I believe one of Americas weakest and strongest points is our desire for individuality. While being an individual has helped us flourish, it is also now hindering us as we try to achieve better healthcare. Like some of my classmates, I too think that now if the time for the government to help step in and assume a little bit more control in trying to create a stronger system. Our laissez-faire insurance driven system clearly doesn't and is not working as we have millions uninsured and unable to pay for basic health care. We need to step back and learn from countries like Israel who establish healthcare systems under the concept that their population not only needs healthcare, but that it is a basic right. Instead here we espouse the idea of having good healthcare, but only if you can afford the pay to play system. Israel is on the right track with a strong primary care system, and that also is a direction we need to think about system our healthcare system is so heavily ladened with specialist. I know that Israel's system is not without its faults as well, but I guess it is the whole idea of learning from both the good and the bad.

single payer system with quality

Unlike U.S., Israel health system has universal coverage and is run by the government (single payer). Each citizen pays certain percentage of their income as health care tax and Israel spend less GDP in health care than U.S. There are 4 HMOs in Israel and they compete to attract more citizens with better medical benefits. Like in Japan, the ministry of Health sets guidelines for these 4 organizations by providing a list of medical treatments and services that each has to provide to the members. The undocumented immigrants and minorities in Israel may not have full health coverage due to segregation and lack of development of culture-sensitive health care services but at least they have some access to the health care. The combination of a single-payer system with the possibility to choose between four public providers (HMO) makes the Israel health care system relatively equal and efficient. The bottom line is Israel has fairly better access to care than U.S. while maintaining high quality and controlling the costs from the government.

Looking at Israel's health care system just reinforces the common theme that these ideas, including robust primary care, a basic package of health benefits for all, mandatory insurance, etc are good ideas and work in a variety of settings. Why can't we do the same? I think what current reformers need to do is to work together instead of bickering so much that nothing ends up being done. The US needs to learn that in the end, doing something is better than doing nothing and needs to put the health of the population first. In Israel, people migrated from diverse areas but are much more united by their history of persecution and common religion (birthright, mandatory military service, etc). In the US, however, differences between groups are exaggerated and are instead used to hinder any real reform.

It is ok for the government to get involved!

I have come to realize that one major obstacle that keeps America from adopting universal health care, is the fear of government involvement. Although, we see government involvement in the field of health care working for other thriving nations, we refuse to see the benefits and in fact the responsibility we should be placing on our government to provide all of us with coverage. Israel is a great example of a nation that has let the government take the lead in health care. The people are not afraid nor are they hesitant to let the government be a figurehead in health care.
Additionally, I believe that there needs to be a revolutionary spin on the principle of individuality in America. I know that America is founded on principles of independence, liberty, and individualism. These are good principles and values, but we need to re-shape the way individualism is viewed. Just because we unify as a country under one government who will provide every citizen with health care, it does not mean we are denouncing our rights and our uniqueness- our individuality. In terms of health care, we need to shift from an individual-goal oriented society into a group-goal oriented society, once again realizing that this does not mean we are giving up our individuality. Israel views health care as a right and as something that everyone should have access to. I think America needs to do the same.

"Too many minds, one mind."

The one thing that I've learned and have been influenced by our class in thinking is that health care is a right. Initially, I had a difficult time understanding this idea, but looking at various health care systems around the world showed me that most countries think the same way, therefore providing universal coverage.

In Israel's case, I find it interesting that prior to the National Health Insurance law in 1995, 96% of the population was already covered by one of the four "sick funds." The article states that this was possible because of graduated membership fees, which were "founded on need, not on the ability to pay," and also the employers health tax. What was so wrong with this program that they instituted a new law? Was this for the 4% uninsured?

Before the US jumps onto the universal coverage bandwagon, maybe we can apply the "founded on need, not ability to pay" concept. Health insurance fees based on income and family status, would make insurance in the states more varied, yet more affordable. But, then again, since our insurance market is so profit-driven, I really don't know what the insurance companies would feel about this.

The biggest difficulty with the US reform is the US mindset. In the movie, "The Last Samurai," there is a scene in the movie where Tom Cruise is learning to sword fight, but keeps losing to his opponent. A man in the audience approaches him and says, "too many minds, one mind." Then Tom Cruise thinks about the statement, then wins his first match. Similarly, the US is filled with too many minds and opinions. Before we make any reform, we must reunite.

Israel has partial similar health insurance system as U.S., but the availability of services to their people was founded on need, not ability to pay. The ratio of physicians to 1000 persons is 4.6, one of the highest levels in the world and the health system has over 2000 community-oriented primary care clinics operated by the sick funds, the Ministry of Health or the municipalities. The Ministry of Health also operates and funds a successful community health service: a nation-wide public network of 850 mother-and-child-care centers, which offers low-cost easily-accessible services, health education programs, regular checkups to monitor child development and a comprehensive immunization program (newborn to 5 years). As the article mentioned all these health-prevented approach above, the U.S. health care reform could definitely learn to put more emphasize on prevented health programs and facilities, the community-oriented primary care clinics and the public network mother-and-child-care centers are the basic primary care access to people, the U.S. health care system could just simply follow these primary facilities ideas and then enhance the financing management of these facilities; with better primary care emphasize, the future health care cost of total population would have the chance to go down to help rationing the huge U.S. expenditure of health care and relatively poor quality.

Reform by modeling others...

Since United States' main issues are the amount of uninsured and inflated health care costs, United States could learn from Israel that:

- "Two factors have played a major role in the maintenance of a high level of coverage among the population: Membership dues were graduated by income and based on family status, and availability of services was founded on need, not ability to pay."

Because of historical and cultural reasons, I believe the second statement doesn't hold true in the United States, but should be. Health care in the United States has been left to the free market and therefore competes on ability to pay, not need. If the reform passes, health care in the United States will be limited in the free market by government.


Also, to design the insurance exchange component of the U.S. reform it could follow Israel's "basket of basic health services" guidelines:

- "Every resident must register as a member with one of the four sick funds."
(Individual mandate)

- "The sick funds may not bar applicants on any grounds, including age and state of health."
(no exclusion based on pre-existing conditions)

- "Equal status is accorded to all four sick funds."
(Not included in U.S. reform? I don't know exactly what this means...)

- "Health care services covered by the law" are predetermined.
(Public option)

Although, Israel has budget issues also.