Socialized Medicine: Worse Care, or Worse Coverage?

Run Over by a Bus – Healthcare for All

by Reb Akiva at Mystical Paths
Yesterday my youngest daughter was hit by a bus, as a pedestrian (in a cross walk), head on – which then left the scene.

Here’s how the experience went, in Israel, with socialised medicine (for Americans – this is the equivalent of the Democratic cry of “Healthcare for All!”).

– After being struck, Hatzalah was called.  Hatzalah is the (now Israel nationwide) volunteer emergency response service – meaning people who come running or by ambu-cycle with first response medical equipment.  The idea here being that dealing with emergency stabilisation in the first 10 minutes significantly increases survival rates.  Hatzalah is a volunteer service and a charity service – donations make it happen (no personal or government cost).

– A Hatzalah responder arrived within a few minutes, evaluated her and called an ambulance for transport.

– It took a while for the ambulance to arrive through city traffic.  The Magen Dovid Odom (Red Star of David national ambulance service) medics re-evaluated her (unfortunately Hatzalah and MDA don’t play well together, so there is no integration between their data or cross trust in their evaluation costing extra time) and transported her to Ichilov hospital.

– There was a not insignificant delay in the ambulance entering the hospital because the hit Israeli TV show Fauoda was filming there at the time.

– The triage at Ichilov ER evaluated her, noted she could stand up, and sent her (with broken bones and possible internal injuries) to walk down to Ambulatory ER and wait in an extremely crowded inner city ER waiting room with 50-100 other people waiting for their coughs to be seen or wounds to be stitched.

– 2 1/2 hours later, sitting with a likely broken limb and in partial shock, she was seen by an ER “surgeon” who, without doing more than asking a few questions and taking notes (no examination, neuro check, or even taking blood pressure or temp – but I guess those had been done in triage so no reason to check later if she wasn’t passing out or seizing, right?), sent her off to x-ray.

– X-ray was great, had her in and out in 5 minutes.

– She waiting another 2 1/2 hours to be seen by an orthopaedist, at which point I had a yelling match with the overloaded nursing staff about the wait time and signing her out and taking her to Hadassah Ein Kerem in Jerusalem (an hour away), assuming we’d be seen faster traveling an hour and waiting there than in Ichilov.  After demanding to sign her out and being told to suck it up, look at the crowd, or fine – here’s the sign out paper be prepared for the national system to demand you pay (where normally they don’t) because you left without medical permission – after going through that she was magically called 3 minutes later.

– The orthopedist cast one limb and evaluated her other areas as bruised not broken.

– Back to the ER “surgeon”, who this time we didn’t wait for but barged into his room after his previous patient walked out.  Asked about a neuro check, “she’s conscious and CT’s are loads of radiation for a young person – so no” (and socialised medicine means no MRI because they are too expensive unless the person is showing obvious symptoms), about pain control for her severe head pain (she struck her head), “take a Tylenol or Advil”, he signed her out and told her to follow up with an orthopaedist in a week through her (national) HMO.

Israel has a modern first world medical system – the equipment the orthopedist was using was world class – and he did some live action x-rays on the spot with equipment I’ve never seen before.  But healthcare for all cost controls mean facilities are run AT CAPACITY, and where in the U.S. she would have been in an MRI in 30 minutes, in Israel an MRI is not an option due to the cost except in severe situations – and a CT (readily available) has reasons to avoid.  Pain control is a bit of “suck it up buttercup”, both because of cost control and national attitude.

ER’s are ER’s, and I’ve been in good ones and bad ones in the US and, with this experience of a not-so-good-one, in Israel.  But the obvious difference is in the US they throw lots of tests at the problem to make sure a variety of bad things isn’t happening, in Israel they use basic diagnostic techniques – which will miss the 1:100 or 1:1000 situation – to avoid test costs.

Thank G-d, my daughter is banged up moderately and has a fractured or broken limb, but doesn’t appear to have suffered life threatening injury.  In the U.S. I would be comfortable saying “yep, she’s ok” and waiting for the $5,000 in deductible bills to arrive of the $15,000 hospital bill.  In Israel I’m not comfortable saying that all is ok – but no hospital bill will arrive, only an ambulance bill (for $150) which can then be forwarded to the HMO to take care of… and she will be covered by Social Security Disability for her lost work time (Bituach Leumi) and by the national vehicle accident coverage for any medical bills not covered by the HMO (in Israel they combined all the insurance companies medical coverage into a national plan that covers medical costs for anyone hit or injured in vehicle accidents).

So which is better?  Better care, or better coverage?  It’s iffy – for basic care, stitches, broken bones, normal illness – I find better coverage with it’s reduced cost concerns to be much better.  But when things get more serious you run into wait times, effort to prove need, and it’s hard to get more costly services, treatment or medicine – extra approvals, extra wait.  Sometimes that is merely annoying, in this emergency situation it was… distressing.

I don’t know much about the hospital facilities in Tel Aviv, but for ER services I didn’t think much of Ichilov.  In Jerusalem I’ve had good experiences in Hadassah Ein Kerem, and adequate experiences in Shaare Tzedek (though Shaare Tzedek is usually overcrowded).

From MPaths, here.

TODAY: Fascinating English Tour in the Old City

This afternoon, Wednesday, February 5, there will be”h be an English-delivered tour of the Muslim quarter, given by Daniel Luria, executive director of Ateret Kohanim.
The tour is meant for yeshiva students who are currently studying in Israel, and will be given for free (the guy giving the tour charges usually 50-60 shekels per person…).
Meeting 13:45 at Sha’ar Shchem train station. Aiming to finish somewhere around 15:00.
This tour is expected to be fascinating and uplifting.
For more info: 0545373574
[Communicated.]

Kabbalah Really Belongs to the MISNAGDIM!

Where’s the ‘Snag Kabbalah?

I went into my neighborhood seforim shop (in Flatbush, we have neighborhood seforim shops, it’s the B&N that necessitates a big trip “out of town”) to peruse the new translation (by R’ Avraham Yaakov Finkel, noted translator of short books for school fundraisers) of the Nefesh haChaim, the central expression of Misnagdish Torah philosophy by the founder of the Lithuanian Yeshiva Movement, R’ Chaim Volozhin.
It looked rather small for a book whose modern editions tend to be fairly large and thick. I started flipping through the back and saw that the entire text was included in Hebrew in the back. Whoops – filler! How much actual English text is there? Not a lot, and the print isn’t even that small.

Why is that? There was a note from the author at the beginning, that he had not translated the kabbalistic material. Huh?

One of the big strengths of the Nefesh haChaim is that it speaks in the same kabbalistic idiom as the Chassidic books. It was addressing the same early-19th-century audience, and making a case for the primacy of Torah study over other non-prayer activities. I’ve even seen some of the same imagery in both R’ Chaim’s writings and in the writings of the last Lubavitcher Rebbe – that the mitzvos are a rope between ourselves and God, strands being severed by sins. By cutting out the Kabbalah, R’ Finkel has cut the meat off the bones of the Father of Yeshivos, leaving his work a poor meal indeed.

Note, I haven’t extensively studied the Nefesh haChaim, so it will wait for someone more knowledgeable to write a proper review. I’m just talking about the form; the substance needs deeper appreciation.

But what about Kabbalah for Misnagdim? Following the publication of the works of the Ari, Kabbalah spread throughout the Jewish world, supplanting the pure intellectualism of post-Maimonidean philosophy. This led to the Sabbatean disaster, and in an effort to root out secret conventicles of Sabbateans, different communities had different approaches. The Sephardim, I don’t know, there was some strong opposition, but did secret Sabbateans continue much among them? The Ashkenazim were plagued with them throughout the 18th century. Two distinct approaches developed:

The Chasidim gave a quasi-messianic role to their Tzaddikim, their Rebbes. Not that “every Chasid thinks his Rebbe is Moshiach”, which is a canard put forth by some Lubavitchers to justify their continuing belief that their late Rebbe is/was [a suitable candidate for] Moshiach. Rather, they believe (see, e.g., Beis Aharon by R’ Aharon of Karlin) that the soul of Moshiach is distributed among all Jews, with Tzaddikim having a somewhat higher proportion of that soul.

The Misnagdim outlawed Kabbalah. This continues to this day. Until the end of the 18th century, the major rabbinic figures in the Ashkenazic world were almost all Kabbalists, and thought of their Judaism to some extent through its filters. Some of the greatest wrote amulets for the common folk, who believed wholeheartedly in the Kabbalah. It’s clear that the general run of educated Jews in that time knew Kabbalah, because the Chasidic writings for them are all written in Kabbalistic idiom. But after the founding of the yeshiva at Volozhin, Kabbalah was taken out of the yeshiva curriculum. So today, Misnagdim don’t know Kabbalah. And there are no more Misnagdish Sabbateans, nor are there messianic obsessions such as arose over the last Lubavitcher Rebbe.

However, the Chasidim and Sephardim still deal in Kabbalah. Only kooks and entrepreneurs (such as the Bergs and lehavdil R’ Aryeh bar Tzadok) seem to be truly involved in Kabbalah in the yeshivish and modernish world. More and more kabbalah is becoming available, even in English, but it’s still frowned upon. The closest one gets is an underground shiur in Tanya at major yeshivos, such as Philadelphia or Ner Israel. Even at YU, the “intro to Kabbalah” is taught in the college and the graduate school, not in the yeshiva.

Hence this edition of the Nefesh haChaim, and both English translations of the Ramban’s commentary on the Torah, have excised all Kabbalistic material, even though that’s a lot of the meat of the writers’ material.

The Sabbateans have been gone for 200 years in western Orthodoxy. Is it perhaps time for the yeshivish world to rejoin the rest of Judaism, and expose its practitioners to Kabbalah in some organized, controlled way?

From ThanBook, here.

Some Arguments in Favor of the Natrona’i Gaon-Ra’avad Techeiles Method

How to tie your tzitzit: arguments in favour of Ra’avad

 By 

About half a decade ago, I wrote an article justifying the opinion of haRav Bar Hayyim regarding how to tie tzitzit. It was the first time I had tried my hand at this sort of thing, and it came out a bit of a mess. I recently took another look at it, however, and I found the arguments more convincing than I remembered, though it needed a lot of editing. So without further ado here is my first foray into Rabbinics (Click here).

From Haggadah Berurah, here.