Sunday, December 10, 2017
Opinion

Next time Romney should listen

Mitt Romney's awkward trip overseas was so peppered with amateurish missteps that one of his big policy statements was passed over without much attention. It turns out the presumptive Republican nominee wants America's health care system to look more like Israel's.

This is what he told donors at the King David Hotel in Jerusalem: "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? Eight percent. You spend 8 percent of GDP on health care. And you're a pretty healthy nation. We spend 18 percent of our GDP on health care. Ten percentage points more."

Romney's right. Israel spends far less per capita, about $2,200 compared with our $8,400. It also covers all of its citizens in a system that provides accessible, technologically advanced treatment. How does Israel do it? Israel is a socialist country. It has national health care in which all citizens are part of HMOs paid for by the government as a single payer. The cost of the system is covered by taxes.

Romney continued his remarks by saying, "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."

Israel does this through government control. The government caps hospital revenue, contracts with salaried physicians and decides how much it will pay the HMOs, while guaranteeing that comprehensive health services are provided. Coverage is so generous that the Israeli average life expectancy is four years higher than that of an American.

The very approach so anathema to Romney and his fellow Republicans — federally mandated health insurance with strict government regulation — is Israel's recipe for success.

Similarly, the U.K., an earlier stop on Romney's journey, has socialized medicine that also results in British citizens enjoying a greater life expectancy than Americans while spending far less per capita. He might have lauded that system too, if he didn't spend so much time on the campaign trail bashing the European model of everything. ("Europe isn't working in Europe," he said during a primary debate. "It's not going to work here.")

But even someone as focused on American exceptionalism as Romney should have noticed that during the opening ceremonies of the Olympic Games he attended there was a paean to the U.K.'s National Health Service. He couldn't miss it. The extravaganza included 300 hospital beds and more than 600 actual nurses and other health care workers, celebrating a point of national pride. The NHS is widely considered one of the country's greatest achievements.

Can anyone imagine celebrating America's system? Certainly not the 50 million people without health insurance or those who have gone bankrupt from medical bills. Certainly not those of us with health insurance who fret about losing it if we lose our job, or the people injured in the Aurora, Colo., shooting who have to rely on fund-raisers and charity to pay their hospital bills.

Unlike the U.K. and Israel, people in the United States have to worry about being hounded for payment even as they seek emergency care. The company Accretive Health, a medical debt collector, has recently been accused of infiltrating hospital emergency rooms to extract payment from patients. One Minnesota resident was hemorrhaging blood while a debt collector demanded $300, according to a court case filed by the Minnesota attorney general that has since been settled. Fearing she wouldn't be able to see a doctor otherwise, she paid up.

It reminded me of the nonfiction book Strength In What Remains by Tracy Kidder that describes medical facilities in modern-day Burundi. Patients who could not pay their bill were imprisoned in the hospital without medical care or even food until someone covered the cost.

Shifting more costs and risk onto medical consumers so they "have skin in the game" and won't overuse services is what Republicans often talk about as the solution to spiraling costs. Here's the ultimate model.

As to Romney's federal-government-hands-off approach to health insurance, it bears no resemblance to Israel's national health care system. Maybe Romney should do a little less talking and a lot more listening next time he digs out his passport.

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