Apply ‘First do No Harm’ principle to SA’s universal health coverage – Urbach

CAPE TOWN — One of the principles and values that doctors worldwide swear allegiance to is ‘First Do No Harm’. Here Jasson Urbach, Free Market Foundation Director & head of its’ Health Policy Unit, argues convincingly that introducing an NHI into South Africa in the current deteriorating politico/economic climate will obliterate that principle. Enforcing an NHI payroll tax means a double whammy for those on private medical aid – and nails the poor and middle class via another new driver of job losses; less money for savings and investment. The ensuing slower economic growth would result in job cuts, impoverishing the very people universal health coverage is meant to help most. Urbach claims the new version of the NHI White Paper is a cut and paste job of the 2015 version. There’s still no costing of the scheme or description of how it will be paid for. Instead we have a ‘one size fits all’ policy. Government should rather concentrate scarce taxpayer resources on the poor and destitute, allowing the private healthcare sector to flourish. To hear Health Minister Dr Aaron Motsoaledi talk, doing the morally right thing by increasing health care access equity overrides any possible unintended consequences. The holy crusade will continue. – Chris Bateman

By Jasson Urbach*

Jasson Urbach

“It’s déjà vu all over again,” as the late Yogi Berra might have said had he read the latest iteration of the national health insurance (NHI) policy paper. We are no closer to understanding critical details, such as how much the scheme will cost and where the money to pay for it will come from. The costing figures presented in the latest iteration are copied verbatim (amongst other sections) from the 2015 White Paper. Despite economic alarm bells ringing throughout the economy, government is going ahead with the scheme in an increasingly authoritarian attempt to limit our civil liberties and freedoms.

As I have argued previously and will continue to do so, in these dire financial circumstances, it is neither necessary nor appropriate for government to provide “free healthcare for all”. Those who can pay for their own healthcare and, generally, do not rely on government provided service, must be allowed to continue to do so. Government’s role should be to fund the healthcare needs of only the poorest and most vulnerable members of society.

The proposed mandatory payments into the central NHI fund will crowd out private insurance. Cash-strapped individuals will no longer be able to afford voluntary private-insurance premiums when burdened with a mandatory NHI payment as well. Those unable to pay both premiums will be forced to burden the already overstretched public health service.

While the rich can hop on a plane and seek medical care anywhere they please, the poor and middle-class will be unable to escape the vagaries of the government-controlled system. NHI will perversely increase the inequalities in healthcare, concentrating power in the hands of state officials and leaving no room for private medical schemes. Taxpayers could well fund healthcare for those who cannot afford it, but why interfere in the arrangements of those who can afford to fund their own healthcare?

Whether directly or indirectly, government would control the availability, financing and delivery of healthcare — the choice would no longer be ours to make. Compulsory NHI funding would serve government’s interests, not our own.

Read also: Anthea Jeffery: Time to stop reckless promises of ‘free’ health care under NHI

South African labour should be fuming since NHI necessitates an increase in the taxes levied on an already overtaxed population. The proposed payroll tax is a tax on labour. Workers will bear the cost, either through lower pay or job losses. This will leave us with less money for savings and investment, and thus the NHI will usher in even slower economic growth and less job creation, again hurting the poor. South Africa’s currently 9.3 million unemployed will have no hope of entering the job market.

South Africans need to exercise real personal choice in choosing private insurance arrangements that best meet their individual needs – not a one-size-fits-all policy that will be determined and dictated by a nameless and faceless bureaucrat sitting in Pretoria.

Read also: NHI looks terminally ill – here’s life-saving medicine that can save it

Increased competition would force the private medical insurance sector and private providers of healthcare to compete directly for money by providing value and choice. Government has no such incentive – clearly, it is not concerned about the price or quality of healthcare. Personal ownership of healthcare would help control costs and guarantee better quality, and eliminate the need to depend on government.

South Africans fought hard for their freedoms from an overbearing state. Allowing government to take over that most personal aspect of our lives, our healthcare, would undo these hard-won gains.

History has demonstrated that once a law is enacted, it is very difficult to repeal. The public sector is in shambles. We should not be trying to expand and emulate the failed policies that led to this situation. Government should be concentrating scarce taxpayer resources on the poor and destitute, and allowing the private healthcare sector to grow, innovate and expand. Such a healthcare model would not only be good for South Africa’s financial health, but would lead to better health outcomes for the poor, which is surely what we all want.

  • Jasson Urbach is Free Market Foundation Director & Head of the FMF’s Health Policy Unit.
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