President Ramaphosa’s push for the National Health Insurance (NHI) plan faces mounting challenges as the legislation, still awaiting Constitutional Court approval, struggles to gain traction. Despite setting aside R36 billion for NHI, the proposal is met with resistance from private doctors and specialists, while the Democratic Alliance remains notably silent. The ANC’s “KZN bomb squad” leads the charge, yet concerns about the plan’s feasibility and effectiveness persist. The future of South Africa’s universal healthcare remains uncertain.
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By Patrick McLaughlin
The NHI plan to Parliament from the President is to urgently come up with a strategy to make universal health care possible. Accepting the fact that the NHI Act has not yet been published by the government printer into law whilst it awaits a ruling from the Constitutional Court that parts of it are unconstitutional, this has not stopped President Ramaphosa from setting aside R36bn into a special fund to support the implementation of an NHI system. Dr Nicholas Crisp’s socialist magic still holds, it appears, but only at ministerial and cabinet level.
What left Parliament as a legislative proposal supported only at the time by the ANC, is now being rejected by a powerful number of private doctors and specialists, the backbone of the health practice system in South Africa. In most countries this would be the death knell of any political plan on health but is appears the ANC still can’t hear the music. Keeping remarkably quiet, is the Democratic Alliance presumably in politeness to the GNU.
The last cowboy
In determination to support an extra-parliamentary compact on the NHI, which BUSA have already rejected, President Ramaphosa has called for “Sustainable and inclusive solutions to challenges in the national health system.” In other words, he saying “lets get something going” – an extraordinary call to make in support of a Bill he has signed intended as law.
But he also insists that the whole plan be underpinned by government leadership on health planning for universal health care in South Africa and for anybody to see based on results alone, there has been little or no leadership on health. The state of the health system stands as an epitaph to political manoevering and failure to govern properly. The electorate said so.
Handover
As the last Parliament closed, each of the parliamentary committees in both houses, the National Assembly and the National Council of Provinces, are attending to what is known as Legacy Reports, called in military circles a handover/takeover document. Such is for any military unit taking over duties from another to ensure continuation of orders from the top.
So, it was with the Sixth Parliament handing over to the new seventh portfolio committee on health, a few days ago. MPs were advised that they are now charged with developing a planning strategy for the National Health Insurance Bill, as passed beforehand, on orders from the top at GNU HQ.
Warm up game
In its first meeting of the portfolio committee of health, under its new chairperson, past Deputy Minister of Health, Dr Sibongiseni Maxwell Dhlomo, the Health Legacy Report from the previous government was introduced, the same committee but with different ANC members but the same one that had used the well-known “swing vote” to muscle through the NHI Bill for signature.
This was practised in a number of committees in an attempt to ensure election promises that were made were interpreted into law, a practice which has come back to bite the ANC in some cases.
Chair Dhlomo made it quite clear from the start of the particular health committee meeting that only discussion on the health legacy report mattered and nothing new was to be discussed, MPs having to acquaint themselves first, he said, with the handover takeover process. This was all in the knowledge that President Ramaphosa had stated in the opening of the same Seventh Parliament, that wider consultation was needed on the new NHI plan and a strategic plan for its implementation was to be undertaken with the department of health in both urban and rural contexts.
Players
To ensure the continuation of the NHI build-up of the Fund, the ANC have assembled a KZN “bomb squad” to fight for the continuation of ANC policy in this regard, all in the knowledge that three parties in the old committee had objected to the NHI. The new strong team to keep health on the straight and narrow is:-
- Sibongiseni Dhlomo: Formerly the Deputy Minister of Health and now the Chairperson of the Parliamentary Portfolio Committee on Health. He has a background in healthcare and is a significant figure in KZN politics. Dr Dhlomo was the MEC for Health in KZN from 2009 to 2019.
- Zweli Mkhize: Former Minister of Health and currently serving as an MP is chairperson for the COGTA portfolio committee. Mkhize is also associated with KZN and has a significant influence in South African health policy.
- Joe Phaahla: The Deputy Minister of Health and previously the Minister of Health, Joe Phaahla also has a history of working in health and politics in KZN.
All three know each other well, their careers intersecting significantly in health and politics and their backgrounds in KZN having created a network of collaboration and shared experience in the field of healthcare. Dr Dhlomo has a long career in medical service to poorer folk in KZN and is well known for his long stay incarcerated on Robben Island. All are dedicated to the cause of creating a massive fund for the application of universal health care and the NHI plan.
Read more: Flip Buys: Even Lenin and Marx wouldn’t have supported NHI
The Opposition
The three parties that would not vote for the adoption of the NHI Bill and in fact objected to its passage were:
- The Democratic Alliance (DA): The DA has consistently opposed the NHI Bill, arguing that it could negatively impact the quality of healthcare and lead to inefficiencies.
- The Economic Freedom Fighters While the EFF generally supported the principle of expanding healthcare, they have raised concerns about the implementation and management of the NHI.
- The Freedom Front Plus (FF+): The FF+ has expressed concerns about the financial sustainability of the NHI and its potential impact on private healthcare.
All voiced various concerns regarding the potential implications of the NHI plan on healthcare quality, financial sustainability, and the efficiency of the system. The legacy report containing these qualifications is therefore now adopted into the new Government of National Unity
The NHI plan
In the meanwhile, medical aids have been busy informing worried members on developments. One medical aid has sent this calmative note: “We understand that you may have concerns about how this new law might impact your medical scheme membership. Please be assured that there is no need to panic. Your membership remains unaffected, and we are dedicated to maintaining your access to affordable, quality health services as usual.”
This letter is far from the usual correspondence between medical aid and its members but it also indicates the societal impact of change in comfort zones that medical aids have built to protect their members, mainly the fear of invasion into security of life style and all kinds of medical help, particularily in old age.
Says Discovery to its members, per Adrian Gore, “Our strong view is that limiting the role of medical schemes would be counterproductive to the NHI because there are simply insufficient resources to meet the needs of all South Africans. Limiting people from purchasing the medical scheme coverage they seek will seriously curtail the healthcare they expect and demand. It poses the risks of eroding sentiment, and of denuding the country of critically needed skills, and is impacting negatively on local and povincial health matters.”
Somewhat polite, we felt, in the circumstances.
A fixture with no date
With President Ramaphosa having signed into law an Act which almost a policy statement with a map and subsequently calling at a late stage for a strategic plan to implement it, Ramaphoda is going to find things hard work. Also, with the ANC generally clueless on its costs and the plan’s unaffordability quite evident, the implications for South African taxpayers leaves SARS at the blunt end to collect the money. As always, nothing is said seriously by National Treasury, probably staggered by an estimated cost floating in the area of R900bn and which is nothing to do with economic development.
Consequently, with the Constitutional Court holding the keys for the moment on any further discussions, the most worrying feature is whether or not the NHI is being held together as a future project by all in government out of politeness to the GNU. As Marius Roodt says for the Institute of Race Relations, “Open and frank discussions should be a top priority for the government”.
Replay
Whatever the feelings are currently, however, we have that sneaky feeling that before any gazette on the NHI is published and the law goes into the SA Statute Book, the entire document will be returned to Parliament for a sensible and professional approach to South Africa’s medical upgrading and the need for proper health service delivery. ConCourt have done that now with three ANC Bills
Looking about, Singapore provides high-quality healthcare services and effective management of health costs but also cannot afford universal health care. Instead, it relies on a system of compulsory health savings accounts (Medisave), government subsidies, and private insurance.
Reality time
As things stand, a simple tweaking of a generally bad idea will not stand up to the fury of Manyi (EFF) or Hlophe (MK), who will take every opportunity to undermine the whole process as a sham project protected by the GNU. Once the Legacy Reports are over, the new engagements start in Parliament on current business.
Pehaps NHI has always been a lame dog idea without a strategy and it is correct that it needs this, but at this point in time no ANC paliamentary “bomb squad ” is going to help medical professionals to feel at home and at ease on the issue of their right to work and earn money how and where they want to. This matter was always going to happen from day one.
We stay monitoring.
Read also:
- SA’s new health minister backs NHI; Woode-Smith says DA must stop the bill in its tracks
- NHI drives health workers and retirees to consider immigration: Andrew Rissik, Sable International
- How the NHI Bill could spell tragedy for SA: Corrigan
This article was first published on ParlyreportSA
