Doctors, businesses and unions get ready for war over the NHI

 ·14 May 2024

Business Unity SA (BUSA) says it is considering taking legal action if President Cyril Ramaphosa signs the National Health Insurance (NHI) Bill into law during a planned ceremony in front of the Union Buildings on Wednesday (15 May).

This will be one more legal challenge to the imminent laws, besides the processes promised by trade union Solidarity and opposition parties in their fight against the laws.

The presidency said on Monday (13 May) that the signing of the bill “directs the transformation of the South Africa’s health care system to achieve universal coverage for health services and, through this, overcome critical socio-economic imbalances and inequities of the past.”

However, the move by the government goes against criticisms and dissatisfaction with the bill’s present state coming from all sectors of society, including businesses, the healthcare industry, worker unions and even legal experts.

These groups have been urging Ramaphosa to return the legislation to Parliament rather than giving his approval, citing major constitutional shortcomings and warning of irreversible damage to the country’s healthcare sector, particularly private healthcare.

BUSA said that the legislation is detrimental to both the healthcare industry and the overall economy, as well as the confidence of investors.

“We fully support the objective of universal health coverage. However, the NHI Bill in its current form is unworkable, unaffordable, and not in line with the Constitution,” said BUSA CEO Cas Coovadia.

“What is especially troubling is that the President is proceeding with the Bill despite extensive constructive inputs made by a wide range of stakeholders, including doctors and healthcare professionals, civil society, public sector unions, academics and business,” said Coovadia.

“The unfortunate consequence is that this version will hamper, rather than promote, access to quality healthcare for all citizens in our country,” he added.

“Consequently, we will pay close attention to the President’s announcement on Wednesday, based on which we will consider our options.

“Our subsequent actions will be guided by our belief that it is essential that we get the NHI right through all means still at our disposal, including appropriate legal interventions, so that the legislation that is finally implemented is in the best interest of our country, and all her people, for generations to come,” said Coovadia.

In February, Coovadia told eNCA that whilst he appreciated that it was election season, the government needed to make commitments “that the country and fiscus can afford.”

“We believe that universal healthcare can be achieved with the optimal use of resources that are both within the public and private sectors,” but “the bill, as it is currently drafted, talks about the single fund model – a fund run by (the) government that will effectively have a monopoly on healthcare for citizens in this country.”

Coovadia said that that bill is unworkable and will “to a great extent not create an environment for the inclusion of the private sector”.

“We believe that it’s actually shooting ourselves in the foot,” he said. “We’ve got a very good private healthcare sector. It has its problems, and we need to deal with those problems – but we have a public healthcare sector that also has its problems,” he added.

Unions fight back

Solidarity has been promising a fight back against the NHI for some time, stating again this week that it “is vehemently opposed to the NHI and is strongly in favour of a market approach, offering a choice to private service providers and to the public, as well as being in favour of an improved public healthcare system”.

“NHI will ruin South Africa and Solidarity is preparing for a major court battle to ensure that the healthcare sector is free, safe and prosperous,” it said.

The union said that the state will destroy the medical schemes industry, severely damage the private healthcare sector, and ultimately centralise and pool billions of rands into a state-controlled fund which will be ripe for corruption.

“Given what the government as curator of tax money has caused as a result of blatant corruption and abuse, this is a chilling thought,” it said.

Funding has been a key sticking point of the NHI, with the NHI Bill stating that funding for the scheme—which has not been officially costed, but estimated to be between R200 billion and R700 billion a year—will come from taxes.

Other unions, like the Public Service Association, have expressed alarm at the lack of detail around funding and what this impact will have on taxpayers, also calling for the bill to be returned to parliament, unsigned.

Doctors disappointed

The South African Health Professionals Collaboration (SAHPC) said that it was concerned about the signing of the bill.

The group is a collective of nine medical, dental and allied healthcare practitioners’ associations representing more than 25,000 dedicated private and public sector healthcare workers.

In addition to its many submissions and engagement in the NHI parliamentary process, the group has also been urging the president to send the bill back on the grounds that it is unconstitutional.

“Our input and insights were ignored,” it said. SAHPC said it is also preparing a legal challenge.

SAPHC also believes its members’ concerns and recommendations throughout the parliamentary process were systematically ignored, raising serious questions about the fairness and effectiveness of the democratic process.

Dr. Simon Strachan, a spokesperson for the SAHPC, said: “Our members have made submissions at every stage of the legislative process, dating back to the release of the green paper in 2011. It is disheartening to see our efforts to contribute to a more robust, workable and patient-centric healthcare system being ignored.

“Where we are now is unprecedented, and we believe that the NHI, in its current form, will reverse, rather than progress, equitable, quality healthcare in South Africa. We have no doubt that the NHI Bill will be challenged in the courts, and we are currently exploring all our options in this regard.

“As healthcare practitioners, our primary concern is the wellbeing of our patients. As experts in our field, we believe the President has an obligation to ensure that the NHI improves, rather than limits overall healthcare for every citizen. He has failed to do this,” he said.

Read: Ramaphosa finds a pen – NHI to become law this week

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