“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.