Having wrecked public healthcare, looted some R1.4 trillion from the public purse, rendered 10 million adults jobless, and put Eskom into a death spiral, the government is now turning its attention to nationalizing our healthcare system, tabling its National Health Insurance bill in Parliament last week.
Does anyone really believe the government can deliver a functioning NHI system? On the contrary, it will be catastrophic for our society and economy. If necessary, the DA will challenge the constitutionality of this bill.
Without doubt, everyone in South Africa should have access to quality healthcare. This is non-negotiable in our unequal society. The point of disagreement is how to achieve it. Two distinctly different plans are on the table: the DA’s Sizani Universal Healthcare plan; and the ANC’s NHI.
NHI centralizes the provision of healthcare, making the national department of health the sole provider in the country and forcing all doctors and other providers to contract to the state. This removes choice and competition and effectively creates a new state-owned enterprise, the NHI Fund, with all the usual vulnerabilities to institutionalised looting and state capture.
It envisages a central fund to buy healthcare services for South Africa’s entire population. It has not been costed but certainly requires a vastly greater budget, to be funded through higher taxes, and will take 10-15 years to implement.
Government spent R4.3 billion between 2012/13 and 2016/17 on ten failed NHI pilots. Yet it now seeks to roll out the failed system nationwide. Inevitably, our talent and tax base will erode as both medical professionals and taxpayers flee SA in droves to avoid having their lives at the mercy of our corrupt, incompetent government.
Far better is the DA’s Sizani, premised on the principle of leveraging what already works well (SA’s private health sector and private pharmacies) to bring improvements to what is currently dysfunctional (SA’s public health sector).
The plan allocates a universal subsidy to every South African resident to cover a comprehensive package of health services within the public health system – free at the point of access to everyone, while retaining and reforming the medical aid system.
It is affordable and can be implemented relatively quickly (5-8 years), funded using the existing health budget together with the tax benefit currently allocated to medical aid members.
Sizani is based on localising accountability to hospitals and district health authorities and decentralising decision-making and appointment process. Costs would be driven down as the public and private sectors become more competitive.
Aspects of Sizani have been implemented in the Western Cape, where the DA provincial government runs the best healthcare system in South Africa. Mortality rates are half of other provinces and life expectancy is highest. Hospitals and clinics are far better maintained and resourced.
The WCPG seeks to bring service at public hospitals in line with the best private hospitals. At some hospitals, such as Paarl, they have already succeeded. By contrast, any equality in health provision achieved by NHI will be through destroying what works, rather than by fixing what is broken.
As with expropriation without compensation, prescribed assets (forced investment of pensions in SOEs) and nationalising the Reserve Bank, NHI is a blatant attempt to open more opportunities for looting. We need to stop playing political games with people’s lives, reject NHI, and adopt Sizani.