Analysis: Litzman takes a bite out of the health basket

Analysis Litzman takes

By JUDY SIEGEL-ITZKOVICH
Although Deputy Health Minister Ya'acov Litzman recently promised the health basket committee he would not intervene in their recommendations for expanding the 2010 basket, he initiated a cabinet telephone vote aimed at deducting NIS 65 million from the NIS 419 m. expansion of the health basket to cover "basic dental care" for children. Although Litzman had originally said the coverage would be for children up to the age of 18, on Monday night he could not confirm exactly what age group would be included. Litzman's proposal wasn't raised during Sunday's cabinet meeting. But after the Health Ministry and Finance Ministry reached an agreement on adding basic dental care to youngsters at the expense of the health basket expansion, ministers were called by the cabinet secretary's office as late as 11 p.m. and asked if they favored the proposal, even though they had not participated in any discussion or heard both sides of the complex issue. As the public committee for expanding the basket of health services, headed by Rambam Medical Center director-general Prof. Rafi Beyar, is due to present its recommendations before the end of the calendar year, Litzman apparently felt he had to go through the "back door" to divert some of the NIS 419 m. the committee has to spend on lifesaving, life-extending and life-improving drugs to dental care. However, for ministers to vote by telephone is very unusual; this voting method is usually reserved for approving appointments, not for matters which call for serious debate. According to an announcement by the Prime Minister's Office on Monday night, the social/economic cabinet was due to discuss the matter but didn't manage to, for "technical reasons. It therefore held a phone vote of the ministers, with 19 voting in favor, four against and three not answering." Prime Minister Binyamin Netanyahu "welcomed the decision to allocate budgets for dental care for children," the release said, "especially the economically disadvantaged. It was agreed between the prime minister and Litzman that the deputy minister will raise the issue before the entire cabinet in his presentation of Health Ministry activities at a meeting soon." The issue is a key one for Litzman, who has so far not managed to push through any major policy changes and has become bogged down by expressing views opposing the lower-brain death criterion for organ donation and advocating the segregation of psychiatric patients by gender in separate mental health centers. Well aware that between a quarter to a third of all Israeli babies today are born to haredi families, many of whom say they can't afford dental care, Litzman, a Gur hassid, seems keen on presenting an achievement to the sector that sent him to the Knesset. The health funds already offer free or highly subsidized dental care to the children of members who take out supplementary health insurance policies - which are held by about 75 percent of Israeli families. Finance Minister Yuval Steinitz told The Jerusalem Post on Monday he had voted in favor of Litzman's proposal, saying he "generally give[s] ministers the benefit of the doubt" when dealing with their own ministry policies. He did not mention the fact that if dental care were to be provided partially at the expense of the NIS 419 m. set aside for expanding the basket, the Treasury would have to contribute less of the NIS 250 million a year Litzman estimated covering "basic dental care" for minors will cost. Litzman did not provide the source of the estimate. The deputy health minister intends to "raise" additional money from other ministries or sources to reach the NIS 250 m. figure. Dental care is notoriously expensive and difficult for insurance companies to cover unless premiums are very high. Sources close to Litzman said he envisioned the free treatment as including instruction by a dental hygienist on oral hygiene, checkups, x-rays, plaque removal, use of sealant on teeth that need it, fillings, temporary crowns and some other procedures, but not the most costly treatments such as permanent crowns and orthodontics. Litzman has reiterated the statistics that 68% of families earning less than NIS 4,000 a month and 57% of those earning up to NIS 8,000 monthly say they can't afford dental care for their children. The deputy minister has also publicized the results of a recent ministry survey that 93% of Israeli adults favor giving free dental care to all children and teenagers. But it was not clear whether the representative sample really understood that this addition would reduce by almost 15% the funding for vital drugs to be provided at nominal cost to the sick. Minister Yuli Edelstein said he refused to participate in the phone vote when called before midnight because "that was not the way to pass reforms." He said he preferred to wait and learn about the issue before deciding. Ministers Avishay Braverman and Limor Livnat also said they declined because of the way the voting was carried out. Critics of the proposal noted that Litzman had firmly opposed using money from the health services basket to purchase enough H1N1 flu vaccine and Tamiflu (anti-viral drugs) to cover the whole population (most of which will probably not be used, even though they will end up costing the Treasury nearly NIS 1 billion), but was now fighting for children's dental care to be financed at the expense of basket's expansion. Others pointed out that the funding of health services other than drugs and medical technologies from the basket would set a precedent enabling the Treasury to use the basket for other health services in the future. Litzman's proposal also doesn't include free dental care for the elderly, some of whom cannot eat properly because of the lack of teeth or dentures. The representation of haredim among the over-65 population is much lower than their representation among minors. Adina Marks, chairman of the Association for Patients' Rights, declared that the elderly needed free dental care as well and opposed financing dental care for children from the addition to the basket. "A serious discussion is needed before this matter is decided," she added. "Who says drugs for Alzheimer's and Parkinson's diseases are not more important?" Meanwhile, the Dolev Fund for Medical Justice threatened to take Litzman's action to the High Court of Justice and demanded that he cancel it. The government has no legal authority to approve the financing of dental care for children at the expense of the basket of health services, it said Monday. The Knesset Labor, Social Affairs and Health Committee invited Litzman to appear at its meeting on Tuesday morning to give his side of the matter. Gil Hoffman and Herb Keinon contributed to this report.