Time’s up for the NHI
The comment period for the National Health Insurance (NHI) Bill – currently before the National Council of Provinces – has drawn to a close, and legal challenges are already looming large.
From midday on Friday (15 September), the opportunity for the public to comment on the controversial bill ended, with the bill’s future now resting with the NCOP.
If the NCOP concurs with the National Assembly on the bill, it will be passed on to President Cyril Ramaphosa to be signed into law.
The original deadline for comment was 1 September 2023, but this was extended by two weeks at the request of stakeholders and individuals seeking to make submissions on the bill.
The Bill has received wide criticism from the private healthcare sector and has been questioned on its constitutionality by medical aid providers, the public, business leaders and even parliament’s own legal service.
In principle, most stakeholders are not against the idea of the NHI and universal healthcare; however, in a South African context, issues of affordability, corruption, skill capacity and state competence have repeatedly been flagged as barriers to its implementation and efficacy in the country.
One of the biggest issues with the Bill is regarding funding, with Health Minister Joe Phaahla saying, vaguely, that the government will pay for the scheme – meaning that taxpayers will foot the bill.
The government itself has not provided any estimate for how much money will be required to run the scheme, but researchers have put the total cost anywhere between R300 billion and R660 billion a year.
Even without an official figure, the NHI will undoubtedly be one of the largest expenses in the South African budget by a significant margin. At the same time, available funds are shrinking due to the government’s poor economic policies.
Trade union Solidarity and its research unit have been tracking and fighting against the bill at every opportunity, including the latest comment window with the NCOP.
The group has been pushing back against the new laws vociferously, arguing that it is “insane” and completely unworkable in South Africa’s current financial situation.
Solidarity and the Solidarity Research Institute’s (SRI) position is that:
The NHI is unaffordable
According to a study by the SRI, the Treasury will need an additional R296 billion to make the NHI a reality. For that, people will have to pay significantly more tax – an estimated 40% increase in personal tax for salary earners. “The Treasury is empty. There is no money for the NHI,” it said.
Incidentally, a similar sentiment was expressed by National Treasury itself. Health minister Enoch Godongwana recently stated that, while the country requires some form of universal health coverage, it lacks a sustainable funding source.
He suggested that money rather be spent fixing the current public healthcare system and infrastructure – a point many NHI critics have pushed.
The NHI is impracticable
According to Solidarity, the NHI will most likely result in many medical practitioners who provide private healthcare services leaving the country.
“There already is a shortage of specialist healthcare workers, and the indications are that this shortage will dramatically increase. The failure of the public healthcare system on a smaller scale, as we are currently experiencing, points to failure on a much larger scale should the NHI be accepted,” it said.
While the union has presented surveys and anecdotal data supporting this view, it is not without its counterpoints.
Some local healthcare practitioners have cemented their roots in South Africa despite the looming changes for the sector.
The NHI is unnecessary
Pressing on the views expressed by Godongwana, Solidarity argued that South Africans already have access to free healthcare, and the real need is for this public healthcare system to be maintained and improved.
“If the necessary resources and energy are devoted to upgrading it instead of setting up a new system, the quality of public healthcare will improve. Along with this, the efficient private healthcare system will remain intact for those who choose to make use of it,” it said.
On top of this, there are deep concerns that the NHI will effectively kill private healthcare in South Africa – severely limiting private practitioners and obliterating medical aids – which businesses have described as “shooting ourselves in the foot“.
The next Eskom?
According to Connie Mulder, head of the Solidarity Research Institute, each of the reasons given is enough, on their own, to warrant scrapping the NHI plans.
However, this is unlikely to happen. With the 2024 national elections looming large, the promise of universal healthcare has been a foundational campaigning tool for the governing ANC.
Solidarity said this will be to the detriment of the country, warning that the scheme is likely to become another “Eskom, SAA or Transnet” – state companies riddled with corruption, mismangement and government interference.
NHI showrunner, the Department of Health’s Dr Nicholas Crisp, has acknowledged the trust and mismanagement issues involved with state-run companies but has argued that the NHI could just as easily become the next SARS (ie, a well-run state institution).
However, the balance of probability does not side with this view when looking at well-run vs poorly-run state companies.
“Contrary to how it is being presented, the NHI will not improve the lives of poor South Africans. Quite the reverse, it will negatively affect the standard of living of everyone in the country, but especially plunge poor South Africans further into misery,” Mulder said.
The group said that it is ready to take the matter to court if the NHI Bill passes the NCOP and is signed into law.
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