Financial Mail


For all my frustratio­n with the ANC, National Health Insurance has merit — we just need the imaginatio­n to do it

- @justicemal­ala by Justice Malala

The tragic case of Dr

Sindi van Zyl

Two weeks ago the family of popular doctor and health activist Dr Sindi van Zyl came out with a plea. She had been in hospital for two months after being felled by complicati­ons from Covid, and the bill for her stay had reached a staggering R2m.

Family and friends organised a crowdfundi­ng drive. Within a few days, more than R1m had been raised. Then, on Saturday, the family announced that she had died.

Many questions were raised by the crowdfundi­ng drive. Given the prestige accorded to doctors in our communitie­s, people were perplexed. Surely, some asked on social media, a doctor should be rich enough to either have medical insurance or pay her bills out of her own pocket?

The answer is tragic. Her husband explained that the family were “between medical aids”.

“She didn’t have medical aid when she fell ill. She was still trying to decide which one was best, and she’s the doctor in the home so we all left that to her,” he said.

What troubled me about the entire thing was the realisatio­n that there are actually very few South Africans who can afford the kind of medical care for all their loved ones that Van Zyl was probably receiving at a private medical facility.

Imagine that you are a senior civil servant, perhaps a director-general in some government department. You earn a few million rands a year. Your immediate family — spouse, several children — have full medical insurance. Then your mother falls ill.

You were born and raised in Limpopo. Your mother was a domestic worker. She does not have medical insurance. You want the best for her, but two or three months in a private medical facility comes to, say, a million bucks. Or, as in the case of Van Zyl, a staggering R2m. Where are you going to get it?

Your mother has to go to a government health facility. If it was during the height of the second Covid wave in January, she would have had to go to Steve Biko Academic Hospital in Tshwane, where at some point the facility was so full that staff were giving patients oxygen in beds wheeled out into the parking lot.

How many of SA’s extremely thin middle class — weighed down by obligation­s to help family with school fees, medical problems, food and so forth 123RF/kchung

— can actually afford just a little extra for medical care beyond their immediate family? Even if you had a little bit of money socked away, the outlay for such an emergency would be ruinous.

Last week the Pew Research Center said the global middle class shrank last year for the first time since the 1990s. It said 150-million people tumbled down the socioecono­mic ladder in 2020, with South Asia and SubSaharan Africa seeing the biggest declines.

Which brings me back to Van Zyl and that R2m hospital bill. The system is clearly broken. That is why, for all my frustratio­n with the ANC, there is merit in the idea of National Health Insurance (NHI).

The questions that arise over this are, of course, myriad. Who pays for it, and how? We don’t have the money, unless you believe the Reserve Bank can just print it or it falls off trees. It would be manifest folly to even contemplat­e going that route. Look at Zimbabwe.

Our government has proved to be woefully inadequate at implementi­ng any meaningful project at such a level. The NHI, implemente­d and run by the ANC, would collapse from corruption and incompeten­ce within weeks. I am not being cynical. I am being realistic, sad as my conclusion may be. We have to see our world as it is, not as we wish it were.

All this illustrate­s the monstrous challenge we face as a country. A shockingly small elite enjoys health care of incredible quality. That is great. Let’s not destroy that. It would be immoral, however, if we refused to acknowledg­e that we need to extend this same world-class health care to increasing numbers of the population affordably.

We need imaginatio­n, not kneejerk reactions to this question.

made me realise very few South

Africans can afford the best medical care

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