I was reading this article in the NYTimes about the cost of Health Insurance in the US.
I was shocked. An average family of 4 (who are self-employed) can easily be paying out $1000 a month for health insurance (if they don't find some company to pay it for them)!
How it actually works in Israel is that by law, part of your Social Security payments goes to your health insurance (Bituach Leumi is 10% of your salary so basically 5% of your salary is goes to Health Insurance).
If you are independent or not working, then you have a minimal Bituach Leumi payment to make of around NIS 100-200 a month depending on your status ($30-$60 a month).
If as an independent you are taking a salary, again it comes out of the Bituach Leumi from the part you take as salary.
I don't have exact numbers, but I think that my wife and I are paying an extra NIS 100 a month ($28 a month) combined, for the "complete packages" to supplement the government required basic insurance package.
If we go to Terem (our preferred private, emergency clinic in Jerusalem), then there might be an additional supplement of NIS 50-70 that we have to pay directly to Terem, and that is regardless of how many X-rays or tests they may do.
Doctors in Israel are also world class, so it is not like you are taking a drop in the level of your treatment. In fact, from what I hear about hospitals in the US, the personal attention and consideration you get in an Israeli hospital simply blows away anything that the States has to offer.
(Yes, I know people are going to disagree with me on the above paragraph with some exceptional cases, but the exceptions aren't the rule).
I think I've made my point here, but I expect some vitriolic comments anyway.
Wherever I am, my blog turns towards Eretz Yisrael טובה הארץ מאד מאד
30 comments:
I've heard one too many stories about how people have had to wait months to get an MRI in Israel. Yeah, we pay more here; but we also receive quicker treatment.
I've been waiting over a year for an MRI.
Every day people knock on my door asking for money for medical treatments which somebodies life depends on which are not covered by the kupat Cholim.
Even if you upgrade you're still not totally covered. If you want to be totally covered you need to buy IN ADDITION a private insurance.
So, no it's not cheaper. In the US if you have a good job they will pay for your insurance. If you don't and your income is low you can get government sponsored insurance which many fine doctors accept.
In Israel you aren't covered at the emergency room unless you are preapproved by your kupa, or else you have to prove that the situation was on their approved list of emergencies.
In Israel you generally don't have a doctor that you can page or call after hours. If you have an emergency after hours, you must go to terem or the emergency room.
You can't call to find out if it is really necessary.
And the fact is that in Israel doctors are making next to nothing. There's a shortage of good doctors, as many are choosing to go and work for real salaries in Chutz Laaretz.
It seems to me that the MRI business would be great to go into in Israel. Last time I was in NY, I saw dozens of private MRI shops. I'm surprised no one has thought to open that here.
If you go to Terem, you pay their NIS 70 deductable (at least for most of the Kupot) and you are covered quite nicely for emergency treatment.
Like HMOs in Israel, the different Kuppot behave differently towards their clients. It depends on which one you got.
Israeli doctor's as good as US?
Well, there are some good in Israel, but the best of the US is far better than the best of Israel.
Now for the worst, while Israel has some Russian's with questionable credentials, Israel is not filled with third world shits -think the subcontinent- ripping off and destroying our health care system.
"In Israel you aren't covered at the emergency room unless you are preapproved by your kupa, or else you have to prove that the situation was on their approved list of emergencies."
Right, you go to Terem or the Kupa's Moked, which makes A LOT more sense for something like a child's earache or a high fever. Who wants to go to a crowded ER to be seen by a dr., when a dr. at terem will do just fine. In any case, I once went to the ER because I forgot about that it and it was very easy to get a retroactive hafnaya from the doctor to cover the visit.
As for waiting a year for an MRI, if you really need one, a good dr. should be able to get you one in a reasonable amount of time. There are so many hospitals between J-m and the merkaz, clearly your dr. doesn't think you need one in a hurry. Or you don't have a good dr.
A JS said, there are exceptions. But I think shelling out $1000 a month for standard medical care is insane (pediatrician and standard gp). And good jobs that really cover you are pretty hard to come by in the U.S. now. The great thing about Israel is that you're not stuck keeping a job you don't like just for the health insurance. I think even good private coverage is less here than in the U.S. Definitely not 4000 shekel a month.
We are a family of four and I'm on my third pregnancy here in Israel. After 8 years, the worst I've encountered was some obnoxious peds.
Joe,
why is that every pro-israel blog feels the need to deal with this "superior" facet of israeli society annually in order to maintain his/her credentials?
in fact:
1) "Doctors in Israel are also world class"
maybe, or maybe not. i have no idea. although i'd like to know what you mean by world class. you mean americans and western europeans come to israel for medical care? (don't impress me with the occasional jordanian patient).
in any case, the contemporary situation does not bode well for the future. israel's top academic minds are leaving the country in droves. even if today's doctors are good, many of the next generation's class will have been taught by second-rate professors. feel free to take your chances.
2) "An average family of 4 (who are self-employed) can easily be paying out $1000 a month for health insurance (if they don't find some company to pay it for them)!"
many (a majority?) potential olim are NOT self-employed and pay far less than $1000 a month. but fine, even if we accept this inflated figure of $12k annually, some of it (though not nearly enough) comes back on your tax return as health expenses. but fine, even if we accept a real 12k loss. most people i know would be taking a hit of much more than 12k (perhaphs many times 12k) by making aliyah (taking into account lower salaries and your country's love affair with high taxes).
also, many employers offer dental insurance. how good is your dental insurance is in israel?
3) my personal anectodes:
a) when i was a baby in israel my pediatrcian said i needed an tonsilectomy/adenoidectomy as soon as possible. i was put on a waiting list and my parents ended up paying for a private surgeon.
b)a friend's mother is currently being treated in israel for cancer. she tells me that the israeli health system is pretty good, but is not as complete in cancer care (the example she gave me was that doctors can't/don't order lab tests as frequently as in the US).
c) two summers ago i took my son to terem. good experience overall except that i payed NIS 400, which is more than my son's pediatrician in america charges for a cash visit.
DANIEL:
"Israel is not filled with third world shits"
foreign doctors sometimes have horrible language skills and it is especially frustrating to deal with them during an ER visit.
but what makes you think they are any less qualified to get into a american residency program than the frum jew coming out of YU or brooklyn college?
"but what makes you think they are any less qualified to get into a american residency program than the frum jew coming out of YU or brooklyn college?"
First of all, they should not even be eligeble for residency programs. If the US needs more doctors , open or expand the US medical schools. IT IS OBSCENE THAT AMERICANS HAVE TO GOTO ST. GEORGE, WHILE WE LET THESE THIRD WORLD SHITS IN!!!!!!!.
There is an oversupply of residency progrmas in the US, not med school slots. This is where we get our Osama doctors. The federal government realized in the early 70's that Medicare was going to bankrupt us, and came up with idiotic fixes- increase the number of MD's and that will increase competion and drive down costs. So the feds increased med school slots and residency slots.
Meanwhile , hospitals realized that since residents are "students on a stipend" and not workers, they could work 100 hours per wek at low labor costs. So hospitals created many new residency slots and the only way to fill them was getting foreigners. Suddenly hospitals were filled with MD.s with third world training.
It was assumed that they'd go back home , but they have stayed and are crushing our health care system. Some hospitals now average 15 consultations per Medicare patient- a good one averages 3. We're talking calling the dermatologist for a skin tag on a 90 year old demented nursing home patient.
We call it "PAN -PATEL CONSULTATIONS".
These third world shits should never have been allowed to come here as long as we have lanzman that get stuck going to Sackler.
In any other field they'd be called scabs.
p.s
I have no problem with Americans of Indian,arab or pakistani background graduating American medical schools, but rather am opposed to bringing in third world scabs who I wouldn't go on an airplane with.
Moreover, the seriously competative residency programs will not take third world shits in. Only the progrmas that can't fill or should never have been created in the first place do.
American med students looking for a residency know to avoid progrmas that are foreign dominated.
DANIEL:
"If the US needs more doctors, open or expand the US medical schools."
very $
"The federal government realized in the early 70's that Medicare was going to bankrupt us, and came up with idiotic fixes . . ."
not that i wouldn't put something like this past the govt., but is this a conspiracy theory or this an accepted version?
"These third world shits should never have been allowed to come here as long as we have lanzman that get stuck going to Sackler."
is it possible that your "third world shits" are more qualified than some (and for the rest of you out there i stress "some") of the lanzmen who cheated their way through brooklyn college?
i understand your frustration about J1 med residents who violate their study terms and don't return home. but frankly, i'd rather be treated by some J1 violators than some frum doctors. (again for the rest of you out there, this is NOT a statement about all frum doctors.)
"why is that every pro-israel blog feels the need to deal with this "superior" facet of israeli society annually in order to maintain his/her credentials?"
What else would a pro-Israel blog do except for talk about how awesome Israel is?
And honestly, your 25 year old tonscillectomy story has little to no bearing about how Israeli medical care is today.
As for world class doctors- yes, we have more than a few. But the real benefit is that everyone gets basic medical care by mostly decent doctors (by that I mean there are good and bad doctors here just like in America). Everyone has a choice, if you don't like your doctor, you just go and find one that you do. But the real benefit is that because everyone gets basic care, I'm not stuck paying for my neighbor having to go to the ER for an earache and not being able to pay the outrageously inflated fee due to insane insurance pricing.
And you better believe that you do pay it through raised taxes, otherwise, they'd have to close up that local ER due to lack of funds. So whatever tax credit you get for health expenses gets drowned out by raised taxes to keep these hospitals going. It's ponzi scheme that's crumbling before your eyes, and it has nothing to do with the few hundred foreign doctors that overstay their welcome.
At least here, we're building new hospitals, while in the US they're closing them all the time, because county and state governments simply cannot afford to keep them going, especially in poorer neighborhoods.
I've gone through three pregnancies and cared for two children and one husband with a slipped disc. So far, we've only had excellent care, give or take a few annoying doctors, which, again, can happen anywhere.
Abbi: What else would a pro-Israel blog do except for talk about how awesome Israel is?
Absolutely! :) Abbi - do you want to guest blog?
LOY: c) two summers ago i took my son to terem. good experience overall except that i payed NIS 400, which is more than my son's pediatrician in america charges for a cash visit. How oculd you forget to add in that you were ALSO able to call me and get a plata for shabbat in record time? :-)
Anon 3:31: I've heard one too many stories about how people have had to wait months to get an MRI in Israel. Yeah, we pay more here; but we also receive quicker treatment.
Really? I know people in the US who also waited for over a year to get an MRI, and were mis-diagnosed (in the US) because of the year long wait.
From my experience, if you have a good doctor here in Israel, you can always get quicker service. If you dont like your doctor, find a different one, or change kupot. The option of different kupot is a great monopoly buster in that there really is competition.
Our Kupat Cholim Clalit pediatrician is simply a G-d send.
Could we please watch the language in the comments section. Jameel's children visit here.
LoZ: If your bill at Terem was NIS 400, it is most likely because you aren't a citizen and therefore not covered by a local Kupah (HMO).
My insurance has some sort of Dental plan. I honestly haven't looked at it, or used the free services they've offered.
I know for a fact that dental care costs far less in Israel than in America.
I have a few friends who are dentists and they tell me that they regularly get Americans coming in who need major work done, because it is so much cheaper here for the same quality work (by American born, bred, and trained Dentists now living in Israel).
If Hillary wins she'll really fix your health care!
With my medical conditions, even if I wanted to return to America I could never get adequate health insurance. It took a lot of research to get insurance for a two week vacation. (I can't tell you if the insurance was any good, B"H I had no claims).
I cannot say that I enjoyed two operations and radiation isolation therapy for thyroid cancer but at least it was done in a timely fashion and I can reach my doctors when I really need to. And I had my treatments done in public hospitals - not using the private supplemental insurance that I do have.
The part of the system that I really find annoying is that, for the most part, the doctors in the hospital and the doctors on the outside are two separate groups and have limited communication with one another and you don't ever see your Kupat Holim doctor when in the hospital. I am happy that at least my doctors do sometimes talk with the hospitals.
On the other hand, if I did not live in the center of the country or could not afford the supplemental insurances (through the kupat Cholim and private) I might be feeling differently about medical coverage in Israel.
JOE:
"Could we please watch the language"
i was just quoting from daniel. jameel should probably censor it out if his kids read this.
although, i thought that the s word is more accepted in israeli discourse. i even specifically recall hearing a former PM using the word repeatedly on CNN
"If your bill at Terem was NIS 400, it is most likely because you aren't a citizen and therefore not covered by a local Kupah (HMO)."
obviously. i just thought i was bring fleeced as the sucker tourist. sort of like hotels that charged foreigners extra or the restaraunts that had different prices in their hebrew and enlighs menus.
"My insurance has some sort of Dental plan."
good for you. my impression was that most israelis don't have dental insurance. (although dental care in general is much cheaper)
JAMEEL's READERS:
"How oculd you forget to add in that you were ALSO able to call me and get a plata for shabbat in record time? :-)"
just for the record, jameel does a great job at providing last minute tourist services. read more about it at http://agmk.blogspot.com/2007/03/haredim-and-gemachs.html#links
(jameel: can i add your phone number to the post? :) )
ABBI:
"What else would a pro-Israel blog do except for talk about how awesome Israel is?"
agreed. i just didn't think socialized medicine is one of israel's highlights.
"your 25 year old tonscillectomy story has little to no bearing about how Israeli medical care is today."
i admitted as much that the story is from a while back. but this is a concern of socialized medicine in general that has not abated. so you are telling me that this does not happen today in israel? then great.
"And you better believe that you do pay it through raised taxes . . ."
i don't understand. somehow i'm still paying lower taxes than you (to say nothing of the offset by much higher salaries in america)
LOY: NO, you can't add my phone number to the post! :)
(Then I'd get 24/7 calls for waffles...)
I personally don't think socialized medicine is a great idea, but I was talking to one of the primary doctors at Terem, and he thinks it is a wonderful idea.
(But from the stories I hear, I do think it happens to work better in Israel than it does in the US).
Go figure.
"I personally don't think socialized medicine is a great idea, but I was talking to one of the primary doctors at Terem, and he thinks it is a wonderful idea."
Joesettler, your approach is ugly and dishonest. You talk about how great Israeli health care is, and then down in the comments you let slip that you really prefer the American system! I don't know if you realize it but you come across as a zealot who's willing to tell any lie if it gets him the results he wants. There are plenty of genuinely good things about Israel; if you would only present them honestly then you might convince more people. See the following post for a good example (I am not affiliated):
http://mysticalpaths.blogspot.com/2008/03/safety-in-israel.html
eran, I don't know where you are coming from, but you clearly don't know me or my positions.
I am a firm believer in capitalism and free markets, and the concept of socialized medicine doesn't quite jive with those beliefs.
Having said that, it is clear that the Israeli system does perform far better than the American one.
I suspect that this is so, because the Israeli health system underwent a major reform a few years ago and the Kupot (HMOs) were suddenly forced to compete to keep their clients (and in Israel it is the individual who chooses his HMO), so while the government still pays for most of the services and insurance (through the Bituach Leumi tax), and requires that all citizens be insured from one of the recognized Kupot, it actually created a relatively competitive environment between the HMOs, and we the citizens profited.
It is more of a hybrid between capitalism and socialism.
But it certainly wasn't that way before the reform.
As for the American system, it is clearly broken. Clearly something is preventing it from working properly and that might be government interference or simply that employers and insurance companies prefer the cheaper managed care plans which cost the HMOs and employers less money - but to the detriment of the patient who might need more flexibility, freedom, more tests, or extended hospital stays.
i don't understand. somehow i'm still paying lower taxes than you (to say nothing of the offset by much higher salaries in america)
LOZ: Someone pays for the uninsured who gets care in the ER that he can't pay for. Who do you think it is? It's the taxpayers.
Your taxes might be "lower", but you're still shelling out for insurance and a myriad other services that we get, and you're still getting crappy healthcare that produces the highest infant mortality and the lowest life expectancy in the developed world. You personally might get adequate healthcare. But it's been firmly established the the U.S spends the highest amount per capita on hc with the least results.
And you still have those niggling 2 million citizens who don't have health insurance.
I agree with Joe.I think the Israeli system is the best of both worlds- socialized with choice. It's not "gov't run healthcare" which is a a great american scare tactic, used to create images of hungry soviets waiting in long lines to get an aspirin.
And it's certainly not a utopia- but it's definitely better then the us system.
As for Terem fleecing you- right, just like when I had to see a ped in the US without insurance and he charged me $300 to check my kid's ear. Um, I believe the term is called "not having insurance". Now you know what your fellow citizens feel like when they need basic care on a regular basis.
Jameel- I'd love to take you up on your offer, i'd just have to think of a relevant topic!
Abbi: please drop me an email - I can suggest a few!
ABBI:
"just like when I had to see a ped in the US without insurance and he charged me $300 to check my kid's ear."
professors at columbia-presbyterian charge $300-400 for an initial consult with no insurance. so if you took your kid to a top ped ENT for a possible ear infection, then that was your mistake. and if you actually paid $300 for the local family ped, then you got ripped off. it has nothing to do with not having insurance. let me know if you are in brooklyn and i will refer you to much more affordable doctors.
"Um, I believe the term is called "not having insurance.""
so non-tourists without insurance would have also been charged the same NIS 400? i could be wrong, but iirc i was charged some type of a tourist or foreigner's rate.
and for a self-gratuitous plug, i just remembered i have a terem-related post:
http://agmk.blogspot.com/search?q=terem
loz: you paid the full rate for the visit, which perhaps your insurance (you did take out travel insurance, right?) could have reimbursed you for.
I took my kid to the doctor in the US to make sure he could fly home with his cold. Cost me $80.
They wanted to innoculate him for some reason with I have no idea what, and why was beyond me why as he wasn't a regular patient and they had no patient records on him.
I put a stop to that.
JOE
"you did take out travel insurance, right?"
i never needed it before. now i know about it.
when we got to the clinic and they told us how much it would be, i called my credit cards to see if i could buy travellers health insurance from them. they said i had to have bought before i flew. again, who knew
"for some reason"
to charge you more $ perhaps?
"to make sure he could fly home"
and that was the reason for our follow up visit to terem (result: "no problem if the ear drum perforates from the pressure. it will be very painful and he'll scream for 12 hours, but it'll eventually heal")
"Cost me $80"
hmm. a lot more reasonable than the $300 abbi spent at the boutique pediatrician. but in any case, how is that the full rate at terem was more money than that a visit in america? you're telling me that non-tourists pay NIS 400 (i think it was about $100 when i was there) for every visit? or is that i got ripped off in israel the way abbi did in america?
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