THINK ABOUT IT: Poverty and health, a tale of two committees

It is said that the camel was created by a committee that had been asked to design a horse.

Health Minister Yael German (R) and acting Director-General of HMO Prof. Tamar Peretz. (photo credit: HADASSAH MEDICAL ORGANIZASTION)
Health Minister Yael German (R) and acting Director-General of HMO Prof. Tamar Peretz.
Two committee reports on important social issues were published last week. The first committee, on the war against poverty, submitted its report on June 23. The second committee, on strengthening public health, submitted its report two days later.
Both committees were appointed by ministers belonging to Yesh Atid, who had served as mayors before joining Yair Lapid’s party at the end of 2012 – Welfare and Social Services Minister Meir Cohen, who was mayor of Dimona on behalf of Yisrael Beytenu (2003-2012), and Health Minister Yael German, who was mayor of Herzliya on behalf of Meretz (1998-2012).
However, while most of the recommendations of the first committee are likely to end up in a paper shredder, most of the recommendations of the second committee have a good chance of actually being adopted and implemented.
Why the difference? I believe that the problem with the Poverty Committee, which was chaired by Israel Prize laureate Eli Alaluf, was that from the very start it had very little chance of success. To start off with, the committee was much too large and incoherent in its make-up.
It is said that the camel was created by a committee that had been asked to design a horse. But at least the committee that created the camel set out to design an animal, able to carry a rider and goods, with a head, a body, four legs and a tail. And although what it produced is useless as a horse, it is extremely useful as a means of transportation in the desert.
The Alaluf Committee, on the other hand, didn’t even produce a camel, or any other sort of animal. The committee was given an extremely broad frame of reference and very few guidelines besides the general goal of reducing poverty in Israel to the OECD average within 10 years.
In terms of the percentage of the population that is beneath the poverty line, Israel is second from the bottom in the OECD, with only Mexico beneath it. The poverty line is calculated in each country as half the mean disposable income per individual, including transfer payments. In 2012 (the last year for which statistics are available), the poverty line in Israel was calculated at a monthly income of NIS 2,256 per person, where the additional sum for every additional family member diminishes (for example, for a family of six the poverty line in 2012 was NIS 9,588). Close to 19 percent of the population are beneath this level in Israel, compared to the OECD average of around 11%.
Since the committee was reportedly not allowed to deal with the structural causes of poverty, it ended up dealing primarily with the financial statistics, or in other words, how to push as many families and individuals above the poverty line by simply increasing direct and indirect financial benefits, and the price tag was NIS 6 billion per annum for a period of five years.
The reaction of the Finance Ministry to these figures was that they were simply unrealistic, and given the fact that our current government is basically neo-liberal in its socio-economic approach, the committee’s recommendations are simply a non-starter. Perhaps if the committee had been provided with coherent policy guidelines, it could have produced recommendations with at least some chance of being adopted.
Another major shortcoming in the committee’s report and recommendations is that it dealt with aggregates, even though the reason for poverty in various sectors – Arabs, haredim (ultra-Orthodox), new immigrants from the former Soviet Union and Ethiopia, senior citizens, disabled persons and Mizrahim – differ, and what should or can be done about poverty in each sector is different.
In the final reckoning it is only in the case of senior citizens and disabled persons that the only solution to poverty is the increase in transfer payments and services.
But to deal with the problem at the sectorial level one needs a policy and priorities. Lip service to a general goal with nothing concrete behind it is as useless with regard to fighting poverty as it is in the struggle for peace.
The Committee on Public Health was a completely different story. First of all, Yael German herself chaired the committee and though she did not start off with a clear conception as to how the problem should be tackled, she was determined to come up with a policy that would receive broad approval, including from the Finance Ministry.
Furthermore, the topic that the committee dealt with was focused – not the general problem of the Israeli health system, but primarily public health versus private health services in the public hospitals. Moreover, German is committed to implementing the committee’s recommendations.
In the TV program Hamateh, on Channel 10 on Saturday afternoon, she stated that despite her reservations regarding the current coalition, she was hoping that it would hold together so that she would have the opportunity to implement the proposed reform.
Contrary to expectations the committee came out against allowing private medical services (Sharap) for Israelis to further develop in public hospitals, although a more closely monitored and taxed system of medical tourism is to be encouraged.
In order to shorten waiting lists for operations in the public hospitals, both the hospitals and the health funds are to receive another billion shekels. It is hoped that the new arrangements will convince the public to give up some of its private health insurance policies – especially those relating to the choice of surgeons – which will become superfluous. Even today many of these insurance policies are unnecessary, and merely cause people to spend a lot of money on over-insurance.
Since the Finance Ministry has agreed to finance the proposed reform (one suspects that Finance Minister Yair Lapid decided to support German on this issue, though it is not clear what his ideological position is on it), the chances for change are good, and certainly much better than in the case of the war against poverty.
German’s apparent success may be attributed to the fact that she is focused, and was willing to invest her own time in directing the committee’s work.
One cannot escape the question of whether the committee which Cohen appointed might not have come up with more focused and practical proposals had Cohen invested a little more time and thought in its make-up and agenda. As mayor of Dimona he proved himself as an effective administrator, and carried out some important reforms in the fields of social justice, culture and the environment.
However, not every good mayor also proves to be a good minister or politician on the national level, and there are quite a few mayors who ventured into national politics, became mediocre MKs and then returned to run their cities, and thrive. Shlomo Bouhbout from Ma’alot-Tarshisha, who was elected to the Knesset on the Labor ticket in the 13th Knesset, was one of these.
After one term in the Knesset Bouhbout returned to his Galilean city, and is its mayor to the present day.
The writer is a retired Knesset employee.