The NHI is becoming a tool for political and factional battles, potentially rendering productive, logical debate on its future – and on the urgency of ensuring universal access to quality health services – untenable, writes Natasha Marrian in Business Day.
The deeply ingrained positions, from all sides of the table, have gone beyond health and are now simply politicking, pointing to the the difficulty the ANC will face in retreating from its hardline position on the legislation.
Most recently, the ANC’s partners in the GNU are scratching their heads after Health Minister Aaron Motsoaledi told Bhekisisa’s Mia Malan that medical schemes were out, even if it meant the end of the government of national unity.
It’s well known that while most signatories to the GNU agree that universal access to basic healthcare is non-negotiable, their issue is with the legislation itself, particularly with having the state at the centre of governance for a future healthcare system, given its track record in managing public funds.
“I would say we are firm on our stance that the NHI is noble in theory and makes for good political rhetoric, but it is thin on realism and there are so many approaches we can take that will be more sensible,” PA leader Gayton McKenzie told Business Day.
“Being opposed to the NHI doesn’t have to mean the end of the GNU, and the debate will have to continue … no single party picked up enough of the vote to have everything their own way.”
Narend Singh, treasurer-general of the IFP, another key GNU partner, agrees that the governance mechanisms suggested in the current NHI legislation fall short of expectations.
“We support universal healthcare…but fundamentally disagree with the financing and governance arrangements… the government has not managed to improve healthcare outcomes in the public sector with the billions handed to it over the years, why would we expect it to suddenly do so now?”
The NHI legislation was a red line for the DA too, but there was agreement during negotiations with the ANC that there was room for further discussion.
DA leader John Steenhuisen does not believe the NHI will be a deal-breaker for SA’s tenuous coalition government.
“That is still an issue that …we are going to have to resolve on and I think we can do it. The unaffordability of the NHI, the loss of this court case now, is a significant blow to it. And that’s just the first of a number of constitutional challenges.
“Third, the private sector and public healthcare system are saying … this isn’t going to work … I think we can find each other because, and I make this point, it’s not just the DA, but other parties in the GNU too,” he added.
Motsoaledi’s comments came after key business and medical bodies boycotted the signing of the Presidential health compact last week because of the central role of the contentious NHI in the framework. Sections of the NHI have already been struck down as unconstitutional by the High Court and more legal challenges are looming for the legislation.
Communication on any decision to rework the legislation would have to be carefully managed. It does not help that senior leaders, like Gauteng Premier Panyaza Lesufi – while on the campaign trail – incorrectly declared that citizens would immediately, after the 29 May polls, be able to walk into private health facilities and receive treatment, with the government picking up the tab.
On Sunday, the SACP urged the government to proceed “decisively” with the implementation of NHI.
Business Day understands the ANC’s national executive committee was willing to look into the issues raised by both the medical sector and opposition parties, but could not completely halt its implementation at the risk of playing into the hands of those such as the SACP, the EFF and the MK party, who have accused the party of “selling out” by setting up the GNU.
Motsoaledi is also a hardline proponent of the NHI, with Singh accusing him of “speaking from two sides of his mouth”.
“One the one hand, he says it’s here to stay even if it ends the GNU, and on the other, he says he is consulting all role-players. Which is it?”
The party will have to finely balance the politics and the practical aspects of implementing the contentious legislation. In the interim, however, most of the country’s citizens will continue to go without high-quality, free, basic healthcare.
“The danger is that this issue is now far too politicised,” Singh said.
McKenzie didn’t mince his words in addressing the politicisation of the NHI by Motsoaledi: “We should avoid acting as if the GNU doesn’t matter or is not needed. If people want to bring in other parties, they should say so with their chest instead of saying nonsensical things like the GNU can rather fail. This is our second miracle and we should appreciate it as that.”
Business Day article – NEWS ANALYSIS: Politicising SA’s health through NHI (Restricted access)
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Motsoaledi to increase push for NHI
NHI tug-o'-war for GNU and new Minister