Israel's savvy new 'deputy' health minister approaches the job with an almost religious fervor.
By JUDY SIEGEL-ITZKOVICHLitzman 248.88(photo credit: Ariel Jerozolimski)
Israel's past few health ministers have been presented on their first workday with a 479-page tome on the health system published by the Defense Ministry. Due to coalition problems and frequent elections, the ministers have spent so little time in their chairs that many left office before finishing the book (if they read it at all).
But United Torah Judaism (UTJ) MK Ya'acov Litzman, the new deputy health minister with no minister above him, doesn't need the book to know what he's doing. Unlike most of his predecessors, he arrived with considerable on-the-job expertise in health funds, hospitals, the basket of health services and public health from his tenure as Knesset Finance Committee chairman in the 16th and 17th Knessets. He voted down numerous bills initiated aimed at saving money at the expense of legitimate public health initiatives.
Although running the third-largest government ministry is quite different from supervising the passage of state budgets and other financial bills, Litzman brings a well-honed intelligence, interest in detail and self-taught economic skills; he certainly knows more about spreadsheets and finances than Finance Minister Yuval Steinitz, who has a doctorate in philosophy.
There was much criticism when Prime Minister Binyamin Netanyahu announced his choice for the Health Ministry - not because Litzman was unqualified but because officially he would be a deputy minister.
Agudat Yisrael, the haredi party that is a partner in UTJ, had a welfare minister representing it until 1953, but when then-prime minister David Ben-Gurion tried to make all religious girls do national service, Agudat Yisrael left the government and did not have representatives in the cabinet or even deputy ministers until Menachem Begin took power in 1977. Subsequently, the haredi party had a few deputy ministers in charge of ministries but did not want ministers because it symbolized taking responsibility for state violations of Halacha.
"I have no problem with being a deputy minister. I wanted to return to the Finance Committee chairmanship; the members agreed I had done a good job, so why make the change [UTJ MK Moshe Gafni was made chairman instead]? My faction decided otherwise for political reasons. Our rabbis decided that since the health portfolio involves life and death, it was important and that I should take the job. I am not Right or Left; I am very objective politically."
AFTER INTERVIEWING the previous 16 health ministers in Hebrew, I found it an unusual experience to speak to the deputy minister in English a week ago. English is really his native tongue, even though his parents were from Poland and Ya'acov was born in a German transit camp in 1948.
His parents took him to the US, where they settled in the haredi neighborhood of Boro Park in Brooklyn, New York. After attending yeshivot and a high school, he was sent to Israel in 1966 to study in a Jerusalem yeshiva. Not long after, he met his wife and settled in the capital. He has induced most of his family to come on aliya, but has a sister still in Boro Park.
Today, after raising five children (three boys and two girls) in a two-and-a-half-room flat in the capital's Ezrat Torah community of Gerer hassidim, they continue to live in the same small apartment. This is an unusual sign of ministerial modesty - contrary to the habits of former health minister and premier Ehud Olmert, who collected expensive homes and hundreds of expensive pens.
Ger (or Gur) hassidism is important to Litzman, and he dresses the part. Gerrer garb is somewhat different from that of other hassidic groups, with the men tucking the trousers of their dark suits into their socks, wearing ritual fringes under a vest and a round felt hat (but a fur shtreiml on Shabbat and holidays). Sidecurls are pinned under the ends of a large black skullcap. Litzman also has a reddish beard that has turned mostly white. When our photographer asks him to stand for additional photos, Litzman declines and says: "I am not photogenic."
THE GER hassidic dynasty was the largest and most important in Poland before the Holocaust - in which most of its 200,000 followers perished. But it has sprung back in Israel, New York, Los Angeles, London and Antwerp, and today is one of the largest in the world. A portrait of the 70-year-old eighth Gerrer Rebbe, Yaakov Aryeh Alter, will soon grace a wall in Litzman's office, not far from the mandatory photos of President Shimon Peres and Netanyahu.
Before the Rebbe dispatched him to a political career in the Agudat Yisrael party, Litzman was director-general of Beit Ya'acov girls schools in Jerusalem and initiated hassidic neighborhoods in Tel Aviv, Ashdod, Beit Shemesh and Arad.
Since he started working three weeks ago in the ministry's headquarters, located in Jerusalem's San Simon quarter, he has first gone daily to synagogue near home, the grocery store to buy basic items for his wife, and then been driven to the ministry. "I am the first in," he says in his soft voice, "and the last to leave at night [besides a secretary across the hall]." As a deputy minister, he had the option of refusing a security guard and decided against one. He also did not ask for the "Shabbat phone" that is a halachic solution for observant ministers, but has arranged for "other means" to keep informed.
Although he obviously has no TV at home, he has long read The Jerusalem Post every day, along with the Globes business daily and Ha'aretz in Hebrew, helping him be well informed.
"I had no problem with the health portfolio. I welcome it as a challenge. We can do a lot of big things and also break rigid notions. There is lots more work to be done than in the Finance Committee," he says in his "yeshivish" English, which is sprinkled with Yiddish and Hebrew words.
"I am invited to all cabinet meetings and can sit there if I want, as many sessions deal with health issues. Not being a minister, I won't have a vote, but the prime minister [who officially is health minister] has agreed he will vote any way I decide on health issues," Litzman says. As for the Israel Medical Association (IMA) petition to the High Court of Justice a few weeks ago demanding that a health minister be appointed, Litzman comments that "it was not smart to bring it to the court. I don't think the justices will intervene." But he would be willing to serve as a full minister if the High Court of Justice required it and his rabbinical arbiters approved it.
ASKED WHAT kind of Health Ministry he had received, Litzman responds: "I would like to change the work ethics here. I don't yet know exactly what the problem is, but I have already tried to be an example by coming to the office early and leaving late." In fact, during our 80-minute interview starting at 8:20 a.m., Litzman yawns half a dozen times due to lack of sleep, even though he was alert, using no notes or assistants for help in answering questions.
When queried about who would be his director-general after Prof. Avi Yisraeli (who has been in the job for six years) said he was leaving (but nevertheless has handily dealt with the swine flu threat), the deputy minister says he hasn't even begun to deal with that issue. "I will after the budget discussions are over. I haven't met with any candidates yet, and nobody knows what I'm thinking."
Unusually for a haredi, Litzman hopes to have a woman - Ruth Ralbag, a former Jerusalem Municipality counsellor who did financial work in the Health Ministry - work closely with him. "I appreciate her and know her from when I was Finance Committee chairman. I would like her to be here, and it was a mistake when she was let go a few weeks ago."
As for fears that the third haredi to be in charge of health (former minister and Shas MK Shlomo Benizri was the first, but he ended up badly as social welfare minister and was convicted of bribery, conspiring to commit a crime and obstruction of justice; Shas Rabbi Nissim Dahan, regarded as among the best health ministers despite his short tenure due to his party's resignation, was the second), Litzman says he does not want to turn the ministry into a haredi enclave. He has decided to appoint a committee of halachic experts to advise him on touchy issues from organ transplants and fertility treatments to dealing with graves in a spot where Ashkelon's Barzilai Medical Center wants to expand. But he will not fill hospitals with rabbis, he promises.
Many Israelis - and the Mexican embassy - were a bit upset when Litzman - scanning reports on the swine flu - said: "We should call this Mexican flu," apparently because he didn't like saying the word "pig." But even though Time magazine made his quote the top item in its Verbatim column, Litzman says he meant it as a joke. "Why would I be serious, if knowing that pigs can cause disease would discourage people from eating them [even though the consumption of pork does not spread this flu strain]?" Litzman also uses the Hebrew term for "pig flu" when discussing the matter with officials.
HIS FIRST priority, he declares, is to ensure that public hospitals have senior physicians - Jews and non-Jews - on duty over the weekends. "From early Thursday afternoons until early on Sundays, there are no senior physicians in hospitals, as they work in private clinics and hospitals or are off," he noted. "This cannot go on."
Some hospital directors have denied the urgency of this matter, noting that many patients prefer to be home on weekends. When senior doctors are needed, they always arrive quickly, they argue.
But Litzman sees Sharap (private medical services in public hospitals) as one of the solutions for this, since when senior doctors are paid by private patients for surgery or consultation, they will spend most of their time in these hospitals treating public patients as well, rather than run to private clinics and hospitals when they are off. Even though Sharap has been the rule in Jerusalem's voluntary hospitals for decades, Litzman is aware that there must be careful monitoring of such arrangements so that those who can't afford to pay (or don't have supplementary or private insurance) don't get sub-standard service. He also wants to measure the quality of work in hospitals.
AS THE ministry has always spent the vast majority of its budget on treating disease and relatively little on preventing it, Litzman firmly believes the proportion should be modified. He has already taken action to abolish fees in Tipat Halav (well-baby) centers so no parents are discouraged from bringing their babies for vaccinations or monitoring. Israel is one of the few developed countries to require such payment.
Litzman admits that as a young man, he smoked for a short time. Now he believes smoking is forbidden by Jewish law, as it unnecessarily harms one's health. Although hassidic men have long been known as heavy smokers, many Gerrers have cut down or abandoned it. "The Rebbe gave instructions that when young men get engaged, they are given chocolates instead of cigarettes." A tax of two shekels has already been put on packs of cigarettes, and tax exemptions at airport duty-free shops have been reduced from two to one carton. He intends to lower the smoking rate even further.
Litzman is well aware of the importance of preventing disease by fighting smoking, training children to stay healthy and promoting early diagnosis. He voted against the Treasury's effort to privatize the school health service, which has been unsuccessful, he adds.
As for the basket of health services, Litzman thinks it will be more practical to initiate another three-year agreement on its expansion, as it would be nearly impossible to persuade Treasury officials to agree to a two percent automatic annual increase. "I don't see these officials as evil. They are good people who have to find a way to meet national needs although the blanket is too small to cover everybody."
He concludes: "people are already expecting a lot from me. I don't want to desecrate God's name by failing."
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