When should Englman’s report have been published?

What does State Comptroller Matanyahu Englman’s first report since taking office tell us about the coronavirus, how he will define his term and how that term will be radically different than the last 12 years of comptrollers?

There is an ongoing debate about whether he is too close to Prime Minister Benjamin Netanyahu and bending over backward to avoid negative publicity of his sponsor for office, or whether he is reining in a Comptroller’s Office that had been exceeding its mandate by entering politics.

The first issue to note about Englman is about what did not happen.

His critics point out that he issued no reports from July 2019 until Monday.

They paint him as stalling and diluting criticism of the government in reports that his predecessor, Joseph Shapira, had started but had not shipped out the door.

Englman sent a draft of his report warning that the healthcare system

has been left badly unprepared for any coming pandemic (which turned out to be the coronavirus) in November 2019.

Critics say once the coronavirus crisis started making headlines in China, the comptroller should have rushed out his report to help push the Netanyahu government to race forward with fixing areas where the system had inadequate supplies and personnel.

By the end of January, there was already a ban on flights from China, and by February 17, there was a ban on flights from several East Asian countries.

Sources with knowledge of the report defended Englman, saying until the World Health Organization declared the coronavirus crisis a pandemic on March 11, it was not clear how massively it would hit Israel.

They say almost all of the most dramatic measures of closing schools, businesses, malls and synagogues only came after March 11, and with the report being sent to the press on March 17, Englman acted fast (the delay from March 17 is typical for comptroller reports to allow reporters time to process the huge documents).

CRITICS SWAT away these defenses and say the threat was clear by January, and the delay showed a desire to cover for Netanyahu and Health Minister Ya’acov Litzman, but holding the report until its original May publication date would look ridiculous.

Sources with knowledge of the report also say there was internal pressure from the Comptroller’s Office staff to get Englman to publish the report sooner.

Also, by February 27 there was the first ban on a European country, Italy, and by March 4, several other European countries were banned.

One metaphor that was used, quoting a former comptroller, was that if a rock starts falling down the mountain, you do not wait to act or evacuate until it gets close to the potential victims at the bottom.

Shapira and his predecessor, Micha Lindenstrauss, both attributed specific responsibility to officials for policy failures or corruption.

Englman has openly opposed this, saying this tactic leads to government officials giving less complete cooperation to the comptroller for the real fixing of problems.

He has also said past comptrollers naming names often paralyzed ministries into inaction because no one in the ministry wanted to be on record for making a controversial decision.

According to Englman’s defenders, government officials need to be able to make hard decisions for the good of the country and, as long as they are acting in good faith, not worry about whether they will be publicly embarrassed if their decisions do not work out as planned.

If government officials think they will be publicly embarrassed, this promotes mediocrity and fear of daring moves, which might sometimes be necessary, according to Englman.

Critics say the opposite: Failing to name names allows mediocrity, cover-ups and sometimes corruption because bad-apple officials can use the shield of a ministry’s anonymity to avoid being called out.

They say naming officials who failed has proven to be far more effective in motivating them to carry out reforms than hoping for them to act out of an inner commitment to what is best for the country, even if it goes against their personal agendas.

THERE ARE also disagreements about changes to the report between the drafts and the final published version.

For example, sources with knowledge of the report say earlier drafts slammed the political class for overly intervening in aspects of the Finance Ministry’s apolitical decision-making processes.

Sources from Englman’s side say many views go into drafts of reports, and only the final version is authoritative, culls together all the disparate views and speaks for itself.

Critics have been concerned that Englman would mostly praise Netanyahu and his government and avoid noting deficiencies.

In fact, Englman’s defenders stress the report notes many deficiencies and believe his predecessors did not fully observe the comptroller’s mandate to note not only negative trends but also positive ones.

His critics say even if Englman’s report notes deficiencies, their proportion and tone are watered down.

Englman’s supporters say simply because he may express himself in a less argumentative and confrontational tone does not mean his highlighting of deficiencies is any less effective.

Sources close to Englman also say his report summaries combined with helpful videos are far more digestible for the press and the public than his predecessors’ report summaries, which few could unpack.

There are also other disputes about whether it is good or bad to be critiquing ministries in real time versus producing either forward-looking reports or reports looking back at an event that has ended.

Moreover, there is an ongoing dispute about whether a committee, whose members Englman altered, will be allowed to green-light Netanyahu to have his public corruption defense legal fees paid for by a tycoon friend, after the same committee under the old comptroller rejected the request three times.

One great thing about the comptroller’s arena is that eventually, reality sorts out in black and white whose approach worked and whose did not.

In another year or so, it will be clear whether it was Englman or his predecessors who were more effective in improving the country. • other major outbreaks. It also showed that hospitals are overcrowded year-round.

The prime minister was quick to respond that the report is irrelevant to the current coronavirus outbreak, “as there has been no such event in the last century and no country in the world could have predicted or prepared for the spread of the virus,” while claiming that under his tenure the health system in Israel has been “significantly improved.”

But Rosner said that the report “sheds a bright light on Israel’s unreadiness for this epidemic.” He said that some people have referred to the novel coronavirus as a “black swan,” but he disagrees, pointing out that this type of epidemic occurs in cycles of about three times each century, and health professionals know that.

“The report acknowledged that the system is overloaded, which we have said many, many times,” he said, meaning that, “there are no reserves whatsoever in hospital beds or ventilation machines – which means that effectively, when we do have to address this pandemic, everything else has to be stopped and delayed because now you need to direct all your medical staff toward this pandemic.”

Israel had to quickly postpone all voluntary medical procedures and canceled any non-essential surgeries or other health visits.

Moreover, Rosner explained that public healthcare does not center only around hospitals and clinics but also preventative medicine, public awareness and health literacy, all of which the report indicated were challenges.

For example, the report said that during the recent global measles outbreak in 2018-2019, Israel had the seventh highest morbidity rate worldwide. Some 60% of 4,300 infected individuals were children aged up to nine years old. Three Israeli citizens died during the outbreak.

Moreover, following a growing trend of anti-vaccine sentiment, the Health Ministry estimates that a total of 1.1%-1.7% of the population is not vaccinated against measles today, compared to 0.6% in 2011. During the recent measles outbreak, among infected patients aged between two and 19 years old, at least 49% were children of vaccine refusers. Half of all those infected were residents of Jerusalem, of which 80% were from the ultra-Orthodox Jewish community.

Rosner said that communication between all minorities and subcultures and the Health Ministry is lacking and therefore all the populations that are in the periphery of society were even less prepared. The government is struggling to obtain their adherence.

“The level of health literacy is low, which means they are not following the guidelines, even ones that are crucial for them to follow,” Rosner said. “Their level of accessibility to the Health Ministry and their ability to prepare for quarantine is very low.”

For example, quarantine requires that people have a separate room for anyone infected or potentially infected, which does not exist for many communities – and it is unclear what alternatives exist for them.

Many in the haredi (ultra-Orthodox) and Arab communities have ignored government directives to remain at home, and police have been called on multiple times to break up large gatherings by members of these communities.

Rosner said that there is “no strategic planning in healthcare.” He compared this to the Defense Ministry, which recently released a five-year strategic plan that consists of its vision and goals.

“One of the reasons for that is that the budget is so small for the HMOs that they are already so overloaded; all of their financial resources are for the here and now, and not for what is needed in five or 10 or 15 years, which could be a pandemic,” he said.

According to Rosner, every year the Health Maintenance Organizations have to appeal to the Finance Ministry for additional funding just to pay for their day-to-day operations.

“Investing in a 10- or 15-year plan or innovation or infrastructure? It is almost difficult to imagine,” he said.

Health Ministry Director-General Moshe Bar Siman Tov promised to “study” the comptroller’s report and learn from it.

In the meantime, as Ben-David explained, “Israel is suffering from the lethal combination of the highest hospital occupancy rates in the entire developed world alongside one of the lowest rates of nursing staff per capita in the developed world to care for them. So, we are shutting the country down to deal with something that we neglected for decades.” •