National Health Insurance in its current form is a cynical vote-catching ploy

Let’s get one thing clear: universal health coverage, where everyone is able to access quality health care at low to no cost, is something all progressive individuals must support without question. The commodification of health care has created a disparity in treatment where the quality of the care you receive depends on the depth of your pocket. It’s trite, but worth repeating, that South Africa has a fragmented, twotiered and unequal health-care system. A world-class private sector — funded through individual contributions made largely via membership of pricey medical aid schemes — caters for just 29% of the population. An underfunded, dysfunctional public health-care system is left to look after the wellbeing of the remaining 71%.

The public health-care sector is under severe strain. State-run hospitals and clinics cannot cope with the number of patients they are required to treat. Health-care provision, hygiene and overall quality of service are substandard. It is now common to see patients lying on the floors at major public hospitals because there are not enough beds to accommodate them. The status quo is untenable and cannot be allowed to continue.

The National Health Insurance (NHI) scheme has been an imperative of the ANC government for decades. It was first raised at its Mahikeng conference in 1997, and was formally adopted as a resolution at Polokwane 16 years ago. It seeks to scrap South Africa’s two-tiered system and ensure that all eligible patients are provided with free services at the point of delivery. If enacted, it will pave the way for the establishment of an NHI Fund that will be the sole purchaser of health-care services, with medical schemes restricted to covering only those treatments not provided by NHI.

This week, the National Council of Provinces approved the National Health Insurance Bill, creating a legislative framework for NHI. But the bill that was passed by parliament is problematic. In their haste to make it law, those in charge of the process completely ignored important stakeholders who have warned that in its current form the bill is unconstitutional.

Business Unity South Africa and B4SA will petition the president not to sign the bill into law, but rather to send it back to parliament for further review. They say input from business, the medical aid industry and private hospitals was completely ignored.

They strongly argue against creating a central fund to purchase health-care services on behalf of all citizens, saying it severely limits individual rights. The fund will have the power to refuse access to certain treatments —a fundamentally flawed provision, and one that is unconstitutional.

“The processes for accessing health care and making appeals when the NHI [system] refuses access to treatment are foreseeably inadequate, to the point where they are more likely to frustrate or even deny the right of access to health services,” Business Unity South Africa and B4SA have said.

A scheme as huge as NHI cannot be centrally controlled by the government alone, excluding the private sector, which has the expertise to manage such a system. It boggles the mind why the government is seeking to decimate medical aids and centrally control the health-care needs of even those who can afford to pay their own medical costs.

When fully implemented, a functional NHI scheme should work alongside the private sector, providing the proverbial Gogo Dhlamini with access to those top medical facilities she cannot at present go to. Those who can afford and prefer to continue paying privately for their medical needs must have the right to do so. There should be an opt-out button.

Lastly, sceptical South Africans will be forgiven for refusing to believe a party under whose watch state-owned assets were looted and collapsed can properly manage a fund of this magnitude without corruption or maladministration.

It is clear the ANC has rushed a flawed bill through parliament to use it as a votecatching tool. A functioning universal health coverage scheme should be the ideal we all strive towards. But we cannot allow it to be used as an electioneering gimmick.

Those who can afford to pay privately for medical needs must have the right to do so.