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HPCSA president Simon Nemutandani recently told parliament that National Health Insurance (NHI) should be the only funding for health in South Africa. The Free Market Foundation (FMF), which prides itself on furthering human rights and democracy, has announced its condemnation of the expropriation of medical aid funds. Chris Hattingh, Deputy Director of the FMF, joined the BizNews Power Hour to explain why and his views on the new proposed gun law. Market commentator David Shapiro also weighed in on the matter.
Chris Hattingh of the Free Market Foundation on whether South Africans should be allowed to arm themselves:
I think being able to arm yourself is a cornerstone of any properly liberal democracy that would consider individual rights to be important. So part of what we would consider to be a good state would be one that can protect citizens’ lives and if it can’t do that, then citizens should have every ability to arm themselves. This doesn’t mean that we think, for example, every citizen should have a nuclear device in their homes. We can have that sort of discussion with the anarchists. But I agree very much that this kind of legislation in the works makes one very concerned about people’s future security and safety. And of course, again, it affects low and middle-income people the most. For other people, they can go overseas, they can afford – well, if you have the right political connections – you can afford VIP protection services. But if you can’t afford that, then you’re at the mercy of the criminals.
On whether politicians would look at the law differently if they weren’t so well protected:
This is something that I’ve tried to highlight a lot in the last few years. Now that we talk so much about state capture and corruption, the more you mix politics and economics the more it becomes a case of, you can afford the necessary services and the necessary goods if you have the right political connections. It’s not really a case of economic activity. It’s not a case of services and goods anymore. It’s simply about who you know, not as much as what you do and what services you provide.
I think it’s important to highlight that in all of these issues – the gun issue, we’ve got NHI – all of it ultimately points back to the National Democratic Revolution, the guiding ideology of the governing party, and believing that they should control all the levers of state and that citizens should rely on them for everything. When the citizens can’t do that anymore, I think it’s deeply immoral to, for example, remove something like the right to gun ownership.
On the NHI and nationalising medical schemes and their funds:
I wish we had Frans Cronjé from the IRR [to] answer. He could sketch the different scenarios of whether the NHI will happen or not. I think you touch on there – it might simply just be to sort of see where the climate of opinion goes, the discussion kind of thing now, voicing these suggestions. I think the state very much wants to be in charge of all healthcare. It believes it should provide healthcare to all of us. It should be at the centre. Medical schemes take away from the control that the state might have – private hospitals, that kind of thing. It’s all couched in very noble and altruistic language. Everyone should have access to quality healthcare, that kind of thing. But fancy words can only take you so far when you run into reality.
South Africa’s debt-to-GDP ratio is approaching probably 86% at this point; we’ll probably hit 100% in the next two or three years at the current pace with government spending being what it is. And the NHI will simply create another state-owned enterprise that the state will have to pay back the debt on. There’s no guarantee that the NHI will function any better than the other SOEs. I think it’s a fool’s errand, as it were. I don’t think the capacity exists within the Department of Health to really administer an effective NHI. If we had a different sort of competency in the country – we could talk about, you know, whether it could actually run effectively or not – but at this point, I think it’s folly to think, you nationalise the management of all healthcare services in the hands of the state and then it’s going to increase services [and] service delivery for all South Africans.
Again, we run back into the problem of lower and middle-income citizens who are forced to stay in South Africa. They don’t have a choice about whether they go overseas but politicians and those who are well connected can go to Dubai and other countries to get the healthcare that they need.
David Shapiro on NHI:
I think the pandemic has taught us who we can rely on. And I think if we look at Netcare – their results were out – 32,000 patients and a comprehensive list of what they did. And I had the unfortunate issue of my brother who was there, unfortunately, he passed away but I cannot fault Netcare or the doctors there for how they tried. And you saw the level of service, the level of dedication was just remarkable. And you saw today with your vaccination with Discovery how well organised, how many people were there, how you knew what to do. You cannot move away from what the private sector can do, and why not build on it instead of trying to replicate it or trying to mimic it and force people in the other direction? It just does not make sense to me.
Chris Hattingh on radical structural reform, corruption, and increasing state control:
How does one balance very abstract arguments versus the concrete? But I think you point to something very important in terms of the generational opportunity as it were because we get a lot of the buzzwords around radical structural reform and radical economic transformation. From our perspective, policies that increase the control of the state aren’t radical. That’s simply the path we’ve been on and they’re going to increase the problems that we’ve seen. So if you can connect for people the link between ideology and concrete policy – I think policies are downstream from ideology – then you can show people, if this is the fountain of the policy, depending on the ideology, the effects will always be the same.
This isn’t just a case about the current ruling party. You can have the most competent politicians and bureaucrats in charge of the NHI; it’s about structures and incentives. If you place the pot of gold there, you’re going to increase the chances for more corruption. So I think the NHI will make something like state capture look quite paltry, maybe even will be in the realms of the arms deal and that kind of thing. If you place the incentives there for the wrong consequences to happen, don’t be surprised when it happens and don’t complain about it afterwards.
David Shapiro on the importance of good leaders:
The incentive is not there and you need the leadership. We’ve both been in business or both exposed to business – true leaders – they’re there. You need those kind of people to take us forward and that happens at the top of a country as well. You can’t just use ideology to produce the kind of people that you need to run this and nobody wants to do it. You know, the one thing about the ANC coming through there – they don’t realise that this is an admin job. No one wants the admin job. They just want the trappings of the position. Sitting in front of a big desk with a blue light brigade that’s going to take you home, etc. Running a country, running a business actually takes a lot of time and effort. And that’s why I’m saying I just believe in the private sector and that we shouldn’t mess around with what is already working. Rather build on what we’ve seen in this country and what we have had in this country at one point.
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