No-one can deny that South Africa is a country whose healthcare system is not in good shape. Public hospitals and clinics have become bywords for failure. Patients are left unattended. Medicine stocks run out. Ambulances take hours and hours to pitch. Waiting times stretch all the way from here to the moon.
In a way, it’s like President Mbeki said all those years ago: there are two South Africas – one where healthcare works and people are looked after, and one where healthcare is a disaster and clinics and hospitals are where people go to die, rather than get better. It’s a depressing situation.
Now, we all can surely agree that those South Africans whose healthcare is neither healthy nor caring deserve better. The question isn’t “Should people get better healthcare, the care they really need?” – no, the question is actually “How can we ensure that all South Africans have access to the healthcare they need?”
This is where we turn our attention to the National Health Insurance scheme, the NHI.
NHI = A massive medical stokvel?
On the face of it, there is some appeal to this idea: pull money from all South Africans together in a sort of a massive medical stokvel, and then pay for the healthcare of those who need it. So far so good and fluffy. However, the kick comes in when we drill down into what has actually gone wrong with healthcare in South Africa, especially for the poorest in our communities.
There already exists a network of healthcare institutions that are supposed to provide free healthcare to people who can’t afford it – it’s called the public healthcare system, run by the government. Surely, the NHI will do something to fix what has gone wrong in the existing system that South Africans spend billions of taxes on? Well, no. It won’t improve management, standards of appointments, stock monitoring and supplies, or standards of care. When push comes to shove, there’s nothing in the NHI that will fix the existing system.
Instead of really looking at the current failures of government-run healthcare, the government has decided that it needs a new healthcare thing to run despite being unable to run the existing thing anything close to properly. But we’ve seen this government actually do this before – with South African Airways (SAA) – where a government-run thing failed and got replaced with a government-run thing.
Death to private sector healthcare
In reality, the NHI will have only two main effects, despite its enormous cost of trillions of rands – a cost so huge, government and the ANC have been unable to tell us how much the whole thing will cost!
Effect number one will be to essentially kill the private sector healthcare industry. Now, if you’re tracking with me here, that’s the part of South Africa’s healthcare system that actually works. Yup, that’s getting the chop under the NHI.
Effect number two will be to put all the money South Africans spend on their healthcare in the hands of politicians and government officials. How on earth can anyone think this will end well? Isn’t it enough that the previous Minister of Health had to resign in disgrace because of massive corruption he was involved in? Now people want to put more money in the hands of these crooks and cronies?
The NHI is really nothing less than a cash grab that’ll be run into the ground like almost everything the government is supposed to manage. Think SAA. Think Eskom! Now there’s a thought… Government-run electricity gives us load-shedding – what will government-run healthcare for all South Africans give us? Life-shedding.
Some ideas are just plain stupid
The NHI is quite blatantly a stupid, stupid idea. It is unaffordable, will make no actual difference to the current public healthcare system, give billions of rands to politicians and government cronies to manage (read ‘steal’), and will destroy the best bits of South Africa’s healthcare system. All of this with nothing to show for it. Does this mean we should just throw our hands in the air and accept that some people are always going to get bad healthcare because they can’t afford it? Those who argue for the NHI say ‘yes!’ – reality, actually, offers a firm ‘noooo’. There is a healthcare crisis in South Africa, but where the NHI will make things worse, other options will make things better.
Firstly, government should stop interfering, and micromanaging medical aids and funds. The private healthcare industry started working on solutions to get poorer South Africans healthcare more than ten years ago. Plans were drawn up for medical aids and funds to work on affordable healthcare coverage of less than R200 per month, something that most people could afford and most employers could make part of employment packages. The idea was to create a whole range of options for the poorest South Africans to get access to the best private healthcare that richer South Africans already can afford. Instead of making healthcare access equal by dragging good healthcare down to the level of government-run healthcare, the range of affordable healthcare packages would have equalized upwards by making many dependent on failing government-run healthcare able to access the high standards of private healthcare.
Sounds good, right? But what happened. Well, government happened.
With regulation after regulation, government started making the idea of these affordable plans, well, unaffordable. Government started regulating that all medical aid plans needed this or that sort of coverage – medical aid plans for people unable to get pregnant now needed to include coverage for pregnancies. That sort of nonsense. What this ended up doing was making cheap plans more and more expensive, until they were no longer cheap at all.
Solutions that will actually work
One option, therefore, to put healthcare on the right track in South Africa is for government to stop being stupid and allow entrepreneurs, people who want to make a living by selling their talents and ideas and goods to others to solve problems, to come up with affordable healthcare plans. Government intervention made affordable healthcare plans impractical. The solution to this is for government to get the hell out of the way and let problem-solvers solve problems.
Another option as an alternative to the NHI, an idea that will actually give the poorest people access to the healthcare they really need, is the idea of healthcare vouchers.
Healthcare vouchers are simple to understand and to implement:
Instead of government spending billions and billions on behalf of South Africans, why not just make those billions available to the people who need access to healthcare? In practice, this would mean that poor South Africans receive a healthcare voucher on a regular basis that they can spend on their health at any clinic or hospital in the country. No longer will people be forced to wait for government-run hospitals and clinics to look after them (not that that always happens, but you know what I’m saying), people can then just decide for themselves which clinic or hospital to go to spend their healthcare voucher and get the care they need and the care they choose.
Keep an eye out
So, looking ahead into 2022, the topic of the NHI is bound to be a big one. Government officials love it – why wouldn’t they? It gives them more power and more money! So, expect politicians and government crooks and cronies to push hard for the NHI. Expect them to call anyone who opposes them cruel, harsh, callous, unfeeling, uncompassionate. And probably a racist, because that’s what everyone is called by these folks if they dare disagree.
But the NHI isn’t a sure thing to become government policy. We, the people, can still say ‘no!’ to stupid ideas that will make the government rich, but do nothing for those who need help the most and only make everyone worse off.
If you’ve never sent an email to a member of parliament or minister, perhaps now is the time to start. Send an email to a few MPs and ministers asking them where they stand on the NHI. If you don’t get an answer, send three more emails. Then send six more. Then write a letter to us here at FAN saying you’re getting no response from this MP or that minister. Then write to a few newspapers.
As South Africans, we’ve not come close to using the tools at our disposal to make the politicians listen to us. With the NHI on the table this year, we can make 2022 the year we find our voice and make those in power listen to us. If we can do it on the NHI, well, folks, the sky is the limit. We’ll make our country a true home of freedom.
Cover image adapted from here.
