Expect no sob stories from Marcie Natan.
That’s just not the way the national president of Hadassah rolls.
The top executive of the mammoth women’s Zionist organization might well have a handful of such stories — the nearly three years she has spent as president have been far from peaceful — but she prefers to regard them as challenges rather than problems.
She is not soft-peddling Hadassah’s issues.
Recent years have seen the Hadassah Medical Center in Israel — funded by philanthropy raised by mostly American Hadassah members — faced with crippling deficits, widespread labor strikes, media criticism and resistance from Israeli politicians so far unwilling, or politically unable, to help bail it out.
The organization has also yet to fully recover from significant losses caused by its investments with Bernie Madoff, the Ponzi schemer now serving life in prison.
Natan is far from undeterred by these challenges but insisted in an interview this week that she’s not only willing to fight for the organization but that she’s very gratified to be fighting these battles today, when Hadassah is facing some of the most daunting issues it has ever faced.
“I fought for the position,” she emphasizes when asked about how she came to be president in 2011.
An early childhood educator, she has raised a family, taught Hebrew and Sunday school and operated a small manufacturing business, which she eventually surrendered in favor of ever-increasing Hadassah obligations.
She has, in fact, been active with Hadassah for more than 40 years, starting with her leadership of her home chapter in Eastern Pennsylvania, leading to a host of national positions, including treasurer, vice president, secretary and chair of planned giving and estates.
Natan is an longtime friend of Denver Hadassah leader Sandra Schiff — “who I met holding up a wall at a Hadassah event many years ago” — and spent last weekend here, speaking to members of the Denver and LEA chapters, leaders of the Boulder and Colorado Springs chapters and headlining a community-wide event at Temple Sinai.
Natan — smooth, articulate and poised — gave the following interview to the Intermountain Jewish News.
IJN: How difficult has this job been?
Natan: “It has been extremely challenging. Even serving as national president when things are relatively quiet is a full-time, very demanding job. Nobody believes me when I say that I am thrilled to be the president now.
“By nature, if I’m going to do something I want it to really make a difference and I think because this is such a pivotal time for the organization and the hospital that it will make a difference that I am serving now.
“I believe I have the temperament to deal with the constant crises that we’re in, with the negotiations that are painfully slow and yet delicate and need full attention, need to be weighed very carefully from one meeting to another.
“So it’s totally consuming. I’ve all but put my personal life on hold, but I feel privileged and indeed honored to be serving now.”
You seem very confident, to be captaining this ship rather well.
“Another thing in my background is I am a trained mediator.
“In Lancaster, Pa., there are a lot of Amish and Mennonites and the Mennonites are very heavily vested in the concept of mediation. They have been going into places like South America and all over the world for many years and they did a training session. I qualified and then did mediations through the Mediation Society in Lancaster.
“That little piece of something has been very helpful over these last couple of years.”
Have the majority of the challenges you refer to had to do with the Hadassah Medical Center in Israel?
“It’s a very big thing because nobody questions that there will continue to be a Hadassah Medical Organization in Israel at the end of this crisis.
“The question is, what will it look like? Will it be just another community hospital?
“Will it be the esteemed research and teaching center that it is today?
“It is very consuming but I will tell you that there are other aspects of what is happening at Hadassah that are extremely important as well. We have a membership of 330,000 — members, associates and donors — in the US with international members as well, from Europe, South America, Australia.
“Bringing the next generation along, connecting them to Israel and to the Jewish people and to a commitment to organizations, not just Hadassah, is something that we are very focused on, at the very same time that we are dealing with the issues relating to the hospital.
“I’m kind of managing things on two fronts. I do have a very effective executive director. I have a volunteer who works very closely with me and they are managing a great deal on the American side while I am spending enormous amounts of time in Israel.
“At seven o’clock this morning I was on the phone to Israel. I’m always on the phone with Israel at seven o’clock in the morning.
“Hadassah is a large, complex organization and this is right now the biggest piece of it.”
Hadassah Medical has been criticized for inefficient management practices, for fiscal practices, for “hubris,” as one article put it. You have responded to some of those criticisms by saying those things need to be worked on; on the other hand, the State of Israel has a huge piece in this too. Could you encapsulate the conflict and your opinion about the long-term viability of the medical institution in Israel?
“I will never say that there is a party involved in this that is without any responsibility. We all have made mistakes. When we say we’re going to fix them and it almost sounds like we’re glossing over it, it is because until we can negotiate an approach, a settlement that will allow the hospital to move forward, nobody has the time or even the ability to know what it will look like.
“We are working — Hadassah, the Women’s Zionist Organization of America — directly with the government, primarily with the Ministry of Finance but also with the Ministry of Health, to find the ways to ensure that there will be a fiscally sound hospital moving forward.
“We are looking at, among other things, the structure of the HMO board, the governing body, and how to strengthen it so that some of the issues that allowed this to happen will be better controlled than they have been in the past.
“But more than 50% of the ongoing deficit of the hospital can be directly linked to the fact that Hadassah’s reimbursement by the health funds in Israel is significantly less than that of any government-owned hospital or health fund-owned hospital.
“Why? In part, because at the end of the year, all of the hospitals are in deficit. The health system in Israel is not functioning well. We won’t discuss the health care system in this country, but theirs is not functioning well. They [the Israeli government] wipe out the debt of both the government-owned and the health fund-owned hospitals.
“Hadassah gets nothing. Whatever the deficit is remains.
“The way the health funds work is that there are contracts that are opened every three years. Each hospital negotiates with each of the health funds to establish the level of reimbursement that they will get.
“In an effort for Hadassah to be attractive for the health funds to send patients to us, we gave deeper discounts than either the government or health fund hospitals gave.
[Natan adds that Israel’s policy of setting cost caps in reimbursing hospitals for medical services rendered is also a major factor in limiting Hadassah’s ability to obtain adequate compensation and recover debts.]
“If we were operating as a private hospital, we could simply say, ‘Sorry, we’re not accepting anyone who needs this particular procedure because it’s not cost effective for us.’ But we operate as if we were a public hospital. We follow all the regs of every other public hospital in Israel.
“We must have an emergency room, 24-7, on both campuses [Ein Kerem and Mt. Scopus, both in Jerusalem]. We accept everyone who comes through out doors and I don’t think anyone in Israel will argue that we get the hardest cases, the most difficult cases.
“We are seen as the hospital of last resort, and the cost for those patients is therefore more than serving somebody that comes in with something routine.
“Reimbursement is per bed, not per how the bed is used, and there’s a cap on the number of beds. So if we have somebody in what we refer to as a black bed — which is to say, it won’t be covered by anything, because [the government] will only cover you for 500 beds — what do you do? They’re in a bed, they are being treated and we are not being reimbursed.
“It’s a crazy system and that part of it, we believe, is the responsibility of the government. Their contracts expired in 2013. We should have been able to renegotiate more wisely and the government legally put a freeze on all health fund contracts. We cannot renegotiate contracts.”
“Well, that’s a good question and one we need to ask. Are we going to be able to open negotiations in three years? They’re not answering that question. It doesn’t matter. We will die before we get through another three years.
“We are working with the government to try and find an acceptable way, a creative way, for them to partner with us to take on some of the financial burden so that the hospital can continue.
“We are giving many additional compensations as well, including some of our assets. Today we got an outside appraisal of those properties.
“In fact, if we give those properties to the government, which we are prepared to do, I would argue that they’re not giving us anything. If they develop this land it will more than cover the money that we’re working to provide.”
How much of this is political, i.e., caused by a fiscally conservative government, and how much has this forced you to become a lobbyist or political activist?
“I don’t want to spend a lot of time on the politics in Israel except to say that the prime minister is one party, the minister of health and minister of finance are a different party. It makes it complicated, let’s leave it at that.
“We are well aware that in order for Hadassah to have support in Israel and to maintain the trust and support of our donors, we cannot just allow the press to trash our doctors, our institutions and our organization, and yet at the end of this, we must we able — as we always have, for 102 years — to stand with the government of Israel and move forward, all of us focused on the best health care for the city of Jerusalem and State of Israel and the impact that Hadassah research has on health care worldwide.
“It’s very complicated and we’ve lashed out at the government a bit, publicly.
“About a month ago we set up a tent across from the Knesset and asked people to sign a petition. We had all of the TV and radio and everybody else there.
“Last week we were on the Hill in Washington and asked members of Congress to write to the prime minister in support of Hadassah because we do understand that we cannot just allow the brouhaha to go without any kind of public response.
“The other piece of this very complicated situation is that our physicians, nurses and administrative workers — everybody from finance to HR to cleaning staff — are all unionized. And those unions are, as they should, fighting to get the best deal for each of their constituencies.
“At this point in time, we believe we have come to agreements that everybody can live with, both the nurses and administrative union; and there is still a significant gap between what the doctors and the government are expecting. But there are five doctor unions and there isn’t necessarily agreement even there.”
Is it correct to say that the bottom line is that the status quo is unsustainable, that it’s a potentially dire situation?
“You are not overstating it. This hospital must find a way by partnering with all of the political people — which now includes the government, the physicians, Hadassah and the management at HMO — if we are going to sustain this hospital with its unique qualities.
“We have five schools and the research that comes out of Hadassah is literally a revolving door between the clinical side and the research side, an approach that has been extraordinarily successful.
“We don’t believe that can be sustained if the hospital is taken over by the government because we can’t come to a resolution, or is somehow turned over to someone else to manage.
“We are fighting with everything we’ve got to ensure that Hadassah and its vision for the hospital will be sustained well into the future. I do believe that the government of Israel is behind that resolution as well.”
How well is Hadassah doing with the Gen-X’rs, the Gen-Y’rs, the Milennials or whatever name they’re giving to those who are, say, in their 40s or younger? Is it catching on?
“We are still very challenged in attracting that generation. We’re trying to restructure our national approach in terms of social media communication because we believe that is very much a component of getting that generation to at least know who we are.
“By the way, many of them are members. They’ll say, ‘I’m a life member. My mother or grandmother made me a member when I was born, when I was Bat Mitzvah, when I left for college.’
“But what can we do so that you’re not just a member, so that you understand that your generation, that is very focused on what’s in it for me, needs also to step out of that role and understand the connection to Israel and, as a Jew, being a part of a people and feeling responsibility to be there for those people?
“That has to come from you.
“You are that next generation, whether it is advocating with our government in support of Israel, or taking care of yourselves and being sure that you and your family will have what you need, whether it’s looking at issues that go beyond the Jewish community, like human trafficking or breast cancer and making sure that those who should be tested for BRCA 1 and 2 are tested, or equal pay for women, or gun control.
“What can we do, each of us in our own local communities, to make a difference under the auspices of Hadassah?
“How do we help this generation — and I have children, so believe me I understand what they’re juggling — to manage a chapter, have a couple events a year to get connected with like-minded Jewish women?
“Do we need better support in some areas? Do we need a better communication system?”
Are you optimistic or pessimistic about that at this point?
“Worried, but I think that if the kernel of understanding gets there now, there will be times in our life when we do have more time. You’re in your 20s, 30s, 40s, you are completely immersed in raising a family and taking care of the kids and managing a career.
“Then they’re off to college or you’re ready to retire. What are you going to do now with that time that you didn’t have before?
“If we started the conversation earlier on, I believe that many of them will find their way. We just have to have the right opportunity for them, so we’re listening to them all the time. What will engage you, what will connect you?”
Copyright © 2014 by the Intermountain Jewish News