Patrick McLaughlin: ANC remains determined to execute on NHI
The ANC's push for a National Health Insurance (NHI) system is facing mounting resistance from the public and healthcare professionals. Concerns about rising taxes, the exclusion of private medical aid, and the financial sustainability of the plan are central to the debate. Legal challenges, like the one from Solidarity, further complicate the NHI's future. With ongoing court battles and public anxiety over healthcare access, the NHI remains a contentious and unresolved issue.
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By Patrick McLaughlin
ANC determined to bring in NHI in long term
The National Health Insurance (NHI) proposals are at a decisive point. Despite promises made in support of the GNU, the government appears to be stalling on issues surrounding private medical aid cover and how it may, or may not fit, into the long-term plan for universal health care being mapped out by government. Meanwhile, the minister in charge appears fixated on pushing through the proposals as they stand.
For many South Africans, concerns regarding the future of medical aid plans are a significant source of anxiety, particularly in the context of the current cost of living crisis. The notion of a 30% increase in personal tax with the NHI fully implemented is regarded by most as unacceptable.
Up in the air
For the medical community and the pharmaceutical industry, the continued uncertainty surrounding the application of NHI is not only discouraging in terms of investment and future planning but also profoundly frustrating, added to which the Department of Health is fighting a rear-guard action over NHI generally with the courts leaving a query as to what portions of the proposals might change.
While the idea of adopting universal health care seems generally acceptable, the prospect of endorsing a scheme that professionals deem unworkable, financially unsustainable, and unlikely to deliver results has created a medical crisis. Nevertheless, President Ramaphosa somewhat theatrically turned his signing of the NHI Bill into a very public event at the Union Buildings, impressing other countries in the process.
Frustrated
As events unfolded, he then called upon the NHI Bill's author, Dr. Aaron Motsoaledi, to reconsider portions of his new proposals after meeting with
business and pharmaceutical delegations who expressed their dismay over state prohibitive processes. At the same time, the medical fraternity, which had objected strenuously to the Bill's final passage through Parliament and angered by having their opinions ignored or overruled by Dr. Crisp and his DOH team in debate, gave notice of seeking new horizons.
The President then assured stakeholders at the time that he would only proclaim the NHI Bill as an Act of Parliament "when the time is right," whatever that might mean. Such an unwanted crisis was carried through into the GNU developmental talks, but politics continue to play into ANC hands. Quite clearly, the Bill had been promoted as 'free medical aid for all' during the election run up at provincial and local government level.
Solid wall
Also in May 2024, Solidarity filed initial court documents against the NHI at the Gauteng North High Court, calling for a halt to the progress of the NHI proposals. So far, DOH has failed to submit a counter-argument within the four-month period granted and is currently requesting more time. According to Business Tech, on what was now an extra-parliamentary matter, "A central part of Solidarity's challenge now looks at the unconstitutionality of Section 32 of the NHI Act, which states that medical aids will not be allowed to reimburse members for services following the implementation of the NHI."
Such a clause is unlikely to survive the Court's scrutiny, say most analysts, as the implementation of NHI and the provision of alternative state health services offering universal free care, even if phased in slowly, can currently only be considered vague and possibly doubtful. It is noteworthy that the Gauteng Court has already invalidated problematic Sections 36-40 of the National Health Act concerning the controversial "Certificates of Need," which dictated where medical practitioners could conduct their livelihoods.
Estimates provided to the Court indicate that funding for the NHI would require VAT to increase from 14% to 21%, personal income tax to rise by 31%, or perhaps an additional payroll tax of R1,500 per month for every working person—or a potential mix of all three.
Focus swings
At this point, it seems the DOH could muster some form of opposition to be heard in the Gauteng High Court, the outcome of which will likely compel Dr. Crisp and Dr. Motsoaledi to revise the NHI Bill into a more practical and less intrusive universal free health scheme, particularly on the public right to be use a medical practitioner of their own choice. https://parlyreportsa.com/health/the-nhi-plan-could-be-self-imploding/
Nevertheless, the NHI Bill remains the flag bearer of change for the ANC, their NEC successfully excluding GNU opposition from cabinet portfolios dealing with ANC initiatives on social matters and community development during GNU talks, with NHI initiative being one example. The adoption of universal health care – an issue in itself not contentious – remains a top priority for the ANC.
Unfortunately, Dr. Aaron Motsoaledi is also likely to remain as Health Minister, the question of a citizen's right to choose his or her medical provider probably never having crossed his mind until Solidarity brought the subject up. According to the DOH website, the department's goal is to enhance health outcomes by preventing illness, promoting healthy lifestyles, and continually improving the healthcare delivery system with a focus on access, equity, efficiency, quality, and sustainability.
By prioritizing "equity" to the extent he has, Minister Motsoaledi has made the current NHI proposals even more unworkable. Suggesting to President Ramaphosa that the proposals should rather take the form of a NHI White Paper on future health care, which is really where the proposal should still be, represents action after the horse has bolted
Now, since the whole concept of universal health care has been touted as an election gimmick, turned into law and discussed by the entire African continent at the behest of clumsy electioneers and a frightened ANC, it must be treated for what it really is: a white elephant.
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This article was first published on Parlyreportsa and is republished with permission