Op Ed

Personal Experience Abroad with Health Care Delivery

Ann Goldeen and daughters enjoy a camel ride in Israel before an unexpected health crisis.

I have recently had a unique and revealing personal experience with the health care system in Israel. This letter reports what happened to me and how that has motivated me to become involved with health care policy reform in Oregon and the United States.

My experience convinced me that our system of health care delivery is broken, and I would like to share it with you.

Health insurance available to self-employed people is very expensive and usually offers scant coverage. Skeptical of its value, I chose not to buy health insurance at home. When traveling overseas, however, I bought a travel insurance plan that covered the cost of emergency health care and many other trip maladies. A week into the trip I became extremely ill with uncontrollable vomiting and was directed to Sh’are Zedek Hospital in Jerusalem.

When my family and I pulled up to the ER, I thought we’d come to the parking garage, not the hospital. The parking facilities and the hospital itself were basic–instead of using resources for buying fancy buildings with marble lobbies and expensive artwork, everything was plain and practical. This facility put its resources into people: teams of doctors, nurses, and aides who were there all the time to aid patient recovery. My surgeons visited me two to three times daily. Their offices were actually located near the surgical wing in the hospital; they worked on a salary and had no fiscal motivation to over-treat or over-test their patients. Their goals were not the extraction of money or the operation of machines, but, rather, providing precise and effective help to all who came into the facilities.

The first question at triage was not “What is your insurance?” Instead, they asked for my complaints, and expressed concerned questions about why I had waited so long to seek help. After this, the triage nurse immediately started an IV. In the emergency room we were surrounded by patients and their families. All pertinent medical staff gave me attention as soon as I arrived and without ignoring other patients. In addition, my family was never asked to leave my side. During this fourteen-hour stay in the ER, staff invited and even showed my family the way to escort me to x-ray, CT scans, and the operating room.

Later, the Israeli surgeon questioned my request for written insurance documentation of my need for hospitalization. When I asked the way to the billing office, the answer was “We don’t have one.” Everyone I talked to in the hospital was shocked that we are not required to have health insurance in the United States.

Israelis simply take it for granted that everyone must make regular insurance payments to keep the country healthy. The unemployed and the students in Israel pay one dollar a day for health insurance and a five dollar co-pay for all health care services. Employed citizens pay a percentage of their paycheck, so the better off pay more. All pay the five-dollar co-pay for health services.

I received excellent care at Sha-are Zedek Hospital in Jerusalem, Israel, including emergency abdominal surgery by a team of Israelis and Arabs who know how to work together.

If I had been home–here in Astoria, Oregon–when this acute illness occurred, I would have been tempted to stay home and, possibly, even to die rather than to burden my family with the glut of medical bills that would follow. All over the United States people without health insurance employ this tactic, even for easily treatable ailments such as pneumonia. Many Americans wait until they are half-dead with illness or pain before seeking hospital care. Cost isn’t the only factor. Some of us lack trust in doctors and see the medical system as nearly broken.

The cost of my medical care at Sha-are Zedek Hospital in Jerusalem, Israel, including eight days as an in-patient was $10,000 (or 39,000 shekels). Hospitals here at home charge $40,000-$100,000 for similar treatment. We need a system that gives all Americans access to affordable health care, and we are going to have to learn to pay for it in a new way. Our aggregated resources can provide quality healthcare for all Oregonians–and Americans–at an affordable cost.

As soon as I returned to Astoria, Oregon, I started searching for health insurance. Every plan mandated a six month waiting period. Then I received the pathology report from my surgery indicating that I had a large cancerous tumor in my small intestines that has spread to some of my lymph nodes.

I do not have six months to wait.

I searched Oregon’s high risk insurance pool and discovered a federal program with no waiting period for long term un-insureds with a serious medical problem. The coverage can begin at the beginning of the next month after diagnosis. In July I will have access to health care through insurance. While I am extremely grateful for this opportunity, I wish I had had affordable health insurance for my family of four before this grave illness struck me.