Meeting Mr. Ben-Yizri

The new health minister is a kindly grandfather who is refreshingly unambitious and committed to improving the nation's health.

By JUDY SIEGEL-ITZKOVICH
yaakov ben-yizri 224.88 (photo credit: Ariel Jerozolimski [file])
yaakov ben-yizri 224.88
(photo credit: Ariel Jerozolimski [file])
If cabinet ministers were chosen by public tender, the Gil Pensioners' Party's Ya'acov Ben-Yizri would be an unlikely candidate for health minister: He doesn't speak English, has only a high school education, is not computer literate, smokes like a chimney and will celebrate his 79th birthday in a few weeks. But the country's 23rd health minister (and the 16th I have covered in 21 years) has attributes that many of his predecessors didn't have: He is personally interested in the subject, identifies with sectors of the population that need the most medical care, and has decades of experience in the health system. Eight months ago, almost no one had heard of his party. No one was more surprised than Ben-Yizri when Gil - awarded seven mandates by an electorate dissatisfied with the major parties' continued neglect of its social needs - sent two of its MKs, Ben-Yizri and Rafi Eitan, into the cabinet. And here he is, in the Jerusalem apartment building that serves as ministry headquarters, sitting behind the polished desk that once served the likes of Yosef Burg, Victor Shemtov, Eliezer Shostak, Mordechai Gur, Ephraim Sneh, Haim Ramon - and Ehud Olmert. Suddenly this near-octogenarian is in charge of one of the largest and most heavily funded ministries, which owns all the government hospitals, sets standards for the rest, supervises the four public health funds and is responsible for promoting the nation's health. How does this Kfar Saba resident, who retired 13 years ago and looks like the kindly grandfather he is, suddenly take charge of all of this? "I am the only health minister [with the exception of Sneh, who is a physician and was chief medical officer of the Israel Defense Forces' paratroopers and infantry corps] to have experience in the health system... in fact, 30 years of it," Ben-Yizri proudly tells The Jerusalem Post. He was an official in Clalit Health Services, the country's largest health fund (known during most of its existence as Kupat Holim Clalit) from 1958, nine years after his aliya from Fez, Morocco, until 1993, and for two decades a district manager. He also served for eight years as a member of the Pardes Hanna local council. After he went on pension, he volunteered with pensioners' organizations, which led to his involvement in Gil. "I COME with experience, and I understand the basic material, so ministry staffers don't have to explain too many things." Ben-Yizri, who speaks French and Arabic in addition to Hebrew, says he has also "leafed through and read some chapters of" the 400-page volume on the country's health system that, since its publication a few years ago, has become the standard"gift" to incoming ministers (since they have come and gone so often, wisecrackers have joked that the high turnover will turn this statistics-filled tome into a best seller). But the health minister didn't have an easy initiation. Almost immediately after taking office in May, he was plunged into a health crisis during which cancer patients and their families held a hunger strike outside the Knesset protesting the failure to add expensive life-extending drugs to the health basket. The "solution" which Ben-Yizri approved was to add several hundreds of millions of shekels to the basket this year while acceding to the Treasury's edict not to expand the basket at all in 2007. His next crisis, one of his own making, was trying to appoint a completely unknown "outsider" - Dr. Ehud Frishman of Kupat Holim Leumit - as director general, replacing former Hadassah Medical Organization director-general and public health expert Prof. Avi Yisraeli, who has been in the post for nearly three years. Alleged "irregularities" in meeting professional demands were raised by the press, causing Civil Service Commissioner Shmuel Hollander to delay giving an answer for two months after Ben-Yizri requested his approval. Frishman - a friend of Finance Minister Avraham Hirchson, who was chairman of Leumit - finally withdrew his candidacy, to the relief of many Health Ministry officials, some of whom feared that he had intended to take over the ministry by remote control. "I told Prof. Yisraeli on the first day that I wanted somebody from outside the ministry and hospital system to be director-general. He took it like a gentleman. I had a reason: I thought bringing in an outsider would eliminate vested interests," Ben-Yizri explains. Asked how he knew of Frishman, who has no public record, the new health minister said he met him nine months ago when volunteering as chairman of a pensioners' fund that deals with nursing care. "He was an adviser on private supplementary health insurance, and I learned from him. Only after I decided to make him director-general did Hirchson tell me he was a good candidate. I am very dissatisfied with the way the civil service commissioner treated the matter. He didn't bother to send me a letter or even call for two months. I have nothing personally against Hollander, but he has left a big question mark [on his functioning]. I will write him a letter [of protest], and this will be the end of the matter." ALTHOUGH HIS advisers said the minister had "several other candidates" to replace Yisraeli, he had no one specific in mind. But he got to know Yisraeli better during the weeks of waiting and developed a deep respect for him. "He showed me complete loyalty, honesty and professionalism, and I have absolute trust in him." Ben-Yizri asked Yisraeli to continue as his director-general, and he agreed. "Prof. Yisraeli supports my plans for reform, and what he does is in my name. Anybody who causes him problems will have a problem with me," he declares. Ben-Yizri praises ministry staffers for "their high level of professionalism," but adds that some officials were "busy with irrelevant things such as in-house politics and gossip. There has been such a turnover of ministers that some people are used to 'feeding' every new one with information. So here comes a new one who understands things, and they are surprised..." He has already figured out that the Treasury and the young university economics graduates who run it are a major obstacle to improved health services. "It isn't easy dealing with them," he admits. "They have an ideology of freeing the state from many of its elementary obligations to the people, including their health. I explain my position, and I will fight for my beliefs." The National Health Insurance law, passed in 1994 and applied in 1995, was created with some serious flaws. The basket of services supplied at state expense is not updated automatically. Instead, Health Ministry ministers and officials have to go hat in hat before Treasury officials young enough to be their children (or grandchildren, in Ben-Yizri's case). The health minister says he will clamor for a law - now in the preliminary stage of legislation - to automatically increase the basket by 2% a year and thus circumvent annual Treasury authorization (several of his predecessors tried to do this but were unsuccessful). Prime Minister Olmert, himself a former health minister, "wouldn't promise me his support for such a law; he thinks it doesn't have to be legislated, but just adopted as government policy." These Treasury officials, many of whom are later hired by the big commercial banks, have refused to allow the responsibility for geriatric care to be transferred to the health funds. Only now have they apparently agreed that responsibility for psychiatric care be moved from the ministry (where, like geriatric care, it has been inadequately funded) to the health insurers, starting January 1, 2007. But these Treasury budget officials have been insisting that family health (tipat halav) center services - well-baby and pregnant women monitoring) be handed over by the ministry and a few municipalities to the health funds because it would supposedly save money. Ben-Yizri, who says he has studied the issue, insists he will not allow tipat halav to be grabbed by the health funds, most of whose staffs are not trained in disease prevention and health promotion, and which like the idea of attracting young, healthy couples as new members. Ben-Yizri says he is pleased by the coalition agreement that will increase the pensions of lower-income elderly and reduce their out-of-pocket fees for medications for chronic illness. He is proud of the fact that he, pensioner affairs' Minister-Without-Portfolio Eitan and Knesset Labor, Social Affairs and Health Committee chairman MK Moshe Sharoni all come from Gil and are working to benefit the economically and socially deprived. When I mention that no other developed country charges parents for vaccinating their babies - some even offer a financial bonus as an incentive - Ben-Yizri exclaims: "You're touching a sensitive subject! I will fight for prevention and for increasing the depleted number of public health nurses in the schools. The Education Ministry must be a partner. Last year's budget was so short that some schoolchildren didn't even receive their shots, but in September they will get what they missed." The new minister - who asked his personal communications adviser Tal Harel and acting ministry spokeswoman Inbal Jacobs to be present at the interview - answers questions spontaneously, vociferously and enthusiastically. From time to time, especially when I press him about his smoking, he says "Judy! Judy! Judy!," reminding me of a Cary Grant impersonator (although the late American actor actually never used that rapid-fire triad in any film). Tobacco is a sensitive issue. Ben-Yizri, who has smoked 60 cigarettes a day (except Shabbat) since he was 18, says today he has the time and legal space to smoke only a third as many - and then only on the balcony of his office. Impressively, there are no ashtrays or tobacco odors in the room and - after allowing himself to be photographed smoking as a newly minted minister - Ben-Yizri has sworn he will not do so in public. He admits he had not heard of the Gillon Committee, appointed seven years ago by then-health minister Shlomo Benizri and headed by Judge Alon Gillon to consider labeling tobacco and nicotine "dangerous drugs." Ben-Yizri is willing to consider backing legislation that will bar tobacco advertising in newspapers and magazines. He may also back the idea that proprietors of restaurants, malls and other places frequented by the public be fined if there is illegal smoking on their premises, and not only the smoker himself. But he prefers "education" about the evils of smoking to privatizing the job of enforcement so that enforcers will have the incentive to hand out fines. Asked how he will know whether he has been a successful health minister, Ben-Yizri concludes: "Each of my predecessors had his or her pluses and minuses; they did what they could. I will be 79 soon, and don't expect to be finance or defense minister, or prime minister. I don't know how long the term will be. But I come with a personal and national mission, and if I can get some of these things done, I will be satisfied."