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Romney Praises Israeli Health Care System

Via Buzzfeed:

“When our health care costs are completely out of control. Do you realize what health care spending is as a percentage of the GDP in Israel? 8 percent. You spend 8 percent of GDP on health care. And you’re a pretty healthy nation,” Romney told donors at a fundraiser at the King David Hotel in Jerusalem, speaking of a health care system that is compulsory for Israelis and funded by the government. “We spend 18 percent of our GDP on health care. 10 percentage points more. That gap, that 10 percent cost, let me compare that with the size of our military. Our military budget is 4 percent. Our gap with Israel is 10 points of GDP. We have to find ways, not just to provide health care to more people, but to find ways to finally manage our health care costs.”

This is, by the way, on target.  I happen to have handy the following table from the book I am currently working on, which only goes through 2009/10, but the basic numbers comport with Romney’s point:

image

So, Romney is correct:  there is a rather remarkable gap between spending in the US and Israel (and, indeed, the US and everywhere—we top out in this list on percentage of GDP, private spending per capita, and public spending per capita).

And, to toss in a little more for the discussion, a few quick facts:

  • Life expectancy at birth is 81.07 in Israel and 78.49 in the US.
  • Infant Mortality per 1,000 live births in Israelis 4.07 in Israel and 5.98 in the US.
  • Maternal mortality rate per 100,000 pregnancies is 7 in Israel and 24 in the US.

So, clearly, the Israelis are doing something right.

The baffling thing about Romney’s statement is that he is praising a system that is unambiguously “socialistic” by his party’s standards.  To quote an article from Health Affairs (h/t: : Jonathan Cohn)

The national government exerts direct operational control over a large proportion of total health care expenditures, through a range of mechanisms, including caps on hospital revenue and national contracts with salaried physicians. The Ministry of Finance has been able to persuade the national government to agree to relatively small increases in the health care budget because the system has performed well, with a very high level of public satisfaction.

Beyond the issue of what might be perceived as gotcha politics, it begs the question as to what it is that Romney thinks is a good idea about health care.    First, why praise a system if it is impossible to even talk about such a model within one’s own party?  Second, does this entire conversation not underscore what is wrong with the US debate over healthcare (and has been for decades) which is:  we have viable models to look at, and yet they are all considered impossible to emulate because of socialism, or something.  All snark aside, it may well be that a given model will not work in the US, but the bottom line is that in terms of a major political debate, we never discuss other models.  Most citizens seem to think that the option are our system of free market, privatized health care v. the worst stereotype of the British National Health Service. This is wrong on so many levels–such as the fact that our current system is hardly free market and is even fully privatized and the fact that the world holds a number of different models to examine.

One last stat, Israel collected an average of 35.71% of GDP in taxes during the 1990-2010 period and the US collected 27.39% (and yes, that’s all levels of government)—so more socialism, I guess.

Here’s some more from the Health Affairs article:

The plans are required to provide coverage to  all Israeli citizens and permanent residents for a relatively broad package of services, which the government updates each year. A committee—which includes representatives of health plans, provider groups, and the government, as well as academic experts and public figures outside the health care sector—recommends additional services each year to be paid for by the government’s annual allocation of new funds.
Most of the funds for the plans come from payroll and general tax revenues, which are channeled to the plans in the form of capitation payments. These payments accounted for 77 percent of health plan revenues in 2009. Additional funds come from individuals’ copayments for pharmaceuticals, physician visits, and certain diagnostic tests; these constituted about 6 percent of health plan revenue in 2009. In 2009 the remaining 17 percent of plan revenues came from sources including supplemental health insurance and the sale of products such as over the- counter medications in plan facilities such as clinics.

The piece makes the following comparative note that questions the applicability to the US:

THE UNITED STATES: The Israeli experience has limited relevance to the United States, given the differences in the structure and scale of the two countries’ health care systems, and in the political and commercial environments in which they operate. The local health insurance exchanges created by the Affordable Care Act of 2010 may loosely resemble the Israeli health care system in terms of financial arrangements. However, just implementing the exchanges is
unlikely to slow the increase in US health care spending very much, in the absence of a political consensus on the acceptability of “rationing” care—especially the need to limit covered services. In fact, Medicare is now forbidden to consider cost as a relevant factor in deciding whether or not to cover a service.

Until there is a political will to limit the resources used by the US health care system, in spite of any consequences in terms of access and quality, it is irrelevant which specific cost control mechanisms are in place. A debate on reducing spending for entitlements may force the American public to accept limits. However, although the debate is occurring, a political endorsement of limits in any broad sense remains unlikely.

Two quick concluding remarks:

1.  I find Romney’s praise of Israel’s system to be strange insofar as why praise something that cannot even be discussed in the US?  Further, it does demonstrate the place that Israel holds in the GOP heart, because if a Democrat praised a similar European health care system, said Democrat would be accused of touting socialism and the Europeanization of America.  However, if Israel does it, it can’t be socialism, right? (BTW, noting that Israel has  “committees” that determine services puts one in the mind of Death Panels.  Does Sarah Palin know?).

2.  It is a shame that we cannot have a full and honest discussion on the topic of health care costs and ways to deal with it.

—–

Sources for table: CIA World FactBook (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2225rank.html ) and OECD Heath Data (http://www.oecd-ilibrary.org/social-issues-migration-health/health-key-tables-from-oecd_20758480).

Health care figures also from CIA WorldFactbook.

Tax figures from  OECD Tax Database (http://www.oecd.org/document/60/0,3746,en_2649_34533_1942460_1_1_1_1,00.html) and Revenue Statistics in Latin America (http://www.oecd.org/document/54/0,3746,en_2649_37427_49402742_1_1_1_37427,00.html)

Strong Government Influence Over The Israeli Health Care System Has Led To Low Rates Of Spending Growth. Health Affairs September 2011 30:91779-1785;

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About Steven L. Taylor
Steven L. Taylor is Professor of Political Science and Dean of the College of Arts and Sciences at Troy University. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. DC Loser says:

    And we are surprised, how?

    Highly-rated. Helpful or Unhelpful: Thumb up 19 Thumb down 0

  2. It does seem kind of off the reservation, doesn’t it?

    The far right has positioned health care as a morality issue with only one answer: free market, personal responsibility, and the ability to fail.

    Any system of universal care stands completely at odds with that.

    Highly-rated. Helpful or Unhelpful: Thumb up 22 Thumb down 0

  3. C. Clavin says:

    @ SLT…
    Facts and figures and references…oh my.

    I have been musing over Romney’s comments since they were first reported. I can only figure he is going to go full-on Mass. Liberal and will replace the PPACA with Single Payer. What other conclusion can one draw???

    A right of center moderate vs. a Massachusetts Socialist? If you are truly a Conservative then Obama has to be your choice in this election.

    Like or Dislike: Thumb up 11 Thumb down 2

  4. Hmm. Per Wikipedia’s Health care in Israel, it looks like the plan I’ve asked for:

    Health care in Israel is universal and participation in a medical insurance plan is compulsory. Health care coverage is administered by a small number of organizations, with funding from the government. All Israeli citizens are entitled to the same Uniform Benefits Package, regardless of which organization they are a member of, and treatment under this package is funded for all citizens regardless of their financial means. Generally, health care in Israel is of high-quality and is delivered in an efficient and effective manner. Partly as a result of this, at an overall 82 years, Israelis enjoy the fourth-longest life expectancy in the world as of 2012.

    It looks like a voucher system, more or less, with full coverage. It is single payer but multiple provider.

    Awesome, we should do it.

    Highly-rated. Helpful or Unhelpful: Thumb up 31 Thumb down 0

  5. Tsar Nicholas says:

    Well, for the same reasons why 1+1 does not = 4, when someone praises one aspect of a nation’s healthcare system (its lower cost-GDP ratio) that doesn’t mean he’s embracing the entire system. I mean, come on, let’s not jump the shark tank.

    Speaking of cost-GDP ratios, if you saddled the Israelis with the likes of the ATLA, the CTLA, class actions, “non-class” class actions, not to mention MDL actions in the areas of Rx drugs and medical devices, plus “jackpot juries” in various places in the Southern states, and elsewhere, they too would have a major cost control problem, despite having only a tiny fraction of our population.

    Poorly-rated. Helpful or Unhelpful: Thumb up 1 Thumb down 18

  6. C. Clavin says:

    @ JP…
    You are right…we should do it.
    I’m not sure why Cantor and Lieberman and the rest of the Israeli Caucus haven’t been pushing for this??? Seriously…we are already paying for it through aid to Israel. Why shouldn’t we enjoy the benefits?

    Like or Dislike: Thumb up 7 Thumb down 0

  7. C. Clavin says:

    “…Speaking of cost-GDP ratios, if you saddled the Israelis with the likes of the ATLA, the CTLA, class actions, “non-class” class actions, not to mention MDL actions in the areas of Rx drugs and medical devices, plus “jackpot juries” in various places in the Southern states, and elsewhere, they too would have a major cost control problem…”

    So Tsar likes the free-market system…just not the free-market part of it.

    Highly-rated. Helpful or Unhelpful: Thumb up 19 Thumb down 0

  8. anjin-san says:

    Yet another country with lower costs and better outcomes.

    Like or Dislike: Thumb up 14 Thumb down 0

  9. SKI says:

    @Tsar Nicholas:

    Well, for the same reasons why 1+1 does not = 4, when someone praises one aspect of a nation’s healthcare system (its lower cost-GDP ratio) that doesn’t mean he’s embracing the entire system. I mean, come on, let’s not jump the shark tank.

    Except that the biggest reason for that which he is praising (the difference in the amount of GDP spent) is the aspects his party is most opposed to (single payor rationing).

    Highly-rated. Helpful or Unhelpful: Thumb up 28 Thumb down 0

  10. @Tsar Nicholas:

    Are you sure it is an “aspect” and not a “result?”

    Do you have a way to “add” Israel’s low costs to a Republican health care plan?

    Like or Dislike: Thumb up 12 Thumb down 0

  11. C. Clavin says:

    @ JP…
    Anything + Zero is that amount. So anything added to the Republican plan would be just that.

    Like or Dislike: Thumb up 7 Thumb down 0

  12. al-Ameda says:

    Oh, his Republican Party hates Single Payer Health Insurance, and here he is praising Israel’s Single Payer Health Insurance system – does he know what he is saying?

    If so, how soon can we expect a denial, a correction, or a complete retraction of those remarks?

    Like or Dislike: Thumb up 14 Thumb down 0

  13. stonetools says:

    The problem here is between the private Mitt and the public Mitt. If you gave Mitt truth serum, he would admit that you can’t get to universal health insurance by just letting the “free market rip”. The three options are going to be :

    1. Regulated private health insurance -the Bismarck option( Germany, Switzerland, Holland)
    2.Single Payer- (Canada, Taiwan, Medicare)
    3. Direct Government provision ( NHS, Veterans Administration).

    All the universal health insurance systems are some mixture of those 3 , with Israel closest to (2)- more “soshulist” than Obamacare without going the full NHS-VA monty.

    The private Mitt understands that “Israelicare” is a pretty good example of a universal health insurance system with one great advantage of those systems-a much better cost-GDP ratio than our own currently f^&*ed up system.
    What happened was that in the midst of public Mitt’s desperate attempts to execute the ” only praise Israel” program he was instructed to implement , the private Mitt popped out for a minute-much to the horror of his handlers , who know this is a departure from the Tea Party gospel.

    I expect that Mitt is going to spend the rest of the campaign trying to make us forget this momentary appearance of “private Mitt”.

    Like or Dislike: Thumb up 10 Thumb down 0

  14. anjin-san says:

    If so, how soon can we expect a denial, a correction, or a complete retraction of those remarks?

    He is trying to walk back his trashing of Palestine. Of course the only way to do that is to lie about what he actually said, but that does not seem to be a problem.

    Like or Dislike: Thumb up 5 Thumb down 0

  15. stonetools says:

    @john personna:

    Are you sure it is an “aspect” and not a “result?”

    Do you have a way to “add” Israel’s low costs to a Republican health care plan?

    What Republican health care plan? AFAIK, the Republicans want to repeal ACA and replace it with ” Nothing”- apparently because ” Nothing” is working so well.
    This is another example of Republican “magical thinking”-if we continue as we are, our health insurance system’s problems will magically resolve themselves through the voodoo of the free market.

    Like or Dislike: Thumb up 10 Thumb down 0

  16. george says:

    @Tsar Nicholas:

    they too would have a major cost control problem, despite having only a tiny fraction of our population.

    Actually, economies of scale work in health care too. It should be cheaper per capita to run a healthcare service for a large population than a small one. For instance, building a hospital with all the best medical equipment (MRI’s etc) for a town of 10,000 is less cost effective than building one for a city of 1,000,000. This plays out in the Canadian provinces all the time; its more expensive per capita in small provinces with higher rural percentages.

    And actually, most public systems (even Canada’s) is more cost effective GDP wise than the American system (and quite a few are quite a bit better than the Canadian, probably including Israel’s).

    Like or Dislike: Thumb up 4 Thumb down 0

  17. Gromitt Gunn says:

    @Tsar Nicholas: I have to be honest. I picture you having a series of constantly-updated Word documents on your computer entitled “Regulatory bodies and regulation-related Federal Legislation – Healthcare,” “”Regulatory bodies and regulation-related Federal Legislation – Environment,” “”Regulatory bodies and regulation-related Federal Legislation – Workplace Protections,” etc., and you just cut and paste in the most closely related Word document after typing in a couple of sentences that are more closely tailored to the actual post. I further imagine that you keep all of these documents open on your computer so that you can easily add the latest LIBERAL OUTRAGE! from Drudge, Ace of Spades, Pajamas Media, etc., to your list as you come across them.

    Like or Dislike: Thumb up 3 Thumb down 0

  18. steve says:

    “, plus “jackpot juries” in various places in the Southern states, and elsewhere, they too would have a major cost control problem, despite having only a tiny fraction of our population.”

    Nope. Every study ever done shows that malpractice adds relatively little to costs, maybe on the order of 1%-2% of our total spending. When we look at places like Texas or California that have passed reforms, we dont see spending decrease. As a physician I would still like to see malpractice reform as I think it would help with doc buy in, and it is annoying, but ti wont affect costs much.

    Steve

    Like or Dislike: Thumb up 10 Thumb down 0

  19. uncivil & right says:

    Israel, population about 8 million. USA, 300 million plus.

    Apples and oranges.

    Like or Dislike: Thumb up 0 Thumb down 12

  20. PJ says:

    @uncivil & right:

    Israel, population about 8 million. USA, 300 million plus.

    Apples and oranges.

    Since I am unable to read your mind, could you please expand your comment and let us all know why the difference in population size makes this apples and oranges?

    There are countries in Europe with six to ten times the population of Israel that are able to offer what Israel is offering and the US isn’t, when does population size become an issue and why?

    Like or Dislike: Thumb up 9 Thumb down 0

  21. anjin-san says:

    Israel, population about 8 million. USA, 300 million plus.

    Sounds like we have vastly more economy of scale potential than they do. Not seeing that as a minus…

    Like or Dislike: Thumb up 6 Thumb down 0

  22. george says:

    @uncivil & right:

    Israel, population about 8 million. USA, 300 million plus.

    Apples and oranges.

    That’s true – because of economies of scale, it should be considerably cheaper per capita in the USA. Which makes it even worse that its not.

    Like or Dislike: Thumb up 4 Thumb down 0

  23. mantis says:

    @Tsar Nicholas:

    Well, for the same reasons why 1+1 does not = 4, when someone praises one aspect of a nation’s healthcare system (its lower cost-GDP ratio) that doesn’t mean he’s embracing the entire system. I mean, come on, let’s not jump the shark tank.

    Yeah folks, listen to Nicky. Romney was only praising the outcome, not the methods by which the outcome is achieved. Duh.

    Like or Dislike: Thumb up 5 Thumb down 0

  24. Kylopod says:

    I think this episode illustrates how much of a novice Romney is at spouting far-right rhetoric. He probably interpreted the right’s “fall into lockstep with Israel” as meaning “praise everything about Israel as a country,” not realizing this formula is generally limited to the Israeli government’s policies toward the Palestinians and relationship with its neighbors.

    Like or Dislike: Thumb up 5 Thumb down 0

  25. An Interested Party says:

    If so, how soon can we expect a denial, a correction, or a complete retraction of those remarks?

    Of course, all of that will depend on which way the Etch A Sketch is shaken today…oh, and perhaps also on how pissy his press aide is….

    Like or Dislike: Thumb up 1 Thumb down 0

  26. Barry says:

    @Tsar Nicholas: “Well, for the same reasons why 1+1 does not = 4, when someone praises one aspect of a nation’s healthcare system (its lower cost-GDP ratio) that doesn’t mean he’s embracing the entire system. I mean, come on, let’s not jump the shark tank. ”

    Wrong, since the lower-cost aspects are not separable from the government-run aspects (judging from the rest of the developed world).

    Like or Dislike: Thumb up 1 Thumb down 0

  27. Barry says:

    @Tsar Nicholas: “Speaking of cost-GDP ratios, if you saddled the Israelis with the likes of the ATLA, the CTLA, class actions, “non-class” class actions, not to mention MDL actions in the areas of Rx drugs and medical devices, plus “jackpot juries” in various places in the Southern states, and elsewhere, they too would have a major cost control problem, despite having only a tiny fraction of our population. ”

    Stop lying – we’ve run that experiment in Texas, with no results worthy of the name.

    Like or Dislike: Thumb up 4 Thumb down 0

  28. Israel also has taxpayer-funded abortion.

    Just saying…

    Like or Dislike: Thumb up 1 Thumb down 0

  29. Barry says:

    @Timothy Watson: “Israel also has taxpayer-funded abortion.”

    Yes, but the GOP can classify that as Israeli government-authorized killing, so they’re good.

    Like or Dislike: Thumb up 0 Thumb down 0