The problem with the proposed NHI

On 29 November, the National Council of Provinces (NCOP) was set to vote on the passing of the controversial National Health Insurance (NHI) Bill. The vote was ultimately deferred to the following week on 6 December, so by the time you read this editorial, the bill would have either been passed by the NCOP or sent back for further deliberation.

The NHI aims to provide access to good-quality healthcare for all South Africans. If it were to be compared to something similar, I presume Britain’s National Health Service (NHS) would be it. However, as some of our readers may know, Britain’s NHS in and of itself is problematic, and I have known South African expatriates to travel to South Africa seeking private healthcare due to the long waiting times and supposed inefficiency of the NHS.

The controversy surrounding the NHI in South Africa is perhaps obvious to those who are well aware of the current dismal status of state-owned and staterun entities, such as Eskom, Transnet and the South African Post Office, just to name a few. Other failures that are also the responsibility of government include failing infrastructure. These entities provide essential services and functions to South Africa and its citizens, and the country’s miserable performance in terms of economic growth and employment is largely driven by the collapse of these kinds of entities. For example, ArcelorMittal South Africa recently announced its plans to close its long steel operations due to weak demand and persistent infrastructure problems. While government cannot be blamed for demand directly, it can certainly be blamed for infrastructure problems. (Moreover, a growing economy could see an increase in demand for commodities such as steel, so government certainly plays a role in this too. Indeed, as reported to Reuters, ArcelorMittal said that steel consumption in the country had dropped 20% over the past seven years, due to limited spending on infrastructure and project delays.)

While in theory the NHI is a great idea, it is a nightmare in practice, as has been pointed out by various stakeholders, who also insist that during the formation of the bill, their suggestions were not considered. If we look at government’s track record of running SOEs and other important functions of society, the problem with the NHI becomes increasingly obvious: the risk of mismanagement and corruption is simply too great. The failure of the NHI will cost all South Africans dearly, and there is no reason at this point to believe that such a system will be a success.

Public hospitals across South Africa are falling apart; these are clearly not being managed successfully, and if government is that concerned with public health and providing adequate healthcare for the poor, as they absolutely should be, they would begin by turning around the already failing public health sector.

We are nearing the general elections in 2024, and I can’t help but think that this is merely an electioneering tool being employed by the ANC. As the ANC scrambles for money to make the NHI work, less money will be spent on other important sectors, such as agriculture and infrastructure. Farmers already struggle to get their produce to market; what happens when even less money is available because it is being spent on a flawed and impractical pie-in-the-sky idea? FW

Janine Ryan, Editor