Attempts to bulldoze the unworkable NHI Bill into reality are foolhardy and driven by ideology and very little common sense, writes City Press editor Mondli Makhanya.
He writes:
In their submission to the National Council of Provinces’ Select Committee dealing with the National Health Insurance (NHI) Bill, South Africa’s two major business bodies emphasised “the importance of universal health coverage (UHC) for the future success of our country and our economy”.
Business Unity SA and Business for SA went on to state that “it is essential that every person, rich or poor, has equal access to quality and affordable healthcare, as provided for and protected in Section 27 of our Constitution”.
“South Africa needs an NHI system that addresses the current unequal healthcare system, but that is also sustainable and affordable for the country and all her people. To do this will need the active involvement of both the public and private healthcare sectors.”
They posited that the NHI Fund should be established as a public funder of health services that will “facilitate the development of public private partnerships as well as the strengthening of public sector capacity”.
“Consistent with UHC principles, quality of care is paramount – whether one seeks care in a publicly or a privately owned hospital, it should not lead to differences in quality or reliability of care.”
This sounds like a bunch of people who want the NHI to happen and who are prepared to assist the government to make it a success.
Yet you wouldn’t think so if you listened to elements within the ANC and its alliance partners, who believe the business sector wants to sabotage a revolutionary idea of providing quality healthcare to all.
Despite all logical advice, the government has ploughed ahead with NHI legislation that even a dimwit redneck from the American mid-west would recognise as unworkable.
The healthcare profession, including progressive health workers who deeply care about the poor’s access to well-being, has spoken loudly about the impending disaster that the ANC – and the government it leads – are about to inflict on the nation.
But no, no, no. Because there was a resolution taken at some ANC conference during the Jacob Zuma years, we should disregard all facts.
And because the ANC wants to prance around in the next six months and lie to the people that it is about to bring Morningside Clinic, Entabeni Hospital, Lifebay View and Medforum to their doorstep, all voices of reason are being dismissed as reactionary.
The ANC, which advertises itself as a listening organisation, has been totally deaf to voices that say it’s navigating South Africa’s health sector towards that giant iceberg.
Last week, as the National Council of Provinces was about to vote on the contentious Bill, business issued a last-minute plea for further engagement. Parliament wisely postponed the vote, citing some programming issues. It was a good cop-out and bought time for more discussion.
But Cosatu said it was “deeply dismayed” that government had wilted like a cheap suit under pressure from a little bit of lobbying by business. Pandering to the vested interests of private industry’s “insatiable lust for profits at the expense of the health of millions of ordinary South Africans marks a dark day in our democracy”.
What the good comrades at Cosatu fail to realise is that the biggest victims of the impending madness will be the members of their majority unions in the public sector. It will be the poor who will be fooled by a government that will further neglect public hospitals because it has found a short cut.
In their deliberate distortion, medical aids and quality healthcare are the preserve of the rich. They are blinded by fealty to a conference resolution that should just have been the beginning of a broader process of arriving at sound policy.
But everything since then has been driven by ideology and very little common sense.
The evolution of the NHI legislation has even abandoned the spirit of the origin of the ANC’s own resolution.
Let’s go back to the ANC’s 1997 Mafikeng conference, where the idea of the NHI properly found expression in a conference resolution.
In that conference, the delegates urged that “government finds urgent answers to the outstanding, unresolved issues in relation to the social health insurance system so that it can be speedily implemented and … explores the potential for public-private co-operation in the provision of healthcare”.
At the Stellenbosch conference in 2002, the resolution was that “such a scheme should enhance the equitable access by the general public to healthcare and reduce the inequities between the private and public healthcare providers”.
It added that “specific emphasis should be placed on strengthening the capacity of the public health system to generate revenue from those who can afford to pay and ensure that such revenue is used to improve the public health system”.
Even in Polokwane in 2007 there was still some reason, with the resolution reaffirming … “the implementation of the national health insurance system by further strengthening the public healthcare system and ensuring adequate provision of funding”.
The problem seems to have started at the policy conference in Durban in 2010, as Zuma’s populist agenda kicked in.
From there it was full steam ahead and no room for engagement. By the time of Mangaung in 2012, NHI was a gospel verse.
Since then, the NHI has become a divisive issue, rather than one around which South Africans should find common ground about the desperate need for universal health insurance and quality healthcare for all.
The NHI is going to be one of the most consequential policy initiatives of the democratic era.
If we were allowed to put it in the strongest terms, the next sentence would explicitly say what this one suggests: We can’t #@%& this one up. This is our one chance at transforming or wrecking a health system.
See more from MedicalBrief archives:
NHI heading for ‘Eskom-level stuff-up’
NHI Bill vote delayed as doctors and business urge amendments
There may yet be a role for medical schemes under NHI, says legal expert
Medical aid tax rebates to go to NHI
Lessons for NHI in world’s largest health study?