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After the Bell: SA’s NHI healthcare disaster starts right here

After the Bell: SA’s NHI healthcare disaster starts right here
Illustrative Image: (Photos: Felix Dlangamandla | Gallo Images / Alet Pretorius)

The ANC is selling the legislation to people not covered by private healthcare, effectively promising an improvement in their healthcare service in the foreseeable future. But even the ANC acknowledges that this is going to take years.

South Africa’s new national health service legislation, which will eventually outlaw Discovery, ParMed, GEMS, PolMed and all the other private medical aids, will almost definitely cross its last legislative hurdle on Wednesday when it is voted on by the National Council of Provinces.

The legislation, the NHI Bill,  is the culmination of a decade-long process, but it has already been passed by the national assembly, so essentially, this is it. From there it goes on to be signed by the President, and then it’s law.

One doesn’t like to be negative, but may I just say this is going to be an absolutely monumental stuff-up of gargantuan proportions.

It’s hard to describe exactly how big a stuff-up it’s going to be, but we are talking easily about an Eskom-level stuff-up. Bigger perhaps. The idea of better healthcare for the poor is clearly desirable, but the idea of doing it in this particular way – trashing an irreplaceable amount of private sector expertise and innovation – is backwards and the whole thing is at best 20 years premature.

So many people are tip-toeing around these issues that I feel it’s my responsibility simply to be honest. People don’t like to be seen as being against free-at-the-point-of-service healthcare because it sounds as though you don’t want poor people to get better healthcare.

Worse care for poor people

But trust me, this legislation will result in poor people getting worse healthcare.

How do I know that? Because the legislation envisages the destruction of private healthcare while neither SA’s public finances nor organisational systems can support a comparable public healthcare system for 60 million people.

So something has to give – and the only thing that can give is the overall quality of healthcare.

Almost no country in the world has a healthcare system envisaging a total ban on private healthcare in the way SA’s system now does.

Just for some perspective: if SA were Sweden, for example, it would be pretty easy to have a high-quality public healthcare system because the country is rich. GDP per capita in Sweden is $64,000 per year, and the average healthcare spend is around $6,400 – neatly 10% of GDP. Totally doable.

But SA’s per capita GDP is around $1,600 per year. To have Swedish levels of healthcare, (or any European country for that matter) South Africans would have to spend two-thirds of their personal income just on healthcare.

So that’s not going to happen because what it would require are taxes at astronomical levels.

SA will get, on average, a far less comprehensive system than those in Europe, obviously. But the NHI will still require somewhere between R200-billion and R600-billion extra government income per year.

That’s a big difference between the high and the low, but nobody knows for sure because the bill’s proponents haven’t really bothered with detailed, accurate, up-to-date costing. But VAT will almost certainly have to double, at the minimum.

The ANC meets this argument with the counterargument that NHI will be introduced gradually as the funds become available (when do they imagine this will happen, I wonder).

Because it’s going to be introduced gradually, there is no need to bother with the whole question of how much taxes are going to be increased. Convenient hey? Politically, they are counting on the frog-in-boiling-water syndrome.

The idea is that the government will ban healthcare insurers from providing, say, hip replacements. Technically, there will still be private healthcare providers; they just won’t get fully paid. Government will then tax the public more to pay public healthcare providers to provide hip replacements. And because they no longer provide that service, private healthcare providers will reduce their fees accordingly as we go.

Basically a tax grab

Eventually, all of the money people pay private healthcare providers now will instead be paid to the government, resulting in healthcare nirvana in which all citizens get equal healthcare provision. It’s basically a tax grab posing as a healthcare system.

Wait. Just say that last bit again? Public providers will reduce their fees because they are now providing less, you say?

Forgive me for being overly cynical, but trust me when I say that is not going to happen. What will happen is that until the last service is banned, people who can afford it will prefer to stick to their private healthcare to the extent they can.

This is South Africa; we don’t rely on government services unless we absolutely have to, and even then it’s a maybe.

But at the same time, taxes will have to increase to pay for public healthcare. The result will be much more expensive healthcare for everyone and much higher taxes, which, in case you haven’t noticed, are pretty high already. That means fewer businesses, more unemployment, and ultimately a lower tax base. The usual stuff.

Constitutional challenges

In the meantime, a whole range of institutions in the industry are already briefing lawyers, because before he signs the legislation, President Cyril Ramaphosa has to consider its constitutionality. And there is not going to be just one case – there are going to be many – because at least three groups are going to lose out.

First, healthcare providers presumably will have a constitutional claim against the government for the destruction of their businesses under Section 22 of the Bill of Rights; the freedom of trade, occupation and profession clause. Probably not the strongest case because the clause envisages government “regulation”, but we will see.

Second, provinces have a constitutional case because healthcare is currently a joint provincial/national mandate, and the legislation makes it exclusively a national mandate. Of course, only the Western Cape has objected, but constitutionally that might be enough.

And third, a whole range of organisations, including doctors’ and nurses’ associations, have a procedural claim because even the sponsoring department, the Department of Health, acknowledges weaknesses in the legislation which were pointed out, ad infinitum, but not rectified during the consultation process. And there will be more.

This could all have happened in a totally different way.

Government could simply provide better healthcare. And then people would think, “Why am I paying so much for private healthcare when I can rely on the public system?”

Instead of forcing people out of the private system, they could welcome the public in by competing in the marketplace and providing a better service.

The most instructive thing about this legislation is that government knows, in its heart, that it can’t compete, so the only thing to do is rely on force and create a monopoly, with all the joys a monopoly brings. Where is the Competition Commission when we need it?

The 2024 election

So, in the face of this barrage of criticism and scepticism, why is the ANC pushing ahead? The answer is obvious: the 2024 election. The ANC is selling the legislation to people not covered by private healthcare, effectively promising an improvement in their healthcare service in the foreseeable future.

But even the ANC acknowledges that this is going to take years, perhaps even decades. What happens when five years pass and nothing has happened? Or something has happened and it’s bad? Will voters still be convinced about its utility?

With the Eskom crisis now rampant, the Post Office in bankruptcy, Transnet in disarray, and so on, could there be a worse time for the government to introduce legislation that nationalises such a critical function?

But this is the way it has unfolded: the ANC is facing an election and it needs to make promises – and, as always, politics trumps function and common sense.

What I want to know is this: do SA’s parliamentarians know they will have to toss away their Discovery cards? That they too will join the queue at Bara, bringing their own sheets and their own food?

Do Cosatu members know they will have to trash their GEMS cards?

Do politicians know they are voting for VAT to double?

Like so many other pieces of election-inspired legislation, do politicians even know what they are voting for? DM

Gallery

Comments - Please in order to comment.

  • Ben Lev says:

    You have to remember just how desperate the ANC employees are. I don’t just mean the collective, but the individuals. They are making decisions as people who have no skills, no competence, no hope to get another job, no care for the consequence. A desperate cling to power is the ONLY rationale driving their decisions.

  • A MANSTEIN says:

    “Instead of forcing people out of the private system, they could welcome the public in by competing in the marketplace and providing a better service. ” The author is right to be sceptic of public sector capability and financial feasibility. But if he doesn’t believe in fairy tales why then this fluffy idea of the market will fix it? Health insurance 101 dictates that you cannot sustain a quality system which pools the poor and sick while the well off and healthy exclude themselves from the risk pool. If you believe in private healthcare so much take note of the US and its biggest spend on health with some of the poorest outcomes in OECD.

    • Vanessa van Vliet says:

      He’s not saying the market will fix it, he’s saying that you can pull people away from the current system by offering something better. Then people wont mind paying more tax. Btw people already contribute to the risk pool right now, they’re not excluding themselves

    • Stephen Paul says:

      Here’s the problem. You can say what you like about inequality, but the biggest tax payers will now have a reason to take their money out of the country. The government will lose its biggest cash cows.

    • Greg Ash says:

      USA is a poor comparator . No constraints on costs . SA private healthcare makes a profit , is excellent quality and costs a fraction per person per head of any of the state of the art comparable socialist systems (NHS in UK, NZ or Canada) . The competing forces of Doctors ( wanting more healthcare events , more expensive hospital equipment and higher fees) hospital ( wanting higher fees , less equipment and cheaper (lower qualified ) staff and funders ( wanting lower fees and less healthcare events work together with market forces ( out of pocket costs if doctors more expensive) to keep our system nicely balanced .
      The best thing government can do to upgrade state healthcare is to utilise this . Our funders have far better systems for controlling fraud or excessive expenditure than any future state fund ( NHI) and have the huge advantage of being present now , tried and tested at no cost to government. If the state paid the funders a small amount per month per citizen ( of the order of R200) they could purchase outpatient GP care , with a formulary of tests and treatments for the entire population. This low level care is what NHI aims to do first anyway and has the biggest bang for your buck . Treat diabetics to prevent kidney failure and heart attacks , high blood pressure to prevent strokes , HIV to prevent AIDS, strep throats to prevent Rheumatic fever and so forth . It will have the additional huge advantage that GP’s will have a commercial reason to build rooms in under serviced areas with money they borrow from banks … taking away the need for the state to spend billions it does not have to build these clinics . Almost all state doctors in SA are employed by hospitals in bigger towns and cities . This means that patients must pay taxi fare to get to the hospital every month, sit in long queues just to get their blood pressure checked and a re supply . Free “ at the point of service” misses the point that most of our people pay huge amounts in transport . A state funded outpatient GP care via our excellent funders will reduce costs to poor patients achieve a massive improvement in healthcare and unload government hospitals .
      Use the excellent private system – don’t destroy it !
      Dr Greg Ash

      • Dee Bee says:

        Dr Ash, the problem is, the ANC simply HAS to control every facet of lives in SA – they need to ensure that the bulk of voters depend on them for every single thing, or they will cease to be relevant. As long as they’re able to convince the desperate that without them, they’ll have even less, the desperate will cling to the myth of ANC beneficence. You’re spot on in your analysis, and it’s a great addition to the comments here, but the ANC will yield nothing to anyone and to hell with the consequences for the poor, as long as they calculate that it will keep them in power.

  • Richard Bryant says:

    You forgot to include my constitutional right to freedom of association. That I can choose which medical doctor I wish to use and also choose the way that doctor gets paid. Whether that be medical aid, medical insurance, self insurance or any combination of these. I certainly cannot be forced to pay for a system I don’t wish to belong to. In SA, only SARS can impose a tax, not the Dept of Health or any ministry. And only SARS can collect a tax. So if they impose NHI, I will immediately resign from my medical aid. The assumption that all medical aid contributions will be paid into the NHI is absurd. They will simply evaporate. In which case, VAT will need to quadruple or something more.

  • Jon Quirk says:

    It is now clear and certain that the ANC, all it’s various wings and guises, would sink the country as it tries to hang on to the levers of power; that we will shortly be hurtling even further down the greasy pole to polecat status, passing Venezuela, Zimbabwe and the other skunk states on your way to absolute rock bottom. THIS will be the inevitable result of this suicidal behaviour.

  • Notinmyname Fang says:

    Jobs for All
    Free water for All
    Land for All
    Free healthcare for All
    Sound familiar?
    The day we see our most feckless and corrupt leadership lining up on benches for hours to collect their supply of Panado, I will be convinced about the feasibility of the NHI
    It has taken business too long to wake up
    The portfolio committee starts its hearing with the following question: ‘are you for or against NHI?’ …if that is the starting point about a hugely complex political issue, what do we expect
    The Deputy Minister has been keeping his seat warm, waiting for promotion since this saga began. Vile, cynical, corrupt politics and we will be left to pay the price

  • robert kruse says:

    It is sad to think that so many voters will believe this NHS nirvana, despite 30 years of ANC destruction.

  • Anne Swart says:

    Sadly, the very example of Plato’s view of democracy being the rule by the lowest common denominator. I wish for the day that we have credible opposition parties and it is hopeful that the process is starting to unfold, but it will take another generation to mature.
    In the interim, for those able to afford it after increased taxes, Botswana will be the most favoured travel destination. Their private health care industry is doing well by all accounts.

  • José Lueje says:

    It’s many years ago, in the 70’s actually. More than 50 years ago. A meeting I attended organised by the Catholic Archdiocese, about the acceptance of black pupils at the private Catholic Schools in Bloemfontein.
    The reaction from the black delegates, was to negate any advantages for their Community.
    What they wanted was to close the existing Catholic Schools in the white areas, and open new ones in the black areas !.
    I stopped going to such meetings after that. Now I see nothing has changed. What is there and works, must be destroyed, and a new set up created for the benefit of a few connected individuals !.
    The parliamentarians & politicians will not be aware of any shortcomings. They will go out of RSA, East or North, for their medical needs.

  • Louis Botha says:

    So the full horror of the NHI is not fully understood by people in general. About 7 million people choose to use our world class doctors, specialists, hospitals and diagnostic services by paying for it themselves by huge medical aid contributions and excesses. This is a considerable burden for those that can afford it, but it is world class. On the flipside, unemployed and low income earners are reliant on the state for a mediocre or dysfunctional mismanaged government offering. The ANC and other useful idiots want to reduce this gap in offering, not by improving the dysfunction, but by destroying everything, and force everybody to use what is left according to their own rules.

    The NHI is not a new hospital of facility. It is a fund. In money terms it will be the biggest SOE. Those that now pay for a medical aid, will probably be forced to pay the same amount to NHI. And then they will be told which doctor or hospital they will use. No more doctor patient relationships that you are used to in private medicine. The doctor and hospital will then be re-imbursed by the NHI at the published rates. Imagine the SOE Postoffice style inefficiency here.

    For those that can afford the NHI premium, AND a private medical aid on top of that the following horror awaits.

    Scenario.
    You have paid your NHI premium, linked to your income. You have paid an additional fee for a private medical aid. Your 4 year old needs a tonsillectomy. NHI covers tonsillectomy so THE PRIVATE MEDICAL AID IS NOT ALLOWED TO COVER THE TONSILLECTOMY. So your child will be sent to wherever the NHI staff chooses. It could be to one of those hospitals where blood is on the floor, there is no safe parking, doctors and nurses are overworked, staff get mugged, patients get robbed, linen is stolen and patients don’t get food. You’re only other alternative to this is to contract the private hospital directly and pay cash, AFTER you have paid the NHI contribution, PLUS the medical aid fee. Imagine your horror then if the private hospital then doesn’t have a bed for your child because the hospital is full, busy with all the tonsillectomies from all those patients, who don’t contribute to NHI or a medical aid….. And then while this unfold you read the news headlines…. BILLIONS IN NHI FUNDS CORUPTION EXPOSED….or ….HUNDREDS OF NHI STAFF SUSPENDED FOR 2 YEARS ON FULL PAY…or NHI EXECUTIVE BUYS R150 MILLION HOUSE IN CLIFTON

    Currently
    Our private healthcare is world class. It is expensive, but it exists. It is not subsidized by government. You can choose to use it if you afford it. The high income earners use it. That choice will disappear under NHI. If they cannot use it, the high income earners that can will leave. The JSE listed hospitals will make less money and they will invest less. The death spiral.

    Currently
    The unemployed and low income earners are reliant on the state facilities. I am sorry for them. The proper solution is for the state to fix the dysfunction, corruption, theft and mismanagement. The money to do so is collected and spent every year. They can even raise VAT to increase the amount of money spent on healthcare provided they manage and implement properly, the way private enterprise does. Unfortunately our government cannot do anything properly. I wonder if they have ever done a root cause analysis. If they have, they probably don’t have the appetite to fix the root cause of the problem. So if we have to believe the incompetents, hot on the heels of the total inability to run a SAA, ESKOM, Postoffice etc. they will run NHI properly. LOL.

    • Roelf Pretorius says:

      No, it is not going to work that way. What is going to happen is that the government health institutions are going to be privatised – it is clearly implicated in how the legislation is explained. Because the whole national health budget (which currently pays the doctors, nurses, equipment, electricity, water, municipal rates, and everything else, even the salary of the CEO’s of the hospitals) are now going to go to the NHI. If the current state hospitals and clinics want to get paid any of it, they have to deliver services and then claim the published cost of the services back from the NHI – and all the above-mentioned expenses will have to be funded by that. THAT is privatization, nothing else. Unless of course the government is prepared to pay bail-outs that will make the half-trillion guaranteed to Eskom look like the cost of a Sunday picnic; but it is clear that the Treasury is not willing to do such, in fact it has indicated a LOWERING of the budget. And it has also indicated that taxes can’t be made higher (I believe that is to appease the ANC cadres given all the lucrative directorships at the SOE’s so they will keep funding the ANC). So I would say that the hospital CEO’s and clinic managers will have to start planning for having to fund ALL their expenses from the services they give and claim from the NHI. That is privatization, no matter how you spin it. The big risk is of course the risk of corruption, and that is where SA has to start planning to prevent.

      • Nicol Mentz says:

        You cannot just privatize (Malema style) i.e take it. Compensation has to be paid. Conservatively Billions if not trillions. There is no money!!!

  • deandredb says:

    The biggest problem is political parties wanting to end the horrible reign of the ANC’s government are NOT entering the rural area where the ANC gets the majority vote. WHY is it opposition parties are attacking the urban voter who sees and understands the failure of the ANC? It is not to late for the opposition to dig deep like the IFP has done in KZN and tackle the demon by the horns in deep Eastern Cape, Mpumalanga and Limpopo rural areas.. Can those leaders of the opposition actually lead, or are we also been led astray by what they perceive will end the ANC and bring true democracy to all South Africans…

    • Louis Botha says:

      I wonder, if we have a new coalition goverment….. will they succumb to power and also play the deployment of friends and corruption game ….

  • Rob Rhodes-Houghton says:

    Excellent article but, sadly, I suspect that the legislation will be bulldozed through. Telling stupid (government) people that they are stupid is a total waste of time. They won’t get it. Oh, and don’t forget, certain people fly off to Russia, Cuba, …., when they have headaches.

  • John P says:

    This can only lead to the majority of doctors moving out of SA to where their years of training and hard work can continue to earn them the living they deserve.

    The ANC leadership will of course not have a problem with their medical care, it will all take place overseas at the taxpayers expense.

  • Who drafts the legislation for these idiot plans?

  • Derek Jones says:

    After messing everything up, what on earth makes them think they could do this?
    Cant choose your own doctor. Cant choose what hospital. Cant get proper medical treatment. The ANC controls it all. I don’t think so. Not going to happen to us, we will leave. SA medical will go like Zimbabw if this is implemented. We will watch family members die from incompetence and corruption. That happened to my family in Zimbabwe, I won’t let it happen again.

  • Ben Harper says:

    All the anc is interested in is getting their hands on more money, that’s the ONLY reason they are pushing this through

  • Alley Cat says:

    Many doctors and specialists have already left the country and many others are planning to leave. As a senior citizen, close to retirement, I too am contemplating the journey to better (rainy, cold) shores. I really don’t want to leave, but I will not abide by the dictates of these populist crooks and looters!
    In a recent conversation with a (really competent) specialist, she told me of her passion to work in state hospitals but that there were no vacancies because the state can’t afford it.

  • Talk to doctors. We have massive facebook groups where we are all fighting for government jobs – you can only specialise via Government hospitals that are medical university affiliated. There is no budget. I worked for free for 6months just to do a diploma. I am 37 years old. Tell me why my colleagues and I are being forced to emigrate because our country doesn’t employ doctors eventhough there is SO much work in government hospitals. How will NHI work when clinical staff aren’t being employed? Elective surgery isn’t being done because the budget is frozen until next financial year.

  • Willem Boshoff says:

    Brace yourselves for mass emigration of qualified citizens if private healthcare gets the bullet. People can suck up a lot but the NHI will be the last straw (log?) that breaks the Camel’s back. No person who has the skills to make a decent living in a country with less crime and access to qualified, motivated medical professionals will hang around in a country where you’re likely to get stabbed and then have to queue for hours.

  • Vincent Britz says:

    The corrupt ANC government doesn’t care what they do or how they do it, as long as they can loot the state’s coffers & fill their pockets with the taxpayer’s money.
    THE CORRUPT ANC GOVERNMENT MUST FALL!!!

  • Alain Coret says:

    That bill doesn’t make sense at all when looks at the state if the public health sector. The government is basically bankrupt, our tax base diminishing day and private care will fight the bill tooth and claw as there is too much at stake. What a joke!

  • fayisa77 says:

    I’m afraid Tim gets the consequences wrong.

    1. The NHI is no NHS hence it is about patient funding than revolutionising public healthcare provision. What public healthcare facilities is government bringing to the table?

    2. Because the NHI is no NHS what will happen is the decimated public healthcare system will continue its downward spiral characterised by goal displacement and goal ambiguity.

    3. In the meantime demand for healthcare will continue to grow the result is more reliance on the private healthcare industry with NHI paying. The SA government is essentially shifting the burden to the private healthcare sector.

    4. The result is SA will see the transformation of the private healthcare landscape like with education. I took a trip to a neighbouring country where many residences near the central business district had been converted into surgeries, trauma centres, 24 hour casualty clinics, private hospitals, diagnostic and testing centres and laboratories.

    NHI and revolutionary incompetence will result in the emergence of barebones private healthcare. NHI as a patient funding mechanism will ensure effective demand. Judging from the current situation as with education, this transformation will likely be led by foreign nationals while the locals will be waiting to be empowered, that is casting their eyes at Mediclinic, Netcare.

    5. So in essence there will be deepening and widening of private healthcare. It is time to invest in good property suitable for conversion into healthcare facilities. And advisable to have entrepreneurial friends and associates in the medical field.

    6. As with all things revolutionary in addition to goal ambiguity if not displacement, there will be mission creep, mission expansion and other distortions.

  • Johann Olivier says:

    The old horror movie. Don’t go there! It’s a dark, scary passage. We know the Slasher is there. How can you be so stupid…? Phew! Thank god that was just a movie… Let’s go for a beer. WAIT…what? Nooooo…. It’s real!!! Aaaargh!

  • Johann Olivier says:

    In the US, because of the interference by private investment (private equity) in the healthcare system, squeezing every dollar out of the system, many physicians have rebelled. They’ve created private associations, where a doctor offers slots to, say, 200 families. Each family pays the doctor, say, $3000 per year. In addition, they pay for their visits. What they get as members of the Club is the kind of service that is barely seen any longer. I can see similar structures arising in SA.

  • SMnguni2nsm says:

    The sad part in addition to what’s mentioned above SA’s borders remains open for all…we are beyond being over population with the highest rate of unemployment this would mean a further catastrophic in a depression of this country’s economy. This is really sad and will continue to aggrivate anger to the working class citizens as this will be additionally to things that this government keeps shoving down to their throats. Will this ever be halted with all these dead and continue dying so called SOE…

  • peterwaller3 says:

    Well said Tim. Total train wreck for all.

  • Pup Dog says:

    I’ve had to use gov hospitals for some time, once you cut through the rude and indifferent layer you find by some of the staff. The heads of department are amazingly adept at what they do. Over worked in the extreme, under funded but never give up. My inside perspective of HHI is that it will fail in a spectacular fashion. Insufficient funding, insufficient poorly trained staff and governments attitude that once you are qualified and your contract ends you either go into private practice or leave. My daughter left!!

  • Les Thorpe says:

    Welcome to the ANC’s biggest scam to date. No doubt the comrades will be fighting/murdering each other for a share in the NHI contracts.

    • Gordon Bentley says:

      Hear, hear, Les Thorpe. Fully agreed…

      If you think Eskom was/is bad with regard to Corruption and Stealing WAIT for NHI.
      This promises to be a situation of: ESKOM AND SOE CORRUPTION MULTIPLIED BY BIG FACTORS – Criminals with highly placed Criminal Contacts are rubbing their hands with glee and anticipation…

      My sources, for example, are the NHS in other developed countries and particularly, in the UK. In spite of having vey good management, they have a permanent department whose sole job is to seek out corruption and scams to loot the NHS. Apparently here are many, many scams. They even have a TV Documentary on BBC Brit which has quite an entertaining content of tracking down and successfully Prosecuting the Scam Artists and Individuals who steal millions of pounds from the NHS regularly.

      It is very satisfying to see these Public-Enemy-No 1, Criminals being heavily fined and put away for long sentences.

      South Africa???…

  • Albert Palombo says:

    ah !! but the consequences are in the future. For the present it is important for the ANC to remain in power so as to allow for the continued diversion of the country’s resources to their pockets. An electorate that votes by emotion rather than reason perhaps deserves them

  • Johan Buys says:

    in effect 10m people are serviced by private providers and 50m by the state.

    Until now, state has no say in who private health patients used for what treatment or how they funded their private medical affairs.

    What the comrades want to achieve is (1) that private providers must also service the 50m that it fails to service despite spending three times what China and India spend; and (2) that state can decide who I use for what treatment and prohibit that I make my own choices and fund it myself.

    What could possibly go wrong when cadres that can’t run Police, Justice, Energy, Education, Transport or public health decide what specialist procedure I can or cannot have.

  • Hervey Williams says:

    Having worked in KZN Health for 28 years until 2022, I agree with most of the article. I have never understood how NHI will improve government service healthcare. If government health institutions can be raised to the standards required for NHI, then, as the author says, many would no longer see the need for private health care and the government would have done its duty, without setting up NHI. Rather than being a tax grab, however, my thinking is that NHI is more an outsourcing of healthcare. The government does not really want to keep running health institutions and reasons that it would be simpler to just provide funding. This might work in cities with a choice of private health institutions, but difficult to see working in rural areas where government hospitals and clinics are the main healthcare providers, many doing quite a good job.
    As the author correctly states, the organization required to run an NHI system is not present in the government health service. A great many people will need to be employed to allocate the funding and a great many to claim it.
    A paradox is that although the case for NHI emphases the present inequality between private and government healthcare resources per patient, the government spends billions subsidizing private healthcare for its employees.

  • Ken Shai says:

    If they pump more money into healthcare, the hospitals will just be more corrupt, and will do more unneeded surgeries deceiving patients about their diagnosis. Free medicine is better, at least medical specialists have no incentives for fraud.

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