Blind and deaf to NHI disaster
PRESIDENT Cyril Ramaphosa must be able to marshal enormous reserves of personal charm. How else to explain the ease with which he has for the past five years managed to dazzle and bamboozle business?
This column has, often enough, argued that business needs to be less trusting and more transactional in its relationship with the government. They should use the same hardnosed negotiating style they would employ in any commercial deal.
Instead, they take at face value the nod-and-a-wink assurances that CR gives them.
The most recent dupes in this mugs’ game are some of the big medical schemes like Discovery. They muted their criticisms of the proposed National Health Insurance (NHI) in the mistaken belief that, in exchange, the government would produce an NHI Bill that, behind all the socialist rhetoric, would allow a workable role for the private health sector.
Instead, the legislation that was bundled through the National Assembly and now sits before the National Council of Provinces (NCOP) is as draconian and destructive as it ever was. The medical schemes are now belatedly squealing and have launched a campaign to shape public opinion through organised business forums.
Discovery founder and CEO Adrian Gore is now begging the government to abandon its “go-italone” posture and not create an “inflexible” legislative framework. “Create some wriggle room,” says Gore, “so we can work collectively and find out how to make it work.”
On Tuesday, at the very last moment, the NCOP postponed discussion on the bill for another week. This raised hopes that some kind of accommodation would be reached between the private sector and the government.
As Daily Maverick’s Marianne Mertens put it: “Effectively, a week has now opened up for further consultations and engagements even if just to tell organised business to calm down and stand down.”
Presidency spokesperson Vincent Magwenya acknowledged that big business had in the past week raised concerns “directly” with the president and hinted that the door was not closed.
Well and good if real negotiations were on the cards. If such an accommodation did occur, it would be a significant reversal in the arrogant attitude of the government to advice and criticism, as encapsulated by the Department of Health’s Deputy Director-General Nicholas Crisp at a recent cardiology congress.
When the specialists dared question the government’s ability – based on what happened at Eskom, Transnet, SAA, Denel and a host of other state enterprises – to run an efficient and honest operation, Crisp didn’t bother to hide his disdain. “This distrust (of the government),” he snapped, “must stop.”
Much as one might hope that delay in the bill heralds a new era, it seems unlikely. The party rank-and-file, giddied up by the tripartite alliance’s trade union and communist partners, is heavily invested in a dirigiste health model.
More likely than a real compromise is that Ramaphosa will, behind the scenes, slap some corporate backs, press some flesh, and make some soothingly amiable noises. And as has then previously happened with a host of issues – expropriation without compensation, the collapse of passenger rail, the airways, the road and rail networks, and the post office – the governing party’s ideologues will prevail.
The government, bound as it is in the blood pact that is the tripartite alliance, cannot countenance anything that smacks remotely of a betrayal of the National Democratic Revolution. Any form of publicprivate partnership on terms that would be remotely attractive to investors remains unthinkable to the ideologues who still dominate the ANC.
That the NHI Bill has, until now, rattled through the legislative process with a blithe indifference to cautionary voices should be warning enough of Ramaphosa’s bad faith.
In 2018, at a health summit attended by the president, his deputy David Mabuza reassured South Africans that the NHI would not “negate the existence of private health schemes for those who desire (them)”. Yet here we are.
Both Ramaphosa and Finance Minister Enoch Godongwana have on occasion grudgingly conceded that the NHI is going to put enormous extra demand upon the fiscus. The Institute of Race Relations estimates R700 billion a year; Discovery reckons R212bn; and a 2017 government White Paper projected that by the time of its intended launch in 2025, it would cost R256bn, calculated in 2010 prices. Yet here we are.
It would seem that the only people not taken in by the ANC’s weaselly words are the medical professionals themselves. There is a terrifying outflow of expertise taking place.
The NHI is shaping to be the worst disaster ever of ANC rule.
It will be more corrupt, more mismanaged and more dogmatically implemented than anything we have yet seen.
But, as Cyril and Nicholas say, just trust them and everything will turn out fine.