NHI divide in South Africa grows
South African business group Business Unity South Africa (BUSA) says that promised engagements with the government over the National Health Insurance (NHI) Act have not yet taken place.
Instead, there is now growing rhetoric from the government villainising critics and characterising their views as anti-poor or propaganda.
BUSA chief executive Cas Coovadia said that the group was deeply concerned about the “inappropriate rhetoric” arising around the NHI this week against those who have “raised legitimate concerns regarding the Act in its current form”.
Health minister Aaron Motsoaledi told an international audience this week that those who were pushing against the government’s NHI scheme were employing “apartheid tactics” by mimicking a type of “swart gevaar” around the laws, effectively painting them as fear-mongering propagandists.
This echoes similar sentiments expressed by the minister in recent months.
Contrary to this, however, Coovadia said that BUSA has kept its doors wide open for discussions with the government around the NHI and reiterated business’ willingness to engage with the state on universal healthcare and reform.
But the conversation has not happened.
“We are disappointed that despite commitments by the government to engage on the NHI Act, structured discussions have not yet taken place.
“It is only through formal, constructive engagement with the President, Minister of Health and National Treasury, focused on collaboration rather than division, that we will create a healthcare system that is equitable, effective and sustainable for generations to come.
“BUSA remains ready to participate in meaningful dialogue with the government,” he said.
The CEO said that businesses have been explicitly clear on their position regarding the NHI, and have never wavered in a genuine commitment to healthcare reform.
“Our primary objective, in conjunction with the government and other stakeholders, is to ensure that everyone in South Africa has access to quality healthcare, and that the inequalities across the healthcare system are addressed in a responsible and expedited manner.
“This is not only a social necessity but also essential to driving the economic growth our country so desperately needs,” he said.
However, the NHI is not the path, he added.
“We have, on many occasions and across every legislative forum, made constructive proposals on how the country can do this without negatively impacting our economy, healthcare system and fiscal stability.
“We have also been extremely clear in our position that the NHI, as is envisioned in the Act, is unaffordable, unimplementable and unconstitutional, and therefore requires urgent amendment.”
Coovadia said raising concerns with the NHI is both appropriate, responsible and necessary to ensure that the path to universal healthcare is viable and sustainable for the country.
Health department has a different view
While BUSA sees criticism and concern over the NHI as appropriate, the health department has taken a different view.
Motsoaledi said this week that negativity around the NHI was being created by critics to scare people off and make them angry about the NHI—tapping into the “same kind of “white fear” “swart gevaar” spurred during apartheid over the incoming government.
“It was used to scare those who are clamouring for freedom, never even to think about it because it was going to bring terrible things to them,” he said.
“‘Swart Gevaar’ was so successful in scaring people off that white people started hoarding essentials like tin food, candles, matches, etc, waiting for the doomsday when (Nelson) Mandela becomes the first black democratically elected President of South Africa.
“The same strategy is being deployed today… the screaming headlines are designed to scare people off and make them angry about this NHI,” said Motsoaledi.
The minister has used several opportunities during his time as health minister under the seventh administration to double down on the NHI and its most controversial policies, as well as paint any critical or dissenting voices as “hooliganism”, anti-poor or “propaganda”.
At the same time, the government has tried to force NHI acceptance onto businesses and stakeholders through the second Presidential health compact—which was boycotted by the vast majority of previous signatories—and has not yet engaged with them as promised.
Delivering his opening of parliament address in June, President Cyril Ramaphosa acknowledged the pushback against the NHI and put forward a message that the government would seek consensus on the laws and—vitally—bring the private sector on board.
He committed to bringing stakeholders together to reach an agreement on the NHI Act, acknowledging that the resources and capabilities of both the public and private sectors are necessary to equitably meet the health care needs of all South Africans.
In the weeks that followed, the Health Department appeared to echo this, with Motsoaledi promoting an ‘NHI roadshow’ to ‘engage stakeholders’ who had voiced their concerns.
Ultimately, however, the minister dismissed any consultations (“Consultation for what?”), revealing that the roadshow was based on invitation, where he sought to clear up “confusion” created by the media and NHI critics.
While the minister has expressed a willingness to listen to anyone who has ideas or proposals for healthcare reform, he said he will not entertain discussions around “foundational” policies in the NHI, saying it would be “a waste of time”.
Foundational policies of the NHI include severely diminishing the role of private healthcare financing through medical aids, which will not be allowed to govern any services covered by the NHI.
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