This article was first published by BizNews on 30 October 2024
“If you can dream it, you can do it.” Well no, you can’t. Dreaming about something is neither necessary nor sufficient for anything to get done. If your reverie is about a talking mouse that lives in a fairy tale castle in Disneyland and your name is Walt, maybe you have a shot, but not if you are the ANC and your dream is the NHI. What Mickey Mouse has that the NHI doesn’t is that he had an architect who thought it through. Walt Disney conceived of an idea every bit as fantastical as the NHI but he sat down, drew up the storyboards frame by frame (24 per second), and made sure he did it in a way that the people who ultimately paid for tickets bought into the narrative. Most importantly, he started with a budget.
The NHI (National Health Insurance) Act has none of this. It is so pie-in-the-sky that not even the four and twenty blackbirds will go near it. There doesn’t appear to be a coherent plan, a rollout schedule or, bizarrely, a budget. In this cautionary tale, if you are health minister Aaron Motsoaledi, you wish upon a star and the money appears; anything that doesn’t work is the big bad wolf called ‘racism.’ The government is struggling to meet the demand for social grants of R350 per person per month. If you now allocate just R2,000 per month as an estimate for the most basic medical healthcare package and give that to each of our ±50m legal population that brings you to a figure closer to a trillion, double what you’ll get when you combine current medical aid spending plus the annual health budget. Where will the money come from? The golden geese have already fled the country and the ‘black diamonds’ will refuse to become a replacement. Take into account that a significant number of current medical aid clients are black and middle class and they will not tolerate a decrease in quality of service for themselves or their families.
Implementation of the NHI will require the biggest extraction and extortion of tax from our fragile base in our country’s history. Proceeding with it will result in the most terrifying consolidation of financial power in one ministry, overpowering Eskom and electricity supply. We should be up in arms about this, marching in the streets. Opposition parties and the largest association of medical specialists, the SA Private Practitioners Forum (SAPPF) have launched court cases over it, claiming unconstitutionality. It threatens to disrupt the GNU as two parties have indicated they might leave the GNU because of it. Still, the ANC pushes on. Why? I blame motivational speakers for this. We have generations of people going around understanding success to be related to believing in yourself and never giving up. It’s delusional thinking. Ordinary people and politicians alike confuse the intensity of their ‘feeling’ about issues with the veracity of the idea. Nelson Mandela famously said: “It’s always impossible until it is done.” The problem with that statement is that Mandela probably didn’t originate it and even if he did, it does not mean that impossible ideas automatically become un-impossible simply by not giving up.
A better person to pay attention to at this time might be Thomas Sowell who says: “Much of the social history of the Western world over the past three decades has involved replacing what worked with what sounded good.” Indeed, it does sound wonderful when you tell people everyone will be equal and have the equivalent of medical aid. Unfortunately, like the little pig’s house, the feel-good fantasy will fall apart at the slightest breeze and there’s a storm coming.
A good course of action for the ANC at this stage is to do nothing. Simply stop it. Quietly put the NHI out to pasture and then publicly claim you fixed everything. Look at your recent successes, specifically how you fixed load shedding; then apply a similar formula. The government silently made a U-Turn on their plan to aggressively replace the existing coal-based infrastructure with renewables and started maintaining the former instead.
Furthermore, they acknowledged the value added by private companies and consumers themselves. They would do well if they did the same with our health services landscape. People who put up their own solar power relieved the national grid of pressure. Citizens who have private medical aids do the country a comparable service. While the government must contribute to the health needs of the poor, we can incorporate the important contribution of individuals who have their own medical aid and health insurance or make use of traditional forms of medicine; which represents a significant portion of our population. The government cannot, and should not, try to be Midas and Prince Charming simultaneously. There will be no happy endings.
Like Mandela said: “Advance is easy, but retreat from it is difficult.” Mandela didn’t say that; half of the sayings attributed to him he didn’t say, but it sounds good and it will work, so the government should go with it. All they have to do is retreat and do the hardest possible thing for any government – to do nothing, or at the very least, as little as possible.
