It’s been a head-spinning few days. One minute President Cyril Ramaphosa is riding roughshod over private sector input on the National Health Insurance (NHI) Bill and assenting to legislation that he knows will be challenged all the way to the Constitutional Court. The next he’s telling this paper’s sister publication the Sunday Times that he’s considering a mechanism “that will allow for more engagement and collaboration with business” and that SA’s legislative framework “allows for amendments to be made”.
This is no way to make policy. No president should be giving the go-ahead to legislation that heralds sweeping reform, and then signalling to a key constituency whose submissions have been roundly ignored that the law he has just agreed to can be changed.
The NHI Act sets in motion the ANC’s contentious plan for universal health coverage, in which a government-controlled fund will purchase services from public and private providers, and medical schemes will be banned from covering benefits provided by NHI. The policy is built on laudable social solidarity principles, with the rich and healthy subsidising the poor and sick so that all eligible patients receive care that is free at the point of delivery.
But as critics have pointed out for years, the NHI Act is so deeply flawed it poses major risks to the parts of SA’s health system that function well and is completely unaffordable in the current economic climate.
Ramaphosa’s flick-flacking gives credence to the view that his signing into law of the NHI Act last week was a cynical move ahead of the May 29 election, intended to fend off pressure from within his party and send a message to voters that the government is intent on improving access to health services. With an eye to the ANC’s core constituency, he lost no time in castigating the private sector, painting healthcare businesses as hell-bent on generating obscene profits and medical schemes as serving only the elite.
Amidst all the uncertainty over NHI created by the president in the past few days, one thing is clear: he cannot decide where he stands on the private sector and what role it should play in NHI
Neither narrative is true. Some private healthcare businesses are as modest as a GP running a solo practice, and many medical scheme members — including a large number of civil servants — are not particularly well paid.
The irony of this narrative appears to be lost on the president and his cabinet, not to mention the MPs who pushed the NHI legislation through parliament, as they are quite happy to turn to the private healthcare sector when they and their families fall ill.
It is also quite disingenuous for health minister Joe Phaahla to complain about private sector prices when he has ignored the recommendations of the Competition Commission’s health market inquiry, which proposed establishing a mechanism for tariff setting as part of a suite of measures aimed at widening access to private healthcare. The inquiry positioned its final recommendations as a means to stabilise the private healthcare industry ahead of NHI, yet even so its work was de facto mothballed.
Amid all the uncertainty over NHI created by the president in the past few days, one thing is clear: he cannot decide where he stands on the private sector and what role it should play in NHI.
It is such a pity. As the Covid-19 pandemic and SA’s energy crisis have demonstrated, the private sector is willing and able to step in to collaborate with the government, if only it could find a partner willing to engage in good faith.
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