THE ISRAELI HEALTH CARE SYSTEM

   Author(s): BRUCE ROSEN AND RUTH WAITZBERG   Source: MYERS-JDC-BROOKDALE INSTITUTE

IsraelWhat is the role of Israeli government?

Government, through the Ministry of Health, is responsible for population health and the overall functioning of the health care system (including the regulation of health care insurers and providers). It also owns and operates a large network of maternal and child health centers, about half of the nation’s acute-care bed capacity, and about 80 percent of its psychiatric bed capacity.1

In 1995, Israel passed a national health insurance (NHI) law, which provides for universal coverage. In addition to financing insurance, government provides financing for the public health service and is active in areas such as the control of communicable diseases, screening, health promotion and education, and environmental health, as well as the direct provision of various other services. It is also actively involved in the financial and quality regulation of key health system actors, including health plans, hospitals, and health care professionals.

Who is covered and how is insurance financed?

In 2015, national health expenditures accounted for 7.5 percent of GDP, a figure that has remained stable during the last two decades. In 2015, 62 percent of health expenditures were publicly financed, a share that is one of the lowest among Organisation for Economic Co-Operation and Development (OECD) countries. (The Israeli figure is down from 63.5% in 2010 and 68% in 1995.)

Publicly financed health insurance: Israel’s NHI system automatically covers all citizens and permanent residents (aside from soldiers, who receive health care directly from the army). It is funded primarily through a special income-related health tax in combination with general government revenues, which in turn are funded primarily through progressive income-related sources such as income tax.

Employers are required to enroll any foreign workers (whether documented or undocumented) in private insurance programs, whose range of benefits is similar to that of NHI. Private insurance is also available, on an optional basis, for tourists and business travelers. Nevertheless, there are people living in Israel who do not have health insurance, including undocumented migrants who are not working. Several services are made available to all individuals irrespective of their legal or insured status. These include emergency care, preventive mother and child health services, and treatment of tuberculosis, HIV/AIDS, and other sexually transmitted infections.

Within the NHI framework, residents can choose among four competing nonprofit health plans. Government distributes the NHI budget among the plans primarily through a capitation formula that takes into account sex, age, and geographic distribution. The health plans are then responsible for ensuring that their members have access to the NHI benefit package, as determined by government.

Private health insurance: Private voluntary health insurance (VHI) includes health plan VHI (HP-VHI), offered by each health plan to its members, and commercial VHI (C-VHI), offered by for-profit insurance companies to individuals or groups. In 2014, 87 percent of Israel’s adult population had HP-VHI, and 53 percent had C-VHI.2 HP-VHI premiums are age-related and cross-subsidized, and health plans cannot reject applicants. C-VHI premiums are risk-related, and coverage is tailored to consumers. C-VHI packages tend to be more comprehensive and more expensive than HP-VHI packages. While C-VHI coverage is found among all population groups, coverage rates are highly correlated with income.

Together, these two types of private VHI financed 14 percent of national health expenditures in 2014. The Ministry of Health regulates HP-VHI programs, while the Commissioner of Insurance, who is part of the Ministry of Finance, regulates C-VHI programs. The focus of C-VHI regulation is actuarial solvency, with secondary attention to consumer protection; in HP-VHI regulation, there is more attention to equity considerations and potential impacts on the health care system.3

Israelis purchase VHI to secure coverage of services not included in the NHI package (e.g., dental care, certain lifesaving medications, institutional long-term care, and treatments abroad), care in private hospitals, or a premium level of service for services covered by NHI (e.g., choice of surgeon and reduction of waiting time). VHI is also supplementary to NHI, as it extends coverage of services in the health basket such as more physiotherapy or psychotherapy sessions. However, it does not cover user charges. VHI coverage is also purchased as a result of a general lack of confidence in the NHI system’s capacity to fully fund and deliver all services needed in cases of severe illness.

What is covered?

The mandated benefit package includes hospital, primary, and specialty care, prescription drugs, certain preventive services, mental health care, dental care for children, and other services.

THE U.S. HEALTH CARE SYSTEM

   Author(s): TCF STAFF   Source: The Commonwealth Fund

United StatesWhat is the role of the American government?

The Affordable Care Act (ACA), enacted in 2010, established “shared responsibility” between the government, employers, and individuals for ensuring that all Americans have access to affordable and good-quality health insurance. However, health coverage remains fragmented, with numerous private and public sources, as well as wide gaps in insured rates across the U.S. population. The Centers for Medicare and Medicaid Services (CMS) administers Medicare, a federal program for adults 65 and older and some people with disabilities, and works in partnership with state governments to administer both Medicaid and the Children’s Health Insurance Program (CHIP), a conglomeration of federal–state programs for certain low-income populations.

Private insurance is regulated mostly at the state level. In 2014, state and federally administered health insurance marketplaces were established to provide additional access to private insurance coverage, with income-based premium subsidies for low- and middle-income people. In addition, states were given the option of participating in a federally subsidized expansion of Medicaid eligibility.

Who is covered and how is insurance financed?

In 2015, about 67.2 percent of U.S. residents received health coverage through private voluntary health insurance (VHI): 55.7 percent received employer-provided insurance, and 14.6 percent acquired coverage directly. Public programs covered roughly 37.1 percent of residents: Medicare covered 16.3 percent, Medicaid 19.6 percent, direct-purchase 16.3 percent, and military coverage 4.7 percent.1

In the first quarter of 2016, 27.3 million individuals were uninsured, representing 8.6 percent of the population, down from 9.1 percent in 2015.2 The implementation of the ACA’s major coverage expansions in January 2014 has increased the share of the population with insurance. These reforms include: the requirement that most Americans procure health insurance; the opening of the health insurance marketplaces, or exchanges, which offer premium subsidies to lower- and middle-income individuals; and the expansion of Medicaid in many states, which increased coverage for low-income adults. Between 2014 and the start of 2016, the overall rate of health insurance coverage increased for most racial and ethnic groups. Hispanics had the largest increase (6.6 percentage points), followed by Asian Americans (4.8 points), non-Hispanic blacks (3.1 points), and non-Hispanic whites (2.4 points).3 It is projected that the ACA will reduce the number of uninsured by 24 million by 2018.4 However, with the likely repeal of the health law by the new Congress and administration, it is unknown how progress in reducing the uninsured population will be affected.

Public programs provide coverage to various, often overlapping, populations. In 2015, more than 10 million Americans were both entitled to Medicare and eligible for Medicaid services (the so-called dual eligibles).5 CHIP, which in some states is an extension of Medicaid and in others a separate program, covered more than 8.1 million children in low-income families in 2015.6

Undocumented immigrants are generally ineligible for public coverage, and nearly two-thirds are uninsured. Hospitals that accept Medicare funds (which are the vast majority) must provide care to stabilize any patient with an emergency medical condition, and several states allow undocumented immigrants to qualify for emergency Medicaid coverage beyond “stabilization” care. Some state and local governments provide additional coverage, such as coverage for undocumented children or pregnant women.

What is covered?

Services: The ACA requires all health plans offered in the individual insurance market and small-group market (for firms with 50 or fewer employees) to cover services in 10 essential health benefit categories:

IN-DEPTH EXAMINATION: KEY LESSONS FROM THE ISRAELI SYSTEM FOR THE US

   Author(s): Karen Wolk-Feinstein, PhD   Source: Jewish Healthcare Foundation

Jewish Healthcare FoundationSource: http://www.jhf.org/publications-videos/list.php?publication=7

Israel's healthcare system has significant relevance and important lessons to lend to healthcare reform efforts in the United States. In 1995, as the US failed to enact healthcare reform, Israel achieved significant redesign of its healthcare system.

Through the adoption of a National Health Insurance law, Israel created an overall framework for its healthcare system, provided universal coverage and delineated a basic benefits package to which all citizens and permanent residents are entitled. Fourteen years later, with government-financed insurance coverage provided through four competing health-maintenance organizations, Israel's per capita costs are half those of the United States and its outcomes in many areas are superior. 

Some of the differences between the two systems emerge from a divergence in basic values: in Israel, healthcare is a “universal good,” which society is responsible for making available to all its members, while in the US, healthcare is an individual good that is “organized” largely through market forces and includes many for-profit actors. These basically different values set in motion a series of processes that yielded, in the US, a health sector involving multiple, competitive providers and payers emphasizing high yield, acute care, inpatient health information technology (HIT) and expensive medical education, but also cutting edge R&D.

By contrast, Israel's emphasis on social solidarity prompted the development (as early as the 1920s) of organized systems of care focused on improving population health efficiently via an emphasis on primary care, supported by heavily subsidized medical education. In recent decades, the Israeli healthcare system has benefited from major investments in outpatient HIT and the creation of a process for prioritizing investments in new technology that is among the most advanced and transparent in the world.

In important respects, the US health reform debates have been about the best way to move the US toward a more integrated model aligning payment with care delivery and targeting safety, efficiency, access and quality.

Therefore, as the US moves to revisit the 2010 Patient Protection and Affordable Care Act – which aims not only to expand access to health insurance, but also to strengthen primary care, contain costs and require multi-provider accountability for coordinated high quality care – there is much to learn from Israel, where these concepts are already at work

To explore key lessons from the Israeli system for the US, the Jewish Healthcare Foundation engaged

ISRAELI HEALTH CARE: A MODEL FOR THE U.S.?

   Author(s): CHRIS MITCHELL   Source: CBN.COM

Trump & Israeli PMAs a close friend and ally of the United States, Israel may have a few tips to offer the U.S. in the ongoing debate over health care.

Despite Israel's location in the one of the world's most volatile regions, this small country – with its population of 7 million – has a lower infant mortality rate and a longer life expectancy rate than America. So, from a medical perspective, the Jewish state must be doing something right.

Some would say comparing the U.S. and Israeli systems is like comparing apples and oranges because the U.S. population is 40 times higher than Israel's. But with the healthcare debate raging in the U.S., the Israeli system is worth looking into, especially since polls show that at least 80 percent of Israelis are satisfied with the medical care they receive.

'Mixed Bag': While most refer to Israel's healthcare system as socialized medicine, some say it's actually a mixed bag. Dr. Bruce Rosen, director of the Smokler Center for Health Policy Research in Jerusalem, spoke with CBN News about Israel's health care system. “Most of the financing [is] coming from the government and that's good because that makes sure that the system is equitable and everybody has access,” Dr. Rosen said.

But the system works, Rosen says, because there is market-style competition. Each citizen chooses from four non-governmental providers, called a kupat cholim (literally, “sick funds,” the U.S. equivalent of “health care” providers).

By law, the kupat cholim must provide a benefits package that covers hospitalization and doctors' visits. The co-payment for most drugs is nominal. Procedures ranging from in vitro fertilization to liver transplants are provided to anyone in the system, usually without a long wait.

Israeli System Preferred:The system is paid for mostly through income taxes. Even though Israelis pay much higher taxes than Americans, many who have received care under both prefer the Israeli system.

“I was in America … “

Walking in the Garden

   Author(s): thomas kinkade   Source: thomaskinkade.com

“I remember seeing a painting of a similar subject in a church as I was growing up and the image has always stuck with me. Perhaps I realized then that this was my chance to create a composition reinterpreting this scene. Here we see Jesus strolling comfortably with Peter. In his hands, Peter holds the symbolic keys to God's kingdom. What truths and insights could they be sharing? How marvelous to have the chance to listen in on the kind and insightful words of the Savior as He patiently shares wisdom with those He loves.” – Thomas Kinkade

Walking with Jesus

TEST ARTICLE #2001.5

   Author(s): WILLIAM   Source: UCI STAFF

You may need to start, stop or restart system services, such as Apache or MySQL, on your DV server. This can be for a variety of reasons.

  • You may have updated a configuration for the service, and you need to restart the service for your changes to take effect.
  • A service may be malfunctioning or “snowballing” and require a restart or a hard stop.
  • A service may have crashed and require a start or restart. 

THE MUSLIM BROTHERHOOD IN AMERICA: THE ENEMY WITHIN

   Author(s): FRANK GAFFNEY   Source: CENTER FOR SECURITY POLICY

Muslim Brotherhood Banner

The Center for Security Policy is making available to Democracy Under Attack a FREE ten-part video course called “The Muslim Brotherhood in America: The Enemy Within.”

This course connects the proverbial dots, drawing on a wealth of publicly available data and first-hand accounts to present a picture that has, for over a decade, been obscured, denied and suppressed; that America faces, in addition to the threat of violent jihad, another even more toxic danger – a stealthy and pre-violent form of warfare aimed at destroying our constitutional form of democratic government and free society. The Muslim Brotherhood is the prime-mover behind this seditious campaign, which it calls “civilization jihad.”  

Click here to view the free course


IRAN MISSILE STRIKE ESCALATES WAR BETWEEN RADICAL SHI'ITES AND SUNNIS

   Author(s): YAAKOV LAPPIN   Source: INVESTIGATIVEPROJECT.ORG

IRAN MISSILE STRIKEIran's recent missile attack on ISIS targets in eastern Syria represents another escalation in the ongoing war between radical Shi'ites and jihadist Sunnis across the Middle East.

Iran, which is leading an array of heavily armed Shi'ite proxies and militias deployed in the region, fired a volley of six to seven missiles at targets located 700 kilometers away. It was in retaliation for deadly ISIS terror attacks earlier this month on Tehran's parliament and a shrine of Ayatollah Khomeini, who founded the Islamic Republic.

Israeli sources have reportedly said that most of the missiles missed their targets.

But more missile strikes could follow. Despite Tehran's rhetoric, however, those strikes will not target strong states in the region any time soon, a senior defense expert told the Investigative Project on Terrorism (IPT)

The Syrian strikes mark the first time Iran fired surface-to-surface missiles outside of testing programs since the Iran-Iraq war, nearly 30 years ago, said Tal Inbar, head of the Space and UAV Research Center at the Fisher Institute for Air and Space Strategic Studies in Herzliya, Israel.

“In this respect, there is perhaps a certain crossing of a psychological line. Ballistic missiles are seen as strategic weapons that are rarely used,” he said.

Shedding light on the type of missile used, dubbed the Zolfaghar (apparently named after the sword of Imam Ali, the first imam of Shi'ite Islam), Inbar said, “This is the most advanced of a whole family of solid fuel missiles, that began with the Fateh 110 missile. The Fateh 110 missile exists in Syria, and according to many reports, it has also been passed on to Hizballah [in Lebanon].”

This family of Iranian missiles comes with advanced guidance systems, including

'CORRUPT MOTIVE' AS THE CRITERION FOR PROSECUTING A PRESIDENT

   Author(s): ALAN M. DERSHOWITZ   Source: GATESTONEINSTITUTE.ORG

DershowitzMy academic and political colleagues who insist that President Trump has obstructed justice point to his allegedly “corrupt motive” in firing former FBI Director James Comey after telling him that he “hoped” he would end his investigation of General Michael Flynn. They concede – as Comey himself did – that the President has the constitutional authority to fire the director and to order him to end (or start) any investigation, just as he has the authority to pardon anyone being investigated. But they argue that these constitutionally authorized innocent acts become criminal if the President was “corruptly motivated.”

This is a dangerous argument that no civil libertarian should be pressing. Nor would they be pressing it if the shoe were on the other foot. If Hillary Clinton had been elected and Republicans were investigating her for asking the Attorney General to describe the investigation of her as a “matter” rather than a “case,” my colleagues would be arguing against an expansive view of existing criminal statutes, as they did when Republicans were demanding that she be locked up for espionage. The same would be true if Bill Clinton or former Attorney General Loretta Lynch were being investigated for his visit to her when she was investigating his wife's misuse of email servers.

“Corrupt motive” is an extraordinarily vague and open-ended term that can be expanded or contracted at the whim of zealous or politically motivated prosecutors. It is bad enough when this accordion-like term is used in the context of economic corruption, but it is far worse – and more dangerous to liberty – when used in the context of political disagreements. In commercial cases where corrupt intent may be an element, the act itself is generally not constitutionally protected. It often involves a grey area financial transaction. But in political cases – especially those not involving money – the act itself is constitutionally protected, and the motive, which is often mixed, is placed on trial. It becomes the sole criteria for turning a constitutionally authorized political act into a felony.

What constitutes a corrupt motive will often depend on the political bias of the accuser. For some Democrats, the motives of all Republicans are suspect. The same is true for some Republicans. Corrupt motive is in the eye of the beholder, and the beholder's eyes are often more open to charges of corrupt motives on the part of their political enemies than their political allies.

I know because I am currently being accused of being corruptly motivated in making my argument

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