National health insurance for all?

4 May 2021

Is national health insurance (NHI) the wonder cure for the decay of state healthcare in South Africa? While the world is trying to find solutions to the COVID-19 crisis and to recover from the immense economic impact caused by the lockdown measures, the parliamentary process for the NHI Bill will soon continue in South Africa.

The proposed Bill – as is the case with most of the government’s proposals – sounds too good to be true. Looking at the fund through the rose-tinted glasses of the government, the fund promises among other things that every South African citizen and long-term resident, rich or poor, will get access to the same standard of healthcare and that medical costs are going to be lower. Medical aid funds to get quality healthcare in South Africa are going to be all but redundant, although you will still be free to get your own private medical fund additionally.

The big question, however, that worries most people is: How does the government intend funding this ambitious plan? The answer should not come as a surprise to anyone and is general knowledge – NHI is going to be funded by your tax money and you will be required to contribute based on what you earn, by deductions from your salary. The employer will have to deal with this administrative process of recovery.

One may choose to ignore the fact that there is a further increase in unemployment owing to the government’s lockdown measures, that the tax base as a result has been shrinking to a considerable extent, that NHI will put even more financial pressure on a small and dwindling group of South Africans and that people who already are living at the poverty line will face deductions from their salaries, which will further impoverish them. One may choose to ignore the fact that most state hospitals do not meet the requirements of NHI, which will put more pressure on private hospitals when this system is introduced, and that NHI, on the contrary, may result in worse service in private and state hospitals. Even if all these facts are ignored, one cannot ignore the fact that the government has shown time and again that self-enrichment and corruption are the order of the day. How will the NHI fund be different?

Dr Zweli Mkhize recently said the following during proceedings on World Health Day: “The reformist agenda is based on capturing the elements of universalism, equality, social solidarity, strategic procurement, access to quality healthcare services and financial risk protection.” It is ironic that risk protection is one of the arguments advanced for this fund, while our risks are going to be increased precisely by corruption, misspending and the extent to which the government is held accountable for these outrages. Recent examples of this include the large-scale investigation at GEMS (Government Employees Medical Scheme) where an amount of more than R300 million is involved, and the unlawful PPE contracts amounting to R13 billion. The GEMS investigation speaks volumes if one bears in mind that GEMS is a likely candidate to administer this fund. The role played by BEE (black economic empowerment) in awarding contracts also became clear during the lockdown, and this will seriously restrict the extent to which the private sector can participate in the process for collaboration. Do we want the present government, with its history of shocking corruption and self-enrichment, to run a massive fund like this? Isn’t it about time we learned from our mistakes?

NHI or similar solutions cannot be built on an already shaky foundation. We cannot look at First World solutions while vulnerable citizens still have to cover kilometres on foot to reach the nearest hospital or clinic or such hospital or clinic does not meet the necessary standards, and this while the economy is in its current state. And then I am not even mentioning the challenges brought about by COVID-19 and the government’s lockdown fiasco.

National health insurance will not soon or ever offer a feasible solution to the health crisis in South Africa, and this fund is simply going to be yet another temptation for long fingers, without there being effective control. I shall be watching tensely the upcoming oral submissions, and I am putting my foot down.

Mariaan du Toit is a Campaign Officer at AfriForum.