There are vague signs that some people in the higher echelons of government are beginning to catch on to the fact that the much vaunted NHI will need more than just political posturing and grandiose rhetoric.
In fact, finally, some glimmer of realism appears to be peeking through, writes Financial Mail editor Rob Rose after speaking to Deputy President Paul Mashatile.
He writes:
To set the scene, the ructions began two months ago, when the NHI Bill was adopted by Parliament. It soon turned out, however, that nobody in the ANC paused to consider where the funding of more than R250bn a year would come from, what measures would be employed to ensure that money doesn’t end up in a cellar in Saxonwold, or what would happen to the country’s decomposing public hospitals and clinics.
And the money is important – medical aid Discovery, which would be largely wiped out were NHI to be implemented in its current form, estimates VAT would have to be hiked from 15% to 22%, or steep new payroll taxes implemented to finance the fund.
So what do these NHI fantasies say about the ANC’s economic realism, the FM asked Mashatile.
Mashatile replied that President Cyril Ramaphosa has specifically raised this issue with him – and is adamant that the NHI Bill can’t be signed into law before a “further discussion” is held on how to fund the new plan.
“Everyone is raising the (funding) question, but there are others who feel NHI will affect medical aids, so before we sign it into law, there are things we are going to look at,” he said.
That’s pretty vague, but it’s a vital concession nonetheless.
Yet, like much of the fog around Mashatile, it’s hard to know what to trust. The ANC under Ramaphosa has been quick to trot out platitudes, presumably to lure CEOs into injecting the bazillions they keep in their couches into the economy. But when it comes to actually making sure any of the promised reforms materialise, these “good intentions” fizzle.
Whether this inertia is due to the ANC’s hard-baked ideological suspicion of the free market, or fear of the electoral consequences of embracing economic reality, isn’t clear. Either way, it creates huge doubt over the sincerity of its promises.
Still, unlike many of Mashatile’s ANC peers, he does seem to get that to simply build a wall around the existing crumbling public health system and forget about it, while focusing on the bright shiny new thing of NHI, wouldn’t be optimal.
As he put it: “One thing we want to do is fix our hospitals; they are not up to scratch. Eighty percent of our people use public hospitals, so it is in our interests to sort them out. We already met (Health Minister Joe Phaahla), and told him more investment was needed in public health facilities.”
Here, Mashatile is half-right: public hospitals are indeed a wreck. But NHI was never even intended to fix this.
Last week, Western Cape Health MEC Nomafrench Mbombo explained this succinctly in the provincial legislature, saying NHI isn’t about providing universal health coverage (UHC) to millions of South Africans; rather, it’s just about redistributing money.
“There is no one in the world who could say no to UHC,” Mbombo said. “We are saying ‘no’ to NHI because it focuses on the funding without necessarily looking at strengthening the whole health system.”
But the ANC again illustrated that its support of NHI is based on rank ignorance. In response to Mbombo, ANC MPL Rachel Windvogel spoke of how the NHI pilot project was a “success”, and that “experts” had “repeatedly debunked” arguments over the cost of the project.
Windvogel has no idea what she’s talking about.
First, nobody has “debunked” the concerns over costs, not least because the ANC hasn’t provided any inkling over what these costs are.
Second, the (exceptionally limited) NHI pilot projects had “mixed success”, according to a report funded by the Department of Health, due to “inadequate planning, lack of resources, inconsistent communication, a lack of co-ordination where necessary and insufficient mechanisms to monitor progress”.
So, either Windvogel is making it up as she goes along, or that withering diagnosis is actually what passes for “success” in modern ANC parlance.
As Wits University Professor Alex van den Heever said, no funding models or institutional models for NHI have ever been tested.
“With no financial or institutional feasibility studies having been done, this is no Apollo mission. If these guys ran Nasa, they’d have put some firecrackers under a dustbin and called it a rocket to the moon,” he says.
Also, where Mashatile is wrong is that the issue isn’t that more investment is needed. Rather, the problem is that the existing money is badly spent and there’s zero accountability for that.
When politicians say “more investment is needed”, they’re misdiagnosing the problem. As Van den Heever told the FM a few weeks back: “This isn’t a money problem; it’s a governance problem, and more money won’t solve it.”
Still, it’s commendable that there’s at least some recognition from Mashatile that the questions around financing NHI must be answered first. And that’s not good news for NHI die-hards, for whom economic realities are some small technicality to be ironed out later because, you know, there’ll always be money from somewhere.
If anyone had bothered to listen to most critics, they’d hear that this isn’t about ditching NHI entirely; it’s about putting in place a better and workable system of universal coverage.
But this version – this scrappy Band-Aid of an unformed plan, teetering treacherously on 1 000 contingencies – doesn’t cut it. And just maybe, Mashatile and Ramaphosa are starting to realise it. Or maybe they’re just saying that.
BusinessLIVE article – ROB ROSE: Economic ignorance fuels NHI fantasy (Restricted access)
See more from MedicalBrief archives:
NHI restructuring will impact 130 000 jobs
‘No way to fund the NHI’ – Discovery CEO
Income tax hike and payroll tax proposed for NHI funding