The value of life
"Our national list of health services" - the health basket - "is the most advanced in the world. We approve medical technologies far ahead of other countries. Dialysis in England, for instance, is not provided to anybody older than 65. Here even an 88-year old can get dialysis. Despite all, life is highly valued here."
The man who made that statement is responsible for the biggest number of patients in the State of Israel. His name is Zeev Vurembrand and he is the general manager of Clalit Health Services, which provides medical coverage to 60% of Israel's population. Vurembrand in this stated, out loud, to a newspaper, what every person in the medical establishment knows: most of the criticism leveled against Israel's "health basket" is populist. Israel's health basket is one of the most generous in the world.
As general manager of Clalit, Vurembrand has no inherent interest in saying so. In fact no doctor in Israel has an inherent interest in saying so. They are the ones facing the patients and have to treat them using the means at hand, and they are the first who would have an inherent interest in expanding the list of drugs.
The state is the one which allocates the money to the health services to provide a wider range of drugs, so if anything it is entirely in the health services' interests to press to expand the basket all the time.
That is one reason why the petitions to the High Court of Justice, to force the government to decide on expanding the basket this very week, not in another eight days after the elections, are being pushed by doctors. But the quality of Israel's health basket cannot be concealed any more. Vurembrand is simply the first to publicly admit as much.
It is time to strip off the populist masks decking out the health basket. For one: there are no life-saving drugs that are not in the basket. Yes, you read right: if there is a consensus that a drug will save lives, it will be in the health basket. What isn't necessarily in the basket are drugs defined as "extending life", especially when the drugs may possibly extend the life of a certain group of patients with a certain type of cancer, for a certain average number of months.
The cost of some of these drugs comes to tens of millions of shekels a year, close to NIS 100 million, just to extend the life-span of certain terminal cancer patients by an average of five months.
It is true that the sanctity of life is a value that cannot be quantified; one cannot say how much money a month of life is worth. But the NIS 80 million that such a drug costs could be spent on security barriers for dangerous roads, for instance, or on modern drugs to reduce cholesterol for the wider population, which could well in the long run save more lives. To be frank, the NIS 80 million could be spent on education reform, which the State could decide would contribute more to its future as a modern nation and to its prosperity than extending life by a few months.
In its 2006 budget that won the support of the cabinet (but that hasn't passed the Knesset yet), the state budgeted another NIS 200 million for the drugs basket. In the petitions filed with the court yesterday, the Drugs Basket committee demands NIS 300-400 million extra.
Maybe the committee is right. The state could decide that the sanctity of life is important enough for it to invest any amount to make its health basket the most advanced in the world. The state could decide that even NIS 2 billion more, not just NIS 400 million, is appropriate.
But such a decision should be made with open eyes. The state must decide that is the amount it wants to spend, at the expense of other things. It must decide that it prefers to spend NIS 200 million on the health basket, for new drugs to which there is more or less consensus, rather than on road safety, child allowances, education, community policing, security, or aid for the elderly.
That is the decision that needs to be made. Even though the issue at stake is human life, make no mistake: it is at heart an economic decision. It is an administrative decision. It is another decision on how to manage the nation's priorities. Health is just one of the many services that the state wants to provide to its citizens, and it is not necessarily the most important one.