obama signs bill 311.
(photo credit: AP)
Although US and Israeli healthcare policymakers and administrators can learn from each other, Israel’s medical system is considerably ahead of America’s, and President Barack Obama will find implementation of his reform difficult to carry out, according to experts speaking in Jerusalem on Tuesday.
The Brookdale-Myers-JDC Institute invited four American healthcare experts – members of its foreign advisory board – to speak at a symposium on US healthcare reform, along with four Israeli experts. There was broad consensus that the American mostly private system – which consumes 17 percent of the GDP compared to 8% in Israel – has a lot to improve before it reaches the successes of Israel’s universal basket of services, a state-supervised system based on four nonprofit health funds and managed care.
Some 15% of the US population of 317 million has no health insurance,
but can get help for acute problems in public hospitals, said Prof.
Stuart Altman, who teaches at Brandeis University’s Heller School for
Social Policy and Management.
“It is not something for us to be proud of,” he added.
The new law passed by Congress earlier this year will make it illegal
for private health insurance companies to deny coverage to individual
Americans based on their medical condition and those who have no
coverage via their employer because they are not working, he said. But
there are significant problems it will not resolve, he added.
Israel prohibited discrimination in the provision of care in 1995, with
implementation of its largely successful National Health Insurance Law,
but Altman said the Israeli model could not be implemented in the US
because the population there strongly distrusted government and feared
anything that smacked of “socialized medicine.”
The healthcare reform program that failed to be passed under the
Clinton administration, he continued, was essentially the system that
Israel has had for the last 16 years. At least half of US residents
would be happy if the Obama reform could be rescinded, he said, because
those with health coverage – especially those over 65 via Medicare –
worry that they will have less.
The new law lacks ways of controlling cost or ensuring quality of care,
but mostly expands coverage to those who lacked it, said Altman. The
reform will cost an additional $300 billion over the next decade,
according to estimates.
Health Ministry director-general Dr. Ronni Gamzu said that Israel could
learn from the US experience both what not to do, such as having the
healthcare system run by private companies and without strong managed
care to set limits, and what to do, such as setting pricing for
services in a sophisticated way and allocating a budget for change.
Israel is fortunate in having widespread electronic medical records and
lacking the jury system to decide malpractice cases, which greatly
promotes defensive medicine by physicians as well as unnecessary
University of Michigan pediatrician Prof. Gary Freed worried that with
the number of children unchanged from 1950 but representing a smaller
proportion of the population, the proportion of money spent on child
health would decline as other costs increased.
Spending 17% of the GDP on health doesn’t mean Americans are healthier
than Israelis, who spend less than half that share, said Ben-Gurion
University health economist Prof. Gabi Bin-Nun. Here, life expectancy
is longer and infant mortality is lower than in the US, he said. The
US, he added, must cut administrative costs, computerize medical
records and minimize defensive medicine and over- and underuse of
medical services. Reimbursement systems should reward higher quality
and lower costs, Bin-Nun suggested.A feature on the symposium will appear on the July 14 Health Page.