Cosatu and Motsoaledi on collision course over NHI

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Health Minister Aaron Motsoaledi and his department are on a collision course with Cosatu over the National Health Insurance (NHI), ahead of the governing ANC’s critical national policy conference in July, reports Business Day.

While the department sees a role for the private sector in the implementation of the NHI, which aims to introduce a single fund that purchases healthcare services for all South Africans that are free at the point of delivery, Cosatu is adamant the private sector should be excluded.

Cosatu, with 1.8m members, is South Africa’s biggest labour group and a member of the governing alliance. The report says it recently used its political muscle to force the government into delaying its plans for provident fund reforms and won concessions on the national minimum wage.

The public sector lacked the infrastructure, technical capacity and administrative flexibility to implement the NHI in one fell swoop, Health director-general Precious Matsoso said in the report. Cosatu is pushing for a big bang approach to implementing a single NHI fund, in which there is no space for other funding mechanisms, such as medical schemes.

‘The ‘single payer, single fund’ may be the ideal, but the conversation is what will happen tomorrow…. You don’t wake up one day and have a fund,’ Matsoso said. ‘I can assure you, we will end up with unintended consequences,’ she added.


Cosatu spokesperson Sizwe Pamla labelled the latest approach as “SA’s version of Obamacare“. A Rapport report notes that the comparison is supported by the contents of the discussions between Matsoso and medical schemes.

Profmed principal officer Graham Anderson says Matsoso invited them to make funding proposals on condition that they should come up with a specific benefit option. ‘It sounds as if all schemes will have to have a sort of NHI (benefit) option with the emphasis on comprehensive but cost-effective cover.’

The report says this is a similar approach to Obamacare in the US – where most citizens would be forced through legislation to belong to a medical scheme while medical schemes would be prohibited from rejecting new member applications – something which is already implemented in South African legislation.

The report says the aim is to drastically increase the risk pool to ensure affordability of premiums. Currently, only 8m people are covered by medical aid. Anderson said the government would have to subsidise the poor for them to afford medical aid.

Business Day report (subscription needed)
Rapport report

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