Seven reasons why it will not in the US.
As Israeli citizens, Marcia and I enjoy Universal Healthcare here. It works well and it is not expensive. Prescription drugs are also much less costly than in the US too. Many in the US point to Israel (especially after Romney’s visit) and to Europe and Canada and conclude, “If it works there, it will work here.“ Since so many Canadians and Europeans (and even Saudis and Turks and Egyptians…) of means come to the US for important surgery, it’s not that clear that Universal Healthcare really “works” in Europe and Canada.
But this post discusses why the Israeli system’s success will not translate well to America.
Reason One: In Israel, everybody pays. That’s right. Even though there are many rich people in Israel, and while you can find demonstrations damning them for their success almost any day in Tel Aviv, the system does not hold them totally responsible for the care and feeding of others. It demands that every participant in healthcare pays something. Now, the costs (taxes) of healthcare are “progressive.” The bigger your home or apartment, the more money you make, the more you will pay for the same access and services as your less fortunate neighbor. Just the same, every Israeli citizen must pay a minimum each month toward the upkeep and viability of the system. In the US, the “unfairness” of this policy is the stuff of magnificent rhetoric. Liberals waved the flag and many so-called conservatives have followed. The healthcare entitlement train is off and running with Obama-care, But the Israeli model is no justification, and one of the reasons is that in Israel, everyone pays.
Reason Two: Hamosad Bituach Leumi, The National Insurance Institute.
In 1995 the National Health Insurance Law [in Israel] came into effect…the law set out a system of public funding for health care services with a progressive health tax, administered by Bituah Leumi. (link)
In Israel, it seems that every adult citizen cannot avoid making at least one appearance in person to register with the National Insurance Institute. The institute also accepts payments and keeps precise track of every system member. By law, citizens must record changes in personal information with the institute including banking info, address changes, phone numbers, credit card info and current earnings. In theory, some of this can be done by phone or mail. In practice, the branch offices are swamped. Although I’ve never suffered at the Bituach Leumi office in Jerusalem, I can attest that a typical visit there will shock the average American’s system. Language issues aside (which is no small thing), a visit begins by…
- queuing up outside the building (yes, on the sidewalk) to gain access
- answering questions, once up front, about your reason to visit
- waiting while anything you are carrying is searched
- pass inside through a metal detector (like the pre-body-scan old days at US airports)
- lining up again to get a number then moving to a crowded room to wait for it to be called
In the waiting room you’ll find crying babies, people reading prayer books, confused immigrants (like me) and a battery of overworked civil servants with computer consoles ready, eventually, to keep up with every detail of your life. Can you imagine George Clooney, or Donald Trump standing in such a line–much less a US Senator or Congressman?
Reason Three: Israeli doctors are not entrepreneurs, they are ordinary employees. In Israel, a patient can schedule an appointment with a doctor on line. Usually, the appointment can be set for the next day. Here is the amazing part…
Your appointment is typically set to last no more than 15 minutes! It will usually occur on time and take no more than the allotted time. That sounds tight but think, you will see your doctor for fifteen whole minutes. The doctor has an office but no array of waiting rooms. He calls you in, scans your plan card, performs an exam, writes prescriptions and, if there are any problems later, you can call his cell. He does not have a team of nurses to line up the masses and tell each to strip and wait for a three-minute audience. Neither does he own a medical lab nor hold a financial interest in an X-Ray or Cat Scan business on the side.
The doctors in Israel are competent. They work long hours, usually in more than one location and they are accessible. They prescribe GENERIC drugs. Can you envision the average American AMA member punching a clock in the US and forgoing beneficial relationships with drug companies? Working without a staff? It won’t happen.
Reason Four: It appears that in Israel, fraud is not an integral component of the system. No drug steering, no scamming the government or insurance companies with false charges or unneeded tests. These are of no benefit to an employee-doctor.
Reason Five: High skill and intense common cause. As alluded to above, most Israeli doctors are Jews (there are fine and dedicated Israeli Arab doctors practicing here as well), and they are generally very accomplished (our dentist lectures at Harvard), obviously having staked there claim in Israel for reasons other than largess. Israel is a small country of immigrants, mostly Jews who, despite their differences, share an overriding sense that Israel is our best and only hope. The doctors seem not to feel that Israel can withstand any abuse they may expose her to in order to get rich. Can you name any subset of American culture, other than the armed forces, that links its behavior to America’s survival?
Reason Six: Israel is “manageable” in number. The US population is 309 million; Israel is 7 million, smaller than 12 US states. As such, and because it is a Jewish state, it is not only smaller but, despite the fact that five languages are regularly spoken here, much less diverse. It defies common sense to expect that a solution that works well for the Israeli population would serve equally well a population over 40 times larger.
Reason Seven: Doctors in Israel are much less concerned about lawsuits. They can practice medicine as they see fit, not as a continuing exercise in defense against malpractice suits.
With all its problems, America’s healthcare system is still enviable in quality and sophistication. It fits the American culture and would be better improved by reforms that are amenable to capitalism and diversity than groping for social medicine. The success of the Israeli system does not stand as a compelling argument for the potential success of Universal Healthcare in the states.