Learn­ing curve

Rom­ney praise of Is­raeli sys­tem draws un­fa­vor­able con­trasts with U.S.

Modern Healthcare - - OPINIONS EDITORIALS -

While eyes around the planet last week were fo­cused on the Lon­don Olympics, U.S. politi­cians were pro­vid­ing truly world-class en­ter­tain­ment on health­care. Let us fo­cus on Mitt Rom­ney, the pre­sump­tive Repub­li­can pres­i­den­tial nom­i­nee. Rom­ney has been all over the map on health­care is­sues, and last week he was all over the globe on the same. On a grand tour of Europe, Rom­ney raised eye­brows with his some­times puz­zling, anti-diplo­matic re­marks. When he made a stop in Is­rael, some state­ments at­tracted the at­ten­tion of health­care pol­icy afi­ciona­dos.

Rom­ney, of course, is the for­mer Mas­sachusetts gover­nor who signed the state’s land­mark health re­form law. It’s a plan based on con­ser­va­tive pro­pos­als from the 1990s and is the fore­run­ner of the Pa­tient Pro­tec­tion and Af­ford­able Care Act, of­ten re­ferred to de­ri­sively as Oba­macare. De­spite his ad­vo­cacy of the state law, Rom­ney is now run­ning away from it be­cause the GOP de­tests the model plan for Oba­macare. And, as we have pointed out re­peat­edly, the con­ser­va­tives who once cham­pi­oned ex­change-based schemes with in­di­vid­ual man­dates have turned against their own pro­pos­als since they were adopted by Pres­i­dent Barack Obama.

So when Rom­ney praised Is­rael’s per­for­mance on health­care, it evoked some cog­ni­tive dis­so­nance.

“Do you re­al­ize what health­care spend­ing is as a per­cent­age of (gross do­mes­tic prod­uct) in Is­rael? Eight per­cent. You spend 8% of GDP on health­care. And you’re a pretty healthy na­tion,” he said at a fundraiser, ac­cord­ing to the New York Times. “We spend 18% of our GDP on health­care, 10 per­cent­age points more. … We have to find ways—not just to pro­vide health­care to more peo­ple, but to find ways to fund and man­age our health­care costs.”

It’s not clear how much Rom­ney knows about the Is­raeli health sys- tem, but he prob­a­bly wouldn’t en­dorse it if he did—and at the same time wanted Repub­li­can votes. That’s be­cause the Is­raeli sys­tem is heav­ily reg­u­lated and funded by gov­ern­ment. The sys­tem de­rives its rev­enue mostly from a pro­gres­sive pay­roll tax and gen­eral rev­enue. The state is re­spon­si­ble for pro­vid­ing health ser­vices to all res­i­dents. Some in the U.S. would de­nounce it as so­cial­ized medicine. Don’t like the in­di­vid­ual man­date here? All Is­raelis are re­quired to carry in­sur­ance and must choose from one of four com­pet­ing, not-for-profit health main­te­nance or­ga­ni­za­tions. The gov­ern­ment re­quires the plans to cover ev­ery­one re­gard­less of health sta­tus (no pre-ex­ist­ing con­di­tion ex­clu­sions there), and it sets the ben­e­fits pack­age the poli­cies must pro­vide.

Ac­cord­ing to a Septem­ber 2011 re­port in the jour­nal Health Af­fairs, the in­sur­ance plans have to pro­vide cov­er­age within the bud­get set by gov­ern­ment. Most care is de­liv­ered through gov­ern­ment-owned fa­cil­i­ties, and the gov­ern­ment sets a cap on hos­pi­tals’ an­nual rev­enue from each plan.

In con­trast, the ACA’s cost-con­tain­ment pro­vi­sions are tepid.

And do the Is­raelis like their sys­tem? The Health Af­fairs ar­ti­cle de­scribes a “very high level of pub­lic sat­is­fac­tion.” Is­rael had the fourth-high­est life ex­pectancy of any coun­try from 200510, ac­cord­ing to the United Nations. The U.S. came in at No. 38.

We don’t know what Rom­ney may have learned in Is­rael, but a cou­ple of lessons from that na­tion and other ad­vanced coun­tries could be ap­plied here. Coun­tries that en­sure univer­sal ac­cess to care achieve bet­ter health out­comes. Be­cause ev­ery­one is in the sys­tem, all par­ties— pa­tients, providers, in­sur­ers, gov­ern­ment—have a stake in con­trol­ling costs and man­age to do so far bet­ter than the U.S.

So in the health­care Olympics, Amer­ica is spend­ing lots of gold but win­ning very lit­tle.

NEIL MCLAUGH­LIN

Manag­ing Ed­i­tor

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