Up until a few years ago, the National Religious Party (NRP) controlled 98 percent of the appointments to the religious councils, griped a senior official in the Prime Minister's Office this week, in response to the repeated criticism of his office for filling the religious councils with Likud political appointees, "and no one said a word."
On the surface, the official is correct, but he is overlooking the element that makes all the difference. In the case of the NRP, the appointments served to strengthen MKs and ministers from a small party. Today, the Prime Minister's Office, with the encouragement of MK Omri Sharon, is using the appointments to determine who the next prime minister will be.
The economic policy plan approved by the cabinet last week will enable the Prime Minister's Office to make approximately 270 political appointments to religious councils, half of them with hefty salaries, if it is approved as part of the Economic Arrangements bill.
There are 134 religious councils operating in Israel. The term religious council is actually used to describe two things: one is general - the system of local religious services headed by the council chairman. The other is the council itself. The panel is supposed to be changed after every municipal election. In reality, only around 50 council panels have been configured since the last local authority elections in 2003.
Last year, the Economic Arrangements Law for the first time granted the prime minister (who serves as minister of religious affairs) the authority to appoint two deputies, one with a salary, instead of selecting a religious council. Sharon has so far exercised this right in around 30 councils. According to the cabinet decision of last week, on June 1, 2006, all of the elected councils will cease to exist and Sharon will be able to choose heads for all the councils.
A team working out of the Prime Minister's Office is preparing a comprehensive reform of the religious councils, to merge numerous councils into regional councils. Doesn't the cabinet decision contradict these reforms? No. The decision is simply plan B. If the reform is approved in the cabinet and the Knesset, the religious councils will cease to exist in their current form and they will be headed by professional managers - many of whom will incidentally be political appointees. If, as expected, the big reform does not pass, the Prime Minister's Office intends to use the Economic Arrangements bill to embark on a mini-reform, and as part of that, the elected councils will cease to function and be replaced, many by political appointees.
Officials in the PMO say that experience has proven that appointees function better than elected council heads. And in addition, the minimum requirements that can be asked of them, such as higher education and previous experience, are greater. The director of religious services, Meir Spiegler, says, "The root of the problem with religious services is the political structure," and that professional appointees will resolve this problem. According to him, "I haven't received instructions from Omri Sharon. As far as I'm concerned, I work only with the prime minister's adviser."
The legal adviser of the Shas Party and many of the religious councils, attorney David Glass, is convinced that there isn't a majority in the Knesset to get the reform passed. "I don't believe it'll pass. It's bubbe meises (old wives' tales), a lot of nonsense," he says.
Senior officials will be removed
The committee to update the basket of health services is the most important allocations committee in the country. It is important not only because it allocates millions of shekels each year for the purchase of drugs and medical technologies; and not only because every decision it makes puts a drug or treatment into the basket of services for many years, and therefore the sums involved are not in the hundreds of millions of shekels, but in the many billions of shekels. It is important primarily because every decision it makes affords life and quality of life to hundreds and thousands of people.
The committee members determine who will live and for how long, and how much pain and how many side effects patients will suffer. Against this backdrop, the makeup and status of this committee is of very great importance. The series of investigative reports, "Haaretz Report - Basket of Health Services," written by Haim Shadmi in 2001, exposed a series of flaws in the composition and working methods of this committee.
One flaw is that this very important committee does not have any official status. The good news is that as part of the economic and political plans for 2006, the committee this week received official government recognition for the first time.
Another problem uncovered in the investigative reports was that many committee members are senior managers in the health maintenance organizations and hospitals. They represent the interests of these organizations no less, and sometimes much more than those of patients. The recent cabinet decision stipulates, "A representative who works in any capacity for a health maintenance organization or hospital shall not be appointed to the committee." This is a major change.
Yet another problem is the extreme pressure exerted on the committee by the drug companies, the dirty tactics they use to get the committee to buy their drugs and treatments, and the perks they give physicians. The cabinet's decision to bar Health Ministry employees from accepting gifts and benefits from drug and medical equipment manufacturers represents a partial solution to this problem. Why is it only a partial solution? Because doctors can still work in the future as paid consultants for the drug manufacturers, write medical opinions in praise of them and promote their interests in the basket of health services committee.
In 2001, the committee included no less than ten representatives of the public. Haaretz criticized the fact that many were not actually representatives of the public, but rather senior officials in the health establishment.
The doctors have taken over
The current committee has seven representatives of the public, as well as some doctors. Now the cabinet has decided that in the future, the committee will have 12 members, not one of them a representative of the public, and that there will be only one ethicist among them.
On the other hand, there will be three representatives of the Ministry of Health, one representative of the Finance Ministry, six doctors and two health economists. In other words: there will be almost no one representing the interests of the public, looking out for ethical considerations and ensuring adherence to the rules of proper administration.
Prof. Avi Ravitzky of the Hebrew University of Jerusalem, who has been a member of the committee to update the basket of health services for many years, says, "It sounds shocking to me. The main questions facing the committee are not professional in nature, but rather a matter of ethical and moral priorities. Therefore, the committee has to have philosophers, halakhic experts, ethicists and sociologists. Doctors needn't comprise even half the committee members." Ravitzky cautions that the committee discussions can turn into "negotiations between doctors and economists. The public must protest this at all costs."
Here's the mystery. Ostensibly, the proposals in the economic plan are submitted by the various ministries for comment. However, the Ministry of Health refused to comment, arguing that there were still differences with the Finance Ministry with regard the makeup of the committee. This means that the new makeup of the committee approved by the cabinet is not acceptable to them.
Who needs representation?
The investigative series, "Haaretz Report - Who is a Citizen?" that I wrote in May 2005 dealt, among other things, with the insufferable ease with which Israeli citizenship is annulled. This is a process that starts with an inquiry by the population registry and ends with the conclusion that citizenship was obtained fraudulently.
The population registry appeals to the citizenship revocation committee to rescind citizenship. It decides, in a non-judicial process that lasts an average of ten minutes. In many of the cases, the person suspected of fraud is not summoned to appear before the committee. In almost all cases, he is not represented by a lawyer, even though this is a matter that is liable to completely change his life. The committee's recommendations are subject to the approval of the interior minister. In many cases, the person's citizenship is revoked after he and his family have already been here for many years.
This week, the Ministry of the Interior circulated a memorandum on the proposed bill on revocation of citizenship. Instead of transferring the authority to revoke citizenship to the courts, as many in the political establishment are demanding, the bill actually grants official status to the citizenship revocation committee. The new bill also does not obligate the committee to summon the person suspected of fraud to appear before the committee, nor does it require it to grant him legal representation. In other words, the bill only worsens the existing situation, because it entrenches it into law.
The Ministry of the Interior said in response, "A recommendation to revoke citizenship that was obtained fraudulently is made only after a thorough review by officials from the population registry, including a hearing, and only if there is absolute certainty that false details were indeed submitted." The ministry said, "Since the formation of the committee, there has been a gradual decline in the number of revocations of citizenship which has peaked during the tenure of the current minister, Ophir Pines-Paz."
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