Thursday, September 6, 2012

Free health care?

Since the ruling of the Supreme Court this summer, to uphold the health care overhaul, there has been a mix of cheers and concerns from the US population.  With it being an election year in the US, the subject is being heavily discussed and a friend asked me to expound on how the universal health care is working for us here.

I've been with and without health insurance in both the United States and Israel, as well as having been a member of three out of four of the HMO's in Israel (basic-only and supplemental plans).  Many people hear that health care is free in Israel.  Well, it's not.  But it certainly costs a lot less...

A mish-mosh of cultures and languages collided in this little corner of the world as millions of refugees flooded in from every direction with only the clothes on their backs, greatly outnumbering the local Jewish population.  The first public health fund was established by farmers during the times of the British Mandate and eventually taken over by the labor union.  Since becoming a modern country in 1948, Israel has always placed a lot of thought and effort into health care and by the early 50's the Health Ministry managed most hospitalization services while smaller clinics were expanded by "sick funds."  Membership dues were paid on a sliding scale.

The National Health Insurance Law went into effect in 1995, making health insurance coverage mandatory.  This law established the responsibility of the state to provide health services for all residents.  A standardized "basket" of health services were to be managed by the sick funds with funding from the government, the employers' health tax, employee deductions and modest co-payments (currently around $2 for the first visit to your primary doctor [$6-7 for a nutritionist or physical therapist] in each quarter of the calendar year, but there are discounts and exemptions available for welfare-based or medical grounds).

Equal status was given to each of the four sick funds and they may not bar membership for any reason, including age or health condition.  Every resident, from the age of 18, must register with one of these four funds and make monthly payments based on wages and status (for example: students pay less, the unemployed have a low flat rate, a married woman who doesn't work is covered by her husband's payment, etc.--for more details see the NII website).  Some people choose to purchase additional coverage through private insurance companies or the supplemental insurance offered through their sick fund.  With this optional additional coverage, vision and dental are heavily discounted in addition to other health services.  Annual preventative dental care for all children is free in Israel (recently extended up to age 12).

At the dentist: kids free, adults half price with Maccabi Gold
While looking deeper into the differences between health care in the US and Israel, I've come across some interesting statistics (per capita, taken from the OECD):

Total health expenditure:
Israel $2,165; US $8,233
Public expenditure:
Israel $1,254; US $3,967
Physicians per 1,000 people:
Israel 3.5; US 2.4
Annual doctor consultations:
Israel 6.2; US 3.9

Much of the health care savings in Israel are attributed to preventative health care.  Because everyone has affordable access to it, illness are prevented or treated in the early stages.  No one goes bankrupt from getting sick or looses coverage along with their job; the words "pre-existing condition" are never uttered. 

If such a young country, with such a disorganized and fractured government, can pull off a universal health care system then I'd say there is hope for the US to do the same.  Affordable preventative health care doesn't just save money, but adds years of quality life to each of us.  Israel is #4 in life expectancy in the world, with the United States trailing behind at #38.  I think the coming health care reforms will eventually help the US climb further up the list.

When I was back in the US for a while, my children were enrolled in CHIP and received vaccinations, regular checkups, preventative care and medical treatment for illnesses.  It was a relief to know that at least they were covered, but my husband and I weren't for a year and a half when we were each working part-time.  When I started working full-time, I finally had insurance but he still didn't.  I worried a lot during that time about what would happen if we/he needed serious medical care.

Don't expect the new system to be perfect though--remember that there is always waste and disorganization, in both the government and private sectors.  When we came back to Israel, we found ourselves in a "waiting period" before our health care would resume.  I was six months pregnant with baby #3 (story coming soon!) at the time and should have had the ability to "redeem" the waiting period with a payment of NIS 9,000 but was denied the chance to even do that and ended up without prenatal care.

In answer to the whole "is it constitutional to require health care payments" I have this to say:  Governments levy taxes to provide social services to the general population.  If you own a house or piece of land, you will owe taxes that go toward paying for public schools in your area.  What if you don't have school-aged children, or you send them to private school?  That's fine, but you still pay into the system so that every child can have access to at least a basic education.  From what I see, with both educational and health services, the issue is not about "robbing the rich to care for the poor", it's about ensuring "life, liberty and the pursuit of happiness."  After all, if you haven't got your health, you haven't got anything really.

Do you have questions about public health care in Israel?  Let me know in the comments section below:


  1. Love this post, this is one of my favorite subjects. :) Have you ready the WSJ article "How American Health Insurance Killed My Father?" The author of that brings up a lot of the same points you do.


    1. Thanks, Gittel. I haven't read that article--will definitely look it up.