September 28, 2017


How Israel Got Universal Health Care 20 Years Ago, and Why It's Working : Government-regulated competition, legislation that largely excludes the courts, and a 'social lobby' that backed even neo-liberal economic policy into covering 100 percent of the Jewish state's citizens. Is there a lesson for the United States? (David Chinitz, September 27, 2017, The Tablet)

Israel's health system constitutes the most extensive and successful implementation of regulated (or as it known in the United States, "managed") competition in the world. One-hundred percent of the population is entitled to comprehensive coverage provided by four competing health plans. Bernie Sanders, who talks about a single-payer system for the United States, would do well to point to the Israeli system as a model more closely adaptable to the American context.

If Israel is famous for having chronic problems when it comes to governance, the Israeli health care system is the exception that proves the rule. Under Israel's 1995 National Health Insurance Law (NHI), entitlements to health services are defined and detailed in legislation, and have largely removed the courts--which have a long history of being the forum of last resort for everything from kosher food to women's prayer at the Western Wall--from insinuating themselves into medical decision-making.

Uncharacteristically for both Israel and the Jewish people ("He who saves one soul, it is as if he has saved a whole world"), no health service, no matter how ostensibly urgent or life-saving, can be covered by NHI if there is not a defined source of finance to back it up. This means that only treatments included (with detailed medical indications) in the NHI "standard basket of services" are guaranteed to be covered. While the U.S. Affordable Care Act lists 10 major categories of "essential health benefits" (and de facto leaves detailed coverage determinations to states and the market), the Israeli law includes an appendix that is hundreds of pages long, detailing the drugs, tests, and treatments that are covered and the conditions under which a patient can sue if denied access.

Cost-wise, the Israeli system is considered parsimonious to the point of being underfunded. The country spends less than 8 percent of its GDP, and about US$2,600 per capita on health, beneath the Organization for Economic Co-operation and Development (OECD) average. The equivalent numbers for the United States in 2016 under Obamacare rules were 17.8 percent of GDP and US$10,345 per capita.

  And that $2 trillion can be put to good use instead of wasted on health care.

Posted by at September 28, 2017 7:11 AM