National Health Insurance (NHI) is becoming a tool for political and factional battles, potentially rendering productive, logical debate on its future — and on the urgency of ensuring universal access to quality health services — untenable.
The events in recent weeks have pointed to the difficulty the ANC will face in retreating from its hardline position on the legislation, signed into law by President Cyril Ramaphosa on the eve of the May 29 polls.
Whether the subsequent dip in ANC support in tracking polls had anything to do with concretising the bill remains up for debate, but there was a clear drop in its support for the ANC days after the signing, which it did not recover from, culminating in its 17 percentage point decline.
Health minister Aaron Motsoaledi made a comment that left the ANC’s partners in the GNU scratching their heads: he told Bhekisisa’s Mia Malant that medical schemes were out, even if it meant the end of the government of national unity (GNU).
It is well known that the vast majority of the signatories to the GNU agree that universal access to basic healthcare is non-negotiable, but take issue with the legislation itself, particularly with the idea of placing the state at the centre of governance for a future healthcare system given its track record in managing public funds.
“I would say we are firm on our stance that the NHI is noble in theory and makes for good political rhetoric, but it is thin on realism and there are so many approaches we can take that will be more sensible,” PA leader Gayton McKenzie told Business Day.
“Being opposed to the NHI doesn’t have to mean the end of the GNU and the debate will have to continue ... no-one party picked up enough of the vote to have everything their own way.”
Narend Singh, treasurer-general of the IFP, another key GNU partner, agrees that the governance mechanisms suggested in the current NHI legislation fall short of expectations.
“We support universal healthcare, that the rich and the poor should get the best and equal healthcare, but we fundamentally disagree with the financing and governance arrangements around the NHI ... the government has not managed to improve healthcare outcomes in the public sector with the billions handed to it over the years, why would we expect it to suddenly do so now?” Singh said.
The NHI legislation was a red line for the DA too, but there was agreement during negotiations with the ANC that there was room for further discussion. DA leader John Steenhuisen does not believe the NHI will be a deal-breaker for SA’s tenuous coalition government.
“That is still an issue that we’re going to have to find each other and resolve on and I think we can do it. I think the unaffordability of the NHI, this loss of this court case now is a significant blow to it. And that’s just the first of a number of constitutional challenges.
“Third, the private sector and public healthcare system are saying ... this isn’t going to work ... I think we can find each other because, and I make this point, it’s not just the DA, but other parties in the GNU too,” Steenhuisen said.
Motsoaledi’s comments came after key business and medical bodies boycotted the signing of the Presidential Health Compact this week because the contentious NHI played a central role in the framework. Sections of the NHI have already been struck down as unconstitutional by the High Court and further legal challenges to the legislation loom.
What is at play, however, is the ANC having to carefully manage perceptions pushed by its opponents that it has “sold out” in its set-up of government with the DA, IFP and other parties instead of opting for a tie-up with the likes of the EFF and Jacob Zuma’s MK party.
Communication on any decision to rework the legislation would have to be carefully managed, the party believes. It does not help that senior leaders — such as Gauteng premier Panyaza Lesufi — while on the campaign trail incorrectly declared that citizens would immediately after the May 29 polls be able to walk into private health facilities and receive treatment, with the government footing the bill.
On Sunday, the SACP — the most vocal in opposing the GNU in the congress movement so far — urged the government to proceed “decisively” with the implementation of NHI.
Business Day understands the ANC’s national executive committee was willing to look into the issues raised by both the medical sector and opposition parties, but could not completely halt its implementation at the risk of playing into the hands of those, such as the SACP, the EFF and the MK party, who have accused the party of “selling out” by setting up the GNU. Motsoaledi is also a hardline proponent of the NHI, with Singh accusing him of “speaking from two sides of his mouth”.
“One the one hand he says it’s here to stay even if it ends the GNU and on the other, he says he is consulting all role players — which is it? He is playing to the gallery.”
The party will have to finely balance the politics and the practical aspects of implementing the contentious legislation. The risk that it faces is that in the interim, the majority of the country’s citizens will continue to go without high-quality, free, basic healthcare.
“The danger is that this issue is now far too politicised,” Singh said.
McKenzie didn’t mince his words in addressing the politicisation of the NHI by Motsoaledi: “We should avoid acting like the GNU doesn’t matter or is not needed. If people want to bring in other parties, they should say so with their chest instead of saying nonsensical things like the GNU can rather fail. This is our second miracle and we should appreciate it as that.”
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