The thing about pipe dreams is they go up in smoke

TWho will ever forget how the abysmal ‘command council’ brought the economy to its knees

here’s a kind of reassurance you get that when the ANC or its cadres in the state insist something is going to happen, you just know it isn’t. The politicians need flags to wave to distract the poor from their lamentable service.

Now that Covid has, hopefully, done most of its killing, it is no surprise at all to hear Nicholas Crisp, the deputy director-general of the department of health, insist that his National Health Insurance (NHI) project is back on the table. He told News 24 the government wants to get the NHI Bill through parliament by the end of the year. The plan is to have the system in place by 2026.

“We are ready to respond to the wording and strengthening of the bill,” he said meaninglessly, but we are not going to backtrack on creating one health system; it is not on our agenda. We want everybody in SA to get a good health system.”

I don’t know any reasonable South African who disagrees with that last sentiment, but the system Crisp and his fellow policy ideologues have in mind is an unaffordable pipe dream, even with inevitable tax increases. The state’s last NHI cost estimate was R256bn a year. That was done back in 2019, before Covid. Private sector health economists reckon that will already have risen to R500bn by now. By 2026 we’re north of a trillion rands before we fix schools, roads, railways, ports, the post and our defences.

Just imagine trying to get this thing off the ground in the hands of people who so royally mismanage the ramshackle health service we have now. A year after a massive fire at Johannesburg’s big public hospital, Charlotte Maxeke, not a single repair has happened. Doctors have begged President Cyril Ramaphosa to intervene as patient queues for some cancers stretch to five years. The only movement is the replacement of one promise by another, one expression of resolve by another.

Of course, no-one in the ANC dare raise a hand and suggest that perhaps, comrades, we need to think this NHI through a little more carefully. That would invite immediate branding as a capitalist tool or whatever the insult of the day might be.

It is useful, though, to look for signs of caution. The newish health minister, Joe Phaahla, has backtracked on some extreme new Covid regulations designed to replace the state of disaster.

Who will ever forget how for two years the abysmal “command council” brought the economy to its knees with alcohol and tobacco bans that cost thousands of jobs and tens of millions of rands in taxes as ministerial and presidential hubris (“we’re saving lives”) fed the illicit economy.

Gone in the past few days, it seems, are initial replacement regulations that would have given officials the power to quarantine travellers and even to force medication on people, and Phaahla, after some dithering, has extended the period during which the public can comment on the new rules by a whole three months, to July 5.

That gives him some badly needed political space. From what we have seen of Phaahla since he replaced Zweli Mkhize, he’s a thoughtful man. The dropping of powers to detain and medicate tells me he fully grasps the danger in giving such terrifying powers to cadre-deployed bureaucrats.

What he will still have to defend is a mask mandate for indoor gatherings that makes no sense. Don’t get me wrong; I normally put on a mask when I’m in any kind of crowd indoors (especially now as an Omicron variant fuels our fifth wave). But I wear a mask I trust. The regulations, though, allow for pretty much any covering. A silk stocking would do, which is absurd and would surely not survive legal challenge in court.

And if we are to take health department steps on the NHI seriously, it needs to build some degree of credibility.

Earlier this month the World Health Organisation published new estimates of excess deaths associated with Covid for 2020 and 2021, bringing the full estimated global death toll for those two years to 14.9-million. That’ sa lot. Tellingly, SA ranked 15th in the multiple by which excess deaths outstripped reported deaths captured by the department of health. We undercounted by 2.8 times.

Given that Egypt undercounted its Covid deaths by 11.6 times and India by almost 10 times, we might not look too bad. But it is still nearly three times worse than the UK, where reporting systems, access to care and proper documentation got it to a near perfect one.

We don’t get to one by throwing ideology at our health services. We get there by doing our duty and jobs properly.