Circles of Exclusion: The Politics of Health Care in Israel

Foreword

Foreword 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 of the impact of neo-liberal market policies that are currently being imposed on health care throughout the globe. In both countries we see a decline in concern and funding for public health and the exclusion of the poor racial and ethnic minorities from increasingly privatized health care systems in which the survival of profit-making enterprises seems to be the paramount concern. Using the Israeli example as a case study, Dr. Filc raises questions about the very future of egalitarian notions of health and social services in af- fluent industrialized societies that have become more concerned with the wealth than the health of the species. And he does so by tackling a subject x Foreword that is of interest to anyone—Jew or non-Jew—who is concerned with the fate of the first and only Jewish state in the world. Circles of Exclusion tackles these issues with both passion and scholarly rigor. Dani Filc is a practicing physician, and an Israeli citizen who has a firm identification with the Israeli state. He is also a scholar and a social justice/public health activist and advocate. Dr. Filc in fact emigrated to Israel from Argentina and was promptly integrated as a citizen and a professional under the Right of Return policy, which awards citizenship to any Jew who desires it. He knows what it means to have voluntarily chosen the land of Israel as his own. As someone who tried to serve the poor and underserved in his own native country, he was also deeply impressed with the commitment to egalitarianism and social solidarity he encountered when he first came to Israel several decades ago. Today he is deeply concerned about how the current market-oriented health care theories are undermining the very ethical concerns and principles that were embedded in this early Zionist model. In spite of its collective roots, the Israeli health system now increasingly mimics some of the worst aspects of the American privatized system. Dr. Filc grounds his analysis on classical public health theory. For the poor and elderly Jewish citizen, for the Bedouin in the unrecognized villages , for migrant workers, and for Palestinians in the occupied territories, myriad resources—financial allocations from the state, high-tech and tertiary facilities, safe water and sewage control, specialty services, roads and transport to medical facilities, as well as the social determinants of health such as education and decent employment—are all difficult or impossible to access. For a public health advocate like myself, the message of this book is crystal clear. Obsessive preoccupation with free-market formulas are intensifying social and health care problems in industrialized countries, not resolving them. Of course, Filc shows us how this has happened in Israel, which because of its history puts a very specific spin on the problems of the poor, the old, racial and ethnic minorities, and the new migrant working class that crisscrosses the globe. Nonetheless, in Israel and elsewhere, preoccupations with profit are crowding out concerns for the classic social determinants of health and, as Dr. Filc points out over and over again, are not saving money but actually wasting it. The final echoes contained in this book regard the inevitable lessons about the links between military occupation, health care, global health, and Foreword xi global peace. Indeed, as Dr. Filc explores the close connection between the Arab-Israeli conflict and American military support, anyone who has been fighting for a more just and accessible health care system in the United States cannot help taking note. Not only does Dr. Filc elaborate how health care has become another weapon in a seemingly endless conflict, he also points out the tragic consequences of spending billions on military hardware and personnel rather than on the provision...