The ANC’s push for National Health Insurance (NHI) is an outdated attempt to garner support, rooted in a misinterpretation of Marxist principles. Originally introduced by Ramaphosa as a means to ensure equality in healthcare, this approach neglects the reality that Marx and other communist thinkers envisioned such systems in a mature phase of communism, not socialism. South Africa’s current economic and governance challenges mean the NHI could exacerbate issues rather than resolve them. The country needs a robust economy and efficient public services before attempting such sweeping reforms.
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By Flip Buys*
The ANC’s continued plans for the NHI will not stand the test of time. The signing of the law just before the election was another desperate but unsuccessful step by the ANC to increase support.
It is important, though, to examine where his reason for the NHI comes from. Ramaphosa based his motivation for the NHI on Karl Marx when he introduced the NHI in his SONA of 2018: “Everyone will contribute according to their means and will receive benefits according to their needs, in effect ensuring the rich and healthy subsidise the poor and sick”. Marx’s words were: “From each according to his abilities, to each according to his needs”.
This comes directly from Marx’s ideas, but it is a misinterpretation of Marx’s views. In this case Marx referred to the ultimate phase of communism and not to the socialist phase that precedes it. In the socialist phase, his formula was: “The same amount of labour which he has given to society in one form, he receives back in another.” Ramaphosa’s misconception is that even Marx felt strongly that a “free for all” medical service could not work.
Not only was Ramaphosa wrong about Marx but also about Lenin who put it even stronger by stating, “He who does not work, neither shall he eat.” Lenin said that this principle is unavoidable if we are not to indulge in utopianism.
The South African Constitution is not the first one to contain socio-economic rights such as the provision of health services. The first constitution that contained all of these rights was the 1936 Soviet Constitution (“Stalin’s Constitution”). On the subject of the 1936 Constitution, Stalin explained, “The principle applied in the USSR is that of socialism: ‘From each according to his ability, to each according to his work.’” With this he made it clear that there would be no free services such as for health care but that everyone would only be entitled to as many services as they work for.
Trotsky
Even Trotsky followed that line by stating: “… in its first steps the workers’ state cannot yet permit everyone to work ‘according to his abilities’ – that is, as much as he can and wishes to – nor can it reward everyone ‘according to his needs’, regardless of the work he does. In order to increase the productive forces, it is necessary to resort to the customary norms of wage payment – that is, to the distribution of life’s goods in proportion to the quantity and quality of individual labour.”
From these explanations from Marx, Lenin, Stalin and Trotsky, I conclude that production is a precondition for consumption, or to put it differently: every right is married to a duty. That is why economic growth is a precondition for the realisation of constitutional rights, and that the level of consumption (rights) depends on the level of productivity and the strength of the economy. Thus, Mr Ramaphosa wrongly quoted Marx with regard to the NHI in his SONA. He should rather and more correctly have used the other formulations of Marx, or those of Lenin, Stalin or Trotsky.
Apparently, Mr Ramaphosa and his advisors have not even read the works of all these “dead white men” on whose lips they hang and have selectively googled their quotes. For the same reason they will not know why the ideas of these fathers of communism did not work, and now they want to make the same mistakes as them.
They should rather listen to former President Boris Yeltsin’s mournful cry about the failure of communism when he exclaimed in the Russian Parliament, “Our country has not been lucky. Indeed, it was decided to carry out this Marxist experiment on us – fate pushed us in precisely this direction. Instead of some country in Africa, they began this experiment with us. In the end we proved that there is no place for this idea. It has simply pushed us off the path the world’s civilized countries have taken. This is reflected today, when 40 percent of the people are living below the poverty level and, moreover, in constant humiliation when they receive produce upon presentation of ration cards. This is a constant humiliation, a reminder every hour that you are a slave in this country.”
The medicine worse than the disease
Many people know that the NHI “cure” will be worse than the disease. That is, if you look at the outcomes of the current government’s record instead of at the Constitution’s intentions.
The government’s management of the current public health system does not bode well for a radical expansion to an NHI. The fact that the market is not doing what we wish it would do, is no reason to assume that the government would do better. The danger is that it can destroy the private system without really improving the public system.
There are legitimate concerns about the government’s capacity to manage – and the economy’s ability to fund the NHI. South Africa first and foremost has an economic problem, with the lack of adequate health cover as a consequence. A sustainable welfare system is dependent on a dynamic economy and an efficient state – preconditions that are not present in South Africa. If we do not fix the government, then the state, and then the economy, constitutional rights will unfortunately remain only paper rights.
Private sector
It is true that the private health sector faces serious challenges, but the question is if these can be best solved by more competition, or by less competition in the form of another government monopoly. If the private sector is unsustainable or badly managed, it will go bankrupt and will usually be replaced by something better. However, we have learned that if (or unfortunately when) a government system is badly managed or unsustainable, everyone (users and taxpayers) suffers without end.
An economy does not exist in isolation. It is a component of a still larger ecosystem whose other components – political, institutional, legal, educational, cultural, etc. – are in constant feedback with it and with one another. Together, they form the society in which we live.
An advanced economy needs an advanced society, for every economy is a product of the society in which it is embedded, and it is dependent on its key institutions – many of which are currently in dire straits.
Our problem is the inherent contradictions in the current system. Government wants to implement policies such as the NHI but does not put the necessary preconditions in place, such as economic infrastructure, a clean and capable public service, a functioning criminal justice system, and business and investor confidence. In this way, politicians only create expectations that the economy and state cannot meet. The result is public disappointment and anger.
Back to the future
The fact is that the country does not have the building blocks in place to implement a national health insurance system. The crisis in the existing public health system is the best proof of this. The definition of failure is implementing NHI without these blocks in place, and our well-heeled politicians leaving the rest of us in the lurch and flying off to foreign destinations for treatment.
The only conclusion that can be drawn from the ANC’s continued support for the NHI is that they are still clinging to obsolete recipes of which they also have the ingredients wrong. Let us hope that the RNU and the Minister of Health’s undertaking to again consult widely on the law will bring the sobriety to better manage the public health care system rather than embarking on more adventures.
The world-renowned American political scientist, Professor Fukuyama, stated as long ago as in 1993 the following important position on this issue: “The main obstacle to black social modernization in the future may well be the belief in socialism on the part of the ANC and its communist allies.
“Socialism has always presented itself as a higher and more progressive form of social organization than capitalism. But in the contemporary world, socialism has been revealed to be an obstacle to social and economic modernization – the hallmark of a certain kind of backwardness that needs to be overcome, just like illiteracy and superstition. The countries of Eastern Europe are now moving rapidly backward into the future, undoing the legacy of forty years of dictatorship and socialist planning. Let us hope that South Africa, as it makes the necessary transition to democracy, does not move forward into the past.”
Read also:
- NHI shock: Business leaders cry foul, accuse Ramaphosa of deception – Sara Gon
- How the NHI Bill could spell tragedy for SA: Corrigan
- Ivo Vegter on NHI: Ramaphosa laughs, but SAns are the butt of the joke
*Flip Buys: Chairman Solidarity Movement
