As long as the coronavirus crisis is unfolding, labor unions will be forced to take central roles in it’s management. Even under normal circumstances unions have something to say on policy and professional issues, but in the absence of real leadership, they must be the last line of defense keeping the system from economic starvation and even collapse.
To put an end to the nurses’ strike, the Israeli ministers of health and finance agreed last week on the temporary addition of 2,000 nurses, and on the establishment of a joint team with the nurses' representatives to discuss long-term additions.
Health Minister Yuli Edelstein said about the process: “The health care system has been starved for years. Together with my friend, Finance Minister Israel Katz, we have worked to quickly correct the deep problems created in the system and significantly strengthen the treatment of corona. We have determined that health is above all."
Edelstein spoke to the nurses at the beginning of their strike: “I will be with you in your struggle. I have great appreciation for your wonderful, dedicated and vital work. The shortage of manpower is not just because of the coronavirus, it is an ongoing problem in the health system that has only intensified."
As we celebrate the minister’s support, it’s hard not to wonder at his reaction. The minister is correct in his claim that the problem of manpower in the system is not new. There is no shortage of reports from the Ministry of Health itself, which describe the consistent decline in the proportion of doctors and nurses per capita, and the dismal situation in relation to OECD countries. Just last year, a committee of the ministry issued the Tor-Caspa report, which presents concrete recommendations for improving the internal health departments, starting with a significant boost in manpower. To date, no plan has been put in place to meet these recommendations.
If Edelstein learned about the situation and needs of the healthcare system when he entered his position, and understood, as he said to the press, that it is necessary to add nurses, why did he wait until the nurses went on strike before approaching the Ministry of Finance with demands? Why didn’t he prioritize it as the first task of his position, to demand such necessary manpower adjustments from the finance ministry?
The lab technicians, essential in the fight against corona as well as in the routine functioning of the healthcare system, are currently entering into negotiations with the ministry of finance. It is unclear as of yet whether the Minister of Health will even take part in these discussions.
Ester Admon, head of the union of lab technicians, warned of a serious crisis: an exodus of veteran workers and a lack of ability to recruit young workers. The reason for this is clear. The hourly wage for the job is less than 40 shekels an hour, for people with at least a bachelor's degree. Admon explains that she met with Yaakov Litzman, former Minister of Health, in 2016, after the critical report exposing issues in the system was published. Since then, no plan has been formed to solve this problem which threatens to close down the labs, nor has Admon heard from representatives of the department.
"This is the responsibility of the Minister of Health, but everything looks like some backroom deal in a corner store,” Admon said. “We are talking about the management of an epidemic that caught the healthcare system unprepared. It’s the responsibility of the Health Minister to solve the problem of the laboratories, and he just doesn’t deal with the deeper issues. It looks like the responsible adult here is only the Finance Minister. But that department has a limited understanding of the health system. Where is the Ministry of Health?”
The interim budget of the corona fund is not the answer. The budget is for 10 billion shekel, of which 6.4 billion has already been spent. It cannot provide for the systemic changes that the health system needs. This kind of budget creates temporary and ridiculous solutions, such as bringing in students to interpret corona tests at a higher salary than the experts who train them.
In Israel, the health budget stands at 7.5% of the GDP, compared with 8.8% of the GDP in OECD countries. In absolute numbers, this is a gap of $17 billion a year. No easy fix will close this gap. The Israeli health system needs someone to really fight for it, in emergencies and during routine. The workers cannot do it alone.