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Perhaps it’s all personal. Perhaps it’s all political. One thing is certain, the interests of patients weren’t the uppermost priority last week when the Ministerial Committee on Legislation withheld its backing from a bill that would have regulated who decides on which drugs are included in the state-funded “health basket,” by which criteria they are chosen and how to choose those who do the choosing.
In other words, the bill would have anchored by legal strictures the activities of the Health Basket Committee, which for the past dozen years had been determining which drugs would be offered by the National Health Insurance and which would be left out, thereby rendering medications that are sometimes life-saving – or vital to maintaining quality of life – exorbitantly expensive.
Thus far the committee has operated without any legal parameters, guidelines or prerequisites. This facilitated arbitrary decisions, like excluding from the basket some of the latest and most promising pharmaceutical innovations. It also made it possible for political forces to exploit the limited basket resources for purposes quite divergent from the basket’s commonsense raison d’etre.
Thus last year Deputy Health Minister Ya’acov Litzman (United Torah Judaism) removed a whopping NIS 65 million from the basket’s budget to fund prophylactic and routine dental care for youngsters. This may be a worthy cause in itself, but footing its bill at the expense of the anyway severely strapped health basket was a travesty. Certainly combating tooth decay and providing anti-cancer drugs cannot be weighed on the same scales.
Moreover, Litzman was accused of having callously and cynically preferred the sectarian interests of his own haredi community, where particularly large families often cannot afford dental care for children, regarding it as dispensable in the face of other, more pressing needs.
The bill, sponsored by 30 MKs – led by Rachel Adatto (Kadima), Haim Katz (Likud) and David Rotem (Israel Beiteinu) – would have severely curtailed Litzman’s clout and ability to extract from the basket wherewithal for ancillary pet projects.
It would also have reduced the number of government- appointed committee members from five to two, substituting in their stead Israel Medical Association representatives.
It would have imposed stipulations on how to select the basket committee members, what timetables would bind the committee, how its agenda were to be fixed and on what criteria its determinations must be based. The bill would have empowered the committee to remove older-generation drugs from the basket and replace them with more up-to-date varieties.
In all, a great deal of authority would have been removed from Litzman, a fact that doubtless prompted his vehement opposition.
FOR NOW Litzman has won, having persuaded fellow ministers to torpedo
the bill. A further irritant may have been the fact that the Israel
Medical Association and Adatto, both among Litzman’s staunchest critics,
were driving forces behind the bill. Among its most ardent boosters
were also past and current members of the Basket Committee who
disapprove of how its business is conducted, as well as the nonpartisan
Society for Patients’ Rights in Israel.
Litzman’s initial triumph, however, doesn’t necessarily signify the
bill’s demise. It may still be submitted to the Knesset as a private
member’s bill, though, deprived of government sponsorship, it would
encounter greater hurdles along the way.
That is unfortunate. The Health Basket Committee can sometimes, albeit
indirectly, make life-and-death calls. But without a clearly outlined
legal basis for its operations, too much power is entrusted to the
health minister, who is not even obliged to abide by committee
recommendations. This leads to excessive political intervention in
medical/social issues. Ethical decisions are supplanted by power-plays
and budgetary grabs.
A well-ordered society shouldn’t stomach such irregularities.
Since all still is not lost for the bill, we can only hope that its 30
parliamentary backers won’t back off and will continue to push this very
worthy cause. To be sure, this bill is hardly the cure-all for all the
drug-availability problems that plague our system. But it would insure
greater control by the public and less opportunity for manipulation and
hanky-panky by politicians with vested interests.