BGU | MY PATH, Haim Doron, MD

CHAPTER 9

Stages towards a National Health Insurance Law

Background: Clalit and the Labor Federation Clalit as a Subordinate Entity to the Labor Federation

Clalit Sick Fund was founded in 1911. For 75 years it belonged to the Histadruth, the General Labor Federation, subordinate to the Federation’s principles and institutional decisions. 123 Its subordination to the Federation was expressed particularly in salaries and work conditions of Clalit employees, later with the exception of the sick fund’s physicians. But in matters of health policy, Clalit always had absolute independence. In all my posts and in all my years managing Clalit’s affairs, Clalit health insurance hinged on membership in the Labor Federation and payment of dues called Mas Achid (Unified Dues). There were some advantages in combining Federation membership and Clalit membership, particularly in the first decades of the sick fund’s existence. The advantages were mutual: The combination strengthened the Federation by including health insurance in its services; and it strengthened Clalit by broadening its base to include all members of the Federation. But, over time, this partnership turned into a yoke. This was particularly burdensome when the question surfaced and became a sore point: Why did a person have to be a member of the Labor Federation just to procure health insurance if the person didn’t identify with the ways of the Federation? As a result of this undercurrent of dissatisfaction, people began to leave the sick fund, and others refrained from joining it as an expression of protest against being forced to be a member of the Federation. Not all the cancellations stemmed from this sentiment. After all, Clalit was a massive entity, which, by its very nature, was going to experience members leaving. But a large proportion of the departures were tied to unwillingness to be Federation members. As a result, there was growth in the membership rolls of the Maccabi Sick Fund at the expense of membership numbers in Clalit. The Problem with the Premium Collection The most difficult problem in the partnership between the Labor Federation and Clalit lay with dues collection. The Federation’s dues collection apparatus would collect dues from the membership and distribute the money between itself and Clalit. How it was distributed was never entirely clear to us. It lacked transparency. Moreover, from time to time a levy was imposed on all the Federation’s entities, with the tax being for various objectives or activities the Federation wanted to promote. The Federation had Clalit’s hands and feet tied when it came to dues collection and instituting steps to rectify things. A good example was the Federation’s opposition to imposing a tiny, symbolic co-payment on all drug prescriptions – a measure to discourage members from filling, then throwing out, unwanted prescriptions. Clalit suffered from massive wastage of this sort. For example, we knew that at the clinics in Bnei Brak, a city with a religiously observant population, hordes of people were frequenting the clinics just prior to Passover to dispose of huge quantities of drugs that they didn’t want to have in their houses because the prescription wasn’t considered “kosher for Passover.” 123 The sick fund was founded by members of the Second Aliyah, the second wave of Zionist-motivated immigration (1904-1914) that included many of the ‘movers and shakers’ that dominated and shaped the Jewish homeland as a state-in-the-making. It started as a local sick fund for laborers in 1911, operating as an independent entity until it was incorporated into the General ( Clalit , in Hebrew) Labor Federation in 1921, which had been founded a year earlier - in 1920. Still, up until 1936, membership in Clalit operated separately from membership in the Federation. In 1936 membership dues to the sick fund was combined within dues as a Federation member, and it was labeled Mas Achid or Unified Dues. Clalit was one among many Labor Federation enterprises such as industrial plants and marketing coops, financial institutions, and cultural institutions. For details see, Haim Doron and Shifra Shvarts, Refu’a b-Kihila ” (Medicine in the Community), Ben-Gurion University Press, 2004, pp. 13-21. See also: https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.89.2.248

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