Opinion: From Litzman to German

When a new health minister takes over the little-coveted portfolio this week, it will probably be the first time in the state’s history that the outgoing minister won’t shake hands with his successor.

Deputy Health Minister Ya’acov Litzman – who was the actual head of the ministry even though Prime Minister Binyamin Netanyahu was formally responsible for it – won’t shake the hand of former Herzliya mayor Yael German, not because of any personal hostility to her; the reason is that he is an ultra-Orthodox United Torah Judaism MK and she is a woman.

The two are almost perfect opposites.

Litzman, who in the past half year has said publicly so many times that he wants to keep the portfolio that he actually persuaded himself he would, is fuming over the fact that he will not be deputy minister again and that there will be no haredi MKs in the new government. These were among the reasons behind his extreme, and false, statement on Wednesday that the new government “hates religion,” despite the many believers and crocheted kippot in the coalition.

Litzman devoted many hours a day to the job, and deserves an “E” for effort. But while his public image is, on balance, positive, health experts call into question whether he was the “excellent health minister” that Netanyahu has called him, or even “very good.”

Of the more than 100 leading personalities in the health system, medical faculties and others, very few would say privately that he deserved top marks, even though some of them said both publicly and to his face that he excelled.

Netanyahu was formally health minister because UTJ refuses to have ministers who would be collectively responsible for Shabbat desecrations and other phenomenon they object to; a deputy minister does not sit in the cabinet and thus is formally not responsible.

German, a 57-year-old Haifa born wife and mother of two, with a bachelor’s degree in history, a master’s in business administration and a teacher’s certificate, has dedicated herself to Herzliya municipal affairs and the city council, served as manager of a political consulting firm, headed a school for adult education – and was formerly associated with the Meretz party. She will be the first female health minister since Labor’s Shoshana Arbeli-Almoslino, who served from 1986 to 1988.

Litzman, born in Germany to Holocaust survivors and brought to Brooklyn as a young child, went to a haredi yeshiva that taught mostly Torah and Talmud rather than a religious high school that included a broad secular curriculum as well. He came on aliya at the age of 18 and went to a higher yeshiva.

After the Rabbi of Gur advised him to enter politics, he was elected to the Knesset and served more than once as chairman of the Finance Committee, where he used his expertise in finance. In 2009, he fell in love with the Health Ministry and vowed to reform it, but he proved to be a highly sectorial deputy minister.

He lost the first director-general he appointed, Dr. Eitan Hai-Am, who resigned when Litzman fought to delay the construction of the muchneeded fortified, partially underground emergency department at Ashkelon’s Barzilai Medical Center.

Litzman claimed that bones found at the site, which were identified by archeologists as being of pagans due to non- Jewish symbols found in the graves, belonged to Jews. Hai- Am argued that any more construction delays could endanger lives of patients, staffers and visitors in bombing attacks from Gaza terrorists.

The government later forced Litzman to go ahead with building at the site, and Hai- Am went to work as director general of the Herzliya Medical Center and since then at a medical center in Vietnam.

Litzman also aroused ire for siding with a haredi mother with Munchausen’s-by-proxy syndrome who nearly starved her baby boy. Litzman sided with her and had no praise for Hadassah Medical Center for identifying the cause for the child’s failure to thrive, even though it was clear the mother had prevented the child from eating, for which she was jailed. The deputy minister also ordered that a haredi girl with lower-brain death continue to be treated in an intensive care bed until her heart stopped a few days later.

When Litzman was Finance Committee chairman, he succumbed to Treasury pressure and pushed the privatization of the School Health Service through the Knesset. This service was well run by public health nurses, who were fired and replaced by nurses working in private companies who were supposed to vaccinate all children, perform regular health checks and educate pupils about health. The state comptroller has since written severe reports on the private companies’ functioning, and while the Finance Ministry claims the privatization would save a few tens of millions of shekels a year, it has cost more when public nurses were used.

Litzman saw that the privatization caused severe problems and agreed to return the public nurses in the South, where the problems were most severe, but he never admitted his error, and most schools continue to have the inferior private services.

He also failed to encourage organ donation because of his party’s opposition to taking lifesaving organs from brain-dead patients, and he even asked Hai-Am to give him a flu shot in front on cameras so a female nurse wouldn’t be seen touching him.

His cancellation of parental fees for well-baby (tipat halav) services was well advised, as the health system should encourage families to have their children’s health checked and undergo vaccinations, while charging for the service discourages them to do so.

Litzman pressed for giving basic dental care to children as part of the basket of health services, which was especially welcomed by large families who could not afford dental treatment. But public health experts argue that the money could have been better spent on teaching haredi parents how to prevent dental caries by avoiding sweets showered on children, especially for Shabbat and holidays.

In addition, Litzman arranged for only the four public health funds’ subsidiaries or contracted dental companies to provide basic care, never getting private pediatric dentists on board to earn enough to make it worthwhile.

Some of them have even gone bankrupt or left the country as a result. Litzman declined to allow independent academic research on whether the dental program met its aims and was run efficiently, or whether there was over treatment or other abuses.

The UTJ MK changed his mind about the psychiatric care reform that would give responsibility for such care tp the health funds instead of the ministry. Aware of very long queues for treatment, especially for children, he agreed to the reform, but it is still far from fully implemented.

He also changed his mind about licensing MRI scans and not limiting them (demanded by the Treasury because more MRIs means increasing health costs). Licenses are more freely issued by the ministry, but it is still the hospitals that must purchase them.

His plans for the government to supply basic state provided geriatric nursing care in exchange for an increase in health taxes were widely praised, but opposition by the Treasury could stymie the reform that Litzman hoped to implement in a second term.

Litzman was weak on public health and promoted few initiatives in disease prevention and health promotion, even though this aspect is increasingly being regarded as key to reducing the huge costs of treating chronic diseases.

The long doctors’ strike ended with concessions to young physicians who want higher pay, and generous incentives for those willing to work in the periphery. But now the Treasury, which negotiated the agreement with the Israel Medical Association, wants to tax the incentives and thus weaken readiness to leave the Center.

Much-needed physicians continue to leave the country, work privately or switch to more lucrative professions.

Litzman added a few hundred funded hospital beds around the country, but the number of beds still lags sorely behind population growth, and the need for more nurses and doctors continues to lengthen queues in clinics and cause crowding in the hospitals.

Out-of-pocket fees for medications and certain services continue to burden the public, thus increasing the gaps between rich and poor.

German will take over Litzman’s office on the 13th floor of the new complex behind Jerusalem’s central bus station and find a still-troubled ministry that almost no one wants to run, despite a NIS 20 billion annual budget (the third highest in the government) and its major influence on the lives of every citizen.

As the healthcare field has become increasingly feminized – not only with the presence of female nurses but with the growing number of women as professors, researchers, physicians and paramedics – having a woman minister is a fitting result of the elections after a quarter of a century of men running the ministry.

German will have her hands full, but as an ear-to-the-ground mayor whose responsibility included health issues in her city and as a woman who naturally feels compassion for the sick and suffering, she has the potential of doing a splendid job.