From August 14, 1975 until February 7, 1998, I resided in Israel. When I arrived in the country, health care was organized in the form of four health funds that most Americans might have termed "socialized" medicine. However, behind that label were some realities that were surprising. In the health fund that I joined, I could choose my own doctor. I could go to most specialists without a referral. In the event that I went to a hospital, I had to obtain a form, Form 17 it was called, to ensure that the health fund would pay for the care in the hospital, but that was a simple procedure. Years later, I learned that two of the other funds had similar structures, and eventually, even the fourth one developed into the same structure. Payments for the membership in each fund were based upon a person's salary; a member would have to submit a payment stub to have membership dues calculated.
In 1995, Israel adopted Universal Health Care, a national law that made health care available to all residents of the country. At that point, membership in a health fund became mandatory and dues were collected in the form of a health tax. Salaried individuals paid for it out of their salaries. Self-employed individuals paid for it together with their tax payments. Persons receiving government benefits had the tax deducted from their benefits, and unemployed persons had the tax deducted from their unemployment payments.
That explains the payment part of the health care system, but the real question relates to the quality of the system. From my own viewpoint, I would say that the quality of the system was excellent, and I never feared insolvency as a result of having to partake of health care of any sort; I could focus in on getting well exclusively.
I had surgeries without any significant problems. I was in hospitals ahd received prompt, efficient care. I also tell the true story of my father-in-law who had a stroke and spent a week in the hospital and then afterward spent 2 1/2 months in a live-in rehab center; for the entire period, he paid only $80, and he came out functioning very well.
To see a doctor, I would go to the clinic, where a receptionist would pass my magnetic membership card through a reader to determine if I had paid my quarterly copay -- one payment for unlimited quarterly visits. The amount was very small. When I went into the doctor in the next room, he had all my records online and was ready to treat me. It was the same with a specialist. If a doctor wanted the vital signs, he took them himself; there was no staff employed to do that. Nor were there stacks of folders; all the information was kept online.
Insofar as prescription medications went, I would receive scripts from my doctor that were written on forms from the health fund. I would present them to a pharmacy, where I received the medications at a subsidized price.
When I returned to the United States in 1998, the first thing my father and stepmother hit me with was the hysterical warning, "Get yourself some health insurance - now." I was able to do that soon enough, thanks to some very supportive people that I met. As time has gone by, I could not help but remember how I had lived in a system that worked. It wasn't free; there were taxes, much like the premiums we pay here. Yet everyone had coverage, something we can't say here. All it takes for me to feel nostalgia is to receive a medical bill that insurance hasn't covered, for whatever reason there may be. Having worked in a managed health care company for a short period, I know how the industry works, and it's all pure business; that only makes me yearn more for a system that places health at a higher priority than a profit margin.
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Comments: 52
interesting piece!
Featured in ! Healthcare for EVERYBODY !
That system sounds almost exactly like a modified Medicare Program. Just the system some of us have been advocating. Not Government Run. That's the key . It is a single payer system with choices by Health Insurance Companies. That in no way is Socialized Medicine and would work as well here as there.
Colonel, the part you like so much doesn't seem to have been all that successful. As I read Maurice's post, it was replaced in 1995 by a REAL National Healthcare system.
The only difference I detected was that the government made it manditory. The same providers are still supplying the service.
the same providers that the government put into place the first time around are supplying the service. so how is this NOT total government control in israel? it works for them if you read it again.
obama & the government are not your enemy. i don't agree with everything they do. however; everyone in this country needs & deserves health care & we ALL need to pay for it. just like i help pay for YOUR social security. i'll have to help pay for everyone to have health care. health care that is government controlled to bring down the costs. to bring all doctor's pay in line. no one doctor will get richer than the next. no drug company will get richer than the next. no insurance company will get richer than the next.
Michelle, I will have to live to 109 just to draw out what I and my employers put in to Social Security.
you aren't supposed to draw out what you put in. you put in for others, i put in for others. someone else will put in for me & for my children (hopefully) and so on. that's the way it was set up to work. not saying it's the right way.
If I have to live to 109 most others will too. Where is all that excess money going? There are not that many people who will draw what they put in so SS must be building funds. The answer of course is the government has been stealing our SS funds for years. That's why SS is going broke. They are supporting more than they are supposed to support. i.e. Illegals who never paid in a cent.
The biggest part of S.S. theft is through congress using it to pay their daily expenses and also S.S. disability which it was never intended for.
That and a lot of other things Jack
This sounds wonderful, and I seriously wonder if we'll ever have anything remotely like it. One can wish...
that does sound wonderful
Please submit this to Pain In The Neck. Thanks!
you have presented a very clear description of how a system can be successful. i just wish the powers that be, would look to others that have both successful & unsuccessful systems, to come up with one that will work here in the u.s.
i fear they won't consider all options. we as a society will have to be there to pick up the pieces when it falls apart. i hope i'm wrong.
thanks for sharing your information. :)
Obama is considering only ONE option: Total Government Control
and that differs from israel's 1995 version, how??
Before 1995, members were responsible for paying their membership dues on their own. After 1995, the health tax was either deducted from their salary or benefit or, for self-employed members, the tax was paid together with the other taxes. The services were the same.
In Israel, the control of the services remained in the hands of the health funds always, if that's what you meant.
the services are the same & the israel government is controlling where the tax money goes, right? so it makes it what george calls "total government control". i have no problem with that. i think george is afraid of something else if we go to a socialized medicine system.
For persons who desire to have a doctor outside the system there, it is possible to pay for private care, at a price. It's not something that is easily afforded, just as going to a doctor without insurance here would be difficult to finance. Then the sky's the limit, and not always does it guarantee a higher quality of care. I can think of one case in particular in which an American-trained midwife who took private clients was known to recommend C sections in almost every childbirth that came before her, something that definitely does not indicate better care for the money.
so there is an alternative to what most citizens have for coverage. that would give someone like george the ability to do what he wanted. paying the tax is still there, but you can do what you want & take your chances.
Yes, as there is in Britain as well. It's usually an option for the wealthy, but it does exist.
i appreciate you being so patient with me asking all these questions. i was getting a little crabby since i've seen many posts & comments condemning any form of socialized medicine for the u.s.
i also appreciate you taking the time to write this post. it was very informative!!
I wrote the post at the request of someone who urged me to write after reading the story about my father-in-law. I know that there are many nay-sayers who will say that such a system can never work in the United States. I'm just saying that I lived in a system that worked. It was not without flaws -- if you chose a doctor you didn't like, you had to stay with him a quarter year before you could change him, for example -- but at least there wasn't a feeling that the patient was being broken at the bank for care.
I can recall being hospitalized twice when I had to be concerned with my recovery, and worrying about cost would definitely have made the anguish unbearable. I compare that to a one-night hospitalization that I endured here in the United States that was truly unnecessary for which I had a nightmare for months in dealing with the insurance company and the bill.
Health care cannot be a business for profit and still administer quality care to the patient without leading the patient hopelessly into debt. Why should a person trade ill health for financial ruin?
The system you describe for Israel is very similar to the proposed Single Payer plan before congress now. I understand Obama will veto it if it passes. As far as I can tell it is the best idea out there but Obama is insisting on total Government control. Not the semi control as they have in Israel.
I have a few friends in Canada and in Britain and none of them like the system there. That being said, some of them have never lived anywhere else so there is nothing to compare it to but some of them have and say that the wait times are just too long. These are younger healthy people too.... so it may get worse as they get older.
Thanks for posting that Chuck
This is great information. I do hope we get something similar.
But note, friends, it's not free. And, Col. is right. It doesn't say that the system changed, just that everyone was required to pay in. I totally agree with that. Everyone needs to pay. If everyone actually did, costs would not be so high.
That's what we've been saying all along Marilyn. How did you not understand that?
She understands that, she always has. Just like I'm sure I'm not the only person to tell her I'd happily give up my tax refund in return for a government health care option. She ignores and pretends ignorance to try and garner support for HER agenda.
Actually, you are the only person who has responded that way to me, I believe, Elizabeth. People - here and in the real world - are begging for "free" health care, as if it's really going to be free.
I just emailed my senator and congressman with this link.
KEWL!
National health care is not the buggy man people try to make it into.
How do they do it in Israel? 10-46% income tax ---- 15.5% VAT ---- Insurance 14.2% ---- Sales Tax 2.5% That's somewhere beetween 42.2 and 78.2% TAXES
Taxes are high in Israel; that's a fact. The cost of living there is very high; salaries are not. However, people do manage to live. How? I don't know, but I did it for 22 years.
With all the cussing about other country's Socalized Medicine I have never heard a thing bad about Israel's. In fact you are the first I ever saw mention it. It's usually Canada, The UK, Sweeden or Norway. I'll bet if I check their taxes they will be just as high or higher.
Sweden's taxes are the highest. That I know.
Maurice, we need some more information.
- Did the government pay doctors and hospitals 50% or less of their normal charges like the U.S. government does?
- Did the government negotiate with doctors and hospitals, or did they tell the providers what they would pay and then say "take it or leave it" like the U.S. government does?
- Did the plan cover your drug costs and medical equipment (hospital bed, crutches, etc. for home recuperation)?
- What was your total annual cost for the plan?
Your answers will help us better understand the plan that you say would work in the U.S..
To answer your questions as best I can:
The doctors were regarded as government workers. The hospitals were government supported. Therefore, the government was responsible for the entire amount of the costs. Doctors did not earn necessarily impressive wages; however, there were considerably fewer malpractice suits because the ethics prohibited the doctors from testifying against one another, which is a requirement in a malpractice suit. Insofar as paying the costs for the doctors and hospitals, the government pays, although oftentimes quite slowly; that is common enough in Israel. If you've not lived there, you would find that concept very difficult to grasp; the whole country's payment system tends to move that way. It's a subject for an entirely different post, not for here.
Prescription drugs were dispensed on a subsidized basis. Durable medical equipment was covered. As for home recuperation, care was provided through the National Insurance Institute, which is the Israeli equivalent of Social Security.
Total annual cost for the plan varied according to a person's earning level. A person who earned more paid more; a person who earned less paid less.
This system would work in the US only if the US makes a serious effort to implement it. About that I have my doubts. The concept of prorated membership dues, for example, sounds very Israeli but not very American. Some of the questions you seem to be raising concerning the practices of the US government are things that are not likely to change overnight, if we look realistically at the situation.
Thank you for the information. It helped me better understand how the system works.
I share your doubts about the U.S. government.
I'm sorry but please read the CBO's report on the system they wish to impliment here...
It is a disaster waiting to happen and when it fails, as medicare and medicaid and SS will shortly (without a major infusion of funds) then we will be taxed more and more...
Look at your taxes now....not just federal, state, medicare, SS and UE...look at each bill you get, see all the hidden taxes...on your phone, cell, electrical, gas, oil, gasoline, booze, cigs, lottery/gambling...add in your property taxes and sales taxes and see just how much the government really takes from you...
All these little taxes are supposed to pay for individual things, yet what do they do? They throw all the monies together and then split them up as they see fit with their own greedy cuts from the pie and the taxes that were supposed to pay for one thing don't and so they need more....and more....and more
This is the government you want to give control to healthcare to? Why haven't they done such a great job with SS and medicare and everything else they get involved in...
Open your eyes and see the reality.
I just wish it was not such a hassle of red tape and endless paperwork. Lots of doctors are now refusing assignments because of that.
They also can't charge as much as they wish.
I see the positive benefits in the health care system you described.
But, I also see if that unemployment does run out sooner or later and what if you can't get another job? You'd be out of luck and be right back where you started. Uninsured.
In Israel, persons who ceased to receive unemployment were eligible to receive what was called "assured income" from National Insurance, and the tax was deducted from their benefit. The "assured income" was, in reality, a form of welfare payment for persons who could not find work beyond the period of unemployment benefits, and the health insurance would still continue. Admittedly, the system is for a society with a different structure than the US, one with more safety nets.
It worked/works for me as well. In 1969 I returned to England and always had my preventive health care. in 1978 I was in an accident that left one girl in a coma, one with his leg shattered (this was a mini cab) and me, severed 5th cranial nerve and an exploded spleen, broken front teeth and acattered glass pitted my face and neck.
In a country without National Health care I would be dead. I was a fortnight in ICU, for four years I had no feeling in the left side of my head and face and the teeth had to be rebuilt. I got it all for free! I didn't even have to worry about medicine or rehabilitation. I got a mere pittance about 5 years later, as litigation is not a british pastime, and bought a tiket on TWA to Los Angeles. But without National Health care I would be dead or broke or both!
Shortly after the wall fell in '89, so did the free health care sysytem. They modeled their new healt care on that of the WEST. Profi t First and then the best interest of the INSURED patient.
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