Time to call out ANC’s hollow NHI promises
The National Health Insurance (NHI) Bill’s passage through parliament last week is being triumphantly hailed by the ANC as a key milestone towards achieving universal health coverage. Nothing could be further from the truth.
This legislation has not been developed in a rational process but is a blunt, ideologically driven instrument that has been bludgeoned through each step of the public consultation process with an eye on the governing party’s political calendar, be it an ANC conference or an election.
At no point since the green paper on NHI was released for public comment in 2011 has either the executive or the legislature reshaped it in any meaningful way, despite legitimate and constructive critiques from various stakeholders.
With a general election looming large, it is hardly surprising that the National Council of Provinces rubber-stamped the bill. Clearly under pressure to get the job done, it ignored even the technical corrections suggested by the departmen of health, since any amendment would have delayed the whole thing.
The challenges with SA’s health system are well documented. The office of the health ombudsman has published a series of investigative reports cataloguing the horrors inflicted on state patients. And all the provincial health departments bar that of the Western Cape are haemorrhaging money to inept political appointments and crooked procurement systems.
Access to the generally high-quality healthcare offered by the private sector is largely the preserve of those able dig into their own pocket or pay for medical scheme membership. No-one in their right mind would argue that this is acceptable. The trouble is the NHI Bill is not going to fix any of it. In fact, it risks achieving exactly the opposite of what the ANC is promising.
The bill lays the legislative groundwork for a central NHI fund that will buy services for the entire population from public and private providers, as the sole purchaser. Medical schemes will be barred from offering cover for benefits provided by the NHI fund, effectively merging SA’s two-tier health system into one.
The ANC is assuring the electorate that under NHI everyone can go to local private hospitals when they are sick, and that services at public hospitals will be hugely improved because there will be more money. But this is simply not true. Not only has the department of health itself admitted that NHI will take decades to implement, it is utterly naive to believe voluntary medical scheme contributions can simply be redirected by raising taxes.
A central fund overseen by ministerial appointments is ripe for plunder. And putting the squeeze on medical schemes will destabilise the private healthcare sector, deter investment and create such an uncertain working environment that young healthcare professionals will simply emigrate. The result will be less money and fewer doctors, and a worse deal for everyone.
The NHI Bill is heading for the president’s desk. It is time for him to call out the department of health’s hollow promises and send it back to parliament for a complete overhaul.