Furious opposition MPs walked out of Parliament’s Health Committee last week in protest after the chair declined their request to postpone deliberations on the National Health Insurance (NHI) Bill and allow them more time to consider the complexities of legal advice received last week.
Divergent views on the Bill were given by deputy chief state law adviser Ayesha Johaar, who said it met constitutional muster, while Parliament’s legal adviser, Sueanne Isaac, said the Bill was open to constitutional challenge on several fronts.
Business Day reports that FF Plus MP Philip van Staden said the documents submitted by Johaar and Isaac required careful consideration, and asked for a week’s postponement so that political parties could obtain their own legal counsel on the matter.
“It will be a great injustice if we are not afforded adequate time to seek legal advice on the input,” he said.
He was supported by the DA’s Lindy Wilson, who said the state law adviser and Parliament’s legal adviser had taken months to prepare their respective positions, yet MPs had been accorded barely a week to consider the documents they had submitted.
The EFF’s Naledi Chirwa also called for the meeting to be postponed, saying the party needed more time to consider the legal input received by the committee. “
However, acting committee chair Elvis Siwela declined their calls to postpone the meeting, prompting Van Staden to leave the meeting, followed by Wilson and her DA colleague Michele Clark. They were followed soon afterwards by Chirwa and EFF MP Suzan Thembekwayo.
The DA has written to Parliament’s chair of chairs, Cedric Frolick, to request his urgent intervention in the matter and to its legal advisers, requesting a letter to confirm it was not possible to do justice to the documentation in the time available.
After the walkout, ANC MPs presented their party’s position on the input received last week from the legal and law advisers, agreeing that the Bill was rational and in line with the Constitution.
NHI unrealistic and incoherent
However, writing in Business Day, Michael Settas, who chairs the health policy unit at the Free Market Foundation, pulled no punches on the subject.
“Given the magnitude and sweeping reforms demanded by the NHI proposal, it is necessary to emphasise just how naive or dishonest the government is,” he wrote. “The standard messaging from them – that Gauteng has undergone a large increase in population from inward migration and therefore its provincial health budget is being stretched across more citizens – is simply untrue.”
While healthcare was both a national and a provincial competence, the actual mandate to deliver is purely a provincial one, where each province undertakes management of its personnel and health facilities, he added.
The majority of the provincial health budgets are derived through the “provincial equitable share”, Treasury’s mechanism by which the national health budget is appropriated equitably to the provinces using the latest provincial population numbers.
“This means that as Gauteng’s population has ballooned, so too has the province’s proportion of the national health budget. The latest, March 2022, financials of the provinces show Gauteng’s share of the total health budget at 25%, almost equal to Gauteng’s population share (25.9%) in the 2020 mid-year population estimates, from which the 2022 health budget appropriation would have been calculated.”
Measured in real, per capita terms, from 2000 to 2020 SA’s national public health budget doubled in value, a result of annual budget allocations over that period that exceeded both population growth and general inflation, he wrote.
“So even when factoring in the rising national population and inflation, the government now has twice the health funding it had two decades ago.”
Additionally untrue was that the rate of increase in public sector medical personnel has far exceeded the rate of increase in the overall population, Settas pointed out.
“A concerted effort was undertaken to increase the number of medical personnel in the mid-2000s, with a 43% increase from 2006 to 2016, substantially improving the ratio of patients to medical personnel within virtually every clinical discipline.”
He questioned why conditions and outcomes within the health department had not improved commensurately with these vastly increased resources, and second, the government’s erroneous argument pushing for NHI being that its available resources were declining.
“But as outlined, the government was in fact the recipient of substantially increased resources, so why is the NHI proposal required?”
These two questions expose the incoherence of the NHI proposal, he said, the answers to both being found within the failings of the department of health.
There were stark differences in management capacity between the DA-led Western Cape and the ANC-led Gauteng, wrote Settas. The Western Cape has undergone a similarly big increase in population, but most importantly has kept its governance frameworks and management capacity intact, thus avoiding the disasters so evident in all eight other provinces.
The Western Cape unsurprisingly achieves far lower mortality rates compared with all other provinces. Similarly, its medical legal liabilities are negligible, compared with a colossal R22bn for Gauteng, roughly a quarter of its 2022 health budget.
“The NHI proposal has been centre stage of national health policy for 15 years … and its governance model, based purely on political appointees, dooms it proposal to catastrophe even before it even begins.”
Along with the dearth of technical, feasibility or costing analyses on NHI, this shows “it has little to do with healthcare and more to do with the ANC’s desire to control all of the levers of the economy in support of its Marxist dogma the national democratic revolution”.
“If the government had truly concerned itself with better health care as a primary goal, two critical outcomes would have transpired — the existing public health system would have performed substantially better than it has, and the critically necessary analyses of the NHI policy would have been undertaken free of political influence. Such analyses would almost certainly have highlighted the folly of such a ludicrous proposal, based on failed statist economic policies. The deficiencies are as obvious as they are plentiful.
“Parliament’s legal services unit recently raised alarm bells with the institution’s health portfolio committee over several aspects of the constitutionality of the NHI bill, including clause 33 which seeks to outlaw medical schemes from continuing in their present form.
This despite the private sector, NGOs and numerous academics having repeatedly raised the same concerns throughout the lengthy NHI policy development process.”
This hopefully spells the end of the NHI calamity, Settas added.
A high court ruling in 2022 striking down the constitutionality of the National Health Act’s certificate-of-need provisions, which sought to apply draconian impositions on doctors and medical facilities, is on the roll of the Constitutional Court for ratification. The certificate-of-need is pivotal to the NHI proposal since it provides for authoritarian state diktat on where, how and on whom doctors may practice.
“If it fails to pass constitutional muster, as it surely must, the NHI will be dealt a devastating blow. Along with the valid concern raised in Parliament on the NHI bill we may shortly get to a point where the NHI proposal finally gets relegated to where it belongs — the dustbin of history.”
BusinessLIVE article – MICHAEL SETTAS: NHI an unrealistic and incoherent plan (Restricted access)
See more from MedicalBrief archives:
Conflicting legal views present another hurdle in NHI Bill discussions
NHI Bill meeting delay questioned
Rush to push through NHI Bill before ANC conference – but key questions still unanswered