If you listen to Health Minister Dr Aaron Motsoaledi talking about the National Health Insurance (NHI) scheme, you could be forgiven for believing that it will be the panacea to all of our healthcare ills.
The illusion that is created by the rhetoric around the NHI – by its proponents, that is – is akin to the rhetoric around expropriation without compensation (EWC): that giving back the land will somehow magically defeat the perennial triple national evils of unemployment, poverty and inequality.
It is imperative that both the land question and the public healthcare question must be resolved, but it is confirmation
bias that leads us to believe the implied causal relationships in these two debates.
Neither can survive even the most superficial scrutiny. That public healthcare is in a state of virtual collapse, is the
elephant in the room in the NHI debate.
Yes, the NHI will result in a massive injection of funding into the terminally ill public healthcare sector, but that is hardly likely to heal the patient.
Public education has proportionately one of the highest budget allocations in the world, but, like public healthcare, it teeters on the brink of collapse.
Throwing good money after bad has done little to address the systemic problems in public education, so why should it magically fix public healthcare?
Inasmuch as it is vital that quality healthcare must be provided for the poorest of the poor, and of course, for the eight
million odd unemployed and their dependents, will the virtual destruction of the private healthcare system achieve that goal?
Granted, the staggering rate of medical inflation that drives private medical aid contributions, is making private healthcare progressively unaffordable, but the solution to that problem is a regulatory regime for the sector that will provide for greater transparency in the dealings between the four principal parties in private healthcare: patients, medical schemes, private hospitals and medical practitioners.
The first shot across the bows of private healthcare has already been fired: the existing medical aid co-payment system,
whereby a medical aid member pays a portion of the cost of a particular medical procedure, is on the chopping block, according to Dr Motsoaledi.
This should come as little surprise, as this is a key feature of the NHI.
The next casualty will be the present system of tax deductions for private medical aid contributions. What medical aid members have enjoyed to date as income tax abatements on medical aid contributions, will, if the NHI Bill passes unaltered, contribute to the as yet undetermined cost of the NHI.
Significantly, the NHI Bill provides no details of how it is to be funded, leaving that up to Treasury to decide. Occam’s
Razor suggests the implementation of a payroll tax, since it is broad-based and easiest to administer.
Also up for debate, is whether or not private medical aid will even be permitted once the NHI kicks in.
The – flawed – thinking is that since every citizen will contribute equitably to the NHI, and since every citizen will have equivalent access to healthcare, why would private medical aid be necessary?
Dr Motsoaledi’s take on this issue in a 2017 press report is illuminating: “Now the question, which is also constitutional, if after you belong to NHI, which is mandatory, do you have a right to go and buy another private cover somewhere to use it for
“Once the NHI is up and running, what reason will you have to still keep medical schemes? It’s what they call a mandatory
prepayment of care, that NHI.
“This means once the law is passed it affects all citizens in the country; they have to belong to it, they don’t have a choice.”
Reality, however, dictates otherwise. Anybody who has engaged with the public healthcare system will have encountered the
interminable delays in accessing treatment for sometimes life-threatening ailments, engendered by a system that is woefully
understaffed, and woefully overburdened with patients in need of care, critical or otherwise.
It makes no sense that those who can afford the cost of private healthcare, even if they are afforded no tax deduction and
must also contribute to the NHI and never use its services, be deprived of the right to do so.
And besides, it is unlikely that such a prohibition would pass constitutional muster.
Despite the impossibility of crafting an entirely egalitarian socialist society becoming ever more apparent as the years have passed, our government stubbornly refuses to evolve its policy agenda from the realms of bluesky ideology to the pragmatism of harsh reality, and sustainable healthcare funding is yet another casualty of this pig-headedness.
The NHI Bill and the Medical Schemes Amendment Bill – needed to effect the planned changes to private healthcare –
are open for public comment until end August.
In the idiom of Barack Obama speaking on Mandela Day: become an active citizen and have your say before it is