Organised business has appealed to the National Council of Provinces (NCOP) to delay its vote on the controversial National Health Insurance (NHI) Bill and send it back to parliament’s select committee on health & social welfare so MPs can take another stab at it.
The committee approved the bill last week without making any changes to the version submitted to it by the National Assembly in June, despite inviting written and oral submissions from the public. Not even technical changes and corrections suggested by the department of health were incorporated.
On Monday, Business Unity SA (Busa) and Business for SA (B4SA) wrote to the presiding officers of the NCOP and to deputy president Paul Mashatile, in his capacity as leader of government business in parliament, saying the committee had ignored the constitutional issues raised by four provinces and a wide range of stakeholders.
“This amounts to a serious and significant procedural lapse, and a violation and disregard of parliament’s own public participation model, fundamentally undermining the principles of participatory democracy on which our constitution is based,” they said. Busa represents organised business interests, while B4SA is an alliance of business leaders that works with the government on problems confronting SA.
The bill is the first piece of enabling legislation for the government’s plan for universal health coverage, dubbed NHI. It proposes establishing a central fund that will purchase services from accredited public and private sector providers, which will be provided free at the point of delivery for all eligible patients.
“For the National Assembly and the NCOP to disregard proposed amendments that will have a beneficial and tangible impact on citizens in the interest of rushing the bill through parliament is unconstitutional.
“It makes a mockery of due process and portrays the NCOP as nothing more than a rubber stamp,” Busa CEO Cas Coovadia said.
The bill’s proposal to sharply curtail the role of medical schemes and allow them to offer cover only for services not provided by the NHI fund is unconstitutional, Coovadia said.
This aspect of the bill is one of the biggest concerns of healthcare professionals and business alike.
“No other country in the world has a legislated limitation on the role of private health insurance, not even wealthy countries with a substantial tax base and extensive publicly funded healthcare,” he said.
Frustrated
The SA Health Professionals Collaboration (SAHPC) — a new association of more than 25,000 healthcare professionals from nine industry bodies — said it is disappointed and frustrated that parliament has ridden roughshod over their input.
It too urged the NCOP plenary to send the bill back to the select committee on health & social welfare on procedural grounds, saying the committee has not properly considered the comments and recommendations it had received before it took a vote.
“While reforms to the public and private healthcare sectors are urgently needed, there is too much at stake for the country’s healthcare system to get the NHI wrong. We are concerned that the bill’s hasty progression through the legislative process ... is a lost opportunity to put the country on a pathway to quality healthcare for all,” said SAHPC spokesperson Simon Strachan, who is also CEO of the SA Private Practitioners Forum.
The forum has sent a written submission to the select committee and requested an opportunity to present it to MPs, but has received no response, Strachan said.
The committee did not hear any oral submissions from stakeholders in parliament.
Strachan said the government is promising citizens that NHI will provide everyone with the kind of services now offered by private hospitals, but this is simply not feasible.
Busa and B4SA have consistently said the NHI bill is unworkable and unaffordable. They have said the government’s estimate that it will need to raise an extra R200bn in tax revenue to finance NHI with R480bn a year would require increasing personal income tax by almost one-third, VAT from 15% to 21% or applying a payroll tax that is 10 times higher than the current Unemployment Insurance Fund contribution. Even if the government did manage to raise R480bn for the NHI fund, this would cover only very basic healthcare, they said.
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