What Growing Up in Israel Taught Me About Obamacare


When my family immigrated to Israel from Russia in the late 1980s, my parents struggled to learn an entirely new language, all while feeding and clothing two young children on a small government stipend and searching for work. Fortunately, health care wasn't one of their many concerns.

Like most developed countries, Israel provides free or subsidized health care to all its citizens. We could visit a clinic, see a dentist, or call an ambulance in an emergency without the fear of insurmountable expense.

In the U.S., we were greeted by a very different reality. Though I was lucky enough to have some coverage through most of my twenties, like 48 million Americans, I eventually found myself uninsured. I remember waking up in a cold sweat, wondering if a stomach cramp would turn out to be appendicitis and how much a trip to the hospital would cost. I looked into purchasing insurance, but the prospect of a medical exam seemed daunting. And then of course there would be the monthly bills which, without a job, I couldn't afford.

When Obamacare was signed into law in 2010, I welcomed the upcoming reforms. Though the legislation has many flaws, it extends health care coverage to millions of uninsured Americans, and places long-overdue regulations on America's for-profit insurance system. The provisions that are already in place allow parents to add children under the age of 26 to their insurance policies, prohibit insurers from denying coverage to sick children, and eliminate lifetime limits on insurance coverage. Soon low-income individuals and families will be able to enroll in Medicaid or sign up for subsidized insurance policies.

Though Obamacare will not result in universal coverage, it will bring the U.S. health care system one step closer to that of other developed countries. In rankings that take into account outcomes and per-capita spending U.S. health care has consistently received poor marks. In 2001, it was ranked 37th by the World Health Organization. In a 2013 Bloomberg report that ranked health care systems by efficiency it came in 46th, followed only by Siberia and Brazil.

In contrast, Israel ranked 4th on the Bloomberg survey. Israel spends only 8% of its GDP on health care — compared with 17.4% in the U.S. — yet it has higher life expectancy and provides universal access to basic services. Even Mitt Romney praised the efficiency of Israel's health care system during a 2012 visit.

So how come Israel is able to do more with so much less? Like the U.S., Israel has a hybrid system that includes both private and public providers, and the care is managed by HMOs. The crucial difference is that Israel's system is subject to strict government regulations and its four HMOs are not-for-profit. Before Obamacare, the U.S. system was almost entirely unregulated. U.S. citizens currently spend some 30 percent of their health care contributions on administrative costs alone.

In the U.S. uninsured people who can't afford a visit to the doctor often end up in the emergency room. Stephen Reingold, a pediatrician who moved from New Jersey to Israel, told the Jewish Daily Forward that he was surprised to notice that Israelis only go to the emergency room for “severe cases.” He later realized that this was because routine care was widely available.

With the implementation of the next stage of Obamacare in January 2014 many more Americans will also have a doctor to go to. Yet the legislation still has some serious hurdles to clear before it becomes effective. One of the reasons care is both accessible and affordable in Israel and many European countries is that everyone pays a share of their income into an insurance pool. That's how insurance works, and it makes sense: no one knows whether or when they might get sick. In the U.S., however, healthy people can choose to opt out of insurance, and those with a low income often cannot afford any coverage at all, so they don't pay. This shrinks the insurance pool and drives up costs for everyone.

The insurance exchanges, opening on October 1, and the individual mandate that will go into effect in January are designed to create a fairer and more efficient system, similar to the one that serves Israel and some countries in Europe. Conservatives are doing their best to undermine these reforms by flooding the media with misinformation about the exchanges, and are even willing to risk another financial crisis in an attempt to defund Obamacare.

It will up to America's citizens to make Obamacare work by signing up for health care and lending their support for the basic framework of the reforms. This does not mean that we should stop criticizing Obamacare or pushing for an even more efficient and inclusive system. But if Obamacare is defunded — or defeated through lack of participation — we will return to a wasteful and inequitable system where health care executives reap enormous profits while sick children are denied coverage.

Some Americans have come to regard this as “the way of the world” and they are fearful of change. For people like me, who have lived in countries where health care is a basic right, it is clear that the American system simply doesn't serve its citizens.

Some say that Obamacare will thwart job creation. Both Israel and the state of Massachusetts, where Mitt Romney had enacted a similar set of reforms in 2006, point to the opposite conclusion. Access to health care which isn't directly tied to employment encourages entrepreneurship and innovation.

I would argue that unrestricted access to health care also encourages a more free and democratic outlook on the world. Are we being true to the democratic spirit when we allow bosses and health care executives decide whether or not we can see a doctor? Maybe how you answer that says more about how you feel about democracy than anything else.