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By Ira Sharkansky
 JERUSALEM—I have no dog in the Americans' fight over health insurance. We are covered, like the vast majority of residents in other democracies, by centrally regulated health services that help us achieve better care than most Americans.
The United States ranks 45th in life expectancy, lower than all countries of Western Europe, as well as Japan, Singapore, Hong Kong, Malta, Israel, South Korea, Jordan, Bosnia and Herzegovina.
Lest you claim that America's social diversity is responsible for its limited life expectancy, Israel also has a diverse population. Israeli and US Statistical Abstracts show that Israelis live two years longer than Americans. Israeli Jewish men live five years longer than White American men. Israeli Arab men live seven and one half years longer than American Black men, and eight months longer than American White men. Comparisons are similar in the case of women.
No doubt some Americans have access to the best care and facilities in the world. But Americans should not let their jingoism get in the way of conceding what other countries provide. And elsewhere the best is more likely to be widely available.
Several of America's sacred cows are standing in the way of decent care and longer lives.
It is in the nature of sacred cows that they cannot be killed. What follows is a wish list, based on what occurs elsewhere, but what is not going to happen in the United States.
My professional and personal roots are stimulated by all that I read about the effort to reform American health care.. To tell the truth, I do no more than skim it. I get lost in the details. I suspect the writers of all the commentaries, criticisms, and proposals are also lost. The devil is the details. Those in the proposals and counter proposals are not likely to kill the sacred cows. The complexity of American health coverage is one of the issues that limits it.
We read stories of Americans who spend more time on the paperwork than with care providers. An advantage of a centralized, uniform, and "socialized" system is that there may be no paperwork. An identity card can provide access to care, an immediate knowledge of what must be paid, and gives the care giver access to records about your conditions, treatments, medications, and test results.
Complexity owes something to the sacred cow of free choice.
There is an enormous amount of American government regulation already in place, and virtually no freedom of choice for those needing care. Almost all the choice is in the hands of profit making insurance companies. They sell complex policies and reserve for themselves the decisions as to what is covered. Not only do they limit choice to themselves, but they also support the campaigns that trumpet freedom of choice and oppose regulation.
The last thing Americans want is a uniform set of costs and benefits, administered either by companies or by the government. That, however, is what serves the people in
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countries where people live longer.
Who would define these uniform costs and benefits?
Health professionals, with significant inputs from government departments of health and finance.
BUREAUCRATS you scream.
Evidence is that bureaucrats of government do it better than bureaucrats of profit-making insurance companies.
Do you want your sacred cow, or do you want to live longer?
I'll bet on the greater longevity of the sacred cow.
Socialized systems need not prevent choice. They can assure a basic and sufficient level of care to all, yet allow individuals to buy extra coverage or purchase care directly if they want to pay for such things as quicker service, access to the most prestigious physicians, more comfortable hospital rooms or senior citizens' housing.
Another sacred cow is trial by jury. Most democracies administer criminal and civil courts with professional judges and no juries. There may be multiple judges sitting on individual cases, with more judges deciding about more serious charges. What they are likely to produce is closer to the rule of law than available from juries.
Juries are relevant to health care by virtue of enormous awards for "malpractice," which increase insurance premiums for physicians, and add to superfluous and expensive tests they order to order to protect themselves. Other countries do just as well in protecting patients by more modest and standardized compensation, and by holding physicians responsible via criminal trials for actions defined by professionals as malpractice.
Among the impediments to killing these cows are Americans with access to the best health care. They are likely to be the Americans with the greatest political influence. Many of them fear losing something if the system is made more uniform.
Me first may be the most sacred of the cows in a society built on individualism.
The United States is not the only country that suffers from its sacred cows.
Germany's love with high performance automobiles stands in the way of imposing speed limits on the autobahns. If tourists do not see the carnage, it may be because their eyes are glued on the cars in front or behind them, moving along at more than 100 mph, or because of efficient German cleanup. (Here's a link for comparable measures of road deaths).
Israel suffers from religious fanatics that read part of the Bible that says God gave all the Land of Israel to the Jews. They do not deal with His multiple definitions of the Land (Genesis 15; Genesis 17: Numbers 34), or His failure to actually deliver it all to His people (Judges 3:5-6).
Now that I have proposed the severe regulation of American free enterprise and an end to jury trials, I can go for my afternoon nap.
I know that one does not kill sacred cows.
That's the pity.
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