WASHINGTON — Mitt Romney’s praise for the Israeli health care system, made near the end of his foreign trip, followed him as he returned home Tuesday, raising eyebrows because he lauded a system that has more government control than the Obama health law Romney so strenuously faults.
Romney, speaking to donors Monday, commented on how Israel — a “pretty healthy nation” — spends far less on health care than the United States does. Israel’s success in controlling costs is often attributed to the heavy role of its government and a requirement that everyone have coverage, some of the same qualities Romney condemns in the health law President Obama signed.
“We have to find ways, not just to provide health care to more people, but to find ways to finally manage our health care costs,” Romney said during the fund-raiser at the King David Hotel in Jerusalem.
Romney’s praise for Israel’s health care system was greeted with some surprise.
“We’re laughing — for a Republican to praise the Israeli health care system, which is managed care, universal coverage, with no small amount of federal government control and oversight,” said Karen Feinstein, president and chief executive of the Pennsylvania-based Jewish Healthcare Foundation, which has been studying the differences between the Israeli and US health care systems.
The comments are yet another example of an off-message moment during a six-day foreign trip that tested Romney’s diplomatic skills, and frayed the nerves of some of his campaign aides.
Romney did not praise all aspects of the Israeli health care system, focusing mostly on its ability to keep costs low.
“Our health care costs are completely out of control,” he said. “Do you realize what health care spending is as a percentage of the [gross domestic product] in Israel? Eight percent. You spend 8 percent of GDP on health care. . . . We spend 18 percent of our GDP on health care. Ten percentage points more.”
Health care and left-leaning bloggers Tuesday were all too eager to explain to the candidate the cost-saving lesson he should take from the Israelis: more government regulation is sometimes a good thing.
Romney’s campaign said it was a stretch to view his comments as praising the entire Israeli health care system, saying he was simply commenting on its lower costs and was criticizing the US system more than he was praising the Israeli one.
“The governor was criticizing our broken health care system and the failure of Obamacare to address the health care challenges facing our country,” said a Romney campaign spokesman, Ryan Williams.
Israel’s national health care system, created in 1995, provides universal coverage by requiring citizens to join one of four competing insurance plans that, by law, have to provide certain base-level services. The plans cannot reject customers because of preexisting conditions.
The nonprofits that provide the plans receive funding through the state’s graduated income tax. There are some out-of-pocket payments, such as visits to specialists and pharmaceuticals, and the plans do not cover dental or eye care.
Kevin Tabb, the chief executive of Boston-based Beth Israel Deaconess Medical Center, spent most of his adult life in Israel, including medical school and residency. He said the system in Israel is much different from the one in the United States.
Health care there is treated more as a right, like education, he said, and is not driven by business.
“It’s a system heavily regulated by the government — health care is provided to all citizens — and not, for the most part, governed by markets,” Tabb said.
Of Romney’s comments, Tabb said it is hard to separate out the country’s relatively low costs from the ways in which the system is set up.
“If you’re going to point to a system as an example of controlling costs and achieving better outcomes, then we’re going to need to acknowledge that that system is very, very different than a system he would find acceptable,” Tabb said. “It is interesting that he was complimentary of a system that involves national health care.”
There are some downsides to the Israeli health care system, which could be some reasons why the costs are lower. The country’s hospitals — many of which are government-owned and operated — are often over capacity, which means patients are routinely kept on gurneys in hallways or in waiting rooms. For nonemergency procedures, such as a hip replacement, patients may have to wait several months.
But the system focuses closely on preventive care, and Israel has one of the highest life-expectancy rates in the world.
“I commend Governor Romney for recognizing there are other systems around the world that deliver high-quality care at a much lower cost and are very different than the ones we have in the US,” Tabb said. “I’m not sure he wants to be commended for that.”
Romney on Tuesday wrapped up his foreign trip, which was marked several times by statements that diverted from the messages he wanted to drive.
On Tuesday, for example, Romney was hoping to end his three-country trip with a speech in Warsaw that highlighted Polish-American ties, the “enduring spirit” of the Polish people, and the country’s improving economy.
But his speech was temporarily overshadowed by one of Romney’s aides, who reprimanded reporters for shouting questions at Romney as he walked to his car after a visit to the Tomb of the Unknown Soldier in Warsaw.
“Kiss my [expletive]. This is a holy site for the Polish people,” said Rick Gorka, a campaign spokesman. “Show some respect.”
“Shove it,” Gorka told one reporter. Gorka, who was a spokesman for Charlie Baker, a Massachusetts Republican gubernatorial candidate , later apologized.
Reporters were attempting to get Romney to respond to his remark Monday about how Israeli culture helped make Israelis more prosperous than Palestinians, and whether he thought his gaffes were overshadowing his trip. Although Romney did several network television interviews during his trip — and spoke with two Israeli newspapers — he has not fielded questions from the traveling press corps since Thursday, when he took three questions outside of London’s 10 Downing Street.
“I realize that there will be some in the Fourth Estate, or in whichever estate, who are far more interested in finding something to write about that is unrelated to the economy, to geopolitics, to the threat of war, to the reality of conflict in Afghanistan today, to a nuclearization of Iran,” Romney told Fox News’s Carl Cameron on Tuesday. “They’ll instead try to find anything else to divert from the fact that these last four years have been tough years for our country.”
On Tuesday, Romney’s campaign sought to shift gears, stoking anew speculation over his vice presidential pick — and when it will be announced. Beth Myers, who is running Romney’s vice presidential search, said “the historic announcement is getting closer,” adding that the announcement would be made through a new smartphone app that will allow supporters to get the first official word.
Users of the app, which is called “Mitt’s VP,” will get a notification on their phone as soon as the choice is announced.
The choice seems unlikely to be announced this week. Romney’s wife, Ann, is expected to be in the United Kingdom on Thursday to watch her horse compete in the Olympic dressage competition. Ann Romney has been an integral part of the campaign, and it would be unusual for a candidate’s spouse not to attend the announcement of a running mate.
On Tuesday, Romney’s campaign also released an ad that shows the candidate speaking directly into the camera. With an air of folksiness, he drives an automobile and delves into his biography as a businessman, Olympics leader, and Massachusetts governor.
The ad — a 60-second spot titled “Believe in Our Future” — is the type of positive message some Republicans have been urging Romney to adopt, one that markets his biography and his ideas to voters.
Matt Viser can be reached at firstname.lastname@example.org.