LETTER: NHI could trigger mass emigration - Business Day

Thoneshan Naidoo’s analysis of the dangers posed by the removal of medical tax credits under National Health Insurance (NHI) is a welcome and necessary intervention (“Removing medical tax credits a hidden blow to working families”, July 30).

The proposed removal will indeed make private healthcare unaffordable for hundreds of thousands of working families. But the danger doesn’t stop there. If the NHI is implemented in its current form it will eliminate meaningful access to private insurance and services. Then, many of the 8.8-million South Africans currently using private healthcare might simply emigrate. That outcome would be catastrophic.

This group disproportionately comprises medium- to high-income earners who contribute most of SA’s personal income tax, the largest source of government revenue. If even a small fraction of these taxpayers leave the country, it will hollow out the state’s fiscal base while public finances are already under immense pressure.

In trying to deliver universal healthcare by force, the NHI risks breaking the very system that funds it. But there is a better path. The SA Institute of Race Relations (IRR) has drafted concept legislation — the Better Health Bill — which offers a high-quality, cost-effective and financially sustainable alternative. It retains choice, supports public and private providers, and protects access for the most vulnerable.

I encourage readers to review and endorse the bill, which is accessible from the IRR website. SA needs health reform — but it must be reform that works.

Dr John Endres
CEO, SA Institute of Race Relations

https://www.businesslive.co.za/bd/opinion/letters/2025-07-31-letter-nhi-could-trigger-mass-emigration/