The one big thing Ramaphosa left out of SONA finally gets a mention
Anyone who was playing SONA Bingo during Cyril Ramphosa’s 2023 State of the Nation Address would have noticed a glaring omission in the president’s summary of disasters hitting the nation.
Amid an ongoing power crisis – which necessitated the declaration of a state of disaster – rising levels of crime and poverty, and another swing at corruption and state capture, there was no mention of the state’s other big plan: the National Health Insurance (NHI) scheme.
The omission was highlighted by the Democratic Alliance this week, who said that it was an indication that the president found its implementation “implausible” and unimportant, so it didn’t warrant a mention.
“Despite the desperate state of the country’s public health sector, it deigned only the smallest comment from President Cyril Ramaphosa in his (SONA) in regards to the government’s reckless proclamation of the state of disaster.
“According to the President, the state of disaster will magically enable the government to fast-track the exemption of hospitals from load shedding – an initiative that started off with much enthusiasm and then slowly petered off after a mere 76 of the 213 identified hospitals were exempted last year,” the party said.
However, of the Department of Health’s NHI plans, “not a word was said”.
While the NHI got no mention in the main address, Ramaphosa did give the controversial scheme a nod in his reply to the parliamentary debate on SONA.
The president said that the government’s commitment to quality healthcare has not been abandoned and that the NHI is still on track.
“Access to quality health care – and indeed better health itself – are necessary to improve people’s lives and build a successful society and a more productive economy. We are committed to the provision of quality health care for all regardless of their ability to pay,” he said.
“We will, therefore, progressively implement the National Health Insurance as soon as the necessary legislation is approved by Parliament.”
The last update on the NHI Bill came in December 2022, when health minister Joe Phaahla said that his department was preparing for the new laws to be finalised by the National Assembly during the course of 2023.
Phaahla said that the road to implementing the NHI will not be easy, and conceded that the department was getting ready for legal challenges.
“There are already challenges, just in terms of the implementation of our structure of preparing for the NHI in the department. We are already in court with some of the…organisations,” he said.
“Once the Bill is passed in Parliament, there will be a slew of litigations.”
In the meantime, Ramaphosa said that the government is preparing for the NHI’s implementation through the national quality improvement plan and putting in place the necessary staff and funding.
Where is the NHI at?
2022 saw many rapid and controversial developments around the NHI.
While systems for sharing information between the private and public sectors are being put in place, and recruitment for key NHI positions is now allowed to continue, no one in government has yet been able to address the elephant in the room: how much is the scheme going to cost?
The government’s push for the NHI comes amid a cacophony of warnings and dissenting voices, saying the scheme is unaffordable, unmanageable and unsustainable.
Private healthcare groups have been the most vocal on this front, saying the system is being set up for failure given the scale of what the government wants to achieve against the backdrop of how it has already failed in the public healthcare space.
There are also concerns over an exodus of healthcare professionals who refuse to be subject to the scheme’s harsh conditions, as evidenced by the court ruling the department is appealing.
Medical aids have been fighting for their continued existence, given that the NHI scheme envisions a healthcare system with the state entirely in control and little to no room for private healthcare funding.
Read: Government preparing for onslaught of NHI legal challenges
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