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NCOP passes NHI Bill in face of widespread condemnation by health professionals, business and opposition

NCOP passes NHI Bill in face of widespread condemnation by health professionals, business and opposition
Minister of Health Joe Phaahla during a National Health Insurance (NHI) workshop. (Photo: GICS)

Now that the National Health Insurance Bill has been passed in the National Council of Provinces on the back of support from eight provinces, the controversial legislation will land in the in-tray of President Cyril Ramaphosa, who must decide what to do next.

The options are limited, but not without significance. According to the Constitution, a President can return a law to Parliament over procedural issues and concerns that it may not meet constitutional muster. Or he can refer the legislation directly to the Constitutional Court for a decision on its compatibility with South Africa’s supreme law.

At a media briefing on Wednesday immediately after the National Council of Provinces (NCOP) passed the National Health Insurance (NHI) Bill, Health Minister Joe Phaahla said the legislation would be implemented in stages once it got the presidential nod.

“The passage of the Bill does not close the door on consultations. This is just the beginning… In terms of implementation, all these stakeholders are key. The detail will emerge in regulations, directives and further policy and implementation plans,” Phaahla said.

“The implementation of the NHI, the fact that this will be disruptive, I can’t deny it, [but] the current situation is not sustainable.”

Shortly after Wednesday’s NCOP vote, the South African Health Professionals Collaboration called on President Cyril Ramaphosa to refer the NHI Bill back to Parliament for reconsideration. The collaboration represents more than 25,000 private and public healthcare workers from nine medical, dental, and allied associations.

The Hospital Association of South Africa expressed disappointment. “We urge the Presidency to recognise the compelling inputs into the National Health Insurance Bill made by us and many others in healthcare and to address the issues raised by the private sector,” it said in a statement. 

Last week, the DA said it would petition Ramaphosa not to sign the Bill into law, failing which it would try to mobilise a third of the 400 MPs to support legislators going to the Constitutional Court for a decision on the Bill’s validity. 

Petitions to Ramaphosa will also come from organised business groupings Business Unity South Africa (Busa) and Business for South Africa (B4SA), given their lobbying. 

“The business groups believe that the Bill, in its current format, is not only unworkable, unimplementable and unaffordable, but also unconstitutional, both on substantive and procedural grounds,” Busa and B4SA said in a joint statement shortly after the NCOP’s approval.

Last week, the business groups called for a delay in the vote in letters to Parliament’s presiding officers and Deputy President Paul Mashatile in his capacity as leader of government business, or the liaison between Cabinet and the national legislature.

In the wake of these letters, with just 30 minutes to go, the NCOP did defer the NHI Bill vote for a week at the request of the council’s chairperson, Amos Masondo. This effectively opened the door for conversations, as at this stage of the lawmaking further consultations and changes to the legislation are not possible.

Read more in Daily Maverick: NHI Bill vote delayed amid backroom political twists and last-minute business lobbying

In Wednesday’s NCOP vote, all provinces but the Western Cape were in favour of the Bill. This was expected — the provincial mandates that determine votes were put on public record in the NCOP health and social services committee on 21 November.

Having a debate was unusual for the NCOP, but this NHI Bill is a key political moment for the governing ANC as it marked the fulfilment of a policy principle that dates to the ANC’s 2007 Polokwane national conference and 2010 national general council.

The three-hour debate that gave the majority of speaking time to the ANC provided a PR platform for the party ahead of what’s expected to be a tough 2024 election campaign. That was signalled when Masondo told the NCOP, “We will now listen to the minister address the country.”

Applause from Cosatu

The political import so close to the 2024 elections was underscored in the applauded support from the ANC’s alliance partner Cosatu shortly after the vote.

Government needs to move with speed to resource and build a quality NHI that will guarantee quality, accessible and affordable universal health coverage for all South Africans,” the trade union federation said in its statement. “Cosatu and the overwhelming majority of workers are in support of an NHI.” 

During the NCOP debate, ANC speakers described the NHI Bill as “revolutionary”, “historic” and “a victory for the poor” that would eliminate inequality and the discriminatory two-tier (private/public) healthcare.

Health MECs from Eastern Cape, KwaZulu-Natal, Limpopo and Mpumalanga talked up their ability to deliver the NHI and emphasised how increasingly more public health facilities were attaining the required “ideal clinic standard”. Quality services were being delivered at newly built facilities like the Dr Pixley Ka Isaka Seme Memorial Hospital in KwaMashu, KwaZulu-Natal, which Ramaphosa recently officially opened.

It was a point directly contradicted by opposition speakers from the DA, IFP, Freedom Front Plus and the EFF, who for different reasons rejected the NHI Bill. However, all pointed to corruption, maladministration and dilapidated public health facilities, particularly in rural areas and townships.

Read more in Daily Maverick: National Health Insurance roll-out one step closer, but private healthcare has burning questions

EFF Delegate Mmabatho Mokause rejected the Bill because it effectively outsourced healthcare to the privately owned health industry, which would be enriched. “Today we are being misled by the ANC that this Bill will deal with the collapsed healthcare [system],” Mokause said.

In an illustration of the NHI’s divisiveness, for the KwaZulu-Natal IFP delegate Nhlanhla Hadebe, the debate was an opportunity to publicly reject the NHI, even as the ANC-run province supported it.

For the FF+, delegate Fanie du Toit cautioned of the corruption already present in the health system and misadministration-related shortages that saw babies at hospitals sleeping in cardboard boxes. “Everyone in South Africa will be at the mercy of the nightmare to which South African state hospitals have declined.”

DA delegate Delmaine Christians asked, “How do we trust this government that has failed to deliver service, allowed infrastructure to crumble and corruption?” Her fellow DA delegate Dennis Ryder bluntly said the NHI Bill’s “implementation will result in a half-baked mess”.

‘A very historic day’

Phaahla, however, told the NCOP, “NHI is about ubuntu”, or social solidarity. 

“This is indeed a very historic day and historic achievement because here we are putting into statute a framework, we can create the health insurance fund. The perpetual divisions, at least in the area of health, can come to an end.”

The legislation the NCOP adopted is the same that the National Assembly adopted in June in a close vote, with the ANC carrying the law only with the support of some one- and two-seat political parties.

Read more in Daily Maverick: ANC gets its ‘revolutionary’ NHI legislation adopted despite opposition criticism and likely litigation

Opposition parties, organised business, private sector healthcare institutions, doctors’ unions, medical associations and civil society are agreed on the need for universal healthcare — just not how this NHI Bill foresees it.

Concerns include the referral system that binds patients and GPs, the lack of costings for the NHI — some estimates run up to R500-billion a year — and the paltry state of public health facilities, most of which fail the government’s own standards.

However, the NCOP’s adoption of the NHI Bill is a crucial realisation of the ANC’s longstanding universal public health policy, supported by its alliance partners, Cosatu and the South African Communist Party (SACP).

Once the Bill lands on the presidential desk, it’s up to Ramaphosa to juggle this party political election appeal with widespread concerns over the Bill’s unimplementability. It’s squarely up to him to decide whether to return the legislation to Parliament for another go.

It’s a political pickle — a clash between party and state, so to speak, with just months before the 2024 elections. DM


Comments - Please in order to comment.

  • Hello There says:

    It was clear from the start that the ANC would push this through. I don’t see any reason why Ramaphosa would delay or stop it, if at all, for some show.

    The ANC has the upper hand as long as tax payers aren’t taking more aggressive steps to stop mad policies. Regarding the NHI, if the private sector criticizes or attempts to delay it, it will be to blame for public health failures. Same if the courts challenge it. Then, it’ll be the judges who side with capitalists, white monopolists or some other convenient scapegoat.

    I pity the people who will have no choice left in the future at times of real health needs or crises.

    Another grand social experiment conducted by the ANC that will be gruesome to watch…

    • Graeme de Villiers says:

      Well said. There is already a long list of pushing doctrines through at all costs that the ANC has been exposed for and this will just be the latest one on the pile.

    • Willem Boshoff says:

      One upshot is it will hopefully the final nail in the coffin of government and private sector’s awkward and doomed friendship. The private sector cannot ignore that the ANC is marching on with their National Democratic Revolution with the goal of state control of the entirety of essential services and ultimately what’s left of the economy. They will not listen to reason, no matter that a 8-year old with a calculator can tell them there isn’t close to enough money or skills for this hare-brained scheme. Right now the discussion in boardrooms should be how the private sector can help take this monster down.

  • J vN says:

    Ah, yes, the imaginary concept of ubuntu, which is about as real as Santa, which, along with “raaaayyyyseesm”, is rolled out the minute the facts and reality illustrate for the millionth time exactly how profoundly stupid, incompetent and dishonest the cANCer is.

  • coenvanwyk says:

    No, Minister, NHI is not about Ubuntu, it is about looting.

    • Denise Wendy Muller says:

      Ubuntu? Please. The ANC wouldn’t know Ubuntu if it jumped up and bit them in the face.
      This is all part of Cyril’s boiling frogs plan. We have now reached the point where the water is boiling and sadly, many of us can’t escape the pot. Yet another sad day for South Africans. My poor, devastated country.

  • Louise Louise says:

    Yet another nail in the South African coffin. I sincerely hope that those organisations and businesses with resources and clout will oppose this with all their might. It is THE most insane legislation yet…..

  • John Plaskett says:

    This will guarantee all so called health care is reduced to the lowest common denominator. Combine this with the growing lack of potable water and the future is indeed dystopian.

  • Ernest Lintnaar says:

    Remember Jacob Zuma? When he knew he would likely become irrelevant, he saddled us with FREE EDUCATION. Same thing here, the ANC has that same feeling right now, so they going to leave NHI for us to nibble on, for a long, long time…

  • Ed Rybicki says:

    It is a mystery to me that more people do not understand that taxpayers pay TWICE for medical care: our taxes pay for public healthcare, and we pay on top of that for private. Just as we do for education, and security, and what the Post Office used to do. Establishing the NHI will drag all Medical Aids into oblivion, and immediately consign us minority tax payers to a kind of service we paid to avoid! Private healthcare is NOT a drag on the state: on the contrary, it frees the state up to spend money on those who cannot pay the premiums we do, using the money we pay them. Let’s hope the scheme gets quietly killed before its ugly little head can see the light of day.

    • J vN says:

      The architect of the NHI, that hardcore, brain-dead Marxist, Cde Nicholas Crisp, reckons that the after-tax money that taxpayers spend on private healthcare, belongs to the state. This backward apparatchik wants to “mobilize” the money you and I have already been taxed on and are being forced to spend on private healthcare, and throw it into the bottomless, cadre-infested pit, so that Cde Crisp and his fellow cadre filth can gorge themselves some more.

      • Geoff Coles says:

        He’s come back from retirement, has zero idea about what next and who pays for it, in stages or otherwise.
        Crisp has been to Cuba, maybe sampled their products, rum and tobacco too

        • Johann Olivier says:

          Actually, the Cuban model had some real victories in health outcomes. It was run by a dictatorship which would’ve locked up all the ANC thieves….as only the very top thieves can steal. Which actually works, because there’s enough left over to get the job done. Exhibit 1: the Nats! ‘Keep the basics going for those who vote and skimming off the top is not a problem’. The current band of idiots don’t seem to understand even that. Or, perhaps they don’t care, as those that vote for them are so ign’nant, it doesn’t matter.

  • Vincent Britz says:

    As expected! The corrupt ANC government pushing through their new cash cow to loot and you can be 100% guaranteed that the president will sign it into law. The NHI is the corrupt ANC governments way of vote buying and it’s the new cash cow that will be looted into the ground like they have done to every state owned enterprise’s!

  • virginia crawford says:

    No surprises then. Logic and predictable consequences don’t come into it for the ANC. Ideologues, zealots, looters win the day again.

  • John P says:

    We can only hope that this ends up in the Constitutional court and get’s kicked into touch. Failing that we can look forward to an exodus of quality health professionals to countries where they will be respected as well as rewarded for their years of hard work, their skills and their qualifications. This NHI bill is a Soviet era scheme and is destined to failure.

  • Soil Merchant says:

    Because you know We’re all about that Vote
    ‘Bout that Vote, not People!?!
    We’re all about that Vote, ’bout that Vote, not People!?!
    We’re all about that Vote, ’bout that Vote, not People!?!
    We’re all about that Vote, ’bout that Vote

    Apologies to Meghan Trainor

  • Quentin Moore says:

    Consider what happened during Covid. This has the potential to become another gigantic feeding trough. Will we ever find out how much of taxpayers additional taxes to fund the scheme will actually reach the NHI coffers?

  • Wonder what the anc members of Parliament AND medical aids think of this impending disaster

  • Karl Sittlinger says:

    As mentioned before by others, this is at this point primarily a political stunt to force the opposition to fight the NHI bill, which in turn will be used to convince the electorate that only the ANC care about the poor and their health. And based on past voting patterns, it might just work.

    No matter, all we can do now is to delay this bill with litigation for as long as possible. It’s a great pity, because it will stop any developments in our Healthcare system, the ANC will no longer feel it needs to improve Healthcare with what they have now, always citing the opposition being at fault for the ongoing decay of our Healthcare. They may even worsen current Healthcare purposefully to make this point.

    • Joe Irwin says:

      It’s definitely a tactic one can expect from the ANC. They are not interested in what the NHI will do to the overall health care in SA. What is important is the political gain they will enjoy from their gullible voters.

  • Alley Cat says:

    “Government needs to move with speed to resource and build a quality NHI that will guarantee quality, accessible and affordable universal health coverage for all South Africans,” I am standing at the window waiting for some pigs to fly past. When has the ANC EVER done ANYTHING at speed and that guarantees quality??
    The corrupt cadres in the ANC will tout this as an achievement as they do with electricity… so many millions now have access to electricity etc. whilst ignoring the fact that the people who previously had access to electricity now, along with the newly accessible have no electricity. Healthcare will be the same, millions more will have access to non existent healthcare! Seems ubuntu is interpreted by them as reducing everyone to the lowest common denominator.

  • Andrew W says:

    Much of the commentary is on the immediate Healthcare and looting impacts. More broadly, this will accelerate skills flight, faster erosion of tax base, inhibit FDI. The cadres will get fatter, the poor will die in bigger numbers, and those with options will leave the house to burn to the ground. This surely is the ANC’s Doonsday Weapon dressed up as Ubuntu

  • Beyond Fedup says:

    I sincerely hope that Discovery, Netcare, Mediclinic etc. and all private business fight tooth & nail against this massive crime and fraud that the ever wayward and vile anc party/government are foisting on the nation. NHI is a dream that will totally fail in current SA with corruption and patronage in the ruling party and its fellow travelers so intrinsic in its make up. Sort out the current miserable and failing healthcare first before even contemplating something more complicated.

    • Michele Rivarola says:

      Unfortunately Medical Aids are their own worst enemies. I am a Discovery subscriber and my scheme option has been cancelled and replaced with one where my contributions will increase by a whopping 33% to obtain the same cover despite Discovery stating that they will only increase contributions by app 10%-13%. If that is not cheating your clients in good standing then I do not know what is

      • John P says:

        Michele I now no longer refer to Medical Aids, that concept no longer exists. What we have today is medical insurance and, as with all forms of insurance, payment of claims is secondary to collection of premiums.

  • Sarel Van Der Walt says:

    Once again: the NHI is focused on the financing of healthcare, not the provision of healthcare.

    But the glimmer for opposition is that, under this NHI, public hospitals & clinics could be privatised without the general public losing access to healthcare at those hospitals & clinics. All the bloated & inefficient admin staff at hospitals wont be required, while Incompetent nurses will be retrenched, general workers (such as cleaners etc) will be outsourced. Provincial health departments will be trimmed down to just a regulatory / inspection function, etc.

  • Wayne Gabb says:

    This in a climate of no growth, diminishing taxpayers, climbing debt to GDP, cadre deployment killing delivery, basically bankrupt !
    Dream on !!!

  • Anne Felgate says:

    When the anc lose the election next year, can the new party in power undo this monstrosity?

  • Geoff Coles says:

    Then what….. there’s no idea about costs, timelines or what is to be done…..A Ramaphosa sign-off means very little.

  • Confucious Says says:

    This will be tied up in courts for the foreseeable future. It contravenes so many rights afforded by the constitution, both for patients and medical personnel. Then there’s the impossibility of funding, implementation and administration. IF this ever had to be passed into law, it would be the single most devastating blow to SA. Everyone who uses private medical facilities would want to leave SA… ie, every tax payer that can go, will go! The government has completely destroyed state health, so the ants will go for the honey now.

  • Middle aged Mike says:

    Communist harder Comrades! The 71 IQ electorate will lap this up and hasten our national demise. Turns out democracy hasn’t turned out to be a net benefit for SA.

  • Craig King says:

    Not really about improving the lot of the majority; more about inconveniencing the minority while allowing more looting opportunities for the rodents.

  • Andrew Marais Marais says:

    Your public transport has all but been destroyed, your personal safety has been placed in jeopardy, your children have been robbed of their futures, now the ANC has stolen your health. Watch out, your pension and other savings are next!

    • Middle aged Mike says:

      I’m constantly surprised at them only having stolen public servant pension funds from the PIC so far. It’s inevitable that they will come for the private sector’s nest eggs at some point.

  • Iam Fedup says:

    This is so wrong at so many levels. Ubuntu? Does ubuntu mean that it’s okay to steal from your neighbours? It’s all BS and they know it. Anything the ANC touches turns to dust, and since they have literally screwed up EVERYTHING else in SA, what makes anyone think this will be different? We’ve already seen. Decline in private care, with Discovery premiums for a 4-person family sitting at R18000, the scam of “savings”, which means that they don’t pay any claims after August. Even worse, the Netcare Casualty, particularly at Linksfield hospital, makes you wait four hours for a kid’s broken finger while the overcrowded room is filled with the great unwashed who are there for Workmen’s Compensation, and, I suspect, to get a doctor’s certificate so they don’t have to go to work. I shudder to think what it must be like at government hospitals. (Actually, we know. They have everything Sto,en, run out of medicines, and burn down on a regular basis, even while your car is broken into in the parking.)

    Personally, between all of this, I think that the market is now completely open for a real private medical aid, by exclusive membership invitation only, and real private medical care that is exclusively for members. Personally, I refuse to fund more thievery, incompetence and utterly dreadful patient care by everyone involved – even the current privates, and will probably move to self-funding while I pray for no medical disaster. Alternatively, pissing off from this paradise that has been turned into hell by the ANC and the likes of Cosatu is an increasingly attractive option. Imbeciles.

  • Lisbeth Scalabrini says:

    Yet another reason to flee the beloved homeland for those who can😞

  • John Lewis says:

    A death blow in slow motion. While the lack of funding and court challenges will delay implementation of this lunacy, the uncertainty cause investment in healthcare to shrivel, medical professionals to flee, and what’s left of the middle class to leave the country or collapse. It’s over for South Africa.

  • Trevor chandler says:

    I cant see peoples comments

  • Michael Thomlinson says:

    I think what opposition parties should be pushing for is that all the ANC comrades should put their money where their mouths are and commit to only using state hsopitals when they need medical care. But then the ANC will probably build special wings for themselves staffed with private doctors and nurses. Would it be too much to wish for the ANC to be declared bankrupt and unable to take part in the elections since they can’t pay a creditor R146 mil that they owe?

  • Peter Dexter says:

    Apart from healthcare failing, I predict this will result in the financial collapse of South Africa, as all the wealthy, mobile people move to free market economies.

  • Winston Bigsby says:

    “Government needs to move with speed to resource and build a quality NHI that will guarantee quality, accessible and affordable universal health coverage for all South Africans -Cosatu.
    supported by the SACP. Are we the only country in the world besides China with a Communist Party? You know that ideology that fell apart in the 80s? Wait, they still call each other Comrade for some reason..
    Is this a pre-April joke? Gubberment moving with speed to resource & build quality? Like what? Name one shining example in the last 30 years?
    This is a sad electioneering joke on the poor who suffer more (under the gangster comrade state) every year they are allowed to loot & pillage.
    Be gone thieves! We don’t care for your bills, policies or opinions, you won’t be the “Ruling Party” after the elections. Empty vessels make the most noise?

  • Fanie Rajesh Ngabiso says:

    “But the current situation is not sustainable”

    …is this “situation” the one in which the ANC has already completely broken and stolen critical funding for all the healthcare facilities under its control?

    If so, then I agree completely that it is unsustainable.

    My solution however is:

    Focus on the real problem: get rid of the ANC.

    …it is definitely not give them more funds to steal and more facilities to break.

  • nkosiyezwevezi says:

    This is the finalization the long path path to universal health care for all.
    A path that began with the adoption of the freedom charter.

    • Willem Boshoff says:

      The Freedom Charter is as outdated as it’s socialist ideology. It al sounds wonderful but has never, ever worked ever, anywhere, whatsoever. Someone really need to text the ANC and tell them this is 2023, no 1955.

    • John P says:

      Let’s see where this path has taken us so far
      Our currency has collapsed
      Unemployment is out of control
      Crime is rampant
      Eskom is broken
      Transnet is broken
      The post office is broken
      Education is a failure
      the poor are even poorer
      the ANC elite and their cohorts are rich, rich, rich and not shy to show it.
      where do think the NHI is going?

      • Joe Irwin says:

        Potholes aside, the NHI will be going down the road to failure, where it will join all of the SOE’s in the glorious movements sewage pit.

      • Winston Bigsby says:

        Close John,
        Currency has collapsed
        Unemployment out of control
        No power solution
        Transnet broken
        SAA broken
        Post Office broken
        Old people sent to dodgy NGOs – Esidimeni
        Eskom broken
        SABC broken
        Try not to read too much into it..

  • Johann Olivier says:

    Actually, the NHI as conceived is a very good idea for the majority of South Africans. Except for one damning, overarching, glaring fact: the ANC cannot point to a single – A SINGLE! – successful initiative. They cannot repair roads. They cannot keep the once best rail system in Africa functional. FFS – they can’t keep the PO going….these are the ‘easy’ things to accomplish (forget supplying power & water). AND they want to oversee something as complex as healthcare?? Just HOW delusional is COSATU, among others? If nothing else, this vote proves that, notwithstanding the unrelenting, comprehensive failure of the ANC, they WILL win the next election. Brute (willful?) ignorance trumps good sense, experience & facts.

  • Richard Blake says:

    A final mass looting before the state fails.

  • Beau Charsley says:

    In my opinion, much improvement in the government controlled Healthcare system would be guaranteed if all government and municipal employees were required to use only government Healthcare facilities. From the president down. There would be a massive improvement in all aspects of government Healthcare. Private Healthcare could be used by government and municipal employees at their own cost.

    I believe massive improvement will take place.

    Beau Charsley

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