Almost Poor

The Jewish Ethicist - Almost Poor

Helping the "not-quite-poor" with credit and discounts.


Q. Our medical institution gives free care to the indigent, and those with health insurance obtain care through their plan. But what about people who aren't really poor but don't have the means to get really adequate insurance? They fall between the cracks.

A. The problem of the "almost poor" arises in many contexts. Recently, Harvard College extended its financial aid package to solidly middle-class families. They concluded that the college had become a place for the rich (who can afford it) and the poor (who are eligible for extensive aid), but had emptied out of the middle class.

This problem exists in Jewish law as well. In fact, the mishna specifically states that there is a sharp boundary of eligibility for charity:


One who has 200 zuz [an amount sufficient for basic expenses for a year] may not take the dropped or forgotten sheaf, or the corner of the field [all these must be left for the poor] or the poor tithe. If he has even one dinar less and he is given even a thousand [zuz] in one sum, he may take it.


If [his assets] are liened to his creditor or to his wife's ketubah [support in case she is widowed or divorced], he may take. We do not compel him to sell his house or his [essential] furnishings. (1)


This is similar to your case: an impoverished person is entitled to free medical care, which can easily be worth five times a year's living expenses (the example given in the mishna). But a person who is not impoverished is entitled to nothing!

However, there are various alternative solutions to this problem.

First of all, we need to recognize that even in the case of the impoverished, Jewish law favors loans over gifts, at least when it comes to large amounts of aid. The dropped or forgotten sheaf and the corner of the field are generally small amounts which are enough only for subsistence; even the poor tithe is not usually a huge amount, and a thousand-zuz gift would be very unusual in practice. The very Torah verse which admonishes us to take care of all the needs of the poor speaks of loans, rather than outright charity:


When you will have a needy person from one of your brothers, in one of your gates in your land which the Lord your God gives you, don't harden your heart and don't shut your hand to your needy brother. Surely open your hand to him and lend to him enough for his needs, which are lacking to him (Deuteronomy 15:7-8).


So one practical solution is to offer people of limited means credit, by means of generous repayment terms, even if they are not eligible for a discount.

Another important consideration is that the commandment of charity is precisely "enough for his needs, which are lacking to him." Normally, a person with enough assets for subsistence is not needy, but a sick person has much greater needs. In this case, we fulfill the charity obligation even when we give to a person who would not normally be considered "poor", because in relationship to their extraordinary needs they are indeed lacking. So if it is possible to extend eligibility for aid to middle-class people who have extraordinary expenses this would be desirable

There is also an additional factor at work. Officially your practice defines the regular price as "full price", whereas indigent patients are treated pro bono. But in many cases the reality is that regular patients pay more than what the practice would charge if there were no pro bono cases, so in effect they are making two payments: one is a charge for service, the other a subsidy payment for poor patients.


"Poverty" has to be measured in relationship to a person's needs, and some medical treatments are enough to impoverish even a middle class family.


In this case, it would be fair to charge the patient of limited means only the "true" charge. (This is not the same as "at cost" since you are not deducting your profit, only the subsidy portion.) Jewish law has a clear analog to this. In general every person has to give charity; the most common custom is to give a tenth of one's income by analogy to the poor tithe the Torah imposes on farmers. If a person is poor, then instead of giving charity he receives it. (Jewish law actually states that even a poor person who lives on charity has to give a token amount to charity, (2) since giving charity is a basic human need which is itself "his needs, which are lacking to him".)

But there is also an intermediate category of someone who is not rich enough to give charity and not poor enough to get it. It is appropriate to charge such a person the fee that would apply if there was no need to subsidize poorer patients.

Jewish tradition encourages generosity towards others and obliges us to provide for the poor, but it also educates us to strive for independence. There is no general obligation to give charity to those who are able to make ends meet, even if they have to struggle a bit. But it is certainly desirable to help such individuals out with credit. In addition, "poverty" has to be measured in relationship to a person's needs, and some medical treatments are enough to impoverish even a middle class family. So when expensive treatments are needed even such a family may be considered "needy" for the purposes of giving charity.

Finally, while the almost-poor aren't eligible to receive charity, they are also not obliged to give it (beyond a token amount). So it is desirable to give such individuals a "discount" to credit them for any part of the regular fee which you would consider a kind of subsidy to enable you to provide pro bono services.


SOURCES: (1) Mishna Peah 8:8 (2) Babylonian Talmud Gittin 7b.



The Jewish Ethicist presents some general principles of Jewish law. For specific questions and direct application, please consult a qualified Rabbi.



January 19, 2008

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Visitor Comments: 9

(9) angela, November 23, 2008 11:04 PM

a sudden and unexpected illness hit our son this summer. the medical bills began to accumulate. then my husbands work truck, our primary source of income, failed. we were force to take a loan out to repair the work truck and now we find our son needs an expensive surgery which our insurance is tring to deny us. we have already morgaged our home to cover the work truck loan. now it seems we will not have the necessay funds to afford our son surgery. god help us...

(8) eliezer, January 29, 2008 7:17 PM

too expensive to be jewish

we struggle to send 3 children to jewish school. we make many saccrifices and quire frankly it sucks. its almost cost prohibitive. tuition, shabbat meals, yontif and kosher food. it would be nice if some of the big donors gave to schools instead of the zoo and symphony. the goyish schools require a financial commitment, but dont overwhelm the entire family budget.

(7) Embi, January 22, 2008 5:48 PM

Dealing with the squeeze

Thank-you so much for a very interesting response to this issue. I grew up in a middle-class household where my parents made many sacrifices to send my brother to a Jewish school - and pay for it, albeit on a fortnightly basis (as we never had the lump sum to pay for the school fees at the start of each term). They were alternatively sent financial aid forms and letters requesting donations to help the school educate the children of poor families - as if the school couldn't decide which category we were in. Eventually we realised that we were probably the only family paying full school fees who were not in a position to make additional donations to the school. Which made us wonder what happened to the other middle-class families - did their children miss out on a Jewish education as they could not afford to pay the full school fees but they felt it was wrong to ask for help as they were not 'poor'? With school fees rising faster than wages (at least in Australia), this has become an even bigger issue over the past decade and I don't know how or if we are going to pay for our children's school fees. I like your response about a discount to cover the subsidy portion of the regular fees - and hope it is an option taken up by the Jewish schools here.

(6) Jerrold, January 22, 2008 4:48 PM

day school fees

This article leads up to another major issue that is rendering much of the middle class of American Jewry into the 'virtually poor' -- day school fees. A very difficult subject indeed, and the source of crisis of middle class families throughout North America.

(5) Jacqueline Mamoni, January 22, 2008 11:48 AM

How i was raised..

G-d helps those who help themselves.
Each day one must improve themselves in no matter how small a way.When my mom was dying of cancer she was still reaching out to help her children..I wont allow myself to be any less of a person.. I have met many people that are always ready to take but dont see that giving is a greater goal, its seems they have become so acustomed to open palms...I honestly think its how a person is raised that really determines this..Lastly i think it is society and gov and its actions that allows this to grow as they tax and tax those who can barely afford it and give to those that couldnt care less about giving anything if not just paying their bills, "waste not want not" is sucha powerful thing..OK ok so im a Libertarian..When my grandparents came here before the depression the first thing they wanted to do is plan to buy and OWN land,only to find its not possible here either.. I need to ask Rabbi Salkow about this topic..

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