‘Whether you like it or not’ – Ramaphosa vows to sign NHI into law

 ·15 Jan 2024

Presidency Cyril Ramaphosa has vowed to sign the controversial National Health Insurance bill into law, despite mounting opposition from the private sector, economists, analysts and legal experts, who have called the laws unworkable.

Delivering the ANC’s January 8th statement this past weekend, Ramaphosa addressed the looming NHI as part of the “positives” the governing party had brought to the people of South Africa.

He said that the NHI bill was a result of “30 years of struggle” and assured the crowd of thousands of ANC supporters that the bill would be signed into law to give everyone in the country access to free healthcare.

“This is going to happen whether they like it or not,” he said. “There has been huge opposition against the introduction of the National Health Insurance. I can say we are going to proceed…it will go ahead.” [January 8th address, 31:10]

Although speaking as the president of the ANC, Ramaphosa, as president of the country, is the final hurdle the NHI Bill has to cross to becoming law in South Africa.

The NHI Bill was passed by the National Council of Provinces (NCOP) on 6 December, pushed through by an ANC-led majority despite opposition from various sectors. The bill is currently with the president waiting to be signed into law.

Given the president’s latest comments, assurances last year that he would “not simply sign the bill into law” have fallen somewhat flat, and business leaders are taking note.

In her weekly newsletter, Business Leadership South Africa (BLSA) chief executive Busi Mavuso said that the president’s comments are incredibly damaging for an economy that is already being battered on several fronts.

She said that because 2024 is an election year, there is a heightened risk of populist policy being rushed through parliament to add to the electioneering.

“Already, the passage of the unworkable NHI Bill shows how destructive such moves can be,” she said.

The president’s comments that the NHI is coming “whether they like it or not” was just another blow.

Despite Ramaphosa’s comments, however, Mavuso reiterated the position of business and many other NHI critics: the NHI, as it stands, will never work.

“The law will never work simply because there is no capacity to implement it, and as soon as it is signed, it will be embroiled in litigation on several fronts, including its constitutionality,” she said.

Knowing this, but pushing ahead with the bill anyway, signals that Ramaphosa and the government aren’t interested in a workable solution, but are just hunting for populist votes. In the meantime, the economy and livelihoods of thousands will continue to suffer as a result.

“With economists predicting that the economy will grow only 1.5% this year, having grown 0.8% last year, the need to focus on kickstarting growth is obvious,” Mavuso said. “Populist politicking can obviously harm that effort.”

“The NHI Bill is already giving businesspeople pause for thought about whether they will be able to rely on the South African health system in the future. Health professionals, who are easily globally mobile, are also worried about their futures. It is frustrating for those of us focused on delivering the changes that will push economic activity in the right direction,” she said.

While many opponents of the NHI Bill are not opposed to the idea of universal healthcare, they have long argued that what is currently contained in the bill is not the way to achieve this.

The ANC government’s dream of an NHI is one where all the resources and funds that currently go toward private healthcare in South Africa to service a 19% minority will ultimately be redirected into the national public healthcare pool.

However, as spending on private healthcare is an after-tax expense, the only way to achieve this is by effectively removing the option to spend money on private healthcare. As a result, the NHI concept goes to great lengths to make the state the sole purchaser of healthcare in the country, while forcing out companies and schemes like medical aids.

The government is yet to outline what services the NHI will offer, how exactly it will be funded – except to say it will definitely be taxes and redirecting tax incentives like medial aid credits – and has offered nothing in the way of protections against corruption, except to promise it won’t happen.

Overall, big, complex implementation challenges have been identified with the current NHI Bill, that are nowhere near being resolved.

These include legal (passing the bill and repealing many integrated, standing laws), operational (developing the complex systems needed to take over funding and control of the private healthcare system built over decades) and financial (the funding issues which remain unaddressed by the government).

Read: Warning over major ‘NHI brain drain’ in South Africa

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