The Great Bamboozler

William Saunderson-Meyer says the President has led big business on a merry dance when it comes to the NHI


President Cyril Ramaphosa must be able to marshal enormous reserves of personal charm. How else to explain the ease with which he has for the past five years managed to dazzle and bamboozle business?

This columnist has often enough argued that corporate leaders need to be less trusting and more transactional. They should approach the government in the same hard-nosed negotiating style that they would employ in any commercial deal. Identify and agree beforehand the terms of engagement, the allocation of costs and the sharing of potential benefits.

Instead, they tend to take at face value the nod-and-a-wink assurances that CR gives them: help us get the wagon through the drift and, trust me, we’ll pick you up on the other side and together we’ll ride victoriously into town. Except it never works out like that, as they are crestfallen to discover. ___STEADY_PAYWALL___

The most recent dupes in this mugs’ game are some of the big medical schemes. They muted their criticisms of the proposed National Health Insurance (NHI) in the mistaken belief that the government would in exchange produce an NHI Bill that, despite all the socialist rhetoric, would allow a workable role for the private health sector.

Instead, the legislation that was bundled through the National Assembly and now sits before the National Council of Provinces (NCOP) is as draconian and destructive as one feared. The medical schemes are now belatedly squealing and trying to shape public opinion through organised business forums. 

Discovery founder and CEO Adrian Gore is suddenly imploring the government to abandon its “go-it-alone” stance and not create an “inflexible” legislative framework. “Create some wriggle room,” Gore urges, “so that we can work collectively and find out how to make it work.” 

Suddenly on Tuesday, at the very last moment, the NCOP postponed its deliberations on the Bill for a week. There was a sigh of relief and raised hopes that some kind of accommodation could be reached between the private sector and the government.  

As Daily Maverick’s Marianne Mertens put it, “Effectively, a week has now opened up for further consultations and engagements even if just to tell organised business to calm down and stand down.” Presidency spokesperson Vincent Magwenya revealed to reporters that big business had in the past week taken their concerns “directly” to the president and hinted that the door was not closed. 

As Magwenya pointed out, even if the Bill were to be passed next week, this would not “necessarily mark the end of the process”. The president had a constitutional duty to “apply his mind” before signing the Bill into law and “petitions may be sent, and previously have been sent, to a president as part of this process”.

Well and good if genuine negotiations were on the cards. If a modus vivendi could be reached, it would be a significant reversal of the generally arrogant attitude of the government to the medical sector’s advice and criticism. This distasteful government’s haughtiness was epitomised by the Department of Health’s Deputy Director-General Nicholas Crisp when he spoke at a recent cardiology congress.

When the specialists dared question the government’s ability — based on what’s happened at Eskom, Transnet and other state-owned enterprises — to run an efficient and honest operation, Crisp didn’t bother to hide his disdain. “This distrust [of the government],” he snapped, “must stop.”

So, much as one might hope that the delay in the Bill heralds a new era, it seems unlikely. The party rank-and-file, giddied-up by the tripartite alliance’s trade union and communist partners, is heavily invested in a dirigiste health model. 

In a statement following the NCOP postponement, Cosatu said it was “deeply dismayed” that the government had “wilted like a cheap suit under pressure from a little bit of lobbying by business”. “We need the government to speak with one voice. [We] remind the government that the NHI is an ANC policy mandate, not some seasonal slogan.”

Cosatu’s response reflects, I believe, grassroot sentiment in the tripartite alliance. They are not going to easily accept a watering down of the NHI, especially not with a general election imminent. 

After all, if you cannot campaign on what your party has actually delivered — a failing economy, staggering levels of unemployment and rampant criminality — all that is left is to catalogue the wonderful things you promise to deliver next time around. Or as Crisp, who speaks with the shiny-eyed fervour of a true believer, would say, “Just trust us.”.

More likely than any significant concessions is that Ramaphosa will, behind the scenes, slap some corporate backs, press some flesh, and make some soothingly amiable noises. And then, as has then previously happened with a host of issues — expropriation without compensation, the collapse of state infrastructure — the ruling party’s ideologues will prevail. 

It is unfortunate that the corporate sector, as well as many voters, persist in ignoring the unambiguous evidence before their eyes. The government, bound as it is in the blood pact that is the tripartite alliance, cannot countenance anything that smacks remotely of a betrayal of the National Democratic Revolution. Any form of public-private partnership on terms that would be remotely attractive to investors, remains unthinkable to the ideologues who continue to dominate the ANC, despite the havoc their policies have caused.

That the NHI Bill has, until now, rattled through the legislative process with a blithe indifference to cautionary voices, should be warning enough to business of Ramaphosa’s bad faith. 

In 2018, at a presidential health summit, Deputy President David Mabuza reassured South Africans that the NHI would not “negate the existence of private health schemes for those who desire [them]”. Yet here we are.

Also, both Ramaphosa and Finance Minister Enoch Godongwana have in the past conceded that the NHI is going to put enormous, possibly unaffordable, demands upon the fiscus. The Institute of Race Relations estimates that the NHI will cost R700bn a year; Discovery reckons R212bn; and a 2017 government White Paper projected that by the time of its intended launch in 2025, it would cost R256bn a year, calculated in 2010 prices. Yet here we are.

It would seem that the only people not taken in by Slick Cyril are the medical professionals themselves. Statistics released last year by Health Minister Dr Joe Phaahla reveal a terrifying outflow of irreplaceable expertise.

In 2019, South Africa, with a population then of 58.6m, had a doctor-to-patient ratio of 1 per 1,266 people. By 2022, with a population then estimated at 60.1m, that ratio had plunged to 1 per 3,198. 

There is also a growing shortage of every auxiliary health profession, with that of nurses estimated by the Hospital Association to be between 21,000 and 61,000. The DoH projects that by 2025, the shortage of nurses will be around 34,000 in primary healthcare alone.

Yet, for ideological reasons, the government has closed down the independent nursing training colleges and severely limited nursing training programmes run by the private sector. Netcare, for example, says it could graduate more than 3,500 nurses a year but the government will allow it to enrol only about 350 trainees each year.

The NHI is shaping to be the worst disaster of ANC rule. It is likely to be more corrupt, more mismanaged and more dogmatically implemented than anything we have yet seen.

But, as Cyril and Nicholas say, just “trust us” and everything will turn out fine.

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