Why NHI would be a nightmare – a rational case against universal healthcare in SA

In the short space of the last few days, South Africans have taken turns to enjoy what has become the luxury of electricity. On top of this, residents in parts of Johannesburg have on more than one occasion had absolutely no water. The failure to adequately provide citizens with these two very basic needs lies at the feet of our government. The same government that is pushing to universalise healthcare in South Africa. As Nicholas Woode-Smith points out in this article, parliament’s vision to emulate the healthcare system in the UK is patently flawed. Ridiculous, even. Inevitable brain drain and corruption are only two of the reasons that it would fail miserably and catapult our country into an irreparable crisis. Woode-Smith rightly states universal healthcare in South Africa is “unaffordable, something our doctors really don’t want to happen, potentially disastrous for taxpayers, and fundamentally flawed”. He furthermore offers practical, and more importantly, possible alternative solutions. – Nadya Swart

NHI will destroy South Africa’s healthcare

By Nicholas Woode-Smith*

The National Health Insurance scheme (NHI) is a foolish policy that can only result in further economic destruction, the end of competent healthcare, and the enabling of tremendous corruption in South Africa. The government’s insistence on continuing with such a policy shows a complete lack of understanding of the current state of South Africa and how its very proposed system will actually work.

NHI aims to create a universal healthcare system in which all South Africans can receive healthcare for free, utilising a new card system and being restricted to healthcare facilities near to their place of residence or work.

Already, there are moral flaws in this. Doctors can’t work for ‘free’. But somebody has to pay. And that person is a taxpayer who now will be forced to lose more of their finances to pay for the healthcare of countless people. Just because someone can’t afford a service doesn’t justify taking money from someone else to pay for it. A human right to healthcare doesn’t justify violating the human right to keep what one earns.

But even without the moral argument, the NHI collapses under the logic of reality.

As of the end of February, parliament concluded its public hearings on the planned NHI bill, pushing consideration of the policy into the next stage. This will involve a tour of the United Kingdom’s National Health Service. Already, this presents a danger as South Africans seek to adopt a system from a country with a fundamentally different context.

The UK is an advanced economy with leagues more development than South Africa. It is wealthier, has been politically stable for far longer, has better infrastructure, better administrators and medical practitioners, and simply exists in a very different type of society from South Africa. While the UK had a healthcare budget of £225.2bn (over R4.5trn) as of 2019, South Africa had only around R58.1bn budgeted for 2020, a year facing a pandemic.

Economically, South Africa is a minnow compared to the UK. Yet, the government has far-reaching and utopian visions that not even the UK has been able to achieve. Despite the UK being in a far better position to achieve the grandiose dreams of universal healthcare, the NHS has proven to be expensive, bloated and unable to fulfil the healthcare needs of its populace.

So, the UK can’t even get universal healthcare right. Why do supporters of NHI think it would work in South Africa?

Just take a look at everything that the government runs already. Eskom, the majority of municipalities, road maintenance, SAA, and existing public healthcare, to name just a few. It’s all a mess! By implementing NHI, the government will be given control over all existing private healthcare, taking away our options of seeking better services. Everything down to our neighbourhood GP, to the state-of-the-art private hospital, will be governed – directly or indirectly – by the same government that can’t even keep the lights on.

Furthermore, there is simply not enough money. Government will need to impose new levies and taxes on an already flagging and decimated tax-base, and even this won’t be enough. Not to mention how much of this money will be disappearing into a blackhole of corruption.

How will the government raise the money needed to fund this utopian vision of free, universal healthcare? It already can’t achieve its humbler healthcare budget. How will it ever hope to reach the budget of the UK?

Doctors have already stated they oppose NHI, and will leave the country if it is implemented, leaving us with very few, often unskilled doctors. One cannot blame them. As the government takes over the sector, life will become hell for the doctors who stay. Currently, doctors in training are forced to work in the public sector after finishing their studies, an experience that usually pushes them away from the profession and into the arms of specialised medicine, or even quitting the industry altogether.

NHI will enable vast levels of corruption as new taxes and levies are created to fund it. This money will never be enough for an endlessly growing, incompetently run and bloated service that will have to keep growing alongside a shrinking tax-base.

Universal healthcare is an impossible dream for South Africa. Not even a dream, it is a nightmare. For it is unaffordable, something our doctors really don’t want to happen, potentially disastrous for taxpayers, and fundamentally flawed. 

So, what is the alternative?

We should be embracing increased privatisation in healthcare, not less. It should become far easier to open a private practice that can specialise to serve its community and clientele. With decreased unnecessary regulation over these practices, some can afford to start shaping themselves to serve low-income clients.

For those who still can’t afford private healthcare, vouchers are an option. Healthcare vouchers can serve as a stopgap for the poor until they can gain their financial footing. These can be distributed to low-income individuals and families far more efficiently than a universal healthcare system can be run.

Further, allowing more people to train to become medical practitioners will help immensely. Eliminate artificial restrictions and race-based quotas on studying medicine. Allow anyone who qualifies to study and pass. This will raise the supply of doctors and drive down the costs of healthcare. Yes, doctors will probably earn less as a result, but they will also be able to work less and have far less stress. The reason being a doctor is so unpleasant is very much to do with how undermanned the industry is. Raise the manpower and doctors can spread out the stress.

Allowing for the creation of many private medical schools would help achieve this goal. Alongside allowing the creation of private nursing colleges, the private sector could hold the key to solving our healthcare crisis. The government must just loosen regulations and, more than give permission, remove the need for the private sector to ask.

NHI will wreck South Africa’s financial and physical health. The solution is more private healthcare, not less.

*Nicholas Woode-Smith is an economic historian, political analyst, and fiction author of the Kat Drummond Series and Warpmancer Saga.

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