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

Finweek English Edition - - In The Spotlight - HOWARD PREECE howardp@fin­week.co.za

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.

Newspapers in English

Newspapers from South Africa

© PressReader. All rights reserved.