The National Health Insurance (NHI) plan is not a lifeline for South Africa's broken health care system. It is a carefully engineered ploy to centralise control of more than R1-trillion, ostensibly for universal health care.
South Africans are expected to trust the process led by a government incapable of managing a post office, let alone an entire nation’s compulsory health insurance. This is not progress; this is state capture 2.0, and it will dwarf the Eskom disaster in both scale and devastation.
The ANC, the largest party in the government of national unity, insists NHI will bring world-class health care to all. However, the necessary foundations to sustain such a system do not exist. There are several anomalies, such as the absence of a national electronic health database, non-existent integrated patient records and inadequate digital infrastructure.
Simply put, there is nothing to support NHI but empty promises and a seemingly cynical intent to obliterate medical aid societies. How exactly does the ANC plan to roll out universal health care when it cannot even ensure that state hospitals are run properly?
The answer is simple: it doesn’t have a plan, it has unbridled ambitions. This is not about health care. This is about control and extraction. Ironically, the other major part of government — the DA — opposes NHI to the point of litigation against it.
If public health care is good enough for 60-million ordinary citizens, why is it not good enough for Cyril Ramaphosa, Paul Mashatile or Jacob Zuma
The NHI Fund will be a multi-billion-rand honeypot, overseen by the same politicians who have run every state-owned enterprise into the ground. The health minister will handpick the NHI CEO, the board and the procurement committees.
Like Eskom and Transnet, this NHI venture won't end well. While the ANC forces the scheme down the throats of ordinary South Africans, the party's leaders won't be subjected to the same system. The ministerial handbook ensures that the president, deputy president and all former officeholders enjoy lifetime private medical aid, including fully funded overseas treatment, all paid for by the same taxpayers who will be trapped in NHI’s failing hospitals.
Where is the moral consistency?
If public health care is good enough for 60-million ordinary citizens, why is it not good enough for Cyril Ramaphosa, Paul Mashatile or Jacob Zuma?
Why does the government still operate under apartheid-style provisions that guarantee elite health care while dismantling private options for everyone else? The rot is already evident. Even 1 Military Hospital, once a centre of excellence where former president Nelson Mandela received medical care, is now in ruins. If the state cannot maintain a single VIP hospital, how will it possibly manage an entire NHI system?
The truth is it won’t. It seems not enough thought was put into providing universal health care.
It is not in dispute that South Africa's economy is on life support and cannot possibly afford the grandiose NHI plan.
Unemployment is at 43%, GDP growth is anaemic and only 16.8-million taxpayers carry the burden of 28-million social grant recipients. These already overburdened taxpayers are expected to somehow fund a R1.3-trillion annual health-care monopoly with no efficiency, no accountability and no opt-out.
If NHI is implemented, South Africa's private health-care sector, ranked among the best in Africa, will be strangled to death. Medical aid will collapse, private hospitals will close and thousands of health-care workers will emigrate.
The result? A likely health care implosion, where the rich flee overseas for treatment, the politically connected keep their private doctors and the rest are left to die in understaffed, underfunded NHI facilities.
The government sells NHI as “correcting apartheid’s injustices”, yet three decades of ANC rule have only deepened health-care inequality. Public hospitals are worse than ever, yet instead of fixing them, the ANC’s solution is to drag everyone down to the same level of dysfunction.
Before even dreaming of NHI, SA needs:
- A complete overhaul of public health-care infrastructure, starting with clinics and hospitals that have medicine, staff and working equipment.
- Public-private collaboration, like the successful partnerships seen during Covid, rather than the destruction of private health care.
- Massive investment in digital health systems — electronic records, telemedicine, AI diagnostics — instead of paper files and lost patient histories.
- Independent, corruption-proof oversight of NHI funds by the auditor-general, not the same politicians who destroyed Eskom.
In all honesty, NHI is a predatory scheme designed to enrich the ANC’s network while leaving ordinary South Africans with nowhere to go for decent health care. It will collapse the private sector, chase away skilled professionals and bankrupt the country, all while the political elite continue receiving five-star medical treatment abroad.
If the ANC truly believed in NHI, its leaders would lead by example and subject themselves to it. But they won’t, because they know it’s a scam. South Africa must reject this disaster before it’s too late.
• Lourie is editor and founder of TechFinancials
For opinion and analysis consideration, e-mail Opinions@timeslive.co.za
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