This article was first published by Business Day on 3 April 2026
While most of the nine legal challenges pitted against the National Health Insurance (NHI) have validly focused around constitutional and affordability concerns, these are not the only risks inherent in this deeply flawed and archaic policy.
Two of these challenges were raised directly in the Constitutional Court, which will hear arguments in early May on the validity of the parliamentary process by which the NHI came into being. This has resulted in an agreement with the presidency that no sections of the NHI Act will be promulgated until these hearings.
This temporary halting of the NHI is welcomed, but it must not blind us to the fact that the broad strokes of NHI policy was born out of ideology that is outdated by close to a century and is most certainly massively disconnected from what voters want.
Polling leading up to the May 2024 national elections showed that after President Ramaphosa signed the NHI into law – a mere 2 weeks prior to election day – ANC polling dropped by nearly 6 percentage points, quite the opposite of what it had hoped for. On this policy the ANC had badly misread the room.
Institute of Race Relations CEO, John Endres, posed a relevant and insightful question in a recent talk at the BizNews conference, “Are the politics [in SA] beginning to align with the values and priorities of voters?” His conclusion was that policies could change if that answer is yes.
Positioning his question differently – is the ideological proclivity of our politics succumbing to solution-oriented pragmatism? If so, this presents probability of a future review by the legislature of NHI – more so if a review is compelled should the NHI Act be set aside by the Constitutional Court in May.
Citizens reeled under heavy load shedding imposed during 2022 and 2023, and it was not lost on them that this was a result of Eskom’s monopoly grip on supply – they had nowhere else to go. A current pressing issue for many is irregular water supply, which again is a monopolised supply.
Public health delivery failures seem to have faded out of mainstream press coverage in recent years, with the overt focus rather being on the NHI itself and its lack of affordability. At this juncture, bear in mind that one of the key pillars in arguing for NHI is that the state’s resources have been eroded, hence why NHI – along with new dedicated taxes – is necessary. This, however, remains propaganda aimed at deflecting from the fact that public health resources have improved substantially. Public sector health worker density per 10,000 population has risen from 30.8 in 2002 to 41.7 in 2019 – a massive improvement of 35% as the state steadily employed more doctors, nurses and other medical professionals.
But these failures in delivery, amongst numerous others, have resulted in a steady loss of trust in government and the questioning of its legitimacy. Unless it recognises that voters do not want to be subjected to the vagaries of its dysfunctions, the state will need to shed it ideological shackles and start giving attention to pragmatic solutions that deliver on what voters want.
The NHI represents precisely this monopolised control by the state over citizens, and they quite rightly distrust its prospects of being a success. It also attempts to turn medical professionals into state servants, which will only serve to drive them overseas, a loss the country simply cannot afford.
Living in a vacuous and disconnected realm, where politicians often have the comfort of existing, may present an illusionary functionality. But such apparitions are a result of there being no feedback loop, where politicians can easily fail to grasp the lived experiences of citizens. Politicians who do not observe diligently will get their futures directed to them by the ballot box.
This is precisely what happened at the last national elections, where the ANC’s decades long political hegemony was shattered. Current polling is predicting that situation will not reverse, and it will be a matter of survival to pay attention. Clutching onto policies that are so patently relics of a bygone era may deliver fuzzy nostalgic reminiscences for the party, but it won’t matter where it means the most, and that is to enable a thriving prosperous country, wherein the freedoms and liberties of citizens are inviolable.
