BGU | MY PATH, Haim Doron, MD

Clalit was always in favor of national health insurance through the auspices of the existing sick funds. Moshe Soroka, who was not only a wise man but also a courageous one, once wrote a landmark letter to the Federation secretary, Yitzhak Ben-Aharon. In the letter, Soroka railed against two things: First, foot-dragging by the Federation when there was the urgent need to renew deliberations on national health insurance even it if went against the interests of the Federation; second, the problem of medicine in the community and Ben-Aharon’s opposition to the idea that medical education in the country should invest in promoting community medicine. My own proposal for national health insurance, formulated together with others, is not well known, though I maintain it was an important one. In 1965, Ben-Gurion split the Mapai party, and formed the Israeli Workers’ List, or RAFI party. 130 I supported Ben-Gurion in this move. RAFI’s people turned to me as a physician, and to Joseph Ciechanover, the Ministry of Defense’s legal counsel, as a jurist, requesting that the two of us propose draft legislation that RAFI could sponsor in the Knesset. Our draft legislation dealt with organizing the health system through the auspices of the existing sick funds and hospitals. It was built on regional districts - a central hospital in each area, with a network of surrounding community clinics. This principle was the basis of the regional district structure I would later develop within Clalit. 131 It reflected my belief of the centrality of continuity of treatment between the community and the hospital. To the best of my recollection, this draft legislation was the only one that wasn’t political but but based on providing the best arrangement for the people. It was part of the RAFI party’s platform in elections. And when the RAFI list won seats in the Knesset, every time they wanted to present draft legislation for national health insurance, RAFI’s parliamentarians would request that I prepare the requisite materials, which I did gladly. Thus, the draft legislation of Clalit and RAFI was based on the following principles: 1. Dependable financing would be ensured. It would be based on dues paid in part by the insured and in part by the employer. 2. The sick funds, as service-providers, would develop their own independent services and be held responsible for their quality. This would differ from the German sick funds which have been built solely on reimbursement for fees paid out-of-pocket by the insured. 3. The sick funds would be founded on the principle of mutual liability between the periphery and center of the country, and between the strong, economically established sector of society and the socioeconomically weak ones. To do this, the burden would be shared via graduated health tax payments based on income. 4. Money would not be a factor in relations between patient and physician; rather, service fees would be underwritten by the public-at-large. In this manner it would be possible to be flexible and engage in long-range multi-year planning so crucial for a health system. The Establishment of the Netanyahu Commission - an Inquiry into the Role and the Efficiency of the Health System There were several factors present in 1988 that lay behind the establishment of the National Commission of Inquiry to examine the performance and efficiency of the health system in Israel. It was headed by supreme court judge Shoshana Netanyahu, and thus called the Netanyahu Commission. First of all, there was shame at the financial crisis in the health system, which consisted of rising costs of medical care in parallel with failure in, in fact opposition to, government’s participating adequately in health expenditures. Secondly, there was a general economic crisis in Israel. One cannot ignore that in the latter half of the 1980s Israel suffered from hyperinflation. Thirdly, a less known factor, the internal struggle within Mapai between the Federation and the heads of Mapai - Shimon Peres and Yitzhak Rabin. The struggle got worse and worse. Peres and Rabin 130 RAFI is, in Hebrew, an acronym for Reshimat Poalei Yisrael, the. Israeli Workers List. It was a center-left political party founded by former Prime Minister, David Ben-Gurion in 1965. In 1968 it was one of three parties that merged to form the Israeli Labor Party. 131 Doron discusses his regional district structure in Chapter 4.

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