Bottom Shekel / Basket Case: Let the Health Services Committee Do Its Job

The media had a ball last week at the expense of Deputy Health Minister Yaakov Litzman. "Dental care instead of cancer therapy," the newspapers decried, referring to Litzman's decision to use NIS 65 million of the general budget for medicines and health services on providing free dental care to children, leaving insufficient funds for medicines for people with terminal cancer.

Through these headlines, the media clearly accused Litzman of sacrificing the lives of people with cancer in order to promote the far less important aim of dental care. Is the media correct? What is more important, a drug that might extend the lives of a few dozen cancer patients every year or dental care for tens of thousands of children that will improve their quality of life for decades to come?

The answer is that there is no answer, and it's just as well. No one is in a position to choose which of the two options is better. The decision weighs life expectancy against quality of life, a choice between extending the lives of a very small minority or improving the quality of life for the majority. It's an extremely complicated financial, medical and ethical issue - that's why the state has a mechanism in place to make it. It's called the Health Basket Committee.

There are two advantages to having a committee to decide each year on the expansion of the medicines and health services subsidized by the state. First, since the committee is dedicated to making precisely such decisions its members have developed expertise in doing so. It has mathematical formulas for weighing the cost of a drug against the extension of life that it provides, in order to differentiate between life-extending and lifesaving drugs and to select among different drugs. The committee has the knowledge to weigh the quantitative, financial aspect against ethical considerations.

Second, the committee sees the whole picture. All applications for the inclusion in the health basket of new drugs or technologies are laid before the committee, which then deliberates and forms recommendations. The committee may decide against adding a particular drug to the basket not because the drug is worthless, but simply because better drugs were preferred that year: drugs that extend life longer, or that improve the quality of life for a larger number of people.

Their view of the total picture enables the Health Basket Committee to make the best choices from among the applications it receives in a given year. Only the committee is in the position to make the right decision, and no one else. Including Deputy Health Minister Yaakov Litzman.

So the media's criticism of Litzman was misguided. The problem with the decision is not that Litzman chose dental care over a cancer drug: His decision may not have been wrong. The problem is that the decision took the power to make decisions away from the committee, the only body with all the tools needed to judge and rule on the issue.

Litzman, like the media, acted out of emotion. He identified an important, deserving objective and decided to allocate money to it. Similarly, the media supported an important and deserving objective - a cancer drug - and felt money should be allocated for it. But both the media and Litzman are wrong. The question is not whether or not the goal is deserving, but whether it is the most deserving that year out of all other options, and only the Health Basket Committee is privy to all the information needed to make that decision.

There is no doubt that the state of dental care in Israel is dire - overall dental health here is the worst of all Western nations. It may be assumed that had the deputy health minister asked the committee to consider including free dental care in the health basket his request would have been considered seriously. The committee allocated funds for treatments to help people stop smoking, and dental health in Israel is more hard-pressed than the health of smokers. But instead of submitting to the committee's authority Litzman decided that his decision trumps all.

By doing so Litzman placed his sole discretion above that of the Health Basket Committee. He opted for a quick decision instead of complying with the system. The result - his decision on dental care - may have been the right one in this case, but anyone acting without due diligence is generally fated to make poor decisions. On the other hand, a person who acts methodically, based on a considered, fixed decision-making mechanism, will usually make good ones.

The committee's decision-making mechanism is the only way to ensure that the right decisions are reached systematically. Litzman chose to undermine the mechanism. And in doing so he proved that he, like the media, doesn't understand how to manage the Health Ministry in general or the health basket in particular.