Much as the political focus is currently on the war for control of the country’s policy direction raging between President Cyril Ramaphosa, Public Enterprises Minister Pravin Gordhan and their supporters on the one hand, and Public Protector Busisiwe Mkhwebane, the EFF and their supporters on the other, we must also keep an eye on an important announcement regarding the future of National Health Insurance (NHI) on the other hand.
This afternoon, Democratic Alliance (DA) leader, Mmusi Maimane, will announce his party’s next steps to halt the implementation of what the DA calls “the dangerous and ill-advised NHI Bill.”
According to the DA, the bill in its current form threatens to not only collapse South Africa’s health sector, but places the country’s entire economy at risk.
The NHI is a very important and controversial government policy which aims to completely change the way healthcare is provided in South Africa.
In practice, it will place all medical services under state control.
Although it will not officially outlaw private medical practice and private medical schemes – and while admitting that exact regulations have not been finalised – in practice, all doctors will be paid for services rendered at a fixed price from a central medical fund, paid for by the taxpayer and administered by a civil service-type bureaucracy, which will regulate which medical services will be covered by whom at what point.
Supporters of the NHI claim it will bring equality in healthcare, leading to better healthcare for the vast majority of South Africans.
That majority cannot afford medical aid and elite private health care, which, supporters of the plan point out, has benefited the wealthier majority.
Supporters of the NHI also claim that South Africa will be joining several of the world’s leading nations, such as Britain and France, on whose public healthcare systems supporters claim the South African NHI proposal is based.
The policy decision to implement the NHI was taken by majority vote at the ANC’s conference at Nasrec in 2017, together with other far-reaching decisions such as that the Reserve Bank must be nationalised and the Constitution must be changed to expedite and simplify expropriation of land without compensation.
The implementation of each of all three those decisions have Ramaphosa and his supporters in a double fix, firstly economically and secondly politically. The implementation will have massive economic implications at a time when the country has basically absolutely no room for movement and no cash to pay for those policies.
But the Ramaphosa camp knows only too well the political risk of not implementing those ANC conference policy decisions.
Ramaphosa’s hold on the ANC leadership has always been precarious, at best, and his opponents within the ANC are not letting up at all.
In fact, they are openly organising a rebellion against him, and have given notice, through the leadership of the Durban-based eThekwini region, which has the most ANC members of any region, that a motion of no confidence will be put on Ramaphosa when the next national mass gathering of ANC branches – the National General Council (NGC) – takes place around July next year.
The NGC must take stock of whether the ANC national conference policy decisions are being implemented properly as instructed. The Ethekwini region’s motion of no confidence will be rooted in the claim that Ramaphosa has gone rogue – that he is failing or even refusing to execute the policy instructions and mandate of the organisation which directs him, and therefore the ANC members who elected him have lost confidence in him.
The main examples of the alleged rogue behaviour which eThekwini regional ANC leaders have thus far listed are; failure to implement the expropriation resolution, the Reserve Bank resolution and the NHI resolution.
The motion of no confidence, which, if carried, will be a mortal blow to Ramaphosa’s political credibility, is a clear and present danger, whatever the economic cost of implementation.
But the NHI faces very strong opposition, too. Opponents of the plan say it will destroy the only part of the health system which works, which is the private medical services.
It is furthermore claimed that private medical services benefit the country because although those who use it largely fund the public health system through their tax contributions, they also allow the benefit of that taxation to accrue almost entirely to the poor, because by not using the public health system, they unburden it so that it can focus entirely on the needs of the poor.
Opponents make two other very fundamental points. Firstly, they claim doctors will flee the country in large numbers to escape the dead hand of the state for countries where they can be free.
Anecdotal evidence is that the exodus has already started, which could probably leave the NHI and the country with a deadly skills deficit.
Secondly, opponents ask what proof there is that the state and the government has the ability to implement the NHI when it is clearly not even able to run the current public health system, which is much simpler and smaller, but which is (even by the ANC government’s own admission through its preference for the NHI) an unmitigated disaster.
It joins a list of several other government-directed disasters of which Eskom, the SABC, SAA, Denel, the land reform process and large parts of the public education system are the best-known examples.
On the point of the probable inability of the state to manage the NHI, the DA – which has so far led political opposition to the NHI – scored a major win when its energetic Shadow Minister of Health, Siviwe Gwarube, revealed the results of the NHI pilot projects the state has run thus far.
The government had not shared those results with the public, whose health and lives will depend upon it. The findings thus hidden were that the pilot projects were a disaster.
“The report details the haphazard nature in which various interventions were rolled out, lack of controls and accountability, poor planning and lack of funding in certain instances.
Projects were rarely implemented or completed due to lack of planning and funds not being released on time.
There was infrastructure deterioration because of a lack of basic maintenance, and only 350 part-time doctors were hired across all 11 projects,” the DA revealed.
All of which sounded very much exactly like the state’s failed management of other huge projects. In reaction, Health Minister Dr Zweli Mkhize and his department admitted that the DA information was correct, and offered no explanation why they had not informed the public of the failures.
They simply claimed that they had learnt from the failures, and said the phased implementation of the NHI – of which the legal mandate is contained in the NHI bill currently being discussed by the health portfolio committee in parliament – will go ahead.
This is why today’s announcement by the DA on how the bill will be opposed is so important.
It will help shape a fundamentally important debate on a policy proposal which may be great if implemented effectively, but which could very well create a worse national disaster than Eskom and state capture combined if implemented as poorly as the practical trial runs so evidently were.
The opinions expressed in this publication are those of the authors. They do not purport to reflect the opinions or views of the thesouthafrican.com.