Doctors at Jerusalem’s Hadassah hospital returned to work last Thursday, ending a bitter two-week dispute. The trade unions agreed on a temporary deal for nurses and ancillary staff that left the doctors isolated and resolved none of the fundamental questions affecting the future of the world-famous hospital, its staff and patients.
At the heart of the dispute lie issues that confront workers all over Israel, and indeed all over the world: the subordination of health care to big business and the requirement that workers and the public sacrifice their livelihoods for the benefit of the corporations and banks.
The strike won broad popular support under conditions in which other hospitals have faced closure in Jerusalem and elsewhere. Around 20 other labour disputes were officially declared in the last few weeks in the public sector and at major Israel companies, paving the way to slowdowns and strikes throughout the country.
The labour organisations sought to isolate the Hadassah strike and get staff back to work as quickly as possible to prevent a broader political offensive against Prime Minister Benjamin Netanyahu’s right-wing coalition government and avoid any disruption of their own relations with management and big business.
The strike at Israel’s iconic Hadassah—arguably the best hospital in the Middle East and at the cutting edge of medical science—began on February 4, in the wake of cuts in government funding and low payments from the Health Management Organisations (HMOs). This has brought the hospital to the brink of bankruptcy.
For months, the 1,150-bed Hadassah has been unable to cover its wage bill, and in January failed to pay medical and ancillary staff their salaries in full. The 850 doctors were paid just half their salaries. Debts have spiralled to more than $284 million, presaging mass sackings, ward closures, and cuts to workers’ wages and conditions. Without immediate financial assistance, February’s pay packet will be even lower.
Two days earlier, the Jerusalem District Court had issued a 90-day stay of proceedings preventing creditors from taking legal action against the hospital. Crucially, it approved a financing deal between the hospital and the government that would allow only a partial payment of salaries—85 percent for doctors, 90 percent for others—for the next three months.
Workers rallied outside the court, the prime minister’s residence, the Municipality building and other locations around the city in opposition to the injunction robbing them of their full salaries and ending collective work agreements.
The Israeli Medical Association (IMA), which represents the workers, said that they had only found out that management was seeking a court order from the media. The IMA said management’s aim was to end organised labour at the Hadassah.
Doctors demanded to be paid in full, including their medical insurance, and began operating a weekend holiday schedule on Hadassah’s two sites at Ein Kerem—home of the famous stained glass windows by artist Marc Chagall—and Mount Scopus.
Within days, the rest of the staff on both sites—2,000 nurses, 1,200 paramedical and support staff, and nearly 900 managers—joined them in demanding their full salaries.
Hundreds of medical centres and hospitals throughout Israel went on strike for two hours in sympathy on February 9. Thirty thousand workers at Clalit Health Services, Israel’s largest HMO, said they were holding workers’ assemblies at all 14 of its hospitals, in solidarity. Hundreds of workers camped for the night in the main atrium of the Ein Kerem hospital in protest at having to wait 18 days to get their January wages.
A thousand workers rallied outside the Knesset (parliament), where a special meeting was being held to discuss the crisis. The government’s response has been to offer a paltry $50 million in rescue funds. The doctors were called greedy and money-hungry. The HMO management, for its part, threatened to get a court order forcing staff back to work.
While the unions brought the strike to an end last week, the details of the temporary agreement are far from clear. Workers earning less than $5,000 a month will get their full salaries and back pay due to them. Redundancy notices to 300 workers have been frozen for the time being, pending discussion with the union. The doctors agreed to return to normal work after the Jerusalem District Court ruled that the hospital would have enough malpractice insurance to cover them.
Behind the crisis facing the Hadassah lie years of underfunding and privatisation of Israel’s health service. None of this has been resolved. All Israelis are required to take out a health insurance policy that entitles them to the same Uniform Benefit Package with one of the HMOs. The HMOs are ostensibly regulated, with the government providing top up funds as the actual cost of treatments is less than that paid for by the HMOs, up to about 30 percent, leading to massive deficits, cutbacks, overcrowded facilities, and long waiting lists.
The HMOs have also encouraged people to take out private insurance, diverting more than US$2 billion to private medicine that feeds parasitically off public facilities.
Hadassah’s current contracts with HMOs, set to last for another three years, are grossly underpriced, leading to mounting losses. As well as losing money on every patient treated, the hospital has also lost funding from its owner, the US-based Hadassah Trust, and as a privately owned hospital, does not get the same level of government support as public hospitals.
Total health spending, public and private, is about 7.5 percent of Israel’s GDP, less than the OECD average of 9.5 percent. Israel ranks below the OECD average in terms of total health spending per person, at US$2,165 in 2010, compared with an OECD average of US$3,268.
Hadassah’s financial crisis is not unique. Another Jerusalem hospital, the Bikur Holim, is to close and merge with the Sha’are Zedek Medical Centre, with a loss of 200 jobs. All 560 Bikur Holim workers are to be fired, with only 360 being rehired. They too went on strike last year when they did not receive their September paychecks.
The unions, organised under the umbrella of the Histadrut, have refused to mount any defence of medical workers or the right to decent health care. The Histadrut’s record is one of betrayals and sellouts. While Histadrut’s chairperson, Ofer Eini, threatened several times in the last few years to call a general strike, he did so only twice. He played a key role in ending labour conflicts such as the protracted 2007 teachers’ strike and the university instructors’ strike.
It was the Histadrut that threw Netanyahu a lifeline after his narrow election victory. Eini engineered the alliance between Netanyahu and the then-Labour Party leader Ehud Barak, providing him with a more reliable coalition partner than the alternative at the time, Kadima, which had split from Likud in 2005. This enabled Netanyahu to pursue his right-wing economic agenda that has resulted in Israel being at the top of international league tables of social inequality and poverty among developed nations, and brought hundreds of thousands onto the streets in 2011 over the soaring cost of housing.
Israel’s politics have long been dominated by the Palestinian conflict, rabid nationalism and “existential fears” provoked by unsubstantiated claims of Iran’s nuclear weapons, in no small measure to divert attention from domestic conflict. Recent events show that in Israel, no less than its Arab neighbours, class issues are now coming to the fore.