We Help Fund Israel’s Defense. Why Don’t We Guarantee Healthcare at Home?

Imagine you’ve just been laid off. Your employer tells you when your health insurance ends, so you pull up your doctor’s name and the prescriptions you refill every month. If you qualify for COBRA, you may be able to keep your old plan temporarily, but the bill can now include the share your employer used to pay. You can also shop for a marketplace plan and see what it covers. A week ago you were budgeting around a paycheck. Now you’re comparing deductibles.¹

If you’re covered by Israel’s national health insurance, losing a job doesn’t end your eligibility. Coverage comes through one of four nonprofit health plans, each of which has to provide a package of services set by law. The system is funded primarily by an Israeli health tax and general tax revenue. Employment can affect what you contribute, but your employer doesn’t decide whether you’re covered.²

What Washington agreed to pay for

In 2016, the Obama administration signed a ten-year military assistance agreement with Israel. It called for $38 billion over fiscal years 2019 through 2028, subject to congressional appropriations. The annual commitment was $3.3 billion in military financing and $500 million for joint missile defense. The White House made a practical argument for committing years ahead. Predictable funding would help Israel plan for equipment and defense systems that take years to develop or buy.³

The agreement pays for military assistance. Israel finances its health system separately. The connection I’m interested in is that Washington already understands how to make a commitment credible. If you want someone to be able to plan years ahead, you give them a reason to believe the funding will still be there. We understand that when we talk about military equipment. I think people trying to plan a life deserve the same consideration.² ³

What a worker should be able to count on

The United States already spends public money on healthcare through programs like Medicare and Medicaid. For many working-age people, though, the plan they use to see a doctor is still tied to their job. COBRA can buy time, and a marketplace plan can be a good option. Either way, a layoff can force a person to make a new decision about insurance in the same week they’re figuring out how to make rent.¹ ⁴

Israel shows one way to separate coverage from employment. I’d go further here and establish a single public plan that covers everyone. It would mean moving people out of many plans they already use, shifting more health spending onto the public budget, and making sure hospitals and clinics can handle the demand from people who’ve been putting off care. Those are real obligations, and I think they’re worth taking on. The benefit is that you make the transition once and can keep your basic coverage through the next layoff, the next job, or the year you decide to work for yourself.⁴ ⁵

The worker opening that layoff email already has to figure out how long their savings will last and where to look for work. I want them to be able to call their doctor the next morning without first checking which insurance they’ll have when the appointment comes around.

Notes

1. U.S. Department of Labor, “FAQs on COBRA Continuation Health Coverage for Workers,” questions 1–2, and HealthCare.gov, “Marketplace Coverage When You’re Unemployed.”

2. National Insurance Institute of Israel, “Registration with a Health Maintenance Organization,” and European Observatory on Health Systems and Policies, “Israel: Health System Summary” and “Overview of the Statutory Financing System.”

3. White House, “Fact Sheet: Memorandum of Understanding Reached with Israel,” September 14, 2016, and Congressional Research Service, U.S. Foreign Aid to Israel: Overview and Developments since October 7, 2023, appendix A.

4. Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System, May 1, 2019.

5. U.S. Congress, Senate, Medicare for All Act of 2019, S. 1129, 116th Cong., §§ 102, 106–107.