Letter: NHI neither reasonable nor affordable - The Citizen

Since the National Assembly voted to pass the National Health Insurance NHI Bill, there's been much debate on its affordability. I believe the National Council of Provinces should oppose this legislation.

It is inconsistent with Section 27 of the constitution that requires the state to take "reasonable" measures, within its "available" resources, to make healthcare "progressively" more available to all. NHI is neither "reasonable", nor "affordable".

The government should rather focus on fixing what is broken instead of breaking what works. In March 2022, Finance Minister Enoch Godongwana said the government had not updated the NHI cost model since the 2019/2020 financial year, before the Covid pandemic.

In 2019, then health minister Dr Zweli Mkhize, pictured, said annual costs were likely to exceed the combined total R470 billion of public and private health spending that year. Both he and his successor, Dr Joe Phaahla, were adamant NHI must proceed "regardless of its costs".

The tax increases required to generate at least R470 billion a year and more likely R700 billion a year by 2026 , will be high. Consider that R700 billion is around a third of projected total government revenue in 2022/2023, estimated at R2.2 trillion for 2025/26.

SA already has one of the highest tax burdens in the world, while its tax base is very small. In addition, its public debt remains high. As of 2022, the country's gross loan debt as a percentage of GDP stood at 71%.

The government is already having to spend Ri billion a day over the next three years to service existing debt. It, thus, urgently needs to reduce state spending and cannot increase it in the way the NHI will require.

Mlondi Mdluli, Institute of Race Relations