THE SPINE MAY 20, 2010
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Not a single person is excluded from the system. The non-citizen Arabs of Jerusalem are included in it. The ultra-orthodox Jews, who barely recognize Israeli sovereignty (after all, God did not grant it), use it, probably to excess.
As the United States embarks on its new medical venture, it might be interesting to read an article in the Jerusalem Report of May 2 on the universal health coverage which Israel provides.
Here are seven salient paragraphs:
From the perspective of the bottom line, the figures are impressive: Israel’s per capita health costs are half those of the United States, and the country expends a much smaller proportion of its GDP on health care, yet it provides universal health coverage, and top-notch, technologically up-to-date care. Its outcomes in many areas are superior.
Compared to the US, Israel has more physicians per capita, a lower infant mortality rate, higher life expectancy, and lower rates of cardiovascular disease. The country has the highest number of IVF units in the world per population, and is near the top of the lists of transplant units per population and overall physicians per population.
Although not without its flaws, and always with room for improvement, surveys indicate remarkable general satisfaction with the health care system; a survey conducted every two years by the Myers-JDC-Brookdale Institute consistently shows 88 percent of Israelis report a high level of satisfaction with their health plans.
Notably, that figure is even higher among minorities: The percentage of respondents who were satisfied or very satisfied was highest among Arabic speakers, at 94 percent. “The health system in this country is in good shape, by any measured parameter, in both accomplishments and containing expenses,” says Kobi Glazer, a professor in the Tel Aviv University School of Management, specializing in Health Economics.
In fact, a study that the Pittsburgh Regional Health Initiative (PRHI), a consortium of medical, business and civic leaders in Pennsylvania, commissioned in the autumn of 2009, concluded that the US and other countries might do well to learn from the Israeli health system. “Israel’s healthcare system has significant relevance and important lessons to lend to healthcare reform efforts in the United States,” says Bruce Rosen, director of the Smokler Center for Health Policy Research at the Myers-JDC-Brookdale Institute, who participated in the PRHI study.
“US health reform debates have been about the best ways to move toward a more integrated model, through which payment is aligned with care delivery and that targets safety, efficiency, access, and quality. Therefore, as the US moves to strengthen primary care, contain costs, and require multi-provider accountability for coordinated high-quality care, there is much to learn from Israel, where these concepts are already at work.”
Despite widespread misconceptions, the country’s health care system is not a socialized, single-payer system. Israelis generally accept as almost axiomatic that there should be universal health coverage, with a significant acceptance of government involvement in regulating health care for the sake of redistribution, accountability, and preventing competition from leading to uncontrollable cost overruns. At the same time, there is also recognition of the benefits of keeping a strong measure of competition in the system. This has led to what Glazer describes as “regulated competition”: universal state-financed insurance coverage is provided through four competing health-maintenance organizations.
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27 comments
Let's see one and many miss your point and spend the majority of their post time slagging you. Good, solid post for sure.
- basman
May 20, 2010 at 11:10pm
Nevertheless when some I try to explain the need for health care here to my proIsrael friends on the Right they assure me that "to each from each" is dead and buried and the only way is the "American" way, ie apparently, make lots of money so you can afford health insurance or else. It gets confusing.
- Sophia
May 21, 2010 at 12:47am
I suggest that y'all read the full article linked-to by Dr. MP as it will be clear that the Israeli system is far from perfect and has its flaws & limitations. There are also some severe problems looming in the not too distant future about which I have doubts that the system as it stands will be able to handle. I also often wonder whether the system will be economically sustainable over a long haul of 3-4 generations. An example of the system's also advantages and limitations: My oldest daughter's best friend (and we are close friends with her parents) was diagnosed about 9 months ago with non-Hodgkins lymphoma received state of the art treatment, including therapeutic monoclonal antibodies which cost thousands of $$ per treatment. Her father, himself a neurologist (which was irrelevant to the quality and quantity of care), always critical about everything was very pleased with the treatment, although both father and daughter (she's a med student) were and are angry over an initially botched diagnoses. However, the antibody therapy is only funded for acute treatment. If she ends up needing it for long term chronic care then they will have to fund it themselves. If there is further interest expressed here on more of the ups and downs & trade-offs of the Israeli health care system I'll try to find the time to expand on it. Some looming problems: A severe shortage of hospital beds especially in the periphery of the country and especially during flu season which sends many elderly to the hospital. Also there are already shortages of docs in certain critical specialties, notably anesthesiology. The system is also squeezing out the small or medium size private pharmacist. One other matter. The article mentions an assessment made of the Israeli system by a group that included (and quoted) one Bruce Rosen. I know Bruce from way way back when he was 10-11 years old and participated in a synagogue youth group I led. More importantly, I am reasonably certain that Bruce was deeply involved in the design of the current system during the early 90's. Hence his statement on how wonderful it is should be taken with a grain of salt. But only a grain. Or two. Hershel Ginsburg Efrata / Jerusalem P.S. Haddassah Medical Center in Jerusalem is trying to exploit the relatively high quality & low cost care there (and the presence of a hotel built on the hospital campus) to push medical tourism (see e.g., here). For a while, El Al had a section on its web site also featuring the medical tourism connection with Hadassah but seems to have gone by the wayside.
- ginzy
May 21, 2010 at 6:42am
basman, I accept that challenge: "The ultra-orthodox Jews, who barely recognize Israeli sovereignty (after all, God did not grant it), use it, probably to excess." What is it with the snide "probably to excess." What evidence is there that ultra-orthodox are either sickly or hypochondriacs? It is like Marty can't help but belittle someone in every post completely unnecessarily. ginzy, sorry about your best friend's kid. Two girls I grew up with died early deaths due to leukemia. Nothing keeps me up more at night than worrying about my kids so I really feel for your friend.
- blackton
May 21, 2010 at 10:32am
blackton: "What evidence is there that ultra-orthodox are either sickly or hypochondriacs? It is like Marty can't help but belittle someone ..." Yes, that was a secular-snipe that POSSIBLY is rooted in the American "observation" that ultra-Orthodox marriages generate an unusually high rate of hereditary diseases in the offspring. ginzy, Good Shabbos by now, but I also wish your friend's daughter well. It is so very difficult to even diagnose non-Hodgkins lymphoma. I am at high risk, and have decided to ignore the whole thing after two different specialists (seen for care within their specialty, but I took the opportunity to ask) decided the swelling under my left armpit since last October was outside their specialty. My solution to America's healthcare cost crisis is to seek as little of it as possible to avoid any more damage from the tunnel-vision of hyper-specialization.
- K2K
May 21, 2010 at 12:59pm
blackton: "What evidence is there that ultra-orthodox are either sickly or hypochondriacs? It is like Marty can't help but belittle someone ..." Yes, that was a secular-snipe that POSSIBLY is rooted in the American "observation" that ultra-Orthodox marriages generate an unusually high rate of hereditary diseases in the offspring. ginzy, Good Shabbos by now, but I also wish your friend's daughter well. It is so very difficult to even diagnose non-Hodgkins lymphoma. I am at high risk, and have decided to ignore the whole thing after two different specialists (seen for care within their specialty, but I took the opportunity to ask) decided the swelling under my left armpit since last October was outside their specialty. My solution to America's healthcare cost crisis is to seek as little of it as possible to avoid any more damage from the tunnel-vision of hyper-specialization.
- K2K
May 21, 2010 at 1:00pm
blackton challenge met: on the point you, make I take your point. But that snide comment--Peretz's--is kind of beside my point, I say, even as I agree with you.
- basman
May 21, 2010 at 1:02pm
My memory of the health care debates here at TNR (and elsewhere) a few months ago was that there was fairly extensive explanation of, and commentary upon, systems that obtain in other advanced countries, including Israel. So I'm wondering about the journalistic relevance, at this moment, not about the general content.
- ironyroad
May 21, 2010 at 1:49pm
irony, " journalistic relevance, at this moment," I guess Peretz is checking on the portability of his health insurance when he spends a year teaching in Tel Aviv?
- K2K
May 21, 2010 at 7:54pm
Gee, I don't think the relevance of Peretz's post is to add to the American conversation about its health care. Me, I kind of inchingly incline, tentatively, to be on the periphery of tending to begin to sense, only provisionally, that he's making a point about Israel itself. Could that be so?
- basman
May 21, 2010 at 11:03pm
But then, if it is so, so what? What's the point of that point? A factual description of the Israeli heath care system, despite its closeness to "Israel itself," seems to wander among the stars and the galaxies looking for a home, as indeed a random description of the Peruvian, Hungarian, or Australian systems would do.
- ironyroad
May 23, 2010 at 3:46am
The home is the argument for Israel as has been, and is being, made on this blog. For that home the stars, the galaxies, Peru, Hungary and Australia are not to the point. Consider this: "...Not a single person is excluded from the system. The non-citizen Arabs of Jerusalem are included in it..." You, as a reader of texts, are letting me down mightily.
- basman
May 23, 2010 at 6:05pm
Sorry, basman, but it's like an argument in which the point is hidden even from those who might agree with the argument. If the point is, however, that the Israeli national health system operates on a far more inclusive and socially responsible basis that ours does, than I have no problem with that. I think that might be it?
- ironyroad
May 23, 2010 at 9:54pm
Irony no apologies needed. I was just twitting about being let down mightily. I think Peretz is saying that the Israeli health system is more inclusive and socially responsible then America's. But I also think that certain themes run through his blog and it's a mistake not to see what he says in this post as being of a piece with his general extolling of Israel. That then links up with his geopolitical anlaysis concerning it and that includes his comparisons of Israel to the states and societies in its neighbourhood. I think that that implicit comparison is actually more central to his post than what the his long title and some of the commenting asides suggest about its comparison to the American system. I could see that being a contestable view, though.
- basman
May 23, 2010 at 11:40pm
Faire en ouef.
- ironyroad
May 24, 2010 at 2:47am
Let us try and re-produce Israel's socualist experiment on the United States. Also, let us put America's resources to heal and protect Americans, not Jews and Arabs in the meddle (oops middle) east. That an idea?
- NR027810
May 24, 2010 at 12:40pm
...Faire en ouef.... ? I speak 15 langauges, English and 14 known only to me. Help me Wanda.
- basman
May 24, 2010 at 2:38pm
Fair enough.
- ironyroad
May 24, 2010 at 2:43pm
Aahhh. I'm one of the slower fellahs.
- basman
May 24, 2010 at 10:08pm
basman, you probably know this one, but still: A doctor, a lawyer, and an engineer are sailing in the Pacific and are shipwrecked on a small treeless atoll, without food, about 10 minutes swimming time away from a larger island that looks promising. The sea around the atoll is clearly shark-infested, however, and the guys have a problem deciding what the best thing is to do. The doctor reckons he can fix up minor injuries if everyone makes it to the farther shore. The engineer thinks he can rig up a raft of some kind if they can get to the bigger island with the trees. The lawyer doesn't have an immediately useful skill, but he says that he's up for the attempt. They draw straws, and the doctor gets the shortest. So the doctor goes first -- no good: the sharks converge on him, he starts to swim back, but soon there is just a trace of blood floating on the surface of the sea. The other two guys look at each other in horror. The lawyer says, no matter what, we can't stay here. He dives into the sea, the engineer looking on nervously. The sharks approach, and suddenly they all line up each side of the lawyer like a guard of honor and practically escort him through the waves to the bigger island. The lawyer reaches the shallows, walks up the other beach and waves. Much encouraged, the engineer jumps in and starts swimming. Within a few minutes, however, the sharks converge on him and start to attack. Just before he's dragged under and eaten, he has enough strength to call plaintively to the lawyer, "How did you make it? Why did they do that for you?" The lawyer shouts back from the beach, "Professional respect, I guess."
- ironyroad
May 25, 2010 at 2:46am
Ginzy had offered a version of this joke at least twice when speaking of Rahm Emanuel. It is known, Ginzy said, that when Rahm goes swimming in shark-infested waters, the sharks flee for their life.
- noga1
May 25, 2010 at 9:26am
I'd say that's definitely the kind of story RE wants to have spread around!
- ironyroad
May 25, 2010 at 12:22pm
Yeah, my short version of that joke is: Why did the shark let the lawyer go by? Professonal courtesy. On a more serious note: it would be a tragedy of our times if RE wants to have that spread around. On a less serious note: Sam wants to join a fancy golf club. He says to his wife of 43 years, "Sadie, we're going to a test dinner at the club. You have to be more sophisticated. When they ask you what drink you want, don't say Manischewitz." Sadie asks Sam, "What should I say?" Sam says, "Say you want a martini." So they go to the dinner. After the sommelier gives an extensive discourse on the wine and spirits selection, Sadie is asked what drink she'd like to order. She says, "A martini." The sommelier asks, "Dry?" Sadie says, "No, one will be fine."
- basman
May 25, 2010 at 2:08pm
I prefer the long version. The martini joke is in Olivia Manning's entertaining trilogy (?) of novels set in the Balkans just before and during WW2. In Romania, which is still neutral but tilting Axis-wards, the Brits and the Germans are jockeying for influence. The Germans start increasing their diplomatic and consular presence massively in Bucharest, to try to show who's in charge of events. One of the characters is walking into the Hotel Athena and says disgustedly to another Brit: "This place is flooded with Germans now. It's got so bad, when I asked the barman last night for a dry martini, he gave me three martinis!"
- ironyroad
May 25, 2010 at 2:35pm
Faire en ouef.
- basman
May 25, 2010 at 3:09pm
Fairy Nuff.
- noga1
May 26, 2010 at 8:51am
Basman: I went to the movies last night with my daughter to see a silly movie with Vanessa Redgrave (one of my favourite actresses ever..) and in the coming attractions there was a trailer for Barny's Version. It's with that actor who played President John Adams in the HBO series and was also in Sideways. Yes, Paul Giamatti. Dustin Hoffman was there, too. Seems promising. Mrs. P (Minni Driver): Do I embarrass you? Barney: Yes Mrs. P: Do you have an MA? Barney: No Mrs. P: Do you see me embarrassed? Is it in "Barney's Version" that Duddy Kravitz makes an appearance?
- noga1
May 26, 2010 at 9:06am