So I've managed to do a bit more than watch MTV music videos (they play all day on MTV's international channel) and become confused by relationship swaps on Melrose Place (episodes, too, air all day on Israeli TV). I got some traveling in over the Sukkot break but not before I spent another day volunteering at the PHR clinic.
On this visit, many more patients originated from the Sudan. One of the physicians, who did most of his training in the United States, pointed out that refugee care in Israel was different from America. For one, refugees fleeing persecution from any country who make it to the U.S. generally had the resources to fly, even if that's all they had. The refugees at the clinic in south Tel Aviv never had that option available to them.
Israel does provide these refugees some resources but aspects of care that were straightforward in the U.S. are not necessarily the same here. For one, no 24-hour telephone interpretation service is available at the clinic. Interpretation services usually consist of someone asking in the waiting room if someone speaks both Arabic and English or Arabic and Hebrew if no student interpreter or Arabic-speaking staff is available. Some staff at the clinic do speak both Russian and Hebrew but interpretation can still be limited. Even at an inner-city hospital back in the U.S., professional interpreters were somewhat available and our education emphasized the dangers of letting family or non-professionals interpret (e.g., mistranslation, deliberate withholding of information, etc.). Nevertheless, the clinic must be practical to some extent and utilizes the resources, if any, available to it.
The second difference I've noticed is in the provision of care to HIV-positive refugees. One refugee from Eritrea said that a simple visit to see a doctor at the AIDS clinic in Tel Aviv could cost 1000 shekels (~$250). It is not clear why this disparity exists and I can only guess that the government may provide limited funds for non-citizen healthcare. I can't even imagine what a non-citizen would be charged if she or he had to begin antiretroviral therapy.
Even given these differences, one significant difference remains: every citizen in Israel has health insurance. When I hear physicians complain about the provision of care to refugees in Israel, I am saddened when I think about how we treat our own citizens in the United States. Shame on us. We let ourselves get bullied into a dysfunctional system out of a fear that socialized medicine was two steps shy of Communism, that the government would make medical decisions for our doctors. Instead, HMO's have fulfilled that role instead and even patients with insurance sometimes get left behind.
People debate about the number of uninsured in the United States, whether or not this figure represents a significant number of young, healthy individuals or people between jobs. Regardless, if a single person in these categories develops a disease (e.g., Hodgkin's lymphoma) that is treatable but would drive an individual beyond bankruptcy in the absence of insurance, we have failed as a society. Certainly, there are countless examples beyond the example of Hodgkin's, a disease that tends that affects young, seemingly healthy men in its bimodal distribution.
When I describe our healthcare system to Israelis, they say they cannot even comprehend what is going on the United States. One staff member at the PHR clinic who wants to look at other countries to determine how care could be provided to refugees feasibly and economically said, "We would never use America as an example."
I despise economic arguments because I think that social justice must always take precedence. We've somehow managed to revert from the Declaration of Independence's life, liberty, and the pursuit of happiness to Locke's life, liberty, and property with a much heavier emphasis on the last pursuit than either of the first two. Nevertheless, in a political world where tax cuts inspire action more than the plight of the poor, an economic argument can be made for universal care. Some argue that the United States cannot afford healthcare when mired in an expensive war, but certainly Israel has significant per capita defense expenditures and still manages to see healthcare for all citizens as essential to a healthy society. In the U.S., politicians fail to comprehend that the average taxpayer spends more on our "catastrophic" system of care (because patients wait until something catastrophic, like a heart attack, occurs that costs thousands of dollars to treat) rather than a system of "preventative" care (where we could offer medication to treat hyperlipidemia and reduce the likelihood of a heart attack much more inexpensively).
None of these revelations seemed to have reached our current president, who said that all people have access to care since "you just go to an emergency room." I guess Bush never saw the inside of an emergency room at an inner-city hospital or the crisis that's threatening closure of them and trauma centers all over the country. He seems too busy fighting to make sure American children can't see a doctor instead.
Well, enough about the disaster of U.S. healthcare for the time being. I'm in Israel now, where although access issues exist for refugees, any citizen can receive expensive in-vitro fertilization technology for the birth of up to two children if needed at the government's expense.
On that note, I better go back to watching Melrose Place. It's much less depressing to watch the superficial lives of fictional characters than to think about the superficial approach our leadership has taken to barricading Americans from the right to health.
No comments:
Post a Comment