Thanks to Mitt Romney’s laudatory remarks about the Israeli health system during his trip to Israel, we now know a bit about how another country provides healthcare—and how that nation manages to have better mortality and other outcomes than we do, at a far lower cost. The press, laudably, took a bread-and-butter political story—what Romney said—a big step further, explaining how and why Israel covers everyone and spends far less. Reporters did a good job. I just wish there had been such coverage of other systems three years ago, when the shape of healthcare reform was on the table.
But anyway: On a trip to raise money from wealthy donors in Israel, Romney told the Israelis:
Do you realize what healthcare spending is as a percentage of the GDP in Israel? Eight percent. You spend 8 percent of GDP. on healthcare. You’re a pretty healthy nation. We spend 18 percent of our GDP on healthcare, 10 percentage points more.
What exactly does Israel have? For starters it has a national health insurance system in which every citizen is covered, and those citizens care is paid through a system of income taxes. Some funding comes from out-of-pocket payments and supplemental coverage that provides adult dental and vision care. Israel has four nonprofit health plans that function similarly to HMOs in the US. The Ministry of Finance gives each health plan a “capitation” payment, similar to the payments American HMOs run by private insurance companies give to medical groups to provide care for a group of patients.
Sarah Kliff, a Washington Post health blogger who wrote the best account of Romney’s visit, reported that the Israeli government controls about 40 percent of the country’s medical expenditures through the payments it makes to the four health plans. It figures the amount by adjusting for the age of the citizens they serve and what their healthcare costs are likely to be.The plans must figure out how to provide the best care within its budget, and they are prohibited from withholding care in order to balance their books. Everyone gets treatment, and there are no exclusions for preexisting health conditions.
The government mandates a broad set of benefits which Rich Ungar, a contributor to Forbes, called “pretty darn good.” They include diagnosis, treatment, preventive care, fertility treatments, surgery, transplants, and ambulance services, as well as prescriptions and occupational therapy. Children also get preventive dental care. Contrast that with the US, where dental care for kids is something that’s hard to get if they’re poor. Many states offer dental coverage for children under Medicaid, but in recent years some have dropped coverage because of budget constraints. President Obama’s health reform law tries to expand Medicaid coverage, including dental care, though several states are resisting the expansion.
The Los Angeles Times framed Romney’s comments about the Israeli system as another of his healthcare flip-flops.
Mitt Romney established universal health coverage in Massachusetts with an individual mandate to buy insurance. But he says he’ll overturn an identical system at the federal level. He has dismissed the idea of a Medicare-for-all insurance system in the United States. And what do you know—Israel has something like a Medicare-for-all system.
The reporter didn’t quite get it right. Obamacare is hardly Medicare-for-all. Medicare is social insurance and Obama’s Affordable Care Act firmly rests on the private market. Nevertheless, we haven’t heard that term for a while—not since the Dems were told by their pollsters not to advocate for it since it didn’t play well with voters.
So what does this Medicare-for-all system mean for the Israeli citizens? I looked up some health stats from the Organisation for Economic Cooperation and Development—the OECD, a pretty reliable source. People live longer in Israel. In 2010, the OECD reported that life expectancy for the total population was 81.7 years, compared to 78.7 years in the US.
The day the Supreme Court ruled on Obamacare, the Jewish Daily Forward provided a good explanation of the similarities and differences between the two health systems. One of its points: America can learn a lot from the Israeli system. “The quality is high, and the outcomes are good,” said Orly Manor, dean of Hadassah-Hebrew University’s Braun School of Public Health.
It doesn’t seem that Romney had that in mind, since his campaign soon walked back his praise for Israel’s healthcare system. A campaign spokesman said “the governor was criticizing our broken healthcare system and the failure of Obamacare to address the healthcare challenges facing our country.”
OK. Meanwhile, one of Romney’s comments that didn’t get much play merits some journalistic scrutiny, too. He also said:
We have to find ways, not just to provide healthcare to more people, but to find ways to fund and manage our healthcare costs.
Is Romney another Republican moving away from the goal of bringing more Americans under the private insurance tent? Should he be added to the list of top Republicans who want to de-emphasize more coverage for more people—a philosophical trend that NPR’s Julie Rovner reported might be the new Republican healthcare mantra? Good question.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.