Ran Saar, director-general of Maccabi Healthcare Services, doesn't hesitate to burst a balloon in Prime Minister Benjamin Netanyahu's reelection campaign.

"Netanyahu says that the government has launched a health revolution? I think someone is misleading him," Saar said yesterday in an interview with TheMarker. "If he were to look at the statistics he would see that during his government's tenure there was a drop in investment in public health, and that the gap between the price of a day of hospitalization and the inflation-adjusted cost has grown significantly. That means that the health maintenance organizations (kupot holim ) have less money to invest in health."

Saar, whose organization in responsible for the health of close to 2 million Israelis, says he is very worried. He and his colleagues at the other HMOs have been saying privately for several months now that their budgets are being eroded to the point that they worry they will no longer be able to provide for their members' needs.

The latest setback for the HMOs came a week-and-a-half ago when the treasury announced that it was cutting their allocations by NIS 389 million because of an advance allocation they had received the year before. With the HMOs already suffering deficits approaching NIS 1 billion this year, the lost money threatens them with severe cash flow problems.

The Meuhedet and Leumit HMOs have told suppliers they are reducing payments unilaterally, while Maccabi has told some of its suppliers that it will to wait an extra month for money due them.

The HMOs and the government are locked in two disputes right now. The first relates to the so-called stability agreements they reached in 2011, under which the HMOs are due NIS 700 million. The agreement has yet to be signed and the money has not yet arrived.

The second relates to the High Court of Justice ruling that the HMOs are underfunded because of the formula by which it funds hospital stays by their patients. Under the court order, the state and the HMOs have another month to agree to a new formula.

"I see the crisis as the fault of the government," says Saar. "The government is damaging the public's health and has to stop doing this. That's what the High Court said. The government is giving fewer and fewer allocations to the health system, which makes it responsible for the deficit that the HMOs and hospitals have run up."

He noted that the court had given the government six months to resolve the problem, but officials have done little to address it since then. "There have been very few meetings on the matter and they were all under pressure from the HMOs. We haven't received any concrete promises," he says.

Saar gives Yaakov Litzman, the deputy health minister, credit for some small achievements, such as free child dental care, but nothing more than that.

"The Health Ministry has failed its most important test, which is to bring money to the system," Saar says. "The bottom line is that if [Litzman] doesn't find a solution soon, the system will spin out of control."

Reforms that are in the works, such as in the area of mental health, that will bring hundreds of millions of additional shekels to the health system, are not an alternative to increasing the actual budget.

Treasury blames Maccabi

Informed of Saar's remarks, officials at the Finance Ministry responded angrily. They told TheMarker that the healthcare system has received billions of shekels in extra funds to expand services in the last several years. The government is close to signing stability agreements with the three other HMOs, but not Maccabi, they said.

Treasury officials blamed Maccabi for its deficits, citing its interest in the private Assouta Medical Center, which it effectively subsidized with state funds.

In a recent report, the OECD (Organization for Economic Cooperation and Development ) praised Israel's primary healthcare, namely the HMOs. How does Saar square that with his warnings about the imminent collapse of the system?

"It's true, but the OECD also says that we invest less in public heath than any Western country. It's easy to quote some things. It's true that Israeli doctors are good, but what do you want - to go forward or backward?"

Saar is disappointed that the election campaign has not brought the issue of the problems facing the healthcare system into the public eye.

"Health belongs to everyone, not to any particular part of the population. The irony is that this characteristic weakens it [politically] rather than strengthens it, because it has no one representing it in the Knesset," says Saar.

"We have a democratic system with a lot of sectoral parties, but none of them has raised the flag for health. The country doesn't fight for it, the government doesn't fight for it, the parties don't fight for it - even the [social justice] protesters didn't touch it because they were led by young people."

Says Saar: "I ask: Who is looking out for the sick, the elderly?"

He says the election should be seen by Netanyahu as an opportunity to correct this oversight. Politicians should look at health as a social and moral issue, but also as an economic one because workers losing days to illness or disabilities take a toll on output and productivity. In the United States, President Barack Obama's health reform has been a key election issue. "With us, no one talks about it at all."