Obamacare in Israel, and the People Are Horrified

The public was outraged to learn just how its growing private-medicine practice hurt Hadassah, and its ordinary patients.

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Now and then, factories collapse. A textiles plant, packaging maker, newspaper - doesn’t matter. The owners whimper for a government handout, "for the workers," who are meanwhile picketing and burning tires.

The story makes prime-time but the media generally regresses to generalities - the state of the Israeli worker, plus how much the CEO made. Some call for nationalization of the plant, and are promptly slimed as communists.

Then it's over. Maybe a solution was found. More usually, public interest waned.

Last week it happened again, but this time, the story wasn't some small-town towel manufacturer, it was a hospital. And not just any hospital: the Hadassah Medical Center in Jerusalem, flagship of the Hadassah Women's Zionist Organization and probably the most prestigious hospital complex in Israel.

Hadassah, once a symbol of Zionist success, had degenerated into a bloated, debt-ridden, mess teetering on the brink. Its workers - doctors, nurses - barricaded themselves within the hospital, leaving their patients beside themselves with uncertainty and fear.

Take two bailouts and call me in the morning

Hospitals are not supposed to fail. Banks fail. Hospitals are not supposed to be in the business of being bailed out. Once again, that’s for the finance sector. A hospital is not supposed to go on strike. It is always there. We need it to always be there. We want that certainty in an otherwise unpredictable, cruel world.

But 95 years after its foundation, Hadassah looks more like a failed bank or a bankrupt carmaker than an institution of healing. It's stiffing its suppliers and its staff got only half their January salaries. For two weeks now - (until today, in fact) - it's been turning away the sick, accepting only emergencies and births.

Given that Hadassah normally treats about a million patients, that translates into a lot of patients under stress.

Over the past 10 days, many - too many - reasons were found for Hadassah’s crisis: egregious mismanagement that caused the hospital to rack up 1.3 billion shekels in debt. The casualness with which management approved construction of a new tower - at a cost of, well, 1.3 billion shekels, while workers haven’t been paid. The crisis at the Hadassah Women’s organization itself following the Madoff scandal.

And, the weird situation in which Hadassah remained a semi-private, semi-public hospital, thinly regulated and run with very little supervision from very far away. And now the trouble has cast a spotlight on a very sore point - the hospital’s thriving private medical services, known in Israel by the Hebrew acronym Sharap.

Private care at public's expense

In recent years, Hadassah’s doctors allocated more and more of their time to private patients and medical tourists: instead of working mornings and midday as public doctors and only devoting the afternoons to private work, as they were supposed to, they began to work privately in the mornings as well. This forced patients from the general public to either wait months on end for one of the few remaining slots in the morning, or pay up.

Due to antiquated rules, though the private business was booming, making hundreds of millions of shekels each year - very little of that money - 22%, to be exact - went to Hadassah itself, even though the hospital carried all the expenses. The doctors kept most of the money and the state of the hospital and its services deteriorated further.

This week the scorned public began to see Hadassah’s private business as the chief culprit behind the medical center's troubles.

This view was not entirely unfounded. The public learned just how badly things have gotten at Hadassah. They were outraged to learn of bloated pay for doctors who, instead of treating everyone equally, allocated more and more of their time and the hospital's resources to private patients.

According to a study conducted by Hadassah itself a year ago, public patients waited an average of 55 days for treatment. For private patients, the average wait was 7 days.

Who dunnit

To be fair, it probably wasn't just the Sharap - less than 10% of the medical center’s activity, the hospital claims – that's killing Hadassah. But it is the factor that caused the most indignation.

Becoming the face of medical tourism and private healthcare in Israel over the last decade, Hadassah has come to emblemize the wrongness infecting Israel’s healthcare system. Thanks to its private services jacking up the prices of healthcare, it made the health system in Jerusalem the most expensive in Israel. Thus Jerusalem became a place where - instead of getting treatments through their HMOs - patients were forced to pay more just to get the same treatment by the same doctors. They could suffer, or pay for Sharap.

Hadassah is a leading contributor to Israel becoming a country with two healthcare systems: one for the rich and medical tourists, and one for everyone else.

This is why many Israelis see the Hadassah saga not as being about Hadassah itself, but about Israel’s healthcare system. And this is why more and more voices are calling for the hospital's nationalization. Even the small-government crowd is screaming for Hadassah to be nationalized.

Again, Hadassah isn't alone. It was just the best at consuming public resources for a good other than the greater one.

And thus nationalization is seen as a sensible option. Because a hospital is not a factory, and it is not a bank. Israel’s universal healthcare system used to be a symbol of Zionism at its best, and Sharap has become a symbol of everything that went wrong.

It probably won't happen. Hadassah will not be nationalized. A temporary deal has been reached between management and the workers. For the first time in two weeks Hadassah's doctors and nurses are back on the job. The hospital’s debts have also been frozen, for now.

But the near-universal demand to nationalize Hadassah shows how Israelis felt when they got a glimpse of American-style health care. Israelis did not like it. And whether Hadassah itself will be nationalized or not, the simple fact is that this week has taught us where our priorities lie - and they lie with public health.

Demonstration by striking Hadassah workers at entrance to Jerusalem, February 17, 2014.Credit: Emil Salman

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