by Michael Settas
…Signing of NHI Bill into law nothing but cynical electioneering
President Ramaphosa is now fully committed to deceiving the country with promises that the National Health Insurance (NHI) Bill will bring about better healthcare for all citizens. On 15 May, he will be signing the NHI Bill at the Union Buildings – no doubt to maximise media coverage while advocating the false promises and exaggerated claims of the NHI.
Only the wilfully blind will not see this as a pure electioneering stunt, with the African National Congress (ANC) desperate in the face of their worst electoral performance yet in the 29 May general election.
In classic socialist terms, the NHI is a policy loaded with grievance, blaming an oppressor (the private health sector) for the failures of the oppressed (the public health sector).
Dr Nicholas Crisp, Deputy Director-General of the Department of Health and ultimate driver of NHI, has been telling national audiences for years that the private health sector is unsustainable, corrupt and inefficient, and consumes a ‘disproportionate’ share of the country’s health services. Henceforth the private health sector must be nationalised and collapsed into the public health sector, forming a state-run monopoly, the NHI.
To rub salt into the wound, taxpayers must foot new NHI taxes to the tune of around R240 billion annually, while simultaneously being denied their constitutional right to purchase their own private health cover.
It can only be economic illiterates or political ideologues who can possibly believe that a competing free-market private sector will be outperformed by a national state-run monopoly. One only needs to think of other monopolies such as Eskom or Transnet to know what will become of the country’s health services under NHI.
In getting to this point, ANC policymakers have ignored a few uncomfortable truths.
Firstly, they have regarded private medical contributions as if they are public resources to allocate as they wish.
Secondly, poor public sector performance has been blamed on insufficient resources.
Yet our analysis of more than the past two decades shows that per capita health budgets have grown at substantially higher rates than CPI over this period and that public sector medical personnel-to-population ratios are now better than they were twenty years ago. Deeper analysis of findings by the Auditor-General, the Office of Health Standards Compliance, and the Health Ombud shows clearly that public sector problems lie in poor governance and mismanagement—not an insufficiency of resources.
Lastly, confirmation that the NHI is unconstitutional from both the private sector and the Parliamentary Legal Advisors office has been ignored.
But the most inconvenient truth for Ramaphosa is that his own finance minister, Enoch Godongwana, issued a stark warning last October that the country was unable to afford NHI. Senior National Treasury official, Mark Blecher reiterated this last week at the Board of Healthcare Funders annual conference.
Signing the NHI Bill into law means that legal lawsuits can start. But, given the obvious hiatus on funding, it also means that the NHI will lie in limbo for many years, giving its numerous legal challengers ample time to take their cases all the way to the Constitutional Court.
Michael Settas is the Chair of the FMF Health Policy Unit (HPU)
