PREMATURE NHI REVEALS SA’s ‘STRANGE PRIORITIES’

Parliament, searching for a quick fix, has rubber-stamped the new law — despite canyon-sized holes in how it’ll be funded

South Africa is no stranger to cognitive dissonance. Our politicians, eyes averted from reality, speak loftily of smart cities and bullet trains, even as our freight trains have ground to a halt, their routes stripped of the cables needed to function. Or as outgoing health ombud Prof Malegapuru Makgoba put it last week: “As a country, we have strange priorities.”

Makgoba provided an eviscerating diagnosis of the state health-care sector as he stepped down, labelling it a “shambles”. The Eastern Cape health department was “embarrassing”, while Gauteng’s hospitals are run by “Mickey Mouse CEOs”.

It’s a grim assessment that ought to end in resignations. “What you observe at the Gauteng health department and at Eskom are similar problems. No leadership, no capacity, no vision,” he said. “Of course they’ll blame someone else — apartheid, I think.”

Yet in the same week, the ANC majority on parliament’s health portfolio committee voted to approve the National

Health Insurance (NHI) Bill — legislation on which a new “universal health-care” system will be built.

But the way NHI has been designed leaves so many questions swirling, you wonder why those

MPs didn’t believe some answers were needed before pressing “go”.

In particular, that bill leaves the “shambles” that is the state health-care system entirely untouched, and instead promises that everyone will be able to visit any doctor or hospital free of charge.

It does this by creating a single pool of savings to pay for this — a fund to be run by the state — which will make the government the sole buyer of health-care services.

Philosophically, it’s fabulous. But gosh, it does sound like it’ll cost an awful lot; so, where will this money come from?

Well, that’s a question those ANC MPs never bothered getting an answer to. Which underscores what any vaguely financesavvy person who’s appeared before parliament will tell you: many MPs are economic illiterates who’d struggle to balance a G&T on the bench in front of them, let alone a budget.

The true answer is that NHI can only be financed by a spectacular tax hike. The health department’s Nicholas Crisp said last year that new payroll taxes, a hike in VAT or new general taxes might be needed. And his department adds: “Every person earning above a set amount will be required by law to contribute.”

If that sounds benign, it’s only because they’re not saying how much you’ll pay. In 2017, a government white paper put the cost at R256bn a year, using outdated 2010 figures. Economists say it’ll cost far more. The Institute of Race Relations puts it closer to R700bn a year, saying “major tax hikes will be needed”.

Given Makgoba’s assessment, and that 85% of our municipalities can’t publish “clean” accounts, what will happen when the government is given a giant pot of money to finance all health care? That prospect should send digital vibes down your spine.

This week the CEO of Business Leadership South Africa, Busi Mavuso, flayed NHI in its current format, saying it would force out the private sector while failing to improve health care. “Business would benefit from an environment in which everyone had goodquality health care but one in which no-one had would be catastrophic,” she wrote.

The business sector, she said, has every interest in seeing universal health coverage, but it must be sustainable. “NHI, as it is conceived in the bill is not that. Indeed, [this version] would leave all South Africans worse off, in a system in which state provision becomes impossible, and private health provision is effectively closed down,” she said.

Just about every medical association agrees. Last week, the South African Private Practitioners Forum said it was worried about the “sustainability” of private health care, since medical aids will become redundant, limited to covering “complementary services” outside the ambit of NHI. This infringes people’s right to “make choices about how and where they access health care”.

Mvuyisi Mzukwa, chair of the South African Medical Association (Sama), said the “misappropriation of funds in various stateowned entities casts doubt on government’s ability to handle the health-care budgets responsibly”. Mzukwa asked how anyone could entrust their lives to a state “with an established history of financial mismanagement”.

One group not complaining are emigration consultants. In 2020, insurer PPS said a survey of its professionals showed that 72% would emigrate if NHI was implemented in its current form. This underlined other polls including one from Sama, that found 38% of doctors were planning to leave due to the prospect of NHI.

Makgoba himself is an advocate of universal health care. That’s unsurprising since he worked in the UK’s National Health Service for 15 years, before returning to South Africa. But even he said, speaking to 702 last week, that he doesn’t think “the system is ready for it” here. He pointed out that universal health care can transform a nation the UK has been largely free of malnutrition since 1948. “The philosophy is not in question, but it’s the implementation process that has been proposed I think it has lots of defects that need to be corrected,” he said.

Last year, Makgoba said: “As things stand today, we couldn’t go into NHI with the level of inspections and certification we have done so far, because I suspect most of the hospitals will not meet the high standard required of NHI.”

Yet, silver bullets are catnip for ANC lawmakers. Rather than the more difficult job of fixing the existing public system one in which staff at Mahikeng Provincial Hospital put newborn babies in cardboard boxes for two days, undetected by management they’re seduced by the magic potion of NHI.

Now, even before figuring out how to pay for NHI, they’ve given it the green light. Is it any wonder the country is in a fiscal bind? Strange priorities indeed.