Health Care, A Personal Comparison

Health care – A Personal Comparison


The health care debate rages back in the States. Between those who believe that health care is a basic right and those who believe it is a privilege. Between those ready to sacrifice some of the individual choice basic to the American privileged-based system, and those unwilling to tamper with the market dynamics of the current system. There is considerable middle ground to be had, but a basic philosophical fault line beneath all.

The Robbins family is living this debate. We have just completed the first five years of our son Coby’s life. Hampered by interstitial lung disease, stomach dysmotility, reflux, and eating disorders. We know the American health care system – its greatness, its weakness. Now we live in Israel, where Coby is just completing his first lengthy hospital stay, as a high risk child struck with swine flu. As we do, Amy and I have been switching places in the hospital and at home, and have had a bird’s eye view into the operation of a high-quality Israeli hospital.

In the United States, I thanked God every day that I had a job and a good health insurance policy. I liked my work as a rabbi. I liked it even more because it paid me enough money to pay the massive premiums for its excellent health insurance policy. Before departure, we put down in the vicinity of 1600/month to protect our family.

It was sadly and woefully pathetic to regard the families regularly sitting next to my child and me in Children’s Hospital of Philadelphia Emergency Department, knowing that the ER was their only possible medical destination. With little or no chance to acquire the fabulously specialized treatment that our son regularly enjoyed beyond the confines of the ER into the vast web of medical services offered by CHOP, its satellite care centers, and affiliated pediatric offices.

It was humiliating to navigate the maze of insurance alleyways. So many manned by people eager to serve and help. Yet with a mighty market headwind relentlessly trying to keep your hands off the prized benefits. Pre-certification. Pre-authorization. Expired referrals. Keystone this instead of Keystone that. The wrong department, sorry, and they’re not open now. No, I can’t give you my name or telephone number. You’ll need to call back the same switchboard.

Money, of course. Always money. Time to discharge, because of money.

We wanted privilege, and we got it. Cookies. Shampoo. A parents’ and kids’ center filled with videos, literature, newspaper, computers, and everything else to help make a long or short-stay easier. Not bad things at all. Good things. But how relatively important compared to giving another kid access to the basic health services that our son had?

Here, in Israel, I thank God every day that I don’t have to have a job to have health insurance. We pay relatively miniscule premiums – 50$/month – to avail Coby and the rest of the family of the services that every other citizen of this country is entitled to. That every other citizen of this country is entitled to, by virtue of basic humanity and residence in the society.

There is the bureaucracy, and there are the waits. I cannot get non-emergent specialized care tomorrow unless I pay for it out of my own pocket, purchase an expensive “private insurance” plan, or get lucky. So I have to walk on my painful hammer toe for another couple of months before getting it addressed by a specialist. Should this really be so hard?

In the hospital, I, not the nurse, need to physically give my son his oral medications. I have to strain to take his temperature with a mercury thermometer, because there are just not enough of the digital ones to go around. There is not an endless supply of linen and care-ware for parents and visitors. What you need, bring yourself. Television – pay for it if you want it. Remember those days?

But here, doctors give you their cellphone numbers. Call me when you need. They take their quasi-parental responsibilities quite seriously. Office visits do not require your cash or credit card. Can you imagine that? You’re not reminded of HIPPA every single time you do anything medically.

Friends, I’m rolling on too long. Truthfully exhausted. A fried oleh. Wanting to share a creative thought after a hiatus. Wanting to hopefully make a little impress on your health-care thoughts. And wanting to tell you that the socialist ethic so maligned in the American media is alive and well here in Israel, expressed not everywhere but in some of the absolute right places. Like health care.

Sukkot, As Intended

Sukkot in Israel.

The dream is being realized,
Speedily, in our time.

The ancient rites of pilgrimage,
Recreated,
All over a land.
Journeys to Jerusalem,
A time for tiyulim,
To the woods, the shore, the grove.

Seeing friends not seen since the last journey,
Spring-time.

We come together,
Flimsy roof overhead,
Pious in devotion,
An intense day of feast.

But then we set free.
To roam the land.
6 days, a country on vacation,
Chol Hamoed.

Relaxing in sukkot
As erstwhile
As the American Christmas Tree.
The sukkah, in Israel
Knows no Jewish boundaries.

The ushpizin nod proudly.

The weather concurs.
Sun shines,
The wind blows soothingly,
Clouds receive a hero’s welcome,
The rain pipes in,
Sprinkling in its time,
Returning from its long vacation.

Nature is happy.
The season's change is happening,
And we know it.

Sukkot is here
As it is not in Chul.

The tircha of two-day feasts,
Cumbersome, tiresome.
A chol without a moed,
To most of the people,
And our people.
A time sadly unknown.

It all ends tomorrow night
With one day of chag,
Simchat Torah, Shemini Atzeret, and Shabbat,
Rolled into one.

And then an extra day to celebrate, on Sunday.
Eesru chag,
A time to reside with God,
On the road,
Just one more day.

It is a time for blessing,
This Sukkot.
A time of shuva.
A time we know we have returned.

United our scattered people,
O God,
Gather our dispersed from the ends of the earth.

Vikarev pizuraynu miben hagoyim,
Oonifutsotaynu kanes meyarkitay aretz.

The Turtles Return to Their Shells

September 16


The turtles have returned to their shells.

Not to say in any way that my kids are turtles. Well, at least somewhat. Coby is actually deceptively quick and light afoot, the piker that he is. Getting him to run, or to walk, or to do anything, for that matter, does magically bring out the turtle, however. Adina is slender and decidedly not of camouflage color. Yet she runs like a lumbering turtle, oh so painfully down the 40+ steps of our apartment building each school morning.

Socially, our kids are unquestionably turtles retreated into their shells. If it weren’t for the Anglo-euphoria of the first month in Israel, it wouldn’t be so hard. English, English, English. I’ve never heard the word so much – or at least paid attention to it – as I have since arriving on aliyah. The first month. The almost doting, English-speaking, Nefesh b’Nefesh-working lovers of olim. English-speaking camp for oleh kids. Playdates with fellow new arrivals. The International Herald Tribune (a.k.a. The New York Times) smiling at you each morning as you open the door. Free subscription just bursting at the seams – waiting to suck you dry next month.

Then school began. And so rang the bell calling the turtles to retreat.

Just imagine.

“I don’t understand a xxx!!!- thing going in this classroom. I can’t even say, ‘Can I go to the bathroom?’ Are they playing with me, or are they teasing me? Am I following directions? What are the directions? I can’t play without speaking! I’m sad, I’m scared, I hate this.

“Mom and Dad, I can’t really say this to you, because I am too young to know how to, but, I am royally pissed off at you, and I want to go home to Wallingford and Perelman (Jewish Day School) right now. I don’t want to go to school, I want English certification of any child I am going to play with, and I don’t want to participate in any after-school activities that aren’t in my mother tongue. And I’m going to be really mean to you. I hope you in your infinite maturity and intuition get the message. Do something about this.”

Social retrenchment. Kid crisis. Not enough treats in the world to salve the hurt. Parent crisis. Parent guilt. Ugh.

So sets the stage for the First International Playdate – translators, moderators, the neutral territory of sweets and snacks, the whole nine yards….

Stay tuned.

Go West, Young Man

Thursday, August 6, 2009 -- Day 3


To be exact, I had to go a bit northwest, to Haifa. A rite of passage for most (not-under-duress) olim. To claim our “lift,” our shipment, all-our-life zapped into a 20-fit maroon “ZIM” container. (See its “before” picture).

This aliyah rite of passage is approached with equal bits of excitement and foreboding. Excitement, naturally. We get our stuff! Foreboding, why? Well, what happened to our stuff deep in the dungeon of a mercilessly-hot and damp cargo ship during its one-month voyage over the Atlantic and Mediterranean? Did Somali pirates negotiate its ransom? Did a crew member decide to use the container as his own personal “dumping” station? And how about that fear of all fears – realized all-to-many times, as with the home basement – THE FLOOD? Everything wet and ruined….

Foreboding, also. Dealing with the dreaded shipping and customs bureaucracy. Having to navigate your way – in Hebrew, nonetheless – through ruthless anti-social leathernecks bottled up in some steamy dilapidated building near the port.

And so I stuffed Adina and Coby in the backseat of our rented (1st of 4 rentals within the first 2 months – don’t ask…) Mazda 2 (as popular in the Holy Land as God) and we sped up superhighway Route 6 to Haifa. I put quite a bit of faith in the Holy One on the ride, to tell you the truth, trusting memory, a fairly good sense of direction, and rusty Hebrew to get me to the Haifa port… I would have preferred a GPS, but that is one of the only electronic products/appliances that we haven’t purchased in the past few days. To think we were leaving the consumer culture behind…

And we arrived. So ready to explode in pee that I left the kids in front of a pizza shop in the disgusting port area and ran down a seemingly endless series of corridors to a bathroom that hadn’t seen toilet paper in two years. There’s a lot to thank the King of Kings for here in Israel, especially when your kids aren’t kidnapped in a moment of absolute abdication of parental responsibility.

The Lord was certainly not there the next hour, as I hurried the kids past rows of porno shops on the way to the requisite steamy dilapidated building. As Bialik said, “we will be a normal state when we have the first Hebrew prostitute, the first Hebrew thief and the first Hebrew policeman.” We’ve got ‘em all! In spades, in a country whose cable company is called “HOT,” and brazenly brandishes advertisements for its after-hours adult-only programming.

Then we entered said steamy dilapidated building. Any hope of an air-conditioned office went out the window the minute we entered and felt like we were in a burned-out building in downtown Newark. We walked up the wide concrete staircase, ready for our end – Ray Liotta and Joe Pesci waiting to mow us down. The end came on the 3rd floor, with the first live office in the building – the home of Sonigo Shipping and about 40 other affiliates.

The All-Merciful One returned and blessed us with the miracle of air conditioning, but not enough cash. Yet, we were in the red-light district! – an excellent location to again leave your children in an unknown location and to search out the best black-market exchange rate.

The kids were again not kidnapped, and I was able to sit down and unwind my red tape with Batya, the curt, deep-voiced clearly not-customer-relations representative – there was no such person within 2 miles. I signed my name a gazillion times and handed over 2500 well-traded enveloped shekels to her. “Your lift is here. We’ll likely deliver it next week.” Good, good. “If it clears customs on Sunday.” Bad, bad. “In that case, we’ll bill you for the extra shekels. And you’ll have to pay the movers the balance.” What balance????

Shorn of money, dignity, wits, and any pretensions to the idealistic revelry of Israel, I then got the Muhammad-Ali upper cut to the face on the way out the door, as I stared straight at a massive map of the good ol’ USA, in all its continental glory. Like Bilaam’s donkey, in more ways than one, the map amazingly spoke to me. “You dumb ass, Robbins. You are just plain and simple stupid. You left this great country of 50 states, large and small. You left me, this map whose mantle you worshipped at, in red and blue,every 4 years, whose cities, villages, and hamlets you studied endlessly in the Rand-McNally on every camping trip as a child. Thrilled at the tri-section point of New York, Pennsylvania and New Jersey? Crossing state borders, see if you’ll ever do THAT again.”

With that, I left, kids in tow, Leapster still a battleground between them, Amy likely still waiting for the refrigerator and washing machine delivery man to ante up back in Modiin. Still more red tape, not too mention eternal unpacking, for the rest of the century. Still uncertain about the whereabouts and whatabouts off our accumulated life-stuff, the foundation of our this-part-of-life to begin in Israel.

Stay tuned.

The Heat is On

September 7, 2009


Don’t tell anyone else this -- :) -- but, our sorry, pale-skinned, Ashkenazi bodies are not made for Israel’s heat. Maybe 2000 years ago. And probably another 2000 years before we’re used to it again. No wonder the sephardi/mizrachi population is now the majority of the country.

During the day, the heat’s your shadow. There’s no escaping. It batters, presses, roils and broils. It’s like going for a dunk in the NBA and meeting finger-waving, shot-blocking Dikembe Mutumbo at the basket saying, “no, no, no.”

The biggest difference in the heat here as opposed to the States, at least the Northeastern part of them, is the sun. Sounds a little odd, huh? The sun. It’s always there. No clouds to speak of – for four months. This Shabbat clouds miraculously appeared and sheltered us on our 25-minute walk home from lunch. We felt like the people of Israel strolling through the desert, cloud-cover overhead. It felt 20 degrees cooler than when the sun is out.

So the day goes like this. Take the kids to school or camp at 7:30 or 8:00. Try to get an errand or two in. Then head indoors before the sun begins the rapid extermination of everything stupidly remaining under it between 9 and 5. The sun’s heaviest working hours in Israel.

Then, as if escaping long incarceration, people burst out of their houses, offices, and other cells at 5:30 or so and flood the parks, streets, malls, and any other even quasi-inviting outdoor space that stares them in the face.

The sun goes slowly away, dying a long death, now so pretty, ferocity forgotten.

A day in the life of the Israeli heat and the people it oppresses.

No Free Lunch at School

There is no such thing as a free lunch, or free school, for that matter.


We were prepared for this, but it is still a shock having your kids dismissed from school at 1:30 pm – so relatively early in the afternoon.

To occupy your children in the afternoon – and mostly in things non-academic, mind you – costs many shekels. You can find what you want – typical after-care, arts and crafts, sports, tutoring – but it certainly wreaks havoc with a working schedule and means you may be driving all around town. What to do?

There is an intense focus on children in this country, and also on the dirth of educational spending. Schools just don’t get funded. 35-40 kids in a class, terribly-paid teachers, schools of 400 and 500 students sharing one nurse with three or four other schools. It’s the Western world, but it’s the third world. It’s suburban USA, but also the inner city. Socialist expectations at their best, socialist results at times at their worst.

A kid cannot go to school for 5 ½ hours a day and expect to be well-educated, without putting intense pressures on parents to supplement their kids formal education with additional formal settings.

September 1 -- Adina Meets the Prime Minister

Only in Israel.


Adina Noga Robbins. Olah of one month. First day of school. Prime Minister’s there to inaugurate the year. Adina in front row. Adina shakes the Prime Minister’s hand, exchanges “shalom” with him.

Only in Israel.

This girl of almost 7 has seen the Prime Minister live, up close, twice -- in the first month of her life in Israel. Now, she probably won’t see a Prime Minister again for a decade or so, but it does say something about the country – and its intimacy – that’s she’s already buddies with Bibi.

Today, my worst fears….were NOT realized. Ha-hefech (the opposite), in fact. Coby, who I had to carry literally kicking and screaming to a playdate yesterday, walked shyly into his gan, but then quickly settled down to play with new friends at a table nicely decorated with a Lego-type game. A truly universal language. Words not needed.

Coby’s ganenet (kindergarten teacher), Ofra, and her seeyat (assistant), Yardena, truly set him at ease. They clearly love young children, and (they probably say this about all the kids, but it’s wonderful to hear it about your child anyway, particularly in the beautiful Hebrew words) and said he was madheem (amazing) and makseem (no translation necessary!), blowing kisses via their fingers in a quintessential, endearing Israeli way. He had a great day, and walked confidently out of the school at 1:30. “This is my place.”

Adina is clearly thrilled to be at school, and absolutely exhilarated at the number of children, the Hebrew spoken, and her backpack full of grown-up first grade books. A particular child she is, wanting things just her way. That, I guess, doesn’t make her very particular as a young child!

It was a thrilling day for me too. This was the day that real life began for the Robbins in Israel. And it was good. Very good.

BTW, I lost my keys – car, home, everything – schlepping the kids all around town. Thank God my in-laws were driving with their rent-a-car. But truly small potatoes the deficit was. And typically, for this 6-footer, the keys rested on top of the kindergarten refrigerator between 8 am and the time I returned to pick up Coby 5 hours later. I leave everything everywhere – but up high, not low. Some things don’t change.