Health Care in the Privatized Lane

Suddenly, people are realizing that without a strong public sector there is no strong economy. Health care is an instructive example.

The socio-economic debate came late to the party, but was no less intense for it. After 20 years in which privatization has prevailed, question about the limits of the trend are being raised. After 20 years of recklessly transferring assets and services from the public sector to the private one, the need for a quality public sector is being discovered.

Suddenly, people are realizing that the market will not solve all the problems and without a strong public sector there is no strong economy. The state is missing. Israeli social-democracy has not returned yet, but the yearning for it is here already.

The problem is, it's too late. We have already transferred control over the banks to five families. We have transferred the control over telecommunications to three tycoons. We've given away the Dead Sea, distributed the gas, privatized most of the services. Systematically and consistently we dismantled the state of the many and turned it into the state of the few. Systematically and consistently we replaced social-justice systems with instant-profit systems.

What the Transportation Ministry did between Ben-Gurion Airport and Tel Aviv we have done in everything else - we built an express lane for the top one-percent, leaving the rest of the country stuck in the traffic jam.

Health care is an instructive example. The Israeli health system is basically splendid. It was built on three principles - solidarity, excellence and budgetary restraint. As a result it provided a high-standard of medical care to the whole population. Israel's egalitarian, universal health system outdid the United States and was more professional than ones in many European states. Plus it cost the national economy less than half of the sick and sickening American health system's cost.

However, the Finance Ministry did not appreciate the rare Israeli achievement. Its officials wanted America. So they reduced expenses, lowered costs and encouraged privatization. They subjected the health system to the market forces.

The treasury's privatizers ignored the fact that the basic conditions that enable and justify a market economy do not exist in the health system.

The result was devastating. In the past decade not enough beds were added to public-health hospitals. The number of acute care beds per 1,000 people dropped from 2.3 in 1990 to 1.9 in 2010 and is expected to drop to 1.7 in 2020 (the OECD median was 3.3 in 2006 ). The number of doctors per 1,000 people has already dwindled from 3.7 in 1995 to 3.4 in 2010 and will go down to 2.8 in 2020 (the OECD median was 3.4 in 2006 ). The number of nurses per 1,000 people has already plunged from 6.1 in 1995 to 5.5 in 2010 and will descend to 4.9 in 2020 (the OECD median was 8.7 ).

While in most Western states public health expenditures have increased, in Israel it has decreased. Quietly and covertly the treasury has eroded one of the most important state systems. It has brought Israel's public health to the brink of an abyss.

There was a method to the madness, the same method behind the express lane - privatize, privatize, privatize. Reduce the public-funding rate of the health system from 70 percent to 58 percent. Make Israel's health system's private-funding rate one of the highest in the West (42 percent ). Send the young patients and best doctors to the private Assuta hospital. Leave the elderly patients and exhausted doctors in the corridor. Create a sick and sickening health system like in America. Chip away at the solidarity, professionalism and effectiveness of the social-democratic health system.

Unlike banking, telecommunication and infrastructure - it's not too late yet for health care. The system's collapse can still be prevented. But to do so a sharp change in perception is required. To do so a radical new insight is needed.

The struggle isn't only the fight over the doctors' wages and the nurses' work conditions. The struggle is over rehabilitating an egalitarian, high quality health system, which will provide proper health care for every Israeli.