BGU | MY PATH, Haim Doron, MD

outlays for dental care in Israel were out-of-pocket, without any consideration of the financial burden of paying for dental care for sectors of the population of meager means. Today the most outstanding injustice is the issue of dental care for seniors. Again, I believe there is a crying need to squarely face the problem and budget resources to address it. 138 National Health Insurance also didn’t include preventive medicine, and as a result of this flaw, the health system in the State of Israel is more and more conducted by the Ministry of Finance, not the Ministry of Health. For example, Finance seems to feel that is it possible to privatize preventive medicine services for school children. This approach testifies to the fundamental lack of understanding of the importance of preventive medicine and the likelihood that when such services are privatized not all can afford them. Between the years 1996-1998, a major process was afoot that greatly eroded the principles of the original National Health Insurance Law. This was carried out through the annual Arrangements Law (Chok Hesderim) . 139 The Arrangements Laws for the Economy were spawned in the mid- 1980s when Israel grappled with hyperinflation and there was a need for drastic emergency measures that would take effect immediately. The Arrangements Law did not have to go through any lengthy and thorough parliamentary process prior to the first vote. The yearly Arrangements Law is an appendage, a ‘tag on law,’ that is passed together with the vote on the state budget. If party discipline in passage of the state budget is maintained by the ruling coalition’s whip, then, when the last clauses of the state budget are finally passed with the Arrangements Law right behind, it is usually late at night. At that hour, no one in the Knesset is in any condition to read the small print, certainly not the small print of the Arrangements Law which often runs into hundreds of unrelated clauses. What is relevant to health matters is the fact that the Ministry of Finance used the Arrangements Law to change much of the ideological, medical, and social security aspects of the National Health Insurance Law. What has run like a thread through all the changes introduced through Arrangements Laws has been drastic reduction in financing of the health system from public funding and a dramatic increase in financing the health system by out-of-pocket expenditures. It is for this the reason that I say the Ministry of Finance is the real director of health in the State of Israel; and it bears responsibility for the results. I’m not saying that the health system, or the National Health Insurance Law, as part of Israel’s network of social insurance legislation, can be conducted without taking into account the country’s economy as a whole. But at the same time, one needs to strike a balance between medical and social considerations on the one hand, and economic considerations on the other. Today there is no balance in weighing the two sides, and the Arrangements Laws has played a decisive role in upsetting the balance between public and private funding. Abolition of the Parallel Tax The original National Health Insurance Law made payment of the Parallel Tax by employers compulsory. Prior to that, the Parallel Tax was part of wage agreements between employers and employees. The process of negotiation of these agreements carried a huge advantage from other perspectives, as well. 138 Changes in dental coverage since Doron’s death are mentioned at the end of Chapter 8 in Footnote 122. 139 “The Arrangements Law is a government-sponsored bill presented to the Knesset each year alongside the State Budget Law. It incorporates government bills and legislative amendments that are needed in order for the government to fulfill its economic policy. The law is also referred to as the "Economic Policy Law" and the "Israeli Economic Recuperation Law." Knesset. Lexicon. See: https://m.knesset.gov.il/en/about/lexicon/pages/hesderim.aspx#:~:text=The%20Arrangements%20Law%20is%20a,t o%20fulfill%20 its%20economic%20policy The Fate of the National Health Insurance Law The “Arrangements in the Economy” Law

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