Sunday, February 16, 2014

An open letter to the Israeli government

Dear friends and colleagues,

With everything else you face, the last thing you needed on your agenda was the financial collapse of the country's major academic medical center, Hadassah (comprising two hospitals in Jerusalem.)  That the disruption in patient care, research, and education--not to mention the financial hardship of the doctors, nurses, and other staff--might have been avoidable is of little solace right now.  It will take weeks of thoughtful negotiations and difficult decisions to sort things out and put the medical center back on a good path.  But rest assured that there is a path to long-term success and restoration of this crown jewel. It will be hard, though, for the environment inside an academic medical center is as complex as any; and the forces impinging on the institution likewise are complex.

It is about one of those forces that I now write.  Recently the head of the Hadassah Women's Zionist Organization of America--the owner of the hospital--started a petition drive in which she states:

Financial problems, largely a result of the crisis in the national health system, have beset the hospitals and have resulted in an operational deficit. 

We call on you all to join with us in raising our voices to guarantee the future of Hadassah and Jerusalem as a beacon of medical excellence.

As of this writing, the petition has 5000+ signatories, many with heartfelt reasons for signing the document.

I understand from colleagues that your government feels this petition as a great source of pressure from the American Jewish community and that this perceived pressure might influence the manner in which you work on this problem.

I'm writing to offer my view that is no such pressure or engagement from the American Jewish community at large. 

Health care issues, in general, are exceedingly complex and multi-faceted.  Most of us in America have trouble understanding even the situation in our own community. To think that a large number of Americans truly understand the issues surrounding Hadassah would be ridiculous.  To think that many American Jews would devote their political capital to trying to influence how you handle this problem is even more silly.  With all of the existential issues facing Israel, to the extent we in America raise concerns, it is about the broader issues of survival, relationships with your neighbors, and relationships with the world community.

As I have stated before, this petition drive by HWZOA is a smokescreen for its own failures as a governing body of this hospital:

That HMO has reached the point it has indicates a failure of governance.  Financial and existential crises do not develop overnight.  The current situation has been years in the making, and the inability of the board to acknowledge the trends in a way that would have enabled countermeasures to be put in place indicates a problem in the structure, focus, activities, and perhaps people on those bodies.

I am appalled and embarrassed that, with all the incredibly serious issues facing the relationship between the United Stares and the State of Israel, HWZOA would tap the political capital of American Jewry to solve a problem that is essentially of its own making.  By conducting this petition drive, HWZOA confirms that it should cede its ownership and control of this organization and let it be owned and operated by the Israelis.

Yes, you have generic issues about the funding of health care in Israel that deserve attention, and, yes, some of those aggravated the situation at Hadassah; but the last thing you should consider is a bailout of Hadassah before there is an agreement on the structural changes needed within the institution--and on its ownership.  HWZOA, as well intentioned and generous as it has been in the past, simply does not have the expertise and ability to own, operate, and govern this institution in a health care environment that has grown increasingly complex.  To the extent it wishes to do so, its attitude reflects a tired and out-of-date colonial viewpoint.  It offers nothing to the institution that Israel cannot achieve with internal ownership.  A severance arrangement is timely, with three major provisions:  A commitment by HWZOA to restore all or a portion of the restricted funds that it spent on operations; a transfer of ownership to a new Israeli entity; and a commitment to retain the Hadassah name as a lasting tribute to its founders.

1 comment:

Frank Opelka, MD FACS said...

Always appreciate your thoughtful column, especially today as I sit in a hotel in Jerusalem and read about the troubling times.
I will soon meet with colleagues in Hadassah while visiting Israel. I hope to learn more. Whether Israel, USA, EU or elsewhere, the problems and complexities in health care trouble us.
Hadassah and Israel would benefit from someone like you.
Frank Opelka, MD