Prof. Yehoshua Shemer, the physician who formulated the basket of health services' increment system, says Deputy Health Minister Ya'acov Litzman is "welcome" to reexamine all the medical technologies in the basket and their cost - as Litzman declared Tuesday in the Knesset.
"But he will find that, instead of finding waste, he will discover that the health funds are vastly underfunded. I would be in favor if when it is proven that the health funds subsidize the basket, the Treasury makes up the difference," the highly regarded expert stated.
Shemer - a former ministry director-general, director-general of Maccabi Health Services for six years, and currently dean of Tel Aviv University's School of Public Health and chairman of the Assuta private hospitals - was asked by The Jerusalem Post to comment on Litzman's statement.
The deputy minister said in the Labor, Social Affairs and Health Committee that "the time has come to reexamine all of the drugs [and medical technologies] in the basket and their cost. [Kadima] MK Rachel Adatto attacks me at every opportunity, along with some of the members of the [public committee to recommend additional drugs for] the basket."
Litzman, said Adatto got approval for the health funds to subsidize "a cream for nail fungus when she was a member of the basket committee. Why do they attack me about adding dental care for children when they put in such a cream and contraceptives?
"There is a limit to this cynicism. I won't give up... Dental care for children is important, so I intend to implement my policy until the end," Litzman told the committee, which had convened to discuss his having taken NIS 65 million from the basket increment to cover an unspecified plan for dental care for children.
As haredim have large families, they could benefit disproportionately from the coverage.
Shemer said it is "legitimate that a politician cares most about those who voted for him, but when setting policies, there must not be any discrimination against other sectors.
"I am against the process of deducting money from the basket increment for other uses. That is the Treasury's dream, as it is a precedent they can always use for reducing the money for subsidizing important drugs."
The former health fund director-general noted that it was he who instituted free dental care for the children and teenagers of Maccabi members who have supplemental health insurance. He thinks such coverage should be in the basket - but not at the expense of those who need lifesaving, life-extending and life-improving technologies.
Since then, other health funds have jumped on the dental coverage bandwagon. Since 75 percent of the population has supplementary health insurance policies, most have access to free or subsidized children's dental care from health fund-affiliated dentists, Shemer said.
Others may get such care from voluntary organizations around the country.
Although Litzman declared that he aims to add to the NIS 65 million yet another NIS 185 million from other sources to provide basic free dental care for children and youths, Shemer said such a program would in fact cost at least NIS 500 million a year.
"And the elderly who have difficulty eating without proper teeth and dentures also need such help," he added.
Offering some defense of Litzman, Shemer said that if one wants to make changes that go against the current, maybe one sometimes has to use pushy, unconventional methods.
"But whether his actions lead to more healthcare, that will be the test," he said.
Shemer's basket of health service increment system was designed to update the basket, after its contents began falling behind drug developments, because the Treasury had originally opposed an updating mechanism.
He expressed skepticism that Litzman would actually reevaluate the health basket in the end.
"If it takes two months for the basket committee to assess 500 new technologies and choose a few dozen, how long will it take to examine all the existing technologies?" Shemer said.
"Let him go ahead and appoint a professional team to examine the contents of the basket, but it will take a great deal of manpower and about two years, by which time the results will already be obsolete."
Shemer said he would welcome such an examination, however, if the underfunding of the health funds is corrected by increasing the allocation of state budgets to cover their additional expenses on the official basket - which for Maccabi alone totals some NIS 500 million a year.
Shemer said it was he, as then-chairman of the basket committee years ago, who invited the Treasury do do such an examination of the basket.
"The Treasury didn't do it, because they knew what they would find - state underfunding," he said.
Shemer explained that older drugs that have been replaced by newer, more effective ones do not constitute an expense for the basket, as they are not prescribed.
As for claims that health funds sometimes purchase medications in bulk at less than the official prices, Shemer said those gains were "necessary to supply patients with some drugs that are not in the official basket and for which health funds are not subsidized."
At the Knesset committee meeting, Israel Dental Association chairman Dr. Yitzhak Chen said he favored dental coverage for children in the basket, but that adequate financial sources were needed to do it; he cited the same NIS 500 million a year that Shemer gave.
Dr. Bella Kaufman, a leading breast cancer expert, said that her patients are desperately waiting for January 1 for much-needed new drugs to be added to the basket, but fears they will not be there because the increment has been made smaller.
Meretz MK Haim Oron said he and colleagues have been "bowled over by e-mails from people who say they have been tricked. We supported a deal to take extra drugs from supplementary health insurance policies because we promised the basket would adequately be expanded by NIS 415 million, and now it is smaller."