SA’s new health minister backs NHI; Woode-Smith says DA must stop the bill in its tracks
South Africa's new health minister, Aaron Motsoaledi, supports the National Health Insurance (NHI) Act, aiming to provide universal health care. Despite opposition and concerns over cost and readiness, the NHI seeks to reduce inequality in health services. Critics – like Nicholas Woode-Smith – argue it won't fix systemic issues, and legal challenges are underway.
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By Janice Kew
South Africa's new health minister backed a recent law that will lay the groundwork for universal national health insurance, an indication of his party's resolve to follow through with the controversial program despite having lost its parliamentary majority.
The National Health Insurance Act, which was spearheaded by the African National Congress and signed into law less than two weeks before May 29 elections after years of wrangling, is imperative and must be implemented, Aaron Motsoaledi said in an address to lawmakers on his department's budget allocation in Cape Town on Thursday.
While some believe South Africa isn't ready for NHI and others consider it unaffordable, it is in fact "a health-financing system which is meant to be an equalizer between the rich and the poor," the minister said.
"If you want to see what inequality means, come to the health sector in South Africa," he said. "We can no longer, with our eyes open, sustain such gross inequality."
The country's overburdened public facilities currently serve about 84% of the population, while the remaining 16% who can afford private insurance have access to world-class treatment. The NHI legislation provides a framework for citizens to secure universal access to health care through a centrally managed government fund that buys services from public and private providers. It also bans the private sector from offering cover for treatment available under NHI.
Opponents say it won't remedy the healthcare system's shortcomings, is unconstitutional and that the government hasn't spelled out how much the revamped system will cost or how it will be funded. The Solidarity labor union has filed a lawsuit challenging the validity of the legislation.
Suzan Thembekwayo from the leftist Economic Freedom Fighters said in the debate on the health budget that NHI as currently envisioned would be insufficient to improve health care. As a first step, public clinics should be opened 24 hours a day to assist those that have no other way to access care, she said.
The government must ensure money allocated isn't misspent or stolen, that bureaucratic processes don't take precedence over patient care and that when crises in the public health sector occur there is accountability, according to Karl du Pré le Roux from the centrist Democratic Alliance. The party doesn't support NHI in its current form, he said.
The DA joined an 11-party unity government that President Cyril Ramaphosa forged after the elections failed to produce an outright winner.
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DA must stop NHI in its tracks
By Nicholas Woode-Smit*h
While the Democratic Alliance (DA) has not been given the position of Minister of Health, it should still leverage any power or influence it can to stop the ill-fated National Health Insurance (NHI) in its tracks.
NHI has been touted as a silver bullet to fix South Africa's disastrous public healthcare system by turning the government into a single, universal healthcare payer. But supporters of NHI have failed again and again to reasonably show how the system will be paid for or how it will actually work. NHI is unfeasible financially, placing a huge cost on an already overburdened tax base. Additional taxes will not work. There is simply not enough money in the country.
The current public healthcare system is rotten with corruption, mismanagement and apathy. Giving this ailing system more money will not help matters. The institution is broken and needs a complete overhaul. Yet, the government wants to force all patients under a single system. If NHI is implemented fully, our entire healthcare system is likely to come to reflect our worst public hospitals.
NHI will become a black hole into which taxpayers' money disappears to fund an ineffective system. Just look at other government enterprises. Eskom flung SA into darkness for years. Transnet is collapsing. Whatever the government controls soon becomes infested with criminals and looting.
On top of that, the government should be celebrating users of private healthcare. Not only do private healthcare users not use public health resources, they also pay tax, and fund businesses that also pay tax. The SA economy profits from our vibrant private healthcare sector and the government wants to destroy not just an essential aspect of our healthcare infrastructure, but a source of tax revenue.
The NHI Fund has very little do with actually helping the poor access healthcare, and much more to do with putting a lot of money in one place so that corrupt politicians can loot it; something that has happened to all departments of government, in municipalities and even pension funds.
Doctors have been leaving South Africa for greener pastures, and the South African Medical Association, Solidarity Doctors Network, and Business Unity South Africa have all condemned NHI for chasing away much needed medical practitioners. Doctors don't want NHI. Business doesn't want NHI. Patients who understand what NHI entails don't want NHI.
Rather than embracing NHI, South Africa should be moving towards increased privatisation of the healthcare sector. There should be an influx of new private medical colleges, hospitals and clinics to provide for the shortfall that the public sector is unable to fulfil. Rather than raise the public healthcare budget, it should be used to subsidise a private healthcare sector that can then provide cheap and effective treatment to patients throughout the country.
The DA will win a lot of support, and save the country from a terrible policy, if it can successfully stop NHI in its tracks; stopping NHI should become one of its non-negotiable positions. While the ANC has been playing unfairly and not acting in good faith, the DA may be able to manoeuvre itself to shutdown NHI by threatening to walk away from the GNU. This is something it should likely do regardless, as all of its demands have been shutdown.
Hopefully, NHI does not come to fruition. Because if it does, I am not sure our healthcare sector will survive.
Nicholas Woode-Smith* is a political analyst, economic historian and author. He is an associate of the Free Market Foundation and writes in his personal capacity.
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