JERUSALEM — When the cosmetics salesman from Petah Tikva rolls his Toyota out of the driveway each morning, he does not worry about the Palestinians, the Trump Middle East plan or tensions with Iran — the issues most of the world thinks of when it thinks about Israel.
No, Ronen Yom Tov just thinks about traffic.
And he has plenty of time: It takes him half an hour just to reach the highway four miles away.
“It’s one enormous jam with no end in sight,” he said.
That about sums up all of Israel. And it’s not just the traffic.
Even as Israel has matured from a small, desert nation fighting for its survival into a regional power with an enviable high-tech industry, it has neglected the transportation, education and health-care systems that experts say are vital to its prosperity.
As the country holds its third election in a year, major challenges in each of those areas have drawn precious little attention. Experts warn that without investing heavily, Israel’s ability to keep up with the rest of the advanced world faces a reckoning, and they question whether the country’s fractured political system is even capable of addressing such long-term problems.
“I don’t think that we’ve absorbed the fact that we’re no longer a couple million people growing slowly — we’re a nation of nearly 10 million,” said Jon Medved, chief executive of OurCrowd, a tech investment company in Jerusalem. “We’re passing Sweden. And we’re not set up to deal with this.”
Politicians have begun to catch on: The main challenger in the election, Benny Gantz, promised to build two new hospitals; Benjamin Netanyahu, the embattled longtime premier, rushed to lay the cornerstone for one that had been promised since 2014.
But analysts say that Israel’s multiparty coalitions are too unstable and its ministers too shortsighted to embark on ambitious projects that will require tax increases now but only reap results far into the future.
And the problems are already here.
Thousands of patients a year are dying from infections in Israel’s hospitals, the most overcrowded in the developed world.
Billions of dollars in economic output — more than Israel’s yearly gains — are going up in fumes as motorists sit in traffic, with no other way to get to work.
And test scores show the schools are failing to prepare students for a modern work force. The achievement gap between rich and poor children has only widened, and an accelerating brain drain is causing some of Israel’s most valuable scientists, doctors and innovators to take their talents overseas.
By some measures, the economy is going strong. Unemployment is at a record low. Wages are rising. And the tech sector is so successful it earned Israel the nickname “start-up nation.”
Israel’s daunting challenges arise partly from its vitality: The fertility rate of 3.1 children per woman is the highest among advanced countries, contributing to a population growth of more than 200,000 annually.
“That’s a new city every year,” Mr. Medved said. “A city needs a hospital, right? A city should probably have a university, or a college at least. A city needs roads.”
Karnit Flug, governor of the Bank of Israel from 2013 to 2018, traced Israel’s neglect of vital civilian spending needs to a belt-tightening that began in the early 2000s, after the dot-com bust.
“They sort of got carried away with themselves,” she said. “The diet went on for too long.”
But investment in health, transportation and education had been declining since the 1970s, when critics say Israel began to prioritize tax cuts, welfare for ultra-Orthodox Jews who study in religious institutions rather than work, and expanding settlements in the West Bank.
The 1970s now look like a crucial pivot point.
Hospital capacity, 3.3 beds per 1,000 residents in the 1970s, has fallen to 1.7 beds now. The number of senior research faculty per capita is half its 1975 peak. Congestion on the roads was about as bad as in Denmark or Belgium; it’s now four-and-a-half times worse.
Per capita economic growth also plummeted: After averaging more than 5 percent a year, it fell to about 1.8 percent in the 1970s, where it remains, according to Dan Ben David, a Tel Aviv University economist.
“There’s a huge iceberg ahead,” he said. “And we need to shift the entire course of the ship back to the trajectory that we once were on.”
‘No end in sight’
Israel’s traffic is the worst among advanced economies by a mile. The Finance Ministry says congestion costs the economy more than $10 billion a year.
For Mr. Yom Tov and his colleagues at a small cosmetics company, lost time and blown meetings — not to mention frayed nerves — cost the company about 10 percent of sales, he said, inching his Corolla forward on a drizzly morning.
Public transit, where it exists, is even worse: Lacking dedicated lanes, buses crawl, making riders wish they had walked. Those braving the trains commiserate over their inability to find parking at commuter lots, let alone a seat on jammed trains.
“People are standing above each other’s heads,” said Hadar Israeli, a lawyer who moved to Givat Binyamina, 40 miles north of Tel Aviv, from the Bronx in 2018 and says she misses the New York City subway.
Israel needs to spend billions to catch up to other advanced countries, studies show. But the projects underway — a first light-rail line in Tel Aviv, an expanded light-rail network in Jerusalem — only scratch the surface.
Easing a crucial railroad bottleneck in central Tel Aviv would require rerouting a river. Building a true subway system for Tel Aviv would be a mammoth undertaking, but the municipalities involved can’t even agree on forming a regional authority.
Planned projects, a comptroller’s report said last year, are “not expected to address the foreseeable problems in the foreseeable future.”
Israel didn’t think much about rapid transit until the 1990s and didn’t start investing earnestly until the 2000s.
“What was done was done too late, too slowly and with too small a scope,” the Transportation Ministry acknowledged in 2012.
A siloed government doesn’t help: The Housing Ministry races to build apartment towers, but doesn’t consider how or when residents will commute. So in big new planned cities, like Modiin, one-lane access roads are overwhelmed as soon as families move in.
In Hadera, a beachfront neighborhood was built across a highway from the rest of the city, tethered by a skinny overpass. A hospital is a mile away, but ambulance drivers say they can’t get to it in less than 20 minutes. And new apartment towers are still rising.
Making matters worse, Israelis and their government have become addicted to cars.
The government gets about 15 percent of its taxes from the auto industry, a third from imports, which are taxed at 60 percent. A host of subsidies encourage workers to buy or lease cars in lieu of compensation.
“Sometimes you don’t need a car,” said Yoram Ida, a transportation researcher at Sapir College. “But if you don’t have a car, you don’t get this incentive.”
The result is a car culture more appropriate to 1960s Southern California than to a cramped country that needs to build up, not out, said Moti Kaplan, a leading Israeli planner.
“We need the dream of Manhattan,” he said, “not the dream of Los Angeles.”
‘Starved for too long’
Israel’s hospitals are dangerously overcrowded and understaffed. Citizens who grimly count the toll of wars and terrorist attacks now share battle stories of surviving the health-care system.
Victoria Duek, 97, languished for 48 hours in a crowded Haifa emergency room after falling and having trouble breathing. A Tiberias hospital has a two-year wait for tonsillectomies. The Nahariya hospital was so overcrowded it asked for donations of blankets.
The ultranationalist politician Avigdor Liberman said his 91-year-old mother-in-law was told she would have to wait for months for an urgent MRI.
“After four months, a person does not need an MRI,” he told a radio station. “Either they’ve recovered or, God forbid, they’re dead.”
Israelis are guaranteed basic coverage under a national health system and are often happy with the care they eventually get. And the country spends a remarkable 7.5 percent of its economic output on health care, according to the Organization for Economic Cooperation and Development, far below average for advanced economies.
But critics say that statistic has become a cruel joke.
Dr. Erel Buchinsky, former head of the medical residents’ association, compared his frequent 26-hour shifts to “working in a mass-casualty event,” prioritizing patients who might live over those more likely to die.
“It’s a horrible reality, and it doesn’t have to be this way,” he wrote in a viral Facebook post.
The 94 percent average occupancy rate in Israeli hospitals is by far the highest in the developed world. The logjam extends throughout the system: Geriatric centers, rehab facilities and local health clinics are all overbooked.
A six-minute doctor’s exam, with any eye contact, is a luxury. Specialists make appointments as far as a year in advance. Israel’s doctors are aging out, there aren’t enough medical-school graduates to replace them, and many aspiring doctors are moving to Europe to study, never to return.
“The health system was exemplary some years back,” Ms. Flug, the former central banker, said. “It has been starved for too long.”
At Hillel Yaffe hospital in Hadera, Rotem Novoselsky is head nurse in an internal medicine ward built for 36 patients; it often handles 60. Patients there are routinely discharged while still sick.
She arrives some mornings to find patients overflowing on gurneys end-to-end in the halls, even in a dining area. With just three nurses on the overnight shift, she said, she sometimes discovers patients who have died unattended.
“We work in a state of frustration all the time,” she said, briefly standing still.
With I.C.U. beds scarce, patients on ventilators are left in ordinary wards, and those recovering from surgery often languish in corridors. Experts say the overcrowding is causing the rate of infections to skyrocket: The mortality rate from infections, 38 deaths per 100,000 patients, is by far the worst among economically advanced nations, according to the OECD. (The United States, at 22, is second.)
“People are losing their dignity,” said Dr. Zeev Feldman, a pediatric neurosurgeon. “And it kills people. There is no other way to say it.”
Government funding has failed to keep pace with a growing, aging population, falling from about 75 percent of total health expenditures to about 65 percent. That erosion has worsened inequality and undercut efficiency, Prof. Nadav Davidovitch, a public-health scholar at Ben-Gurion University, testified last year.
“That’s the whole story in short,” he said.
Dr. Feldman say it will cost Israel $6 billion more a year to catch up to the developed world, but Israelis are too willing to count their blessings rather than lobby for change.
“Patients and families are very angry at what they encounter,” he said. But, he added, referring to the Jewish prayer of gratitude for averting disaster, “when they go home, they’ll pray hagomel and continue with their daily life.”
Poor teachers, failing schools
Israel now spends more on education than on its military. But the schools are failing, experts say, with ominous consequences not far ahead.
Scores on the latest international assessment test, which measures reading, math and science, were among the worst in the advanced world — and they don’t include ultra-Orthodox boys, who barely study those subjects.
A key reason is teacher quality. Israel’s teachers score near the bottom of international tests of literacy and numeracy. Starting salaries in elementary schools are around $21,000, about half what American schools pay.
Continuing education for teachers is poor and subject to the whims of each new education minister, insiders say. And teachers are increasingly subjected to violence — from students and parents — with little backup from superiors.
Worse, the country’s attempts to fix the schools have tended to dumb them down, experts say. English is required, but many students graduate with too few English credits to enter a university. Matriculation tests are not calibrated year-to-year, so politicians wanting to show improvement have just made them easier.
To its credit, Israel expanded access to college with the proliferation of less rigorous “academic colleges” starting in the 1990s. But they are doing a dubious job, turning out battalions of law-school graduates, for example, who cannot pass the bar.
Teachers and principals complain of a lack of autonomy, with national officials dictating lesson plans down to the hour, said Ram Shmueli, a longtime education activist. Four out of five new teachers leave the field within five years.
“They know the salaries are low,” he said. “They come to be teachers because they want to influence society. But if we don’t give them any freedom, they will run away.”
The test scores also show widening disparities between Hebrew- and Arabic-speaking pupils, and among Hebrew speakers from different socioeconomic strata.
One reason is that Israel distributes an increasing amount of its education funding through matching funds, which are only available if a municipality puts up its own share. Principals love this money because they can use it for almost anything, but poor towns can’t afford it.
Southeast of Beersheva, Hatem Abu Queder, the principal at a crowded Bedouin school, papered the inside of a trailer with posters of the space shuttle and the solar system and says he dreams of taking kids to visit NASA. But he gets no matching funds.
Everything he has — a weather station, a dance studio for girls too shy to run around with the boys — was built with donations from the village’s impoverished families.
The better-off spend heavily on tutoring. Jewish scouting programs build leadership, self-discipline and teamwork. And elite army intelligence units have stood in for universities, cranking out future start-up C.E.O.s. But those routes are generally closed to Arab citizens.
High-tech executives say Israel is in no danger of running out of super-talented math and science students.
“The issue is not the crème de la crème — it’s the education of the masses,” said Prof. Amnon Shashua, co-founder of the autonomous-driving giant MobilEye. “Whatever you do, it’s never a one-man job. You need support from many other people, not only the brightest.”
Economists warn that Israel is splitting into two economies — the booming high-tech sector, which accounts for about 9 percent of jobs, and everything else, which is dragging down productivity rates.
Some, however, see danger signs even at the top of the educational ladder.
Dan Shechtman, a Nobelist in chemistry in 2011 who chairs the Wolf Foundation, which promotes excellence in science, worries that Israel’s future geniuses will win their prizes elsewhere.
“We don’t allow them to come back,” he said because the country has few advanced labs to employ them. “We need them back.”