The right-wing Kohelet Policy Forum has been best known in recent days for its involvement in the controversial judicial reforms. An opinion piece published in the Israel Hayom newspaper last month by Kohelet researcher Yair Osheroff dealt with a very different, less eye-catching issue: the employment of ultra-Orthodox Jews in the healthcare field. The article, brief as it was, reveals the nature of the “research” taking place at Kohelet and the damage it is liable to cause to Israeli society.
The opinion piece called for lowering the licensing standards for speech therapists, occupational therapists, physiotherapists, and nutritionists in order to allow more ultra-Orthodox Jews and people in the geographic and social periphery to access treatment.
Deceptive, Anti-Social Arguments
Osheroff’s arguments are deceptive and anti-social. They favor economic savings over the well-being of Israeli citizens. They are rife with half-truths and baseless, misleading statements. The piece shares the same strategy as many of Kohelet’s campaigns: start with an extreme neoliberal goal, and try to justify it by taking things out of context and ignoring potential consequences.
Opinion pieces published by Kohelet have had serious influence on Israeli policies. Recent Kohelet opinion pieces have proposed reducing supervision requirements in daycares, decreasing women’s rights in divorce proceedings, and decreasing investment in public housing. Another piece opposed the role of trade unions in Israeli society.
Osheroff’s piece was a response to bills submitted to the Knesset by representatives of the ultra-Orthodox parties that the coalition has committed to promoting. The bills would allow non-academic vocational training as a path to licensing for jobs in speech therapy, nutrition, occupational therapy, physiotherapy and eight other professions. Currently, academic training and practical experience are required for licensing in those fields.
The proposal would allow individuals to be trained in non-academic institutions that received approval from the director general of the Ministry of Health along with an advisory committee. Those who receive this alternative licensing might be approved only to provide care in certain settings (for example, not in hospitals). The explanatory notes of the bill mention ultra-Orthodox Haredi teacher seminaries as potential training institutions that would enable more ultra-Orthodox Jews to work in these professions.
Osheroff describes the bill as a golden opportunity to integrate ultra-Orthodox Jews into the work force. “When ultra-Orthodox Jews want to enter the workforce, don’t prevent them,” the article’s headline compels. He claims that the anticipated ultra-Orthodox integration “is expected to significantly change the field of paramedical treatments in Haredi society, and may even affect the entire health sector, and later also the labor market in general.”
He presents four main arguments in support of the proposal. The first is the exorbitant cost of education necessary to work in healthcare. The second is the shortage of caregivers, especially in the geographic and social periphery, including in ultra-Orthodox society. The third is that the proposal could solve the trend of “overeducation” in Israel, where people receive higher degrees than they “really need.” The final point is that requiring academic studies makes paramedical professions inaccessible to ultra-Orthodox Jews.
Second-Class Care to Second-Class Citizens
Osheroff is not wrong to say that medical training is expensive. The claim expresses a destructive moral position regardless of its factual accuracy.
He acknowledges that “the level of academic training in Israel in these subjects is particularly high, and it is doubtful whether vocational training offered in ultra-Orthodox seminaries will be of a similar level.” But, he says, “academic training has a high cost, both for the state that subsidizes the studies and for students.”
To put it simply, in the name of economic savings, Kohelet consciously proposes to harm the quality of care that part of the public will receive. According to Kohelet, there will be second-class citizens in Israel, in ultra-Orthodox society and in the periphery, who will receive second-class treatment.
This idea is wrong not just morally, but also economically. Kohelet has not yet realized that cheap proposals often end up costing more. Public investment in training medical professionals, in the form of subsidizing studies and especially opening additional tracks in academia, will create economic savings in the future. A society with more, better-trained speech therapists, for example, is able to properly address the struggles of children and adults with communication problems, allowing them to integrate into society and take part in the workforce. Poor care, on the other hand, will leave such individuals behind and require the state to invest in more resources throughout their lives.
Alternative Solutions to the Caregiver Shortage
The second argument in support of the proposal has to do with the scarcity of caregivers, especially in the periphery. According to Osheroff, “the shortage of caregivers is felt mainly in the geographic and social periphery, and particularly in the ultra-Orthodox sector. Therefore, insisting on too high a standard of caregivers causes a decrease in their availability and harms patients."
Scarcity is a real problem. Reports from the state comptroller and others have suggested that current staffing standards are insufficient. In December 2021, the Ministry of Health presented data to the Knesset’s Board of Education that showed that Israel’s school system is lacking about 1,080 therapists, almost 12% of the total required workers in the system. Each missing caregiver means dozens of students are not receiving the care they are entitled to. And according to the 2017 state comptroller report, the shortage is mainly felt in the periphery.
But Kohelet, together with the ultra-Orthodox Knesset members promoting decreasing training requirements, are ignoring the elephant in the room: the salaries of public service caregivers. Investing in healthcare as a profession is a viable solution to the staffing crisis.
Heads of various healthcare union have repeatedly explained the disturbing situation: salaries in the private sector are far greater than those in the public sector. As a result, many caregivers prefer to divide their time between public sector work and private practice work, or even to work solely in the private market. Many say they would be willing to work in the public sector if the pay justified it.
Osheroff’s article does not mention this possibility at all. Unsurprisingly, Kohelet is one of the bodies that opposes wage increases and improved conditions in the public sector. It’s possible that the recent agreements signed by the Histadrut and by the teachers’ union, both of which have to do with wage increases, may change the picture somewhat. But the gap in hourly pay between the public and private sectors remains large, and much higher wages are needed for healthcare workers in the public sector in order to bridge that gap.
Raising wages is not the only answer to the shortage. Reports investigating the issue, including reports by an interministerial team in the Prime Minister's Office, showed that academic training institutions would need to increase their capacity in order to train the number of professionals needed. The academic institutions could open new seats in the programs as soon as next year, if the government were to allocate resources towards this issue, but Kohelet insists on “saving” those resources.
Misunderstanding “Overeducation”
Osheroff’s third argument is absurd in its decontextualization. Osheroff says that requiring academic training for health professions is part of a trend of overeducation. “In recent decades, the state of Israel has undergone increased academization. For the most part, it is welcome, but in part it has amounted to overeducation—academic training that exceeds the necessary requirement for the profession—as Taub Center and Kohelet Forum Policy research indicates,” he writes.
Are the academic requirements for working in the health professions in Israel really too high? To answer this question, it’s worth comparing Israel’s to those in other developed countries. Osheroff did not check, or did not bother to share simple facts with his readers. The International Association of Communication Sciences and Disorders mandates that health professionals be certified by an academic institution, as does the World Federation of Occupational Therapists. This is the case in the United States, Germany, Canada, the UK, Australia, and other developed countries that are members of these unions. In the United States, practicing speech therapy requires not just a bachelor’s degree but a master’s degree.
According to Kohelet, all the developed countries are wrong, and only in Israel, the nation of high tech, research, and academia, can communication disorders be treated by a practitioner without an academic degree. If so, why stop only at therapeutic healthcare? After all, doctors and psychologists also require lengthy training, and there is also a shortage of doctors in the periphery. Does Kohelet propose allowing more limited training for doctors? And for psychologists? Would Kohelet employees send their own children to the same second-class therapists they propose to license? I assume not.
But this is not Osheroff’s only deception. In an attempt to give more legitimacy to the claim of overeducation in the health professions, he cites another research body, the Taub Center, claiming that they too have noted the problematic nature of the phenomenon. The Taub Center is a mainstream social policy research body: not too capitalist nor too socialist. The naive reader might think that there is a kind of research consensus that occupational therapists and speech therapists in Israel receive too much training.
This is simply untrue. The Taub Center’s 2020 study on “Overeducation Among Academic Degrees Holders in Israel," which Osheroff cites, examines “the phenomenon of overeducation for those with academic degrees employed in occupations that do not require a degree." In other words, the Taub Center study does not address the question of whether there are certain professions in Israel for which the academic requirements for occupation are too high. It examines various factors that influence the choice of workers with a bachelor's or master's degree to work in professions that do not require any academic degree.
Alternative Solutions to Employment Barriers
Osheroff’s final argument is that academic studies are a barrier preventing ultra-Orthodox Jews from integrating into the health professions. "Overeducation impedes those who fail to fit into the academic framework from entering into high demand professions," Osheroff writes, "Allowing academic studies to be replaced by professional studies in the therapeutic professions may herald a trend that will initially benefit the ultra-Orthodox, but eventually the entire public."
Here, too, a real problem is presented, but the possible solutions, some of which already exist, are ignored. In order to overcome the barriers to ultra-Orthodox Jews entering skilled professions in the labor market, the Israeli government has initiated various programs tailored to vocational training in many and varied professions. The programs include vocational training, educational subsidies, and subsidies for employers of ultra-Orthodox Jews.
According to data from the Knesset Research and Information Center, thousands of ultra-Orthodox Jews participated in training programs between 2017 and 2019, and the numbers are growing.
Academic training tailored to ultra-Orthodox Jews also exists in the health professions. Students at the ultra-Orthodox campus of the Ono Academic College can study occupational therapy and speech therapy. The ultra-Orthodox Mivchar College in Bnei Brak has a track adapted for women in these professions, and the Haredi College in Jerusalem has a speech therapy track for women. More such tracks are undoubtedly needed, but the programs that do exist prove that the academic requirement is not an insurmountable barrier.
In fact, even some ultra-Orthodox Knesset members agreed to interim solutions regarding changes in the health professions. Following a dialogue between the Histadrut’s Union of Health Professionals and Knesset members from the ultra-Orthodox Shas party, an agreement was reached to maintain academic standards in the field and simultaneously develop the role of “health professional supporters" as a job that does not require academic training.
In other words, contrary to the position presented by Kohelet, a balance can be found in the health professions between academic requirements and the integration of the ultra-Orthodox, without harming creating lower standards.
Dangerous Policies Fly Under the Radar
Kohelet’s activities in the fields of economy, education, health, welfare, and labor are less known to the public than its pro-judicial reform activities. Although they are not as well known, these other policies may adversely affect the lives of millions of Israelis. The public, and especially its elected representatives, must take a closer look at the Kohelet Policy Forum and understand that the forum’s social policy harms the public indiscriminately—supporters of the judicial reform and opponents of the legal reform.
This article was translated from Hebrew by Etz Greenfield.
