As a constitutional democracy premised on the Bill of Rights, the legitimacy and credibility of SA’s democracy depends largely on the ability of its citizens to enjoy the fundamental rights promised in its Constitution. When such rights are seen to be compromised or not realised, citizens have a valid right to question whether the Constitution is living up to its promise.

Perhaps no suite of fundamental rights is as contentious as the right to healthcare. In essence, the Constitution guarantees universal access to healthcare in section 27 — the caveat being that the state must seek to achieve the progressive realisation of such rights. Given that access to healthcare is intrinsically linked to the attainment and preservation of a life of dignity, it is indisputable that a well-functioning healthcare system is a key requirement for the credibility of our democracy.

More importantly, given the fractured distribution of economic resources across the citizenry, the realisation of such a right should ideally not be linked to one’s economic power. Unfortunately, SA suffers from a dual system where the majority of citizens depend on the public healthcare system while a minority uses the private system. The parallels are — as expected — historical and uncomfortable. The public system is dysfunctional and used by the economically poor and largely black citizens. The private system is more functional and is used by those with economic power.

In a country with such deep inequalities, this serves as yet another exhibition of divisions along racial and economic patterns. Which is why the conversation around National Health Insurance (NHI) is so important. In theory, NHI is aimed at ensuring that all citizens — regardless of economic status — have access to healthcare that is funded and administered by the state. In other words, the state becomes the primary procurer of healthcare services on behalf of its citizens. Health Minister Aaron Motsoaledi believes such a model is the only way the country’s healthcare system should be run.

Consequently, the issue of healthcare funding is in the spotlight. A minority of citizens have private medical aid, which they use to finance healthcare costs. Even then, few receive universal coverage and co-payments are part of the system.

In issuing two new bills — the NHI Bill and the Medical Schemes Amendment Bill — the minister has sought to alter the landscape of healthcare altogether. By his utterances, he seems to be of the view that citizens are being kept out of good healthcare by financial barriers implemented by private hospital groups. This implies that he feels that access to healthcare is compromised.

However, this does not stand up to scrutiny. In SA it is not access to healthcare that is the problem; we already have universal access guaranteed by the Constitution. The issue is that the system to which we all have access is dysfunctional and does not offer the quality that is commensurate with why we go to hospitals in the first place: the pursuit of proper medical care. Those who can afford it simply seek alternatives in private healthcare.

Fixing the problem should not focus on discouraging the use of private services by getting everyone to sign up for NHI. Rather, Motsoaledi should ask himself how — in a country with constitutionally guaranteed access to healthcare — citizens still go all out to spend what he terms exorbitant amounts on private healthcare.

Only then might he realise that the problem —

• Sithole (@coruscakhaya), a chartered accountant, academic and activist, chaired the Lesedi Education Endowment Fund as part of the #FeesMustFall campaign. He writes in his personal capacity.

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