Not In Love with Israel

amother

Thu, Jan 31 2013, 12:32 pm

Just a word about health care. I currently have health insurance through my US employer and pay very minimally - $30 a month (no that's not a mistype) to cover myself. I cover my husband and children through a seperate private policy for $300 a month. All preventitave care and visits to primary care physician (even sick visits) are covered. Visits to specialists are $40 copay.

We are seriously considering aliya (some posters will recognize my situation from some posts in a private forum yesterday - it's me who is trying to work out a telecommuting arrangement because otherwise I would be away from home until late) but if it works out to bring my job over from the US I will have to pay into Betuach L'umi as an atzmai. The marginal rate for an atzmai is 16%. And that's on my gross US salary so it's a LOT. And that's aside from Israeli income taxes on which I'd pay a marginal rate of 40%.

So I don't think of Israel as having free healthcare at all. You pay through B.L. and those with higher incomes pay a lot. So nope, healthcare costs is not at all why I want to live in Israel.

But there are plenty plenty plenty of other excellent reasons so I hope we will get siyatta dishmaya in this.

grace413

Thu, Jan 31 2013, 12:44 pm

Re health insurance: We live in Israel while retaining a business in the US. My DH says it would cost at least $1000 a month to insure the 4 of us. We pay a fraction of that here.

Less and less US employers are offering health insurance as a benefit. Furthermore, if you have any pre-existing conditions you are therefore tied to your job because if you move elsewhere you will have no coverage. Many people, especially frum people, do not work for large corporations; they are self-employed or work in somebody elses small business. There are also caps on insurance payouts in the US. When my father a'"h died over 20 years after 18 months of cancer treatment his "good" insurance had long stopped paying for his care.

Not to mention what it costs to be buried in the States as opposed to what it costs here - and no, I don't care if I'm buried in a plot adjacent to DH or not - I'd rather have the extra money go to tzedaka or my kids.

shalhevet

Thu, Jan 31 2013, 12:53 pm

amother, it is BL plus health insurance.
Firstly, the BL includes lots of benefits, like 14 weeks maternity leave at 100% salary, and other less happy benefits.

The health insurance is paid according to income, which means you pay as much as the government decides you can afford and not according to previous conditions, number of children etc. Everyone gets the same basic package and you can choose if you want to get additional insurance from kuppat cholim at a reasonable cost (this provides things like a nominal cost for a private consultation, extra therapies, reduced prices on some medications etc.), or the second strata which is much more expensive and/or private insurance.

There are threads here every week about people who lost their jobs with their insurance, or whose jobs don't provide insurance, or enormous copays.
So I would say to low to middle class people you are guaranteed a reasonable level of medical care whatever circumstances you find yourself in, at reasonable or little cost. People earning high salaries, especially if they don't have children or are young and healthy, might end up paying more here.

Peanut2

Thu, Jan 31 2013, 1:31 pm

amother wrote:

Right. If you have awesome health insurance in America then life is good. If you are healthy it's even better.

The problem in America is that it is such a luck of the draw type thing. A lot depends on what state you live in, even with private or employee insurance. When you work for a big company there are more perks - sometimes.

I've had a million different insurance situations over the past few years and today is the last day of my best health insurance yet. It was over $250 to insure us, through an employer, but with unimaginably low copays and coinsurance, and no deductible.

We've paid privately and it was over $800 and there are only three of us and we are baruch Hashem healthy. I had a CS and even when the insurance doesn't cover birth or pregnancy at all they can raise premiums for that.
With my horrible Jewish-organization employer it was only $100 for me, but to add a spouse was $500 a month and a child or children would have been another $500. The deductibles and copays were bad.
Then DH was employed by a very wealthy large employer who offered pretty lousy and expensive insurance.

Remember that in america you pay for some people to have health insurance as well - those who get medicaid and medicare. And those who pay more in taxes have to pay for their own health insurance. If you aren't lucky, you are screwed. AS in when we paid $800 plus a month we had $1000 deductible per person and around 30% coninsurance after that. We were not making a lot, which is often the situation when you buy your own health insurance. It was like 1/3 of our income or more. If we were to get sick it would have left us begging for money to eat. And we were paying $800 a month for three people.

No health insurance is free. The difference is that in Israel we pay for the insurance to begin with, for everyone. You pay more when you make more. But everyone has insurance. No one is denied treatment (which does happen in America) and you are not paying for those people without insurance who do receive treatment through your own hospital bills (because they have to cover their costs). It's done lechatchila because it's how government and society functions.

It is really annoying when you have to pay more in any kind of tax.

m in Israel

Thu, Jan 31 2013, 2:27 pm

The healthcare issue in Israel is a confusing one because everyone's situations are different. I think the point amother is making is similar to the one I tried making in an earlier post. You often hear people say "yes, many things are more expensive in Israel, but it doesn't matter because you save so much on health care and yeshiva tuition that you come out ahead", or some variation of that. This is NOT true for everyone. For people like amother and me, our health costs actually rise in the Israeli system. As I posted, I had a government job that provided me with FREE health insurance as part of my compensation. I paid about $32 a month to upgrade it to include out of network coverage, so I could go to whatever doctors I wanted to. My copays were cheap, and I had great prescription drug coverage. Here I pay much more for the "mas briut" (which is a part of the B.L., but it is a separate part). I do not consider that the same as paying "taxes" because your eligibility for health care is dependent on you paying that "mas briut". If you fall behind, you will be denied care. I also pay over 400 nis a month on prescription drugs, compared to the U.S. where I paid about $12 a month altogether.

Now I know I was lucky, but there are many other people who have cheap or free health care in the U.S. There is also a lot of government subsidized healthcare for low income individuals (medicaid) and children (S-Chip). In NY you can get pretty decent coverage on sliding scales through programs like Family Health Plus and Healthy NY.

I am not saying health care is objectively high in Israel -- just that it does not translate to "tons of savings" for everyone who makes Aliya. But we didn't come to save money on our health insurance. . .

shoshana11

Thu, Jan 31 2013, 2:29 pm

I totally understand that life is more expensive in Israel. We are contemplating aliyah and we have friends/family who have made aliyah so we heard all the stories Wink

but to be completely fair, life in US is no picnic either financially.
We are center MO family and so the school tuition is exorbitant amount, so is the health insurance (DH works for himself, so we have to pay privately). We pay $1000/month premium for a family of 5, and we have 3000/person, 6000/family deductible!! it's absolutely insane!! we have no savings, and we don't have family help of any kind. DH, B"H, makes decent money so we don't qualify for any "breaks" but at the end of the month we have nothing left to transfer to savings with all the expenses. I am not complaining, B"H we have enough to make ends meet, I am just saying that every country will have it's financial pit falls.
In US if, G-d forbid you get sick, you can literally lose all your savings with hospital bills and/or paying for meds. I have a friend who "ate" thru all her retirement money paying for rehab and long term care for her husband.. There are lots of horror stories here as well. it's definitely a misconception that money "grows on trees" in US. Though I totally understand that it is tighter financially for most people, whom I've spoken to, in Israel.

m in Israel

Thu, Jan 31 2013, 2:34 pm

Also, I pay much more for therapies here for my child with developmental delays. In NY speech therapy, occupational therapy, physical therapy, counseling, special ed services, etc. are available for free through EI and the Department of Health for children up to age 3, and then by the Department of Education from age 3 until 21. These services are provided in accordance with the committees assessment of the child's needs. Here unless your child is in a special ed school these services are provided through the Kuppah with a 25 nis copay per session (which adds up pretty quickly), and only up to a maximum number of sessions per year, regardless of the child's needs. After that you will be paying privately. So if I include speech and OT, my healthcare expenses are even higher!

freidasima

Fri, Feb 01 2013, 9:20 am

No one here is knocking the spiritual benefits of living in EY. That's the main reason for most of us staying here. But the business about the health insurance - gotta tell you that if you are talking about children over 18 and paying not only bituach leumi and bituach briut (think - a couple earns a combined gross salary of NIS 30,000 they are paying 1500 shekel a month just for bituach briut for the couple. Then add to that private medical insurance (let's say you have like us five kids over the age of 18 but for whom you are still paying the health coverage - well we are paying not only bituach briut but also supplementary kupa insurance for us and all the kids (that's another 600 shekel a month) and then private medical insurance for us all for the things which aren't covered (that's another 2000 shekel a month for all of us)...well just add it up and you have 4100 shekel health coverage (and we STILL have to pay for drugs, copay for ultrasounds, x rays, etc. to the tune of another, let's say 1000 shekel a month for all of us.

So if we are talking dollars, we are paying more than $1300 a month for health care and that's without paying for private doctors (for whom we get back less than half) or anything else like that.

Now our Israeli salaries are nowhere near those of american salaries of our equivalents in terms of professions....so saying that someone has an income of $200,000 a year for such a couple while here we earn half of that - AND pay taxes to the point where we have only a take home of 60% (unlike in the USA where we would be taking home much more)...so go and convince someone that health care (good care, not just kupat cholim or if you need elective surgery having to wait at times for almost a year for it!) here is "cheap"..

It's not.

shabri

Sat, Feb 02 2013, 2:15 pm

Yes but FS, most people are not paying health insurance, supplemental insurance, copays and prescription drugs for their grown children, certainly not the married ones. I know my parents are not. Once we got married, or actually way before that once we got jobs, we were on our own.

When I lived and worked in America I was paying $1,200/month for a family plan but it was before I had kids. Copays were $35-$50. If I wanted to add grown children they would have to go on their own plans at a cost of about $600/month for each. So for your 5 children I believe some of whom are over the age of 26 (the age they can no longer be on their parents' health insurance, you would be paying roughly $3,000/month in addition to your family plan of $1,200/month. Much more than you are paying here in Israel. And that is without copays.

shalhevet

Sat, Feb 02 2013, 2:46 pm

I was going to say something similar to shabri. FS, you aren't paying for 7 adults' medical insurance on half of $200,000 a year. You are paying for 7 adults' medical insurance on all you 7 combined salaries. The fact that you choose to give this as a gift to working (or even married) children is very nice, but you can no more say that all 7 medical insurances are coming from you and your husband's combined salaries, that you could say you have to pay for 7 cars from 2 salaries if you chose to buy one for each child.

Plus private insurance is a luxury here - that's your choice, but most people don't have it. You can no more say medical costs cost us $x a month if you are including private insurance, than say you have to have a vacation or meat 3 times a week, or a 7-room private villa in Caesarea. I'm not saying whether or not it is a good choice of luxury, but it's a luxury, and you would be paying a lot less if you paid only for you and your husband and student, unmarried children, and only kuppat cholim, even with supplementary insurance which I think most people have.

freidasima

Sat, Feb 02 2013, 2:59 pm

Shabri in kupa insurance, we are clalit, one can only go to three specialists a year, only heads of departments or their deputies, and you can only get back up to 700 shekel a visit at most. In private insurance you can go to any doctor on their particular list for a second opinion but again, only get back up to 700 shekel. If you go to a private doctor who charges, let's say 1500 shekel, which is a good average these days for a top doctor, you still only get back the 700 shekel.

Here in EY adult children are any children over the age of 18. There was a time that we had four under 26 and over 18, still single. All in school or army at the time. That's quite normal that parents would pay for such children. Here in EY the law is that after 18 you can't be on your parents anything, unlike in the USA where it is 26, hence all of a sudden one ends up paying separate supplementary for all your children who are still living under your roof but over 18. Maybe it isn't common in the USA to have kids under your roof after 18, maybe they all go off to college, but here in EY? It's very common.

mandksima

Sat, Feb 02 2013, 3:54 pm

m in Israel wrote:

This reminds me of the reason we moved up our aliyah plans by a year - our 2 developmental delayed kids were disqualified from their NJ State special ed status and all of a sudden we would have no way of getting them what they still needed (the qualifications for special ed were really high and it was obvious to us that our kids still needed intervention.) Private Jewish special ed schools were around $30K a year each. We had a contact in the yishuv we were interested in and faxed the evaluations to her. We were told the kids would have no trouble continuing special ed in Israel - that did it for us.

My son still receives special ed over 6 years later (he is reevaluated every year and still needs it but NJ denied us! My dd was moved into a regular class after 4 years of regular special ed with a close to full time seit and qualifies for therapies from the State. We had wanted to make aliyah anyway but never thought we'd be rushed because NJ didn't think the kids still needed help. I can't begin to think what my kids would be like had they been denied the help because we couldn't have afforded the expensive private special ed.

m in Israel

Sat, Feb 02 2013, 4:49 pm

mandksima wrote:

m in Israel wrote:

Every situation is different. My kids do not require special education classes (and do not qualify for them in either country). But they do require other support and therapy. Without getting into too many personal details, my older son lost out tremendously when we moved here in terms of what he could receive. We spend a lot of money privately to fill in the gap. One of my younger sons is currently in gan safah, which is great, but we have no good options for next year. He is not eligible (and doesn't require) a full time special ed program, but he definitely still needs speech therapy and OT, and possibly other support services. We will end up getting some through the Kuppah (with copays, etc.), and some things we will just pay for privately.

Trust me, I am NOT trying to talk anyone out of Aliyah. But people should have realistic expectations, and understand that not everyone will find health care cheaper, nor will everyone find developmental support services so readily available (They wait list for therapy through the kuppah when we moved here was over 8 months for speech services for my 3 year old with severe speech delays. Even then, we only got one session a week -- in NY he was getting 3 sessions a week, and we started therapy the week after he got the approval.)