November 2009

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Israeli Health Care: A Model for the U.S." CBN.com investigates.

Socialized Medicine in Israel
Why I Loved Visiting My Doctor in Jerusalem.

-- Rabbi Reba Carmel

Americans who hold dual Israeli-American citizenship often engage in the never ending ping-pong game of ““x” is better in the old country” – whichever country one may have emigrated from – to which the second or third generation native would volley “No, “x” is better here;” and so on. For the small stuff, the game generally ends in the Talmudic ‘taiku’ or draw. But for the big stuff, the issues that are approached in different ways in the two countries, we could learn from each other if only we would listen to each other and consider adopting that which is helpful.

Health care provides an instructive example. Israel’s health care system is fully subsidized by the government; it is socialized medicine. There are three HMOs, each of which offers a ‘basket of benefits,’ which are fairly comparable. The differences between the three are often administrative – such as location of doctors or ease of getting appointments. Each HMO assesses a monthly fee for coverage of every Israeli citizen; the fee increases as the member ages. One can purchase additional benefits within each plan – such as alternative care, occupational therapy benefits and so on.

In addition to the monthly fee, every Israeli employee is assessed a health tax which is determined by income level. A person earning a higher salary is assessed a higher health tax which is separate and apart from the income tax assessed. On the whole it is fairly costly. But – and here is the biggest but – every Israeli citizen has at least basic health insurance. Every Israeli citizen has access to a physician and a hospital when needed. Society bears the cost of insuring its members.

Clinics throughout the country care for children until the age of three. These ‘tippat chalav’ (literally, drop of milk) clinics inoculate children, educate their parents and serve as a resource for informal parent support groups.

The health basket also includes prescription medication. Admittedly, the cost for pharmaceuticals has increased over the years. Arguably, there is medication which should be included but is not; citizens lobby the Ministry of Health vigorously to have access to cutting edge medication. Sometimes they succeed and at other times, they do not.

All physicians in Israel must participate in the country’s HMOs. That means that theoretically, everyone will have access to world class health care. Admittedly, in reality access will not be the same for a citizen relying solely upon the HMO as for someone who can pay privately. The former may have to wait longer in a non-emergency situation. But that citizen will receive care. The system functions on three levels – the purely subsidized, the quasi-private and fully private. For a surgical procedure, for example, a patient can rely upon the physician/specialist on duty at a particular time and the surgeon of choice will oversee the beginning of the procedure and sign off at the end as the surgeon of record. Or, a patient can have a participating surgeon of choice and his/her team perform the surgery for an additional cost at a public hospital. Or, a patient can enter a private clinic and have the surgery performed entirely at his/her cost. It is a three tiered system.

I am not adverse to that type of system. People can use their resources however they choose. But the overarching value is universal coverage.

I loved my doctor in Jerusalem because she loved her patients. A family medicine practitioner, my doctor arrived in Jerusalem from South Africa about 15 years ago. Over the years her administrative duties increased because the HMOs sought to reduce their costs. The HMOs demanded that patients be seen for only ten minutes, as opposed to the 15 or 20 that had been the norm only a few years before, that only a certain number of imaging tests be administered monthly and so on. They required that the attending physician update the patients’ records by computer while he/she was assessing, examining and diagnosing the patient – all in ten minutes!

Doctors approached these requirements differently. One pediatrician I knew held to the ten minute appointment schedule, if that. Patients thought he was fabulous – in and out. BUT he was always available by cell phone. In contrast, my doctor dealt with these requirements another way. No matter how crowded her waiting room (it was!) or how harried she felt (very), she never lost sight of her sacred duty to heal the sick. So we waited for her, and it was fine. She circumvented the computer/administrative requirement by hiring a nurse to do patient intake. This enabled her to read the nurse’s report before seeing each patient, which provided her with the focus and energy to actually concentrate on the person sitting before her. She would complete the computerized record after the patient left. If a medication was not included in the HMO’s basket of medication, she always found a comparable substitute. She worked within the system, but to the extent that she was able to creatively manipulate it to serve patient need, she did.

I have been back in America for a bit over a year and only now, in the midst of the health care debate, am I absorbing the appalling fact that insurance companies let people die; that decisions are made for reasons that have little to do with the patient. I find it shocking that age, income, and race often determine the value of a human life, or at least, the value of caring for it.

Before our elected officials decide how to vote on including a public option in health care reform legislation, I would urge them to look into the eyes of their constituents and tell each citizen whether his or her life is worth healing. Without a public option an unforgivable number of our citizens will remain uninsured. I hope public officials will recall that their mandate is to serve; a physician’s is to heal; and there is nothing more sacred than a human life.

Rabbi Reba Carmel, a former labor law attorney, has taught adult education both formally and informally in Jerusalem, Sydney and the greater Philadelphia area. A freelance writer, she is currently teaching in a variety of settings including synagogues and multi faith groups.

Israel Project's Panel of Experts Discuss Israeli Medical System.

As Americans began debating various proposals for health care reform over the summer months, The Israel Project (TIP) put together an hour long conference call on “Healthcare in Israel” to provide an overview of the universal health care system in Israel. Participants heard the views and experiences of three distinguished scholars and doctors, two in Israel and one in America. They were:

Dr. Alex Leventhal, Director of the Department of International Relations, Israel Ministry of Health

Dr. Bruce Rosen, Director of the Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute (Israel)

Stephen Zuckerman, Senior Fellow, Health Policy Center, The Urban Institute (Washington, D.C.)

The program was organized and moderated by TIP.

For extensive resources on this topic click here.

For the transcript and downloadable MP3 audio of the June 24, 2009 conference call, click here.

To view previous editions from our Israel section, please click here.

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