Here’s my Israeli health care story on the CIJA site, where it’s well presented and easy to read…
Isolating Iran and trying in vain to keep it from obtaining nuclear weapons is a flawed policy. That’s the gist of one of a series of clips from a video interview I did in Canada when I was there on my lecture
tour. This is also an example of me trying to make sense at 8:30 in the morning ;-( on other subjects, including Western media coverage of the Mideast, how journalism has changed in the past 50 years and the obsession of the West with Israel and the Palestinians.
I’ll be back in North America in the second half of May, and I’m putting together some more lectures…I be glad to come to your city if there’s a sponsor.
(This essay is part of Chapter 18 of my book, “Why Are We Still Afraid?”)
“So you’re making trouble?” joked Dr. C, my cardiologist, a little sparkle in his piercing blue eyes.
He made time to see me at the end of his work day after what happened in Tel Aviv a few hours earlier.
I took the train from my suburb to downtown Tel Aviv. That cost me four bucks—we senior citizens ride the train for half price. I was supposed to take a test that included running on a treadmill, but since I had to stop three times while walking less than half a mile from the train station to the hospital, the doctor there thought the test would be too dangerous. He sent me back to Dr. C.
This isn’t really about my coronary arteries. It’s about Israel’s health care system. Start keeping track of how much this whole saga cost me, factoring in that Israeli wages are about three-quarters of those of the US. Compare it to the American system, where a relatively minor health insurance reform has become reviled as “Obamacare,” though it does not even approach the real issues like overall costs, employer-linked insurance, astronomical co-pays and excessive prices of medicines—problems Israel solved decades ago by not going there in the first place.
Israel gets more health per dollar. Israel spends less than a third per capita on health care compared to the US, 7.3 percent of GDP compared to 17 percent in the US—yet Israelis have a life expectancy of 82 years compared to 79 in the US.
Israeli citizens are all insured by one of four government-backed HMOs. We have cards with magnetic strips that allow any doctor or nurse in our system to access all our health records. Besides saving time, since we don’t have to recite our entire medical history to each individual doctor, the system helps prevent errors.
Under normal circumstances, I make appointments with doctors on line, logging in to the HMO site. I also get test results like blood work there, so I can see them even before my doctor does.
The system is financed by payroll deductions between 3.1 and 3.5 percent of a worker’s income. The minimum is about $25 a month, and some categories of people are exempt even from that, like children, unemployed, stay-at-home spouses, soldiers and prisoners.
The more affluent can sign up for supplementary insurance through their HMO. My wife and I have the maximum, for another $120 a month. Private insurance supplements are also available.
Even the basic coverage was enough to cover a life-saving procedure like angioplasty in a state-of-the-art facility with a top-notch surgeon.
But before I got that far, I had to see Dr. C, my cardiologist, again. I’m making it sound as if we go back decades, but in fact, the extra appointment he made for me after the cancelled stress test was only the second time I saw him.
The first time he asked my permission to charge his fee to my standing HMO deduction order. It costs five bucks to see a specialist. I don’t know if he charged me for the second visit or not—my mind was on other things. So was his.
My failure to even take the test showed that I needed angioplasty right away. He called his buddy Dr. A, the chief angioplasty surgeon at a second Tel Aviv hospital, to set up an appointment for me.
The appointment was two days later. Dr. A’s hospital is across from a downtown mall, which is where you have to park. That cost five dollars.
My wife and I walked across the parking garage to the escalator, took it up two flights through the mall, found ourselves outside on a street across from the hospital’s emergency room. We went in, took an elevator up one floor (right there you can see I was sick—I hate elevators, and I usually run up the stairs two at a time).
Emerging from the elevator, we spotted the cardiac department way off in the distance, at the end of a hallway that appeared to be just this side of the horizon. I had to laugh. The cardiac department of my HMO’s headquarters in Jerusalem is on the fifth (top) floor. I see a pattern here.
I made my way slowly down the corridor and found Dr. A’s office in the new wing. He has two old typewriters on a shelf just outside his door, and I was admiring them when he came in from surgery.
Listening to my story, it didn’t take long for the kind, calm, blue-eyed specialist to determine that I needed his services. He scheduled me for angioplasty three days later and sent me to my HMO to get a letter promising to pay for the procedure and the hospital stay.
That’s short notice, since the weekend was approaching, but the HMO came through, emailing me that afternoon that the letter was ready to be downloaded from its website.
After the weekend, it was back to the hospital for the procedure. Getting the preliminaries done took a couple of hours—I watched a clerk constructing a patient’s folder out of many different forms, all paper, a reminder that even here, not everything is computerized yet.
The rest of the hospital story is remarkably routine, considering that angioplasty is a big word that means threading a catheter through an artery, guiding it into a beating heart, finding a blocked artery, jamming in a balloon covered by a collapsed wire mesh called a stent, and then inflating it to widen the artery. Miraculous, not routine, as far as I’m concerned.
Looking at the monitor screen above my chest, Dr. A told me, “I can see why you’re having pain.” I was awake during the whole process. And then, within 20 minutes, he opened the blocked artery.
After a short recovery, I was wheeled back down to my room, shared with a businessman who had a similar procedure. We were hooked up to monitors that showed our vitals on a screen across from the nurses’ station as well as above our heads. Nurses came in every few hours to check our blood pressure and the like. The next morning, Dr. A popped in to make sure everything was OK, and I was released.
This time my wife just picked me up on the street outside the hospital, since standing and walking were no longer a problem for me. The procedure works that fast. The day before, she stayed with me until after I was well installed in my room, taking advantage of a parking deal the hospital has with the mall—seven dollars for the whole day.
There’s also medication. I’ll be on a strong anticoagulant for a year. I got a prescription from Dr. C, and it will cost me $4 a month for the generic version. Two well-known American chains charge more than that for a single pill, though another one offers a month’s supply for about $10.
So if you’ve done the math, you’ll see that beyond my monthly insurance premium, which when I was working full time came to about $500 for my wife and me together, this heart procedure cost us $25 out of pocket—about half of it for parking.
It’s not as if Israel’s government doles out extra billions to make up the difference in costs to the patient. Israel’s government kicks in about 60 percent of overall health costs here, not much more than the US government, which covers about half. The difference is the structure.
That’s not to say there are no drawbacks in the Israeli system. Doctors and nurses are on salary, and many are underpaid. Hospitals are overcrowded, and some are old and rickety. Also, a government-appointed committee has to decide what medicines the HMOs will pay for, and what they won’t. The committee has a fixed budget to work with.
For example, the committee declined to approve an expensive medicine that might extend the lives of terminal colon cancer patients a few months, preferring to use the limited funds for medicines that would help more people. Some would call that a “death panel,” but for the most part, such decisions are accepted as part of the system.
And there are intangibles. My cardiologist, Dr. C, whom I saw exactly twice before the procedure, called me at home the day after, just to tell me he had talked to his friend Dr. A, who said it went well, and to ask how I was feeling.
As the ad says—that’s priceless.
Smitty’s gentle smile popped into my mind late one night when I was thinking about my sudden symptoms and upcoming heart procedure.
Leonard Smith was about 60 when I met him. We worked together at a large CBS-TV station in northern Indiana. I was the 11 p.m. TV news anchor, and he ran the film processing machine in the basement.
It was 1971. I was 23.
Everyone called him Smitty, and everyone liked the slim, erect, unassuming man who usually walked with his head down. He would return your greeting with his smile and a word or two. He kept mostly to himself.
I noticed that the only people he actually talked to were the two other black employees at the TV station, a news photographer and a floor manager. The rest of us got the quiet, calm, unassuming Smitty.
Curious, I would go down to the basement, where the large, noisy film processing machine was running, and try to start a conversation with Smitty. Eventually he responded to the young, brash, college-educated, somewhat radical youngster in front of him.
We’d sit on the front porch of his little frame home in the mostly black section of the city, sipping beer on warm Saturday nights, talking about the world. My world was mostly theory. I hadn’t really done much by then except being raised by Holocaust survivors, delivering the morning paper from age 12, working in a supermarket while editing my high school newspaper, working my way through university with the help of a scholarship, and getting two jobs as a TV news anchor.
Smitty, by contrast, never graduated from high school. He told me, through his own experiences, what it was like to grow up black in the 1920s and onward, through the Depression. Black kids, even smart ones like him, didn’t finish school back then.
He calmly described the discrimination he faced every day of his life. He was born and raised in this city, far up in the North. Even here, the prejudice and mistreatment were constant, pervasive, so much so that they just became a way of life. He said he didn’t think much about it — that’s just the way it was back then.
Smitty worked at a series of unskilled jobs, and then he taught himself photography and hooked on with the TV station.
One day I noticed that as he walked down the long hall from the TV end to the radio end of the station, Smitty was slowing down. I asked him what was wrong, but he just waved me off.
As the weeks went by, it got worse. Finally I saw him leaning on a wall partway down the hall, and I got him to tell me.
He had developed a circulation problem in his legs, he said. He needed an operation.
OK, fine, I said, with all my white self-assurance, so go get this fixed.
He looked at me for a few seconds, and replied quietly, “I can’t. If I tell the boss that I need time off for an operation, I’ll lose my job.”
The boss was a white, middle-aged, decent if somewhat unenlightened newsman. We didn’t get along all that well, especially after my TV ratings passed his, and because I brought in all these ‘60s radical ideas like covering demonstrations, not just news conferences, pointing out that they’re actually the same thing — trying to get on TV.
I knew the boss was no bigot, and he liked Smitty in the same way the others did — in a “Hi, Smitty, how are you?” “Fine, thanks,” kind of way.
I told Smitty that he had a right to sick leave, and that no one was going to fire him, that didn’t happen anymore.
In 1971, the 1964 Civil Rights Act and the 1965 Voting Rights Act were fresh in our minds. The ‘60s had just ended, and the various movements, like civil rights, feminism, anti-war, were still very much active and public.
But that didn’t touch Smitty personally. He was adamant, frightened. What I was saying went against a lifetime of his experiences. He wasn’t willing to take a chance of losing a job at his age, convinced that no one would hire a 60-year-old black man with no education.
I kept up the gentle pressure, but probably what softened his resolve was the steady deterioration of his condition. He was finding it harder to walk, and more important to him, harder to hide his limitation from others, always fearing that if it came out, he’d be fired.
Finally I persuaded him to go to the boss together with me, and we’d ask him for time off for the surgery.
We walked slowly into the newsroom, approaching the boss’s desk. Smitty looked at the floor. I did the talking. Of course there was no problem. The boss told Smitty to get the operation done as soon as possible, take as much time as he needed, and his job would be waiting for him when he got back.
I don’t remember exactly what operation he had, only that it was not all that complicated. I don’t think it was angioplasty (that’s mine), because that was a new, state-of-the art procedure four decades ago.
All I remember are the results. After a couple of weeks to recover, Smitty ducked into the newsroom, called me over, and said, “Watch this.”
Then he went out into the hallway and walked quickly, firmly and confidently all the way to the other end, a huge smile on his face.
Smitty came to mind because all of a sudden I can’t walk very far, either, and I’ve got other symptoms that will get me into a Tel Aviv cath lab to open up a clogged coronary artery or two. Now it’s a common procedure, and I have every reason to believe that soon I’ll be back running up four flights of stairs two at a time to stay out of elevators, riding my bicycle, climbing up on the roof and doing all the other things I’ve been doing since forever.
It’s been nearly half a century since Smitty had his surgery. Nowadays running a catheter into a beating heart is routine. And here in Israel, every citizen has government-backed health insurance, so my biggest expense during this short but intense medical saga has been four bucks for the train ticket to Tel Aviv and back for a test. We senior citizens ride the train for half price.
And it’s been nearly a century since Smitty grew up in an atmosphere of oppressive, debilitating discrimination that led him to fear having that operation. Such fears, even then relics of a bygone era, are almost unheard of today.
That’s progress, too.
The horrific execution video shown by ISIS of the beheading of 21 Egyptian
Christians in Libya is sending waves through the region. Egypt responded with airstrikes against ISIS position in Libya, but what’s just as important, as you can hear in my analysis on KQV Radio in Pittsburgh, is that there’s an ISIS presence in Libya at all–as well as other places in the Mideast outside Iraq and Syria.
I had misgivings about flying home with Lufthansa after my North American lecture tour and stopping over in Munich for three hours. I have been in Germany exactly once, more than 40 years ago, and I cut the visit short, very short. My parents were Holocaust survivors from Germany, so no further explanation is needed.
It turned out even worse than I expected, way beyond simply uncomfortable.
I kept my small, black knitted kipa on my head there. I had it on all over North America, so why should I make an exception for Germany, I figured. I don’t know if that explains the incidents below, and frankly, I don’t care if it does or doesn’t.
From the duty free shop to the cafeteria, female clerks treated me with disdain and hostility. I tried to be friendly with the first one, with no results. I didn’t even try with the others.
Then came the security check before the flight to Tel Aviv. I saw others breeze through with a cursory examination. Here’s what happened to me.
I put my bags on the belt in front of the X-Ray machine–a computer bag and a carry-on–and walked through the metal detector with no problem. Then a small, young, blond German ordered me to stand in front of him with my arms extended, What happened then was the most intrusive, abusive search I have ever encountered. Not only would it qualify for sexual assault–that wasn’t even the worst part.
Standing behind me, the little German peeled off my kipa and closely examined, with prying fingers, the part of my head it had covered. I had to control myself, believe me, but if I had done to him what I felt like doing, I would be in a German prison right now. After a thorough examination of my feet and shoes, the disgusting little German pointed me back toward the belt where my bags had been X-Rayed. There, a middle-aged German woman asked coldly if she could examine by computer bag. I agreed. She fished around in it for a few seconds and let me go.
Here’s where it gets even more personal. I was so shaken by the experience that I just took my bags and went to sit down at the gate without checking them. A few minutes later, another middle-aged German woman came over, calling my name, walking straight toward me–with my wallet and Israeli passport in her hand. This is the large wallet I use for my passports and my foreign currency, and it lives in a front pocket of my computer bag, pretty much all by itself. I was using my American passport at the airport, so the Israeli passport was in a pocket inside the wallet, inside the bag. Someone extracted the wallet and then took out and examined my passport–otherwise, how would German woman #2 have known what I looked like? I angrily asked why someone took the wallet out of my bag, and she angrily denied that anyone had done that. This went back and forth several times until I sarcastically thanked her for bringing it to me, and she left.
As far as I can tell, nothing was taken from the wallet. So what. The lesson is clear.
Stay away from Lufthansa. Stay away from Munich airport. And if you are at all affected by this story–stay away from Germany.