When caring isn’t sharing
Setting up a kind of national health service system in SA will become one of the prime sources of emotionally charged political debate
THE BATTLE NOW UNDER WAY in South Africa about healthcare reflects a major and ongoing issue internationally. For example, in the United States, President Barack Obama has made the US health system – and its costs – one of the major priority challenges of his administration. He readily admits he’s far from the first occupant of the White House to do that.
Over 100 years ago President Theodore ( Teddy) Roosevelt put much improved national healthcare among his prime goals. Many subsequent presidents made similar pronouncements. But while there have been enormous advances in overall healthcare in the US, the whole subject remains a massive source of political controversy. That’s inevitable.
Crucially, almost all of us instinctively think it grossly immoral that some “privileged” people should be able to buy better health – even including life-saving treatment – that’s denied to the great majority who have not the money to pay for it.
Similarly, it seems “wrong” generally that the ability of the chronically ill to obtain, for example, drugs with a proven record of success internationally should be determined by the cost of that medication.
It’s widely assumed in South Africa that the problems and policy dilemma must necessarily be hugely greater in a middleincome country – as SA is classed – than in the rich nations. Further, it’s mostly taken for granted that even in affluent societies the relatively poorer sections of the population are ultimately dependent on whether their local and/or national political leaders are sufficiently “caring”.
There are, of course, important elements of truth in all those views, whatever countries are involved. But there are also many other critical economic factors – distressing as many observers find any debate on costs versus medical need – that can’t in practice be avoided.
That will become more increasingly evident in SA as the question of setting up a kind of national health service – technically, a national health insurance (NHI) system – becomes one of the prime sources of most emotionally charged political debate.
One media report this month set out the broad situation this way: “A proposal on NHI could cost the taxpayer an additional R100bn/year, an amount equal to 9% of general household spending. Economists have warned that if the proposal from an ANC task team is implemented, the cost would cripple the entire economy. In the 2009/2010 Budget total spending was projected at R739bn, with R87bn allocated for health.”
I think there’s minimal chance that President Jacob Zuma and his Government will actually attempt to implement anything on those lines. They know – or will quickly be told – that R100bn in extra taxes would include hefty burdens on the politically powerful emerging/emerged black middle class and/or have a devastating effect on business, not least through the impact on staff of foreign-owned companies.
More, the ANC team plan looks to make private health schemes compulsorily offer extremely poor returns relative to the largest subscribers. That would add greatly to the negative implications for SA and foreign-owned businesses.
Here Zuma’s Cabinet might take heed of some key lessons from countries that are, in terms of average real wealth per capita, much poorer than SA. The Economist reported on 16 April this year: “India’s entrepreneurs are channelling the country’s rich technological and medical talent towards frugal approaches that have much to teach the rich world’s bloated healthcare systems.
“Poverty, geography and poor infrastructure mean that India faces perhaps the world’s heaviest disease burden. The public sector has been overwhelmed, which isn’t surprising considering how little India’s government spends on health as a share of national income.”
Then comes the vital conclusion from that report: “Nearly four-fifths of all health services in India are supplied by private firms and charities – a higher share than any other big country.”
Spending on healthcare in India is expected to soar from US$40bn in 2008 to $323bn in 2023. That will be overwhelmingly reflected in a massive boom in private health insurance – with virtually none of the collectivist, soak-the-rich ideology supported by the ANC task team.
There are frequent complaints in SA – sometimes justified – that too much attention is paid to taking economic lessons from the developed world and too little notice given to what’s going on in other emerging market nations. Yet which country did the ANC health task team use as its prime model for solutions to SA’s problems? The highly affluent Canada – which also has the bonus of all the facilities its public health system can’t properly offer being available, for the many who can afford them, across the border in the US.
India has been forced by economic necessity to extract the maximum value it can for all its healthcare spending. That surely is where SA is far more likely to find helpful answers for this country than in Canada.