BGU | MY PATH, Haim Doron, MD

The Netanyahu Commission recommended that the financing of health insurance be via a health tax for the public, plus the Parallel Tax (Mas HaMakbeel) that had been legislated in 1973. Indeed, we viewed the compulsory Parallel Tax Law payed by the employer as the first step towards national health insurance. However, the existence of the Parallel Tax only supplemented financing sources. It was not the basic-primary source of financing. The Commission recommended that the money from the Parallel Tax would be obtained by Israel’s social security agency, the National Insurance Institute ( Bituach Le’umi , in Hebrew). This was a very positive recommendation, because their collection of social security funds was so advanced and efficient. The Commission had a positive attitude towards the SHARAP , which mixed private practice with public medicine. It was true that Clalit was in the practice of purchasing necessities from private sources when something was lacking and there was no other alternative. But this was a marginal phenomenon. Clalit’s opposition to private medical services in public hospitals and private practice persisted down the years. There was also a minority opinion submitted by Prof. Arieh Shirom, a member of the Netanyahu Commission. He put emphasis on a vision of public medicine versus private medicine; and he opposed, completely, private medical services. I agreed with Prof Shirom, generally; but I did not entirely agree with him: Shirom argued that the culprit behind the crisis in the health system was not the state of the law. Rather, it was government policy on financing. Between the lines of his minority opinion report, it becomes apparent that Shirom felt the structure of a Federation sick fund could continue, whereas I felt that this construct had reached the end of the road. Among the Commission’s many recommendations, it said it wanted “To promote family medicine and the status of the family physician as gatekeeper, to avoid overuse of healthcare services and unnecessary usea and expenditures.” Vitalization of family medicine was a core aspect of my career in Clalit. But there were differences in the approach of the Commission members, and my approach. The argument behind this clause according to the Commission members was purely economic; whereas, my primary argument was on medical grounds not just on economic ones. I think that vitalization and advancing family medicine has led to a tremendous change for the better in the level of primary medicine in Israel, compared to the prevailing situation beforehand. 133 The 1994 National Health Insurance Law In order to get passage of the national health insurance law, Minister of Health Haim Ramon resigned, ran for office as secretary of the Labor Federation, was elected, and then separated Clalit from the Federation. 134 Principles of the National health insurance Law The following are the principles anchored in the national Health insurance bill as originally stated and prior to the changes and amendments that preceded its passage into law. The foundation of the law already appears in the first clause, “justice, equality, and mutual liability,” as well as ensuring health services to all residents as a fundamental entitlement, not as a consumer good. Thus, the law was founded on a clear and unassailable principle -- that health insurance would be universal for the entire population. 133 See Footnote 67 re the 2012 OECD report on health care in Israel. The OECD praised the strength of the Israeli primary care system and its effect on overall system performance. 134 For more on this process see: Yaffa Moskovich, “Goal Displacement in the New Israeli Labor Unions: Lessons Learned”, Current Politics and Economics of the Middle East ; Hauppauge Vol. 10, Issue 4, (2019), pp. 411-439; Yaffa Maskowich, “Activist Leadership in the New Israeli Labour Unions — The Histadrut. Bringing about Privatisation, Downsizing, and Goal Transformation: An Israeli Case Study” , Journal of Organisational Transformation & Social Change , 2015:12(2):159-177; and Yaffa Maskowitch, “Transition from the old to the new: lessons learned in the Israeli Histadrut during the Ramon leadership,” Journal for Labour and Social Affairs in Eastern Europe , 2011:14(4):571-588.

78