A report by Israel's Ministry of Health sheds light on the working of a mixed public-private health system that has considerable popular support, along with continued conflicts over how much and who should pay. http://www.haaretz.com/hasen/spages/1147185.html
The average Israeli family spends NIS 633/month (about US $170) on health care. Of that NIS 169/month is for the supplemental insurance offered by the HMOs. Other private expenditures are for dental care, eyeglasses, and medicines not covered by the HMOs.
The report also shows that the rich pay more. The wealthiest 20 percent of families spend NIS 1,111/month compared to the poorest 20 percent NIS 306/month.
Not included in the average NIS 633 monthly outlay is the cost of the basic service. That comes from a health tax that is progressive. The working rich pay more. Retirees get a great deal no matter what their resources. They are also likely to be heavy users of health care.
As upper-income professionals we paid about NIS 2,000/month (US $500) for the health tax. As pensioners, we pay NIS 400/month.
Israel is not a socialist paradise where everyone gets the same. It is, however, a system that provides coverage to everyone, and where 80 percent of the population is able to pay the equivalent of US $45/month for the government regulated supplemental insurance that produces shorter waiting times for specialists and surgury, more choice of physicians, and greater discounts on medications. Everyone has free access to family physicians, a co-pay for a visit to a specialist is about US $4, sophisticated tests like MRI cost the same, and one's family physician can arrange quick access to a specialist or tests when appropriate. The outlays of this aged family for additional insurances to cover items like access to overseas treatments for conditions not treatable in Israel, medications not covered by the HMOs, and assisted living amount to about US $ 240/month.
There are annual disputes about the medications and treatments to be added to the basic coverage. There are demonstrations by patients, often organized by drug companies, claiming that stingy bureaucrats are denying them medication that will save their lives. Explanations from professionals are that arguments are about new and expensive medications that might prolong the lives of some of the people who take them. A recent controversy dealt with the efforts of the ultra-Orthodox chair of the Knesset Finance Committee to have HMOs provide dental care for children. Opponents claimed that he would be financing large families at the expense of Israelis who would be denied new medications.
My reading and conversations indicate that this outline of Israel's health system resembles those in most European countries. The essentials are extensive coverage for everyone, with added coverage for people who pay for additional insurance, or go outside of the system when they choose. As on many other social indicators, the wealthy do better than the poor, the intelligent choose more wisely than others, and those living far from medical centers find it more difficult to reach specialists.
Any chance that American politicians will support reforms to bring their country into line with other upper income democracies?
An analyst should never say never, but . . .
Standing in the way is the intensity of opposition to government control, apparent in the fierce opposition to Obama's proposal. Somewhere in that opposition were insurance companies, hospitals, and HMOs looking after their interests. Also complicating the picture were complex proposals not readily understood that pushed the hot buttons of abortion, fertility, and government rationing, which the nay-sayers painted as more threatening than existing rationing by insurance companies.
It does not help that health reform comes at a time of massive deficits traced to wars and an economic crisis. Without wrenching cost controls that may be beyond the capacity of the White House and Congress, government outlays for health would increase, and some individuals would pay more for what they receive. Those are tough sells in a culture more committed than those in other western countries to individual choice and low taxes.
Ira Sharkansky (Emeritus)
Department of Political Science
Hebrew University of Jerusalem
Tel: +972-2-532-2725
Fax +972-2-582-9144
irashark@gmail.com