Ramaphosa’s NHI ‘will never happen’ – even if he finds that pen

 ·15 Feb 2024

Analysts, economists and other stakeholders from the private healthcare industry have found commonality in the belief that the National Health Insurance (NHI) scheme – as it stands in the current bill before the president – is dead in the water.

This comes as the country waits for President Cyril Ramaphosa to sign the NHI Bill into law, effectively giving the Department of Health the freedom to launch a new NHI Fund and start the slow process of rolling out the controversial scheme from 2026 onwards.

In his State of the Nationa Address, Ramaphosa said he was “looking for a pen” to sign the NHI Bill into law. However, his position on the overall scheme was interpreted as ‘surprisingly non-populist’ given his insistence that it would be implemented “incrementally”.

Commentators have called the signing of the laws nothing but a political tool used by the governing party – with the reality being that the scheme is entirely unfundable, unimplementable, and will undoubtedly be challenged on constitutional grounds the minute it becomes law.

Various groups – from political parties like the DA, unions like Solidarity, and private healthcare representatives like the South African Medical Association – have all indicated that they will challenge the NHI should it become law, with some having litigation pending, just waiting for the green light.

This is even before private businesses like Discovery and hospital groups launch their fightback, with their multi-billion-rand businesses on the line.

Outside of the inevitable legal fights, however, the government also faces the problem of reality.

According to Stuart Theobald, Executive Chairman of Krutham (formerly Intellidex), “the NHI is a pantomime – it is totally unfundable and will never happen“.

Referring specifically to Ramaphosa’s SONA, he noted that even though the president gave an air of caution with the “incremental” statement in his speech – the fact remains that the NHI Bill before him is not incremental, it’s “all-in”. he said.

“If (the) government wants it to be sequential and gradual, it could make that much more explicit in the legislation,” he said.

“As it is, should the president sign it into law as he has promised, it is going to immediately face a wall of litigation on its constitutionality.

On top of this, Theobald said he expects that the Treasury will “continue to treat NHI as if it is told by an idiot, full of sound and fury, signifying nothing”.

“(Treasury) will continue to just about ignore it for budgeting purposes, apart from some money for feasibility studies.”

This reflects the reality: there is simply no money for the NHI.

This position was also presented by Nedbank in its pre-budget analysis, with the group saying that money is so tight in the national fiscus that it does not expect finance minister Enoch Godongwana to put any more funding towards it.

Business for South Africa (B4SA) Steering Committee Chair Martin Kingston called the NHI “effectively be stillborn”, while Efficient Group chief economist Dawie Roodt said the scheme, even if it is signed into law, will not see the light of day in its current form.

Read: NHI not another Eskom – it will be ‘in safe hands’ with government: Health Minister

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