A good healthcare system is not magical thinking

Martin van Staden / Midjourney
Martin van Staden / Midjourney

This article was first published by Business Day on 20 May 2024

National Health Insurance (NHI) was signed into law on May 15. At best, this move is little more than a cheap electioneering ploy to trick gullible voters into voting for an unachievable utopia — a common tactic the ANC has used over and over since running for government in 1994.

At worst, NHI is an apocalyptic policy that will devastate our healthcare sector, bankrupt the fiscus and produce destructive ripples across our entire society.

Supporters of NHI say that the initiative will lead to all hospitals and clinics rising to the quality of SA’s best private healthcare; there is no backing to this idea, only wishful thinking and self-deceit. Rather than improving healthcare across the board, all that NHI will accomplish is pulling all healthcare down to the level of decrepit, failing public hospitals and nonexistent clinics.

Amid great media furore and coverage, President Cyril Ramaphosa signed NHI into law. The spectacle is a tactic that is being used, as usual, to distract voters from decades of incompetence, corruption and bad ideas. NHI may be the worst policy that the ANC has pushed into law.

In essence, NHI is a taxpayer-funded healthcare fund that will allow any SA citizen, permanent resident, refugee, inmate or special category of foreign national to receive “free” healthcare.

Sounds pretty great, right? But NHI fails to account for the fact that taxpayers are already overburdened. On top of this, the private sector subsidises public healthcare. Not only do private hospitals and clinics pay tax, they also ease the burden on public healthcare, which can then focus on those who need it most.

This is not to mention the administrative nightmare of allowing a flood of people to go to any healthcare facility they want, free of charge. Medical practitioners have already expressed grave concerns over the affordability and practicality of the system.

Healthcare is not an infinite, magical resource. It requires incredibly skilled individuals, expensive equipment and a complex relationship between insurers, practitioners, pharmaceutical providers and a host of other institutions. Imposing a single, incompetently managed fund over all these players destroys an incredibly important system for providing quality healthcare to South Africans.

If anyone can show up to any healthcare facility to receive free treatment, there is no way to manage the scarcity of skills and time. Doctors are already overworked. Under NHI, their remuneration will be threatened while they are expected to give free treatment to anyone who asks.

On top of the pre-existing unaffordability, the money that can be gathered is unlikely to be used for healthcare.

The government is full of opportunistic criminals just waiting to be given access to more public money that they can misappropriate and steal. The NHI fund will be no different from any parastatal or government department in this country. It will become a black hole where tax money is redistributed to corrupt politicians and bureaucrats.

NHI has been under intense scrutiny for the years that it has been publicly debated. Business groups and experts have shown how it is unconstitutional and unworkable, while many healthcare professionals have begun the process of leaving SA due to NHI.

Ramaphosa doesn’t seem concerned that doctors themselves, the entire healthcare industry, medical aid schemes, experts, economists and lawyers all detest NHI. He only cares about winning cheap votes from voters who don’t understand that NHI will help no-one and only serve to sink this country into a darker pit.

The DA, Free Market Foundation, Board of Healthcare Funders, Solidarity and many other civil society organisations, political parties and interest groups have already stated that they will continue to challenge NHI. This is a necessary move for the survival of the healthcare sector.

If the ANC truly cared about delivering quality healthcare to the poor, it wouldn’t be imposing its ignorant, ideological ideas on the country. It should seek to duplicate the success of private healthcare, not bring it down to the level of failing public hospitals.

To accomplish this, the ANC should be deregulating private healthcare to allow for even more private clinics and hospitals to be established. Incentivise the training of additional doctors by removing community service requirements and removing racial quotas on university admissions. Raise the overall supply of doctors and private healthcare, and the price will be reduced. Cut red tape that unnecessarily raises the cost of medical care.

And for those in desperate poverty, unable to afford even the now cheaper cost of healthcare? Rather than establishing an expensive, bloated fund to pay for everyone, rather distribute healthcare vouchers to those in need, in the same way that people now receive grants.

Not everyone in this country needs the government to pay for their healthcare. It is a waste of resources to force everyone into the same fund. Identify those in need and help them, while simultaneously raising the quality and quantity of healthcare through deregulation.

A free market will fix healthcare — not NHI. And hopefully voters will realise this come the elections.


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The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation. This article may be republished without prior consent but with acknowledgement to the author.




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