Health Minister Aaron Motsoaledi says reports that the ANC was prepared to compromise on NHI and medical aid schemes were without basis, denying that there was a shift in the government’s stance.
Rapport and City Press on Sunday reported that the ANC would table a proposal that all employees be obliged to join a medical aid scheme, which would reduce the costs of health insurance as well as the burden on the public health system.
The NHI would compete with the private sector to offer cheaper options, the report said. This, in part, reflects a proposal made by the Hospital Association of SA (HASA) last year that medical schemes be made compulsory for employees, reports News24.
The NHI Act envisages that as the NHI develops over time, medical aid schemes would not be allowed to reimburse members for services they could have obtained on the NHI.
In other words, they would steadily become financially unviable and would fizzle out.
Motsoaledi has strongly championed this “all or nothing” approach.
In his statement on Monday, he described the article as “unfounded and ridiculous”, saying “there is no such plan from either the ANC or the government”.
“Any insinuation thereto is the figment of the imagination of either the author of the article or his unknown sources,” he added.
The report had said the ANC had planned to table the apparent compromise at the first Cabinet lekgotla of 2025.
ANC sources allegedly told the publication that it was hoped the compromise would appease DA partners in the government of national unity (GNU) as well as Motsoaledi.
DA Cabinet members and Motsoaledi were recently embroiled in a heated argument after Motsoaledi wanted to include the NHI in its current form in the medium-term development plan – effectively destroying private medical schemes by 2029.
The medium-term development plan sets the GNU's priorities and interventions for the next five years.
The DA had pointed out to Motsoaledi that the NHI cannot proceed in its current form because there is not enough consensus in Cabinet. The statement of intent, signed by all parties participating in the GNU, stipulates that enough consensus on government decisions and policy is only achieved if parties with 60% representation in Parliament agree.
The ANC (40.2% support) can reach enough consensus only if the DA (21.8%) also agrees, as the support percentages of the other parties in the GNU are too low.
President Cyril Ramaphosa has made it abundantly clear that the NHI will be implemented, despite the threat that this could derail his GNU.
At the ANC’s presidential gala dinner on the weekend, he said: “We want to ensure we implement the NHI and provide universal access to quality healthcare that is free at the point of service – meaning that the NHI will be implemented. We will proceed with that.”
Infrastructure questioned
Meanwhile, the Democratic Nursing Organisation of South Africa (Denosa) in the Eastern Cape has conceded that while it is fully supportive of NHI being rolled out, public healthcare facilities in the province are not up to scratch, and are critically under-staffed and under-maintained.
Outgoing Denosa Eastern Cape secretary Veli Sinqana, who addressed the union's ninth provincial elective congress last week, also took a shot at the “capitalist class”, which he said was preventing low-income communities from having access to affordable healthcare and infrastructure.
“The very medical aid schemes and the entire private sector …that are opposed to the NHI …are not telling South Africans they enjoy subsidies from the public purse,” he said.
Yet despite Denosa being convinced NHI has to be implemented, he added, “we need to be practical through our own analysis within the province”.
“We must ask ourselves if there is any progress… We have Sipetu Hospital in Ntabankulu, which was upgraded with (millions) of rands. But do we have equipment at that hospital? Do we have enough resources?”
He said Denosa was leading an inspection of the NHI-built facilities in the province, but the picture was bleak, and there was “no maintenance of these sites”.
Additionally, budget cuts leading to critical staff shortages meant nurses were being overwhelmed at public healthcare facilities.
“Most have migrated because of poor working conditions …the healthcare system is on the verge of collapse,” Sinqana said.
Meanwhile, trade union Solidarity, which launched a legal campaign against the NHI in May last year, has accused the government of exploiting taxpayer funds to market an unattainable vision of universal healthcare, asking how it justified the costs of expensive, recently erected billboards on some of the country’s highways.
It claimed the advertising mocked the financial struggles of South Africans while extolling the virtues of a scheme many believe is doomed to fail.
“How does the government justify the costs incurred for giant billboards celebrating the upcoming NHI when it is struggling financially in almost every area?” questioned Theuns du Buisson, an economic researcher at the Solidarity Research Institute (SRI).
The financial feasibility of the NHI remains highly contentious aspects, with estimates from various groups pegging the cost of the system at between R660bn and R1.3 trillion, reports Sunday Tribune.
Du Buisson lambasted Motsoaledi for his perceived indifference.
Solidarity further warned the government of national unity (GNU) against adopting what it described as an “ANC culture”, where taxpayers were expected to bear the brunt of fiscal mismanagement.
Critics say the public healthcare infrastructure is ill-equipped for the planned overhaul as envisaged by the government, with reports by the Health Systems Trust highlightiing persistent issues, including poor staff attitudes, extended waiting times, and frequent drug shortages.
These systemic problems, they argue, are a harbinger of what awaits the country under the NHI, and while authorities insist the system will distribute patients more evenly between public and private sectors, sceptics see little evidence that the plan will ease the human resource burden on an already overstretched system.
For now, the promises emblazoned on South Africa’s highways remain just that: promises. Only time will tell whether the NHI can overcome its mounting obstacles to deliver on its pledge of “healthcare for all”.
The Sunday Tribune – Criticism mounts against NHI
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