Wednesday, August 19, 2009

'Obamacare'

Wed & Thursday

The US health care debate


As Israelis observe Americans debate universal healthcare, we find ourselves struck by the fact that our little country is actually more advanced than the US in providing all residents with medical coverage. But we take no pleasure in the realization that political discourse in the US has sometimes deteriorated to the crude levels too often seen in Israel.

Most of America's 307 million people do have health coverage, either through their employers, Medicare, Medicaid, veterans' benefits or special government programs targeting children of the working poor.

But 49 million don't; some of these probably want coverage but can't afford it. An additional 25 million Americans have too little insurance for their needs.

Yet even without universal coverage, America has a budget deficit of $1.8 trillion and spends twice the average share of its gross domestic product - 16 percent - on health as Israel.

President Barack Obama wants every American to be able to choose a private or government-backed health care plan. Members of the House of Representatives and the Senate have put forth several schemes (some with White House input) as they hold town-hall meetings with their constituents. No one yet knows what the final healthcare bill will look like.

Ardent conservatives, among them the influential radio personality Rush Limbaugh, say Obama's plan shows "similarities between the Democrat Party of today and the Nazi Party in Germany." Limbaugh: "Obama's got a healthcare logo that's right out of Adolf Hitler's playbook"; and "Adolf Hitler, like Barack Obama, also ruled by dictate."

Former Republican vice presidential candidate Sarah Palin claims the president is intent on setting up "death panels" of government bureaucrats empowered to determine whether disabled or elderly Americans are "worthy of healthcare."

WHAT explains such vituperative language? Part of the answer is that America's political culture abhors a concentration of power in any one branch of government out of a visceral fear, dating back to the founding fathers, of tyranny.

Moreover, as with all Big Lies, there is a kernel of truth to the implicit charge that universal healthcare will not provide unlimited care, forever, under all circumstances.

On the other hand, those who now have private insurance live under those same constraints, and those who have no insurance have no protection at all. All plans - commercial, governmental or hybrid - "ration" healthcare.

According to the Pew Research Center, most Republicans say the US healthcare system doesn't need fixing, while most Democrats argue the opposite view. But overall, says the center, 75 percent of Americans do want to change the system. And Obama remains popular with an average 53:40 approval rating, while his Democratic Party controls both houses of Congress.

Even Obama supporters say he needs to give the American people more specifics on how the plan will be paid for and better explain why providing a public or quasi-public option is not some elaborate plot for a government takeover of all healthcare delivery.

WE DO not presume to tell Americans how to proceed. We can only point to our own experience which demonstrates - albeit on a smaller scale - that universal coverage is workable.

However, there is no doubt that Israelis sacrifice a level of privacy that Americans enjoy. For instance, medical records in Israeli health funds are computerized, and their confidentiality is hardly airtight.

Visiting a family doctor here tends to be a no-frills affair. Care is generally of a high standard, but there are no stylish offices or solicitous receptionists. You hand the physician your magnetic card; there's a minimum of small talk; you're treated and quickly out the door.

Israelis belong to one of four health funds, equivalent to HMOs: Clalit, Maccabi, Meuhedet and Leumit. Your GP does not oversee your care during hospitalization. There may be a wait for elective procedures.

But hospitalizations and medications are fully covered, though most people also purchase supplementary health insurance from their health fund and some take out additional private insurance coverage.

Everyone is covered. We pay for it all through individual sliding-scale health taxes deducted from our salaries and transferred to the health funds via the National Insurance Institute.

It may well be that a modified version of our system could work well in the American setting.

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