This article was first published by Business Live on 26 May 2025
A spectre is haunting South Africa. It is the implementation of the National[ised] Health Insurance Act (NHI). Those among us who have sadistic masochistic tendencies and being desirous to satiate this peculiar affliction, have only to study the state of the public health service of South Africa and/or visit the public hospitals. Then they will be acquainted with the unspeakable catalogue of the direst miseries that the hapless patients are at the mercy of, as typified by the following, inter alia:
- The Minister of Health has recently announced that 200 nurses, 1200 Doctors and 150 health care workers are to be employed in public hospitals. In direct response to this, the National Democratic Nurses’ Association (Denosa) decries the public hospitals’ state of affairs by stating the “shortage of nurses a devastating crisis”. The figures to address the staff shortages were further dismissed by Denosa as, “The figures are not only inadequate but are an insult to the nursing fraternity”.
- Denosa states that in 2023 alone, more than 400 specialised nurses left the country.
- Over R50 billion was lost to unauthorised, irregular, fraudulent, and wasteful expenditure in provincial health departments between 2019/20 and 2023/24.
- South Africa has the 2nd worst infant mortality rate (32.4 per 1,000 births) among 41 large upper-middle-income countries, despite having the 10th highest per capita public health spending.
- In 2023, the Gauteng Department of Health failed to use R784 million that had been set aside for life-saving cancer treatment. This had incurred the wrath of the independent Section 27 Health Rights Programme that took the matter to court and won the judgement, as reported during an ENCA TV interview with the justifiably furious head of the organisation. Consider for a moment, the many desperate cancer patients who succumbed to agonising deaths and the many whose sufferings were needlessly exacerbated.
- The intrepid Minister of Public Works and Infrastructure has been shining the light on the R836 million budget for oxygen plants for public hospitals, of which R428 million has been awarded to a ‘ghost company’ as reported in the media recently.
- “Unpaid doctors, food shortages rock Gauteng hospitals” reads a frontpage headline of the Sunday Times (May 11. 2025). The masochists can study the gory details of this story, while others can also understand the impact on the patients especially being aware of the invisible patients on the queues who wait for appointments – exacerbated health problems and finally death.
- Amid all these self-inflicted unmitigated disasters, the National Health Insurance will have the private medical schemes destroyed. This is utterly irrational, morally egregious and unconscionable, to say the least! It should be borne in mind that the private healthcare sector is funded exclusively by the taxpayers who invest in the various schemes with a very minor tax concession via the medical tax credit. They offer medical care that is almost second to none in the global health arena. They also have transnational footprints in developed countries and those under par.
- In a futile attempt at trying to allay fears, Mark Blecher (Treasury Chief Director, Health and Social Development) recently stated, “The notion that NHI [National Health Insurance] will entirely replace medical schemes is far from reality in the near future.”
“Not going anywhere soon.” What pathetically politically correct double-speak!
But Mark Blecher in all honesty, acknowledges the fact of requisitioned taxes by a coercive government to fund this disastrous NHI behemoth. He states that “Raising taxes to fund such a large-scale system is not an easy task. Private financing will continue to be a key player for South Africa’ s health-care needs”. The cat is out of the bag!
When the superficial veneer of populist rhetoric of caring for the people especially the poor, is removed, the bottom-line questions loom large. Statist policymakers invariably resort to populist rhetoric to advance their ideological agenda. This subterfuge obfuscates what ought to be driven by facts, empirical evidence, rationality and very importantly – economic imperatives. How is it that the very same department / government that has precipitated these very disasters, be entrusted with bringing about positive outcomes in excellent and efficient health-care delivery? With its existing health-care budget, why does the government not make accessible sophisticated health services from the private sector for those who cannot afford – this category of South Africans being scrutinised and identified on a rigorous means-tested non-racial basis. Why not?
All this mess is demystified by physicist and mathematician Albert Einstein, who had sagaciously advised that, “We cannot solve our problems with the same thinking we used when we created them”.
