The standoff between business, healthcare professionals and the presidency over the health compact due to be signed on Thursday is a clear sign of the difficulties that lie ahead for the government of national unity (GNU).
The compact is the product of 202’s second presidential health summit, and is due to be signed on Thursday. It has been rejected by Business Unity SA and the SA Health Professionals Collaboration because it expresses overt support for national health insurance (NHI), which both organisations say they cannot support in its current form.
The past few months have shown us that cabinet ministers have far more power and agency than we previously assumed.
Within hours of taking office, the DA’s minister of home affairs, Leon Schreiber, extended the temporary concession for foreign nationals awaiting the outcome of visa, waiver and appeal applications, and has since then quickly moved to reduce SA’s huge visa application backlog.
The Patriotic Alliance’s garrulous minister of sport, arts and culture Gayton McKenzie has pulled the plug on funding “superfans” to trot around the globe at taxpayers’ expense, and the DA’s basic education minister, Siviwe Gwarube, last week put the brakes on a suspicious tender for school meals.
So, it is hardly surprising that despite being part of a government that includes parties that are staunchly opposed to NHI, the ANC’s health minister Aaron Motsoaledi is confidently pressing ahead with party’s controversial plan for universal health coverage. He is traversing the country on a roadshow, ostensibly to consult, but to all intents and purposes talking up the ANC’s policy, with no concession made to the fact that only three of the other 10 parties in the GNU support it.
Right now he is dealing with the easy part: broadcasting his rationale for reforming SA’s two-tier health system and assuring the public that NHI is the only way to do it. Casting critics of NHI as anti-poor, he appears blind to the possibility that anyone who questions the feasibility of the National Health Insurance Act might be just as appalled as he is at the inequities in the current system.
The tough part is yet to come. Among the fiercest critics of NHI within the governing coalition is the DA, which vigorously opposed the NHI bill when it was before the legislature, voted against it in both houses of parliament, and has continued to speak out against it ever since.
The ANC is pressing ahead with NHI because it controls both the health ministry and the health department, while the DA wants the act sent back to parliament for a major overhaul.
The act has been signed, but it is not yet in force because none of its sections have yet been promulgated. There is a window of opportunity here for level heads in the GNU to negotiate a way forward. For example, if they agreed to excise one of the biggest flashpoints in the act — the prohibition on medical schemes covering benefits provided under NHI — they would extinguish a host of legal arguments against it and create the space to get on with building trust in a simpler, less-risky version.
It is worth remembering that the coalition government’s statement of intent places an obligation on cabinet ministers to find a way to manage their ideological differences. NHI is going to be a true test of that commitment.
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