LETTER: NHI eliminates choice - Business Day

Foster Mohale’s defence of the National Health Insurance (NHI)  is revealing in more ways than intended (“Medical tax credits benefit employed”, August 4). By rejecting the Institute of Race Relations’ (IRR’s) Better Health Bill, Mohale is not only rejecting deregulation and market incentives. He is rejecting better health itself.

SA already has universal healthcare. Any citizen may walk into a public clinic or hospital and expect to receive care. The problem is not access, but quality. The public system is overburdened, inefficient, wasteful despite enormous allocations, and riddled with corruption. That is why those who can afford to opt out do so, to buy better healthcare elsewhere, at great personal cost and sacrifice.

Financially, they are not abandoning the public system. Quite the opposite: they continue funding it through their taxes while easing its burden by staying out of its queues. The Better Health Bill seeks to make this dynamic work for more people, not fewer. It proposes to extend access to private healthcare by subsidising it for poorer South Africans through a national system of competitive, portable health vouchers.

This is not entrenching inequality. It is breaking it down by helping people access something better. The NHI, on the other hand, proposes to eliminate this choice. Once the NHI is implemented there will no longer be two tiers. There will be one, and it will be the public one, in all its dysfunction. This is not equity. It is a forced levelling-down.

Mohale asks rhetorically where those opposed to the NHI will emigrate to. The answer is simple: to countries not run by thievery corporations masquerading as the state. In those countries public healthcare may work reasonably well, though even there state-run systems are notorious for long queues, rationed treatment and overworked staff. But what makes those systems tolerable is good governance and the option, for those who choose, to buy better care. It is precisely that second layer of freedom that the NHI is designed to abolish.

Mohale also invokes section 27 of the constitution. But he neglects to mention that the constitution requires the state to take reasonable measures to progressively realise access to healthcare. It does not require the destruction of functioning private systems, nor the nationalisation of healthcare financing. Nor does it give government licence to gamble with people’s lives and livelihoods by creating a giant, centralised healthcare bureaucracy backed by the full coercive power of the state.

Winston Churchill once quipped that the “inherent virtue of socialism is the equal sharing of miseries”. That is what the NHI offers: universal access not to good care, but to bad care. Most people, if given the choice, prefer not to share misery. They want to improve their lives. They want access to better care, more options and the dignity of choice. The NHI is the opposite of that, whereas the IRR’s Better Health Bill aims to deliver it.

Dr John Endres
CEO, Institute of Race Relations

https://www.businesslive.co.za/bd/opinion/letters/2025-08-11-letter-nhi-eliminates-choice/