Bernie Sanders released his plan for single-payer health care in America. As an ex-pat/dual citizen living under a single-payer health care system myself, I thought it would be a good idea to share with the community what life is like under single-payer health care from my perspective as a man with a family, a tax-paying teacher, and a football player (don’t laugh).
As you know from my previous posts, I live in Israel. (Side note: this post has nothing to do with the ongoing regional conflict, just the medical system here, which is available to all citizens). We came here 21 months ago when my wife received a post-doctoral fellowship. I gave up my career as a lawyer (and my big house in suburban Atlanta, and my SUV) to move across the world to aid my wife’s career.
Here’s basically the system in Israel:
- Healthcare is predominantly paid for through the government.
- Everyone receives a certain, basic “basket” of services based on their age (children get free basic dental care, people over 90 years old get free home health aids, etc.).
- Everyone pays into the system, or has someone pay for them, based on income.
- The basic payment structure is similar to what Sen. Sanders proposes for the US. Workers pay between 3% and 9% of their salary (progressively based on income) and employers pay a similar matching percentage. We do not have to negotiate for health insurance when applying for a job.
- There are four quasi-private health care providers.
- They open clinics and have affiliate doctors and hospitals throughout the country. A doctor can work for a company’s clinic, or work privately and decide whether or not to accept the customers of each of the four companies.
- All four companies provide the same basic standard of care for similar prices.
- What about competition? Each company wants as many subscribers as possible. So they have to get the best doctors to provide the best care, the best equipment and offices, and availability in the most communities.
- The four companies have options for supplemental insurance above and beyond the basic basket. This includes, dental, long term care, discounted hospital stays, discounts on private (non-plan) doctors, alternative medicine, and fertility services.
- There is private insurance available, also above and beyond the basic basket.
But how does this work in real life?
What We Pay
My wife is a post-doctoral fellow, or a graduate student according to the government. She is paid by stipend. And she does not pay anything for health insurance. The government wants to encourage graduate study, especially in the sciences, and covers the cost of basic health care for graduate students at this level. Neat!
I am a high school teacher. Not on the high end of the income scale. I pay 3% of my income to the Bituach Leumi (national insurance). My employer pays a matching percentage. That comes out to, maybe $2,000 per year. Compare this with the $1,000 per MONTH I was spending in the US for catastrophic care. But more on that later.
We opted to purchase the highest-available supplemental plan with our health insurance. The price is based on age. For two 30-ish adults and two kids, it costs 260 shekels per month… or about $60 per month for a family of four. What do we get for this? You’ll see...
As a Father
If you have kids, you know they go to the doctor a lot. Even healthy kids get colds, viruses, broken bones, and cavities. My local clinic is down the street from my house, maybe a 3 minute walk. But my wife didn’t like any of the pediatricians there, so we take them to a private doctor who is affiliated with our insurance company (also a 3 minute walk from the house). She is considered the premier pediatrician in our very large city. Her daughter also happens to be in my daughter’s class.
We’re in the doctor’s office at least once a month for one kid or another. Kids share germs more than they share toys. For the 20 or so visits we’ve made in the last 21 months we’ve paid nothing out of pocket. Nothing. Not one shekel. We walk into the doctor’s office (sometimes with an appointment, sometimes without), show our insurance card, get an exam and great care, and walk out. No bills.
Prescriptions? You do have to pay for these. I think we pay 10 shekels ($2.50) for antibiotics. I don’t think I’ve paid more than 40 shekels ($10) for anything ever at the pharmacist.
As a Football Player
I took up competitive, full-contact, football at the age of 35. Having no athletic skill, this wasn’t a terribly good idea. But I had the time of my life (I’m writing a book about it). But with competitive sports come injuries. Aside from sprains and bruises, I broke my finger… twice. Both times I needed surgery.
Don’t you have to wait months for appointments with specialists under socialized medicine? HELL NO! The first time I broke my finger, I went online and made an appointment for an orthopedist in my insurance group for a couple of days later. He happens to be British. The appointment was free. He sent me for an x-ray… downstairs. I got it immediately, went back upstairs, and my x-ray was on his screen. Total cost: 36 shekels ($9) for the x-ray.
Now I needed a hand surgeon. Here’s where it got a bit complicated. The best hand surgeon in the country (a French woman) happened to work at the hospital where my wife works. I called the hospital… 6 months for an appointment! That can’t be right. Turns out, the hospital has a “private” clinic that can schedule an appointment with the surgeon THAT SAME DAY. But for how much? First visit was 1,000 shekels ($250). Expensive, but not tragic.
Well… when I got to the appointment, I was told to take the receipt to my insurance provider for reimbursement. A few days later I did (walked into my local clinic and handed the paper to the receptionist). A few days after that, 600 of the 1000 shekels appeared in my bank account. The appointment was only $100. YAY, supplemental insurance!
I needed surgery. It was scheduled for the next week. I needed two days in the hospital, the best hospital in the country in their shiny, new wing. Out of pocket cost for the surgery, hospital stay, medicines, etc.? 260 shekels ($60)!!! That was it. I walked in, paid the $60, and everything else was covered. Again, YAY supplemental insurance!
The surgery was a success. Follow up visits were covered.
I broke my finger again a year later. Same results. Same doctor. Same hospital. This time I was out-of-pocket 400 shekels ($100) for the surgery and the stay. And that was covered by my football team’s insurance.
”You’re a health male, What about women, the elderly, and the poor?”
This I only know anecdotally. My wife is very into alternative medicine. She has visited herbal medicine doctors, massage, acupuncture, and half a dozen other specialists that I don’t understand. We paid maybe $20 per visit at most. All of it is covered by our insurance.
Having babies? We haven’t had one in this country. But from what I know, maternity care is free universally. And you get a payment from the government (like $6,000) when the baby is born. There is also 3-6 months of paid family leave. Compare this with the $12,000 I paid in the US when my son was born (that was with the $1,000 per month insurance).
The poor? They have basic care. The unemployed pay between $5 and $20 per month for their coverage. Senior citizens do not pay for basic care, as far as I know.
How does this work for entrepreneurs?
We’re the “start-up nation.” One of the reasons we lead the world in technology innovation and starting new businesses is that we don’t worry about health insurance. A person is free to leave their employer for greener pastures knowing that they will always have the same health care for the same price. They’re also covered if they’re unemployed.
Striking out to start a new business is also fear free. You will always have health insurance, whether you succeed or fail. If you succeed, you know the cost of health care for yourself and your employees. We complain about a lot of things. But the cost of health care for businesses is generally not a problem. There is no complex search or negotiation. We pay a fixed percentage. And if we don’t like it, we can elect leaders who will change the percentage!
What else makes the program work?
Efficiency. There are no billing and coding staff personnel. Everything is done with computers (and fax?) without middlemen.
No paper files. Everything is electronic. Swiping your insurance card provides any doctor, clinic, or provider access to your records. So the rooms of paper files do not exist. Also, you don’t need to bring or send your medical records anywhere. This improves care and reduces staffing.
When you visit the doctor’s office, you swipe your card at the kiosk and get a number. You wait your turn (if you have an appointment, it’s almost no wait), and you go in and… see the doctor. No multiple nurses to repeat your symptoms to. You just see the doctor. Clinics and offices have a receptionist to help you, and that’s about it.
Is everyone happy?
Of course not! No system is perfect. There are holes that we’re working to patch up. Doctors and hospitals are hit and miss as they are in any system. Sometimes they suck. Some regions don’t have enough facilities or medical personnel. Some of the common medical opinions are antiquated, and standards haven’t been updated in 50 years.
Like in the US, elections matter. Health care is always an issue and various parties offer various improvements. The current Health Minister is a chareidi (ultra-orthodox) man. While you’d think he wouldn’t care or be capable of running this department, much of his constituency is very poor. And he has been focused on delivering better care to children and families. The benefits have been felt by all families.
Can this work in the US?
There are MANY differences between the US and Israel. I’ll narrow it down to three:
Population — there’s only 8 million people here. There’s no reason the program can’t be scaled up, but four companies may not be enough. They would be enormous businesses. Turning existing insurance companies into limited-profit competitors for you business (paid for by the government) might be a viable work-around.
Lifestyle — Israelis tend to be more active and have a healthier diet. We have lower instances of heart disease and diabetes. We have much lower obesity. That alone reduces health care costs. Americans would benefit from a massive campaign to improve healthy lifestyles.
Culture — Israel was founded as an essentially socialist state. Government school, health care, and other services were there from the beginning. Only recently (within the last 30 years) have we moved towards capitalism. The US is coming at this from the opposite direction. Americans have to be able to trust the system for it to be implemented. Given the enormous influence of insurance companies, drug companies, and the medical lobby, it will be a hard sell.
But we’ve done hard things before.
I’d love to hear your questions and suggestions about this system in the comments.
Edit 1: Rec list… awww… I haz da feelz.
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