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Circles of Exclusion

Circles of Exclusion: The Politics of Health Care in Israel

Dani Filc
With a Foreword by Quentin Young
Copyright Date: 2009
Edition: 1
Published by: Cornell University Press,
Pages: 208
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  • Book Info
    Circles of Exclusion
    Book Description:

    In its early years, Israel's dominant ideology led to public provision of health care for all Jewish citizens-regardless of their age, income, or ability to pay. However, the system has shifted in recent decades, becoming increasingly privatized and market-based. In a familiar paradox, the wealthy, the young, and the healthy have relatively easy access to health care, and the poor, the old, and the very sick confront increasing obstacles to medical treatment.

    In Circles of Exclusion, Dani Filc, both a physician and a human rights activist, forcefully argues that in present-day Israel, equal access to health care is constantly and systematically thwarted by a regime that does not extend an equal level of commitment to the well-being of all residents of Israel, whether Jewish, Israeli Palestinians, migrant workers, or Palestinians in the Occupied Territories. Filc explores how Israel's adoption of a neoliberal model has pushed the system in a direction that gives priority to the strongest and richest individuals and groups over the needs of society as a whole, and to profit and competition over care.

    Filc pays special attention to the repercussions of policies that define citizenship in a way that has serious consequences for the health of groups of Palestinians who are Israeli citizens-particularly the Bedouins in the unrecognized villages-and to the ways in which this structure of citizenship affects the health of migrant workers. The health care situation is even more dire in the Occupied Territories, where the Occupation, especially in the last two decades, has negatively affected access to medical care and the health of Palestinians. Filc concludes his book with a discussion of how human rights, public health, and economic imperatives can be combined to produce a truly equal health care system that provides high-quality services to all Israelis.

    eISBN: 978-0-8014-5857-6
    Subjects: History

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Foreword
    (pp. ix-xii)
    Quentin D. Young

    As I sat down to read Dani Filc’s Circles of Exclusion, I expected to learn a great deal about the Israeli health care system. What I did not expect was to find that this tiny country enmeshed in a seemingly intractable conflict in the Middle East would have so many lessons for the world’s most powerful nation—the United States. Several pages into this courageous book, it became clear that the issues Dr. Filc describes hold great relevance for those grappling with America’s ongoing health care crisis. The crisis in Israel and that in the United States are the result...

  4. Acknowledgments
    (pp. xiii-xvi)
  5. Introduction: Four Stories of Exclusion
    (pp. 1-15)

    My patient was as perplexed as she was outraged. “You can’t do it? What do you mean, you can’t do it?” she asked angrily. “I’ve been going there for years and years for my heart checkup! And now you’re telling me I have to start all over again at a new office, with a new doctor? No way!” she exclaimed as she stormed out of my office.

    Ms. Levana Malka,¹ a sixty-year-old retired assistant kindergarten teacher who lived in Givat Hatmarim—one of the poorer sections of Tel Aviv—had cardiac valve disease since she was a child and developed...

  6. 1 The Israeli Health Care System: An Overview
    (pp. 16-42)

    A group of old men meet everyday in the waiting room of one of the Israeli sick funds. Day after day, they gossip, talk politics, argue, and joke. One day they all realize that they haven’t seen Moshe, one of the regulars.

    Astonished and worried, Yaakov asks Pesah, “What happened to Moshe? Why didn’t he come today?”

    “Well,” Pesah, replies without the slightest irony, “Today he is not feeling well. He’s really sick.”

    As with many jokes, this one reveals much about the institutions it seems to mock—in this case, the sick funds in Israeli society, especially during the...

  7. 2 The “Neoliberalization” of the Israeli Health Care System
    (pp. 43-74)

    We arrived at the meeting with the new regional director of Kupat Holim Clalit’s (KHC) Tel Aviv area with apprehension. He had summoned the directors of all KHC clinics to a meeting to explain his program, and we did not know what to expect. In 1993 KHC was going through a severe crisis. There had been a major reorganization of the sick fund. Many young patients were leaving KHC for smaller sick funds, and many medications were unavailable at KHC’s pharmacies. As a way to cope with the crisis, Prime Minister Rabin forced the Histadrut (General Workers’ Union) to designate...

  8. 3 The Health of Israeli Palestinians and Bedouins
    (pp. 75-99)

    Summer in the Negev: heat, dust. El Sara is one of the Negev Bedouin’s unrecognized villages—the home of a few thousand Bedouins. It was not easy to get here since there are no paved roads, nor road signs. It is difficult to walk through the village, which consists of a group of ramshackle houses, because the unrelenting Negev sun makes every movement a torment. El Sara reminds me of the shantytowns in Buenos Aires known as the villas miseria, conglomerations of rundown houses built out of bricks, tin, and wood, with no running water or sewage, that give dubious...

  9. 4 Migrant Workers
    (pp. 100-128)

    “Should we allow a baby with a fever to come to the day care center?” a Colombian woman—one of fourteen immigrants in the room—asked me in Spanish. I wasn’t sure how to answer her. From a purely “medical” perspective, if our goal was to avoid spreading disease and preventing the baby from becoming sicker herself, of course we should insist that the baby stay at home. But I wasn’t asked to speak for the Israeli public. I was asked this question at the end of a meeting organized by Mesila, the city center for support of migrant workers,...

  10. 5 The Occupation as the Ultimate Violation of the Right to Health
    (pp. 129-152)

    Ibrahim is a 28-year-old who’s been suffering from chronic hepatitis for over two years. He contracted the disease in 2005, and by 2007 his condition had worsened. To treat a patient with this condition, doctors have to administer drugs such as interferon. Had he been an Israeli, whose name was Ilan Amitai, living say in Tel Aviv, he would have gotten those drugs. Unfortunately, his name is Ibrahim al Adri and he is a Palestinian living in Gaza, and the tests he needed could not be done in the Occupied Palestinian Territories (OPT) but only in an Israeli hospital. To...

  11. Conclusion
    (pp. 153-162)

    In the National Health Insurance (NHI) law passed in 1994, the Israeli government formally based its health care system on the values of justice, equality, and mutual help. The third article of the law definitively stated that every resident is entitled to health care services and that access to health treatment will depend on medical considerations and will be of reasonable quality. These two articles could provide the legal basis for the recognition of equal access to health care, as a social right. Indeed, in many ways they do. The law established an institutional framework that provided coverage for all...

  12. Notes
    (pp. 163-170)
  13. Bibliography
    (pp. 171-178)
  14. Index
    (pp. 179-192)