The passing of the National Health Insurance (NHI) Bill and SA Postbank Limited Amendment Bill by parliament represent delayed steps towards the implementation of long-standing governing party positions.
A commitment to universal health coverage has formed part of the ANC’s policy deliberations since the 1990s. In the pursuit of a new system it seeks to overhaul the current model, where an efficient and effective private healthcare sector stands in sharp contrast to the state’s overburdened and under-resourced alternative.
In relation to the Postbank bill, President Cyril Ramaphosa has stated that passing it is important since its most critical amendment — moving the ownership of the Postbank from the SA Post Office to a new controlling company — will finally allow the state to move towards designating the Postbank as the official state bank. The commitment to a state bank is also the culmination of a long-standing position of the ANC, which is of the view that the current banking system has particular gaps that would be better addressed by a state-capacitated bank.
Public reaction to both steps has predictably been less than enthusiastic. The NHI Bill, which would completely overhaul the SA health system in its current form, has been roundly criticised for its design, the poor details about how it will work and the effect it will have on the existing healthcare value chain. Concerns about its costs remain subject to a wide spectrum of estimates whose only common feature is that they all amount to hundreds of billions of rand.
The source of funding for the NHI has not actually been identified, and its actual implementation pathway is simply unknown. These were fundamental enough for stakeholders to expect that the government would address them before passing the bill.
The sum of the red flags and the timing of the process ahead of a general election has led to speculation about whether the government is really executing on a critical public policy commitment or simply using the universal sense of importance of healthcare as an electioneering tool.
The projected funds associated with running the NHI — estimated by Intellidex to be as high as R460bn per year — have caused anxiety over both the sums involved and that it will all be administered by the state. The government’s track record in mismanaging huge projects and public finances — particularly in healthcare — means citizens already expect poor execution and waste of funds.
When one translates this poor reputation to the conversation about a state bank, the fear that the resource squandering of yesteryear will only escalate reflects the poor public standing of a state that has continuously discredited itself.
The country is now divided between those who believe the state is so incompetent that a project such as NHI will simply never happen; and those who think it will happen precisely because the governing party is keen to exploit the inevitable loopholes. While all of these are legitimate anxieties, it is still critical that important public programmes that have been well conceived are still able to reach implementation stage, to avoid a public governance paralysis.
The state’s inability to engage with valid criticism in matters such as the NHI and E-tolls means it is a government that is both discredited and disengaged. The expected challenges, both legal and political, mean time lags between the passing of bills and implementation of major public programmes is only going to widen.
The danger inherent in this state of affairs is that when citizens believe that whatever the government commits to doing will never see the light of day, either because it makes no sense or the state is simply too incompetent, it renders the government itself a peripheral structure whose political clout is a matter of election day optics completely divorced from substantive governance.
• Sithole (@coruscakhaya) is an accountant, academic and activist.
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