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By Ira Sharkansky
 JERUSALEM—Hot buttons excite intense emotion. They stimulate opposition to something felt very important by many people. Abortion, coverage of immigrants, death committees, and rationing are among the hot buttons being pushed by those who do not like U.S. President Barack Obama's health bill.
The arguments implicit in hot buttons may have little to do with reality, or a reasoned consideration of benefits and costs. They are not only American, and do not occur only in connection with health. Because of their prominence, however, it is worth considering a few of those clogging our inboxes.
Coverage of illegal immigrants. The reasons for opposing this is the fear of adding to health costs, and incentives for the poor of the world to sneak into the United States. One cannot be sure of things in this undocumented corner of society, but the infirm are not prominent among those who migrate illegally.
The typical immigrants are young, most likely healthier than the average in their place of origin, and migrate in order to work. When they do find themselves in need of medical care, it may be because the work they do is harder, more dangerous, and less healthy than what is desired by legal residents, as well as being paid less than legals are willing to accept. Should not the society that attracts them for unpleasant jobs also pay for their medical care?
Death committees. This is the hot button label for considering the effectiveness of treatments. Without sifting through the thousand pages of the proposal, and making some guesses about what will survive a presidential signing ceremony and subsequent administrative rulings, one can soften the language and discuss professional assessments about the worth of medications or other kinds of care, for the conditions
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presented by individual patients. This is an area not easily covered by rules, insofar as professional judgment is essential. Extreme cases are easy to describe: an expensive treatment that might prolong the life of a terminally ill patient for a short time. Physicians and insurance companies already weigh benefits and costs, without labeling themselves Death committees. There are disputes among the professionals, as well as patients and families who want every opportunity to live longer. In a program that will be funded by the public, it is reasonable to require that costs and probable benefits enter into decisions.
Abortion. Why not? Prohibition of public payment for abortion, like the earlier prohibition of alcohol, expresses religious values. What happened to the separation of church and state? Abortion is a recognized medical procedure. Human life is an important value. Existing laws and court decisions deal with late term abortions, and the rights of physicians and other professionals not to involve themselves for reasons of conscience. Similar provisions can apply to a public program that pays for abortions, just as it will pay for other treatments that patients desire for their physical or emotional well being.
The hottest button currently on the Israeli scene is settlements. Like those discussed above, this one comes to political prominence from the White House. It also shows the president's capacity to produce the opposite of his intentions.
It is hard to think of something more naive than demanding the stopping of settlement construction by a settlement-oriented Israeli government, in the presence of a population convinced that there is no mileage in yet another effort at making peace with the Palestinians currently in power. The real rate of settlement increase is not all that clear on account of Israeli officials expressing themselves in ways to minimize offense to the American president, as well as to enraged settlers. Obama has increased the prominence of the issue among Israelis, and may well increase the tempo of building.
Politics without hot buttons? Not when an issue provokes fears and intensity. Then justice and rationality take a back seat to political realities, and pave the way for fuzzy terminology, disinformation, and the feeling that "he lies."
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