"The problem here is a totalitarian uniformity, a cult-like mentality such that even allies are enemies if they fail to follow the Exact Party Line. " - Phyllis Chesler

Monday, September 29, 2008

Healthcare And Racial Issues That Work Together

Just bringing you another story that you probably never heard. Hmmm

During the last six months, my wife and I have had more contact with health care plans, doctors, and hospitals than we ever had before — and, I hope, will ever have to have again. Medically, the story has had a happy ending. It has also given me a long, close look at Israel's unique health care system, which — like practically everything else in this endlessly self-flagellating country — is the target of frequent criticism. I'm glad to say I can't join in. In more ways than one, I've been impressed with what I've seen and grateful for it.

Yes, the Israeli health care system has its aggravations. Hospitals are overcrowded. Doctors are overworked and underpaid. Patients have to deal with more bureaucrats than they'd like to. Remarkably enough, though, the system works and works well. It's reasonably efficient and patient-friendly, it's strikingly egalitarian in a country that is today one of the most economically unequal in the Western world, and it delivers the same high-quality health care to rich and poor, Jew and Arab, veteran Israeli and new immigrant, at a far lower cost to the individual than does private health insurance in America.

Even the bureaucrats aren't so bad, if — since you can't avoid them — you do the next best thing and befriend them. Their lowest echelons sit in the clinics of Israel's four government-supervised and government-subsidized national health care plan organizations, the three largest of which have branches in every small-to-middle-sized town and in all the neighborhoods of larger cities.

Every Israeli belongs to one of these plans, for which he or she pays a small monthly sum. For my wife and me, this comes to slightly more than $100. The rest is the tab is picked up by Israel's National Insurance, which taxes Israelis at roughly the same percentage of their income as Americans pay to Social Security, and also dispenses old age and disability benefits, child and unemployment allowances, and other transfer payments. Israelis who earn more are thus in effect paying for the health care of those who earn less.

The clinic of your health care plan is your medical home base. You go to it to see a family doctor; to get prescriptions for medicines that you then purchase from a pharmacy at a nominal price; to obtain referrals to specialists; to see nurses for blood tests and other simple examinations; to receive authorizations for more complex procedures and for hospitalizations; and occasionally to argue with someone behind a desk about your right to a given drug or treatment that your health care plan doesn't want to pay for.

If convinced, that someone then telephones someone else and argues with them. Sometimes, you actually win. And you always have the option of switching — or threatening to switch — to a rival health care plan if you lose, since Israeli law requires every one of the four plans to accept every applicant for membership regardless of age or previous health problems, thus keeping them competitive on a level playing ground.

It takes a certain amount of assertiveness, patience, and good humor. If you can muster them and be on good terms with your clinic's doctors, nurses, and office workers, you have a support system you can count on if any serious medical problem occurs, such as the one that sent us to Rambam Hospital in Haifa six months ago.

A public hospital is always a microcosm of a society and in Israel all hospitals are essentially public, since even the privately operated ones give free care to all members of the national health care plans and bill the plan for it. Moreover, Israeli hospitals have no private wards and practically no private rooms. You share a room with others who may come from vastly different social and economic backgrounds. When hospitalized for a week at the onset of her illness, for example, my wife found herself in a room with a young female executive at a hi-tech company, a middle-class Jewish woman from Morocco, and a woman from an Arab village who read the Koran all day. By the week's end, they knew each other's life stories. It was, I told my wife, the woman's version of doing Army Reserve duty.

Even more striking was the hospital staff. It too was a cross-section of Israeli society, stratified economically and ethnically: Ethiopian-born cleaning personnel, Russian-born technicians, native-born Israeli nurses and doctors. The one thing about those native-born doctors that I was unprepared for, however, was that a very high percentage of them were Arab.

It is a cliché to observe that hospitals are among the few places in Israel where Arabs suffer no discrimination at all. But this is in regard to patients. I had never thought of it as applying to doctors as well. In Rambam, at least, it does. Everywhere one encounters Arab radiologists, surgeons, oncologists, hematologists, department heads — and not just Arab men, but even more surprisingly, Arab women, many of them young and just out of medical school. Never once in the course of the six months that my wife was in treatment did I sense the slightest friction between them and a Jewish staff that was often taking orders from them, or the slightest distrust of them by Jewish patients.

What enables Israeli hospitals to be so different in this respect from other sectors of the economy? An idealist might say that medicine is inherently meritocratic, since no one wants to sacrifice his health or life to prejudice; a cynic might say that because Israeli hospitals pay doctors low salaries by American standards, they depend on the labor of Arab physicians who are willing to work for less.

There is probably a measure of truth in both these claims. Yet the fact remains that if you want to see Israel at its best, you could do worse than go to a hospital. Being sick is no fun anywhere, but there may be no other place in the world where you can come out so encouraged by the experience.


Aleta said...

Wow ~ that is something of interest. Interesting that it is in the hospital where lines that typical divide disappear. I would love to know the reason from an Arab point of view or from an extremist who adheres to the views of the hospital. Why they can release the angers and hostilities in a hospital, why not do the same and allow the spirits of this earth to heal as well?

As for the health care system in America, we do have problems and one day (hopefully in the near future), I'll post about our issues with it from Greg's car accident. But I've also heard from people in Europe who say, "America's health care isn't perfect, but it's better than paying 40 % of your income or higher in taxes. At least you have options, instead of the middle class being taxed to death."

Chat Blanc said...

fascinating!! I took special note too of this--"Israeli law requires every one of the four plans to accept every applicant for membership regardless of age or previous health problems, thus keeping them competitive on a level playing ground." amazing!

Lauren said...

Aleta, that would be a great post. Can't wait to read it!!!!

Chatty, Isn't that interesting how that works? We could do that here too, well we could I guess...