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    Israel as a Model for Health Care
    July 30, 2009
    Israel | Social Action (10 comments)

    by Jill Zimmerman
    Eisendrath Legislative Assistant at the Religious Action Center
    (Originally published on the RACBlog)


    As Congress is working to reconfigure our country's health care system, many are pointing to health systems overseas as examples. Israel has one of the most advanced health care systems in the world, and rivals the United States on everything from quality to cost to coverage.

    I recently listened to a podcast by the Israel Project in which Dr. Rafi Cayam (Leumit Director of Medicine for the Jerusalem District) and Professor Shlomo Mor Yosef (Director-General, Hadassah Medical Organization) explained how Israel's health care system works.

    According to Dr. Cayam and Prof. Mor Yosef, Israel's health care system has four key components: (1) universal coverage; (2) cradle to grave coverage; (3) coverage of both basic services and catastrophic care; and (4) coverage of all medications. Patients pay just a small co-payment to see specialists and to purchase medication, and primary care is free.


    So, Israelis seem to have it pretty good: access to all their medical needs at a nominal fee! 

    But they must spend a fortune, right? Not so. All this costs about 8% of Israel's GDP, while the U.S. spends a whopping 17% of its GDP on health care. 

    Israelis pay a health care tax of 4.8% of their incomes, and in turn they can join one of the four Israeli HMOs. Costs are contained a number of ways, including covering only procedure that make sense for you (Cayam calls this "rational medicine, not rationing medicine") and electronic medical records in 90% of physicians offices, compared to 15% in the U.S.

    Well, they definitely don't have high quality of care then, right? Nope. According to the latest World Health Organization statistics, Israel has a life expectancy of 81, ranking in the top 14 in the world, and ranked higher than average in most categories compared to the U.S. and Europe. 

    Israel's first rate doctors attend six years of university, complete a one-year internship, spend five to six years at a residency, and many go on to fellowships in other countries. The Ministry of health issues quality-control measures to the HMOs, testing them at least twice a year.

    Now, I'm not going to get into too many details of how Israel's health care system runs - for that, you can listen to the podcast. I think the most important lesson to be learned is by looking at Israel's priorities in health care. They provide universal access to care while maintaining high quality and controlling costs. Sometimes this means you have to wait a little bit to see a specialist, or purchase supplemental insurance from your HMO to cover extra physical therapy sessions or a elected surgery, but the result is an overall healthier population at a lower cost. 

    Unfortunately, right now the U.S. health care system looks very little like Israel's. Rising health care costs leave a growing number of people without adequate health care, including the nearly 50 million people who are uninsured. The availability of health care resources is often based on ability to pay rather than need. Finding access to quality health care services is difficult for many. The costs of health care threaten the financial health of millions of individuals and families and the long-term financial stability of our nation.

    Congress has the opportunity to change this in the coming months, and I hope that they will look to Israel to understand how universal coverage doesn't have to compromise quality or cost. Senators and Representatives will return to their home states and districts during the month of August, giving you the opportunity to tell them that we need comprehensive health care reform this year. Israel has figured it out, so why can't we?

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    Comments

    david jacobs said:

    Be careful what you wish for. The culture, political system and life style here is different. Israel also not infested with the vultures (attorneys) that we have here to drive up the costs, big time.

    What are the unintended consequences of this monster legislation?

    There's no free lunch. Our government has proven time after time it can not do ANYTHING better that the private sector. What's different this time?

    It's estimated Medicare looses 25-30% from waste and fraud of every dollar delivered. It's been going on for years and the government is unable to do anything about it. The VA administration also has a bad reputation for government run health care. It's a national disgrace. Medicare will have to change drastically in 6-7 years as the money runs out.

    Do you really want to throw the baby out with the bath water? Why not just fix the broken parts of our current system? We have the best system in the world for 85% of our citizens. Do you really want to throw the baby out with the bath water?

    Be careful what you wish for.


    Hineni said:

    david jacobs gives us living proof that repeating the same cliches repetitively (redundancy intentional -- is his?) doesn't prove a point.

    Be careful that the baby doesn't drown while you're wishing for the same dirty bath water.

    Our society needs to function to care for the most vulnerable, not to protect the pockets of the least vulnerable.

    Three cheers for the good work done by the RAC, and by the President. As a happy Medicare beneficiary, I envy my friends who are covered by the VA. And, by the way, I should mention that some of my best friends are attorneys, so jacobs lost me by his gratuitous crack at them.

    Mark Tasch said:

    "Sometimes this means you have to wait a little bit to see a specialist." I wonder what "a little bit" means. Certainly in larger countries with nationalized health care the wait for specialized consultation and treatment can be unacceptable by American standards, often lethally so. Israel is also a relatively tiny and homogeneous country which in significant ways is not analagous to the U.S. It does not have an enormous population of illegal (and therefore uninsured) aliens and does not have the legal atmosphere that inflates medical costs via defensive medicine. (This is not a personal attack on attorneys.)

    Jody Meyer said:

    If I want an OB/GYN annual checkup, the wait is 2-3 months. A dermatology appt for an annual mole check-up? 2-3 months. If it isn't an emergency, I can wait a few weeks to see my GP. So, how worse could it be with health care reform? I can't get in to see a Dr NOW. Israel does not have a homogenous population, it is an immigrant country whose citizens come from all over the world. It may have a different legal atmosphere, but perhaps that's a part of medical care we need to change.

    Sam said:

    My son lives in Israel. He often says that it is easier to bring a legal case to the Supreme Court of the United States than it is to get good, non-emergency care in Israel. Be careful of what you wish for! Israelis are forced to tolerate what we as Americans would never accept.

    Louisa Rose said:

    The present health care debate is largely governed by special interest lobbying groups buying up politicians and quite successfully spreading propaganda amongst the citizenry.

    Right now there are millions of Americans who don't have to wait for specialist visits. They simply can't afford them. They can't have preventive or routine care.

    Right now, the life expectancy of a child born in Israel is 80.73 compared to the United States which comes in at 78.11.

    https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102ra

    Yes, our statistics reflect the fact we have horrible poverty and financial insecurity in the United States. Pointing that out only strengthens the case for coming up with universal health coverage, something available in other developed nations.

    In the USA, our physical/mental health depends on our financial health,which is not always a constant. People who feel secure financially will often find fault with any effort to create a more just system of health care. Any change will threaten those who feel things are working well for them.

    Two cautious questions: (1)Looking ahead, are you really financially secure? (2) Are you really getting the world's best health care or are you getting the doctor's best financial deal?

    American medicine can do many wonderful things, but it also does too many unnecessary things to people who don't need invasive procedures and medical tests with no proven value.

    Unfortunately, you won't know when you've been sold a procedure you really don't need or a medication with risks for you that are unwarranted.

    We could have the best health care in the world, but we sure don't have it now, even for those who think they're getting it.


    Joyce said:

    It's like comparing the DC subway to the NYC subway and saying how great the DC subway is.

    Rabbi Ruth Adar said:

    I'm no health care expert. I can only speak as a person who lived in Israel for a year, got sick or injured more than once that year, and required treatment by specialists before I got back to the USA.

    It was my "Year in Israel" with Hebrew Union College. I was a "second-career" student of 48, so I was familiar with dealing with insurance companies in the U.S. to negotiate health care for myself and my family. Israel was a shock, in that the concern was about making sick people well, not about wrestling with the insurance companies.

    My DOCTORS decided if tests were necessary. My DOCTORS decided if drugs were appropriate. DOCTORS took time with me, figuring out what was the matter, not just taking a brief look and then running along to the next thing because of some insurance-company imposed time schedule.

    The system there is not perfect, but it is focussed on making sick people well, not on making as much money as possible so that investors can be paid dividends and lobbyists can be paid to influence Congress.

    Yes, I had to wait for some appointments. But here in the states, my waits have been far, far longer, sometimes for more urgent appointments.

    Most importantly, no one was going to decide to go digging back through my files, hoping to find some reason to disqualify me from care. That happens here in the U.S. EVERY DAY, it is standard procedure, and if no one in your family has yet had treatment denied for a serious illness because "oops, you don't have a policy anymore," count yourself very lucky indeed. I'm not speaking from hearsay, I'm speaking from personal experience.

    No system is going to make everyone blissfully happy: health care systems of necessity deal with people in some of their most unhappy moments. But surely we can get something better than the mess we have in the USA today. My own experience is that the Israeli system is much better.


    Benjamin Rubin said:

    I can't wait. Start at 10, coffee breaks, lunch hour, finish at 4 pm. Strikes and no work that week ! Then off to private clinic after hours were they will pay cash on the barrel in Euro.

    Randy Drosche said:

    I would like to have the healthcare afforded to Israel. My wife had to wait 6 months here in the United States for her hip surgery, so don't complain about waiting for services to me, your voices sing in a very low volume. Her test were valued in the thousands of dollars with a collection of baseless scares. The test were extensive and expensive, at least she had employer health care. So how much of the money (billions) that the United States gives to Israel helps to support the health care system and the public or private hospitals there? I fine it very disingenuous for the United States to give money for other countries to support their peoples healthcare and not their own citizens! Congress should pass a universal healthcare bill for the people of its country: the same as other intelligent countries.

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