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.

Op Ed

Surfing Without A Pair

Surfer Girl
Justin Floyd

A young surfer recently stopped by my shop to buy an out-of-print book about her passion. During the exchange she used a familiar word to praise a sister wave-rider.

“She really has the ‘cojones’ to surf the big ones,” said the woman.

Most of us have heard some version of this cross-cultural cliché. Language spreads the virulent notion that human courage and strength are rooted in male sex glands. We claim it takes testicles (“cojones” in Spanish) to excel at sports, business, and politics.

Being the sole male in a four-person household, I know this notion is nuts. Our family is fortified by a partnership that transcends gender. Often our daughters ride life’s waves better than Jennifer and I do.

So as husband and dad I’m compelled to speak out for the inherent strength of women. Call it uterine affirmation, in honor of one of the most powerful muscles in the human body. I was compelled to testify on this point with the young surfer in my shop, who patiently nodded at the middle-aged bookseller before dashing off to hit the water.

The next day I learned that 56-year-old Congressman David Wu was accused of sexually molesting the 18-year-old daughter of one of his friends. He has since become the fourth person in Congress to resign this year because of sex scandals. Two Democrats, two Republicans, and four mighty pairs of cajones.

Last spring I defended Wu in the press when Oregon newspapers called for his resignation. At the time the call seemed rash to me, given what had been reported. Several weeks after my column ran, his staff invited me to meet with him during a visit to Seaside. I took my daughters along, thinking it would be a civics lesson.

Having never spoken directly with Wu, I began the meeting by thanking him for his stand on American trade policy with China. From the onset of his service in Washington, Wu advocated that our nation’s commerce with the communist regime should advance human rights and uphold our democratic values.

Wu’s stand earned him flak from some free traders in his district. Yet he held firm, saying: “If the voters of Oregon decide to send me home for [my position on trade with China], I’ll have to live with that. But I’d rather turn my back on the office than turn my back on my principles.”

I read that quote to my daughters, in Wu’s presence, because I wanted them to know they were meeting a leader with strong convictions. If the recent allegations prompting his resignation are true, we’ve also learned such leadership can be sacrificed to those male gonads (“gaowan” in Chinese) that people pretend are the font of valor.

The betrayal of trust reminds me of another family story.

During Jennifer’s first year in college, her sister Jeanne (then 16-years-old) flew down to visit her in California. The adventure began when Jeanne got bumped up to first class, where she enjoyed the company of a charismatic man who accompanied her off the plane to meet Jennifer.

Thankfully, the two young women had the sense to decline when their new 40-something friend, Neil Goldschmidt, suggested that they all go out for drinks. They could tell something was amiss, so they passed up the chance to party with Oregon’s big-balled surfer of political power (now tragically renowned as the perpetrator in a long term sexual abuse case).

That’s “groyse beytsim” in Yiddish, by the way.

From what I’ve seen, the cross-cultural truth about cajones is that they often cause serious wipe outs. Yet for some reason people talk as if they’re essential to success, even for women. When a union leader endorsed Hillary Clinton for president in 2008, he famously described her as being the right person for the job because of her “testicular fortitude.”

Was that what equipped her husband Bill for success in the Oval Office? Did it fortify the public leadership of John Edwards and Arnold Schwarzenegger?

There’s been plenty of debate over where society should draw the line between private life and civic duty. Yet the best comment I’ve heard regarding the testicular exploits of leaders came from my mom, who asked “where do they find the time?”

Presumably such distractions aren’t a problem for most men. Yet for all too many, those “family jewels” are tools of destruction.

Changing caveman notions about success will help counter this failure. Few women in positions of power become embroiled in sex scandals. We need more leaders with uterine fortitude surfing the big waves of society.

Op Ed

What makes us adopt our personal politics?

In an exchange of letters to the editor in recent issues of the Chinook Observer, one letter writer claimed that Nan Malin, who is a Washington  organizer for Americans for Prosperity,  said what shifted her from being a liberal hippie to a conservative Republican was “making some money,” implying that having more money made her more selfish. Malin responded, saying owning a business led her to think “differently about excessive taxes and government regulations.”

A “Fresh Air” radio interview I heard recently provides some perspective on this dialog. Dr. Paul Farmer, a physician and anthropologist who is the founding director of Partners in Health, an organization that provides medical services to poor people in many countries, talked about Haiti in the aftermath of the huge earthquake. His NGO (non-governmental organization) has operated in Haiti for decades; he said that country is referred to as the “Republic of NGO’s” because so many operate there, but conditions overall still don’t improve.

Farmer’s main point was that the Haitian government is weak because it’s severely under funded and NGO’s aren’t empowered to build basic infrastructure to prevent problems. For example, NGO’s aren’t empowered to build a safe water system that could have prevented cholera, only the government is, but it is under funded because most Haitians are very poor and the small Haitian elite that has tremendous wealth refuses to pay higher taxes. Of course, that financial elite also controls the government to make sure higher taxes are never imposed. Farmer’s most telling example was that, as Haiti’s roads deteriorate and become more and more pocked by deeper and deeper potholes, the wealthy just buy bigger and bigger Land Rovers.
Unfortunately, that’s where we could be headed here in the US—less and less money for public infrastructure utilized by all, while private wealth grows and private infrastructure increases, with wages and working conditions deteriorating for the great mass of people who don’t happen to own their own business.

Americans like to believe we’re a “class-less” society. That belief is bolstered by cries of elitism aimed at those who merely think carefully about our problems while those with extravagant wealth are rarely labeled elitist. It isn’t unusual for a CEO to be paid hundreds of times more than any of his or her workers. One thinker says that people strive for wealth because it brings them power, and power in turn brings respect. One friend says we’re on a path to “corporate feudalism.”

I’m reminded of a Daily Astorian editorial many years ago that reviewed statistics showing that private security forces and private recreation facilities in the US were increasing at the same time public police and parks and recreation facilities were declining. This isn’t so obvious where we live because there is still so much public land that we can access, whether county and state parks or state and federal forests. On the East coast, it’s a different story; for example, you can’t walk on a beach in New Jersey during the summer without paying someone. There are also many pressures to “privatize” what have been public lands either by literally selling them to private entities or by contracting with private businesses to manage those lands and in turn charge the public to use them.

Although I haven’t “owned” a business, I’ve been the boss at several non-profits and know how irritating bureaucracy can be. But I realize that regulations aren’t made for the vast majority of us who use consideration and common sense, but for the segment that will violate basic ethical standards to protect their bottom line. For example, Massey Energy had 515 safety violations in 2009 at the Upper Big Branch Mine and another 124 just before the disaster that killed 29 coal miners.

But, I continue to wonder about  Malin’s shift to the conservative side of the political spectrum and think of people I know. Some appeared to be “hippies” in their youth but now are conventional in every way, right down to the BMW in the driveway and the extra homes in Puerto Vallarta and Hawaii. Which came first? The money, or a shift to a more conventional lifestyle in order to fit in and get the money? Were they more “sharing” in their youthful values because they didn’t have much and so wanted a piece of the action? Or, as they matured, got jobs and began to acquire more money did an underlying fear emerge that they’d lose it? It isn’t difficult to hold a set of values if you’re being rewarded for espousing them.

This article first appeared in the Chinook Observer.