Maverick Citizen

NATIONAL HEALTH INSURANCE

‘We want to build a Rolls-Royce healthcare system for all,’ says Ramaphosa on signing NHI Bill into law

‘We want to build a Rolls-Royce healthcare system for all,’ says Ramaphosa on signing NHI Bill into law
South African President Cyril Ramaphosa (C) signs the National Health Insurance Bill into law at a signing ceremony at the Union Buildings, Pretoria, South Africa, 15 May 2024. The objective of the NHI Bill is to provide universal access to quality health care for all South Africans, as enshrined in the Constitution. EPA-EFE/KIM LUDBROOK

President Cyril Ramaphosa has signed the National Health Insurance Act into law in the face of concern from opposition political parties, health professionals and the private medical industry.

Despite widespread concerns about the financial viability and impact on the healthcare system of National Health Insurance (NHI), President Cyril Ramaphosa said it would eradicate South Africa’s stark healthcare inequalities.

“This transformational healthcare initiative in many ways gives further impetus and effect to our constitutional commitment to progressively realise access to healthcare services for all citizens,” Ramaphosa said on Wednesday as he signed the NHI Bill into law at the Union Buildings in Pretoria.

President Cyril Ramaphosa, joined by the Minister of Health, Dr Joe Phaahla, signing into law the National Health Insurance (NHI) Bill on 15 May 2024, which directs the transformation of the South Africa’s healthcare system to achieve universal coverage for health services and, through this, overcome critical socioeconomic imbalances and inequities of the past. (Photo: Mmutle / GCIS)

The NHI, for which membership will be compulsory, is a funding scheme that aims to address healthcare inequity in South Africa by providing equitable access to quality healthcare services.

“In this essence, the National Health Insurance is a commitment to eradicate the stark inequalities that have long determined who in our country receives adequate healthcare, and who suffers from neglect, by putting in place a system that ensures equal access to healthcare regardless of a person’s social and economic standing and circumstances.” 

The vision that no individual should bear an untenable financial burden while seeking medical attention is not just about social justice nor is it a new one. Ramaphosa referred to a document adopted by the ANC in 1943 and noted a paragraph saying the state must provide adequate medical and healthcare facilities for the entire population.

“We are achieving that dream 81 years later and that is why I am going to sign this Bill,” he said.

President Cyril Ramaphosa and delegates at the public signing into law of the National Health Insurance (NHI) Bill at the Union Buildings on 15 May 2024 in Pretoria, South Africa. (Photo: Gallo Images / Frennie Shivambu)

Rectifying a fragmented system

“The provision of healthcare in this country is currently fragmented. It is unsuitable and it is wholly unacceptable. The public sector serves a large majority of the population but faces budget constraints. The private sector serves a fraction of society at a far higher cost without a proportional improvement in health outcomes,” Ramaphosa said. 

Addressing this imbalance required a radical reimagining of resource allocation and a steadfast commitment to universal healthcare, which was a commitment South Africa had made to the United Nations, Ramaphosa said. 

“So, those who are trying to hold us back to a fragmented system are completely out of line with the global vision … which we are a part of… We are not outliers. We are very much in line with what is happening in the global community.” 

Protesters at the public signing into law of the National Health Insurance (NHI) Bill at the Union Buildings on 15 May 2024 in Pretoria, South Africa. (Photo: Gallo Images / Lefty Shivambu)

Don’t listen to doomsayers, says health minister 

Health Minister Joe Phaahla said the day marked a “historic milestone” in South Africa. “The inequities and inequalities that characterise our health systems are unjustified and require a fundamental overhaul to ensure equity and sustainability,” he said.

The NHI presented a comprehensive, transformative approach to healthcare and was founded on the principles of equity, sustainability and social solidarity and ensured that every South African regardless of socioeconomic status had access to comprehensive healthcare, he said.

Phaahla said the implementation was not only about the policy but “about the wellbeing of South Africans” and the Act was not electioneering but a promise to provide a better future for all South Africans. 

“To healthcare workers and professionals: don’t listen to the doomsayers. Don’t listen to the doomsayers and scaremongers who are telling them, ‘Things are going to collapse, you must leave now that the President has found the pen, be on the next flight.’ Stay here, things are going to be better,” Phaahla said. 

The real challenge in implementing the NHI was not a lack of funds, but the best allocation of resources that currently favoured the private health sector at the expense of public health needs, Ramaphosa said. 

“We cannot have a situation where there is a portion of the South African population that continues to live under an unequal system, while the others continue to live in another privileged type of system — this is completely against what the ethos of our democracy is,” he said.

Read more in Daily Maverick: Elections 2024

Protesters outside the Union Buildings on 15 May 2024 in Pretoria, South Africa. (Photo: Gallo Images / Lefty Shivambu)

Addressing criticism of the NHI

Ramaphosa said he was aware of the fears that had been expressed about the NHI. 

“Those who are fearful, those who are afraid, I say, just think about the commitment that the governing party has always had to building South Africa as a sustainable growing nation. National healthcare on a universal basis is going to build our nation in a very practical way.” 

He likened the current anxiety to fears expressed ahead of the transition to democracy and the introduction of the right to strike, and argued that those fears had proved to be unfounded.

Numerous bodies have indicated they are prepared to approach the courts to challenge the Act. 

Read more in Daily Maverick: Avalanche of litigation likely to follow Wednesday’s signing of contentious NHI Bill

Ramaphosa said it was important to remember that South Africa was a constitutional democracy and the Parliament that adopted this legislation was democratically elected.  

“We have a clear Bill of Rights, we have a robust Constitution, so those who fear that this Bill or this Act is going to erode their rights just rest assured that there is a Constitution and a Bill of Rights that protects all of us,” he said.

The NHI had the potential to transform the healthcare landscape, making the dream of quality, accessible care a reality for all, Ramaphosa said.

The NHI fund would procure services from public and private providers to ensure all South Africans had access to quality healthcare and it recognised the respective strengths and capabilities of the public and private health systems, he added.

The private healthcare system was often referred to as the real backbone of health while the public health system was spoken about in insulting ways, Ramaphosa said.

“What we’re trying to build is the Rolls-Royce system of healthcare for all South Africans, and it aims to ensure that we complement the systems and reinforce them with each other. Through more effective collaboration between the public and private sector, we can ensure that the overall is greater than the sum of its parts,” he said.

“If you are afraid of the NHI, take heart and courage from the fact that we are going to implement NHI in a phased manner, so as to ensure that every sub-milestone becomes an important one to make the NHI much more effective.”  

Phaahla said the fundamental structure necessary for implementing the NHI would be established within six to 12 months and that the yet-to-be-established NHI Fund, which would procure services from public and private service providers, would be governed by a board made up of “people of good standing”.

Protesters outside the Union Buildings on 15 May 2024 in Pretoria, South Africa. (Photo: Gallo Images / Lefty Shivambu)

Quality and affordable healthcare, tackling poverty 

The signing of the Act signalled the determination to advance the constitutional right to access healthcare as articulated in section 27 of the Constitution, Ramaphosa said. “Remember, section 27 of our Constitution is what we all as South Africans said we wanted … and this is what we are signing today.”  

The Act set the foundation for ending a parallel inequitable health system where those without means received poor healthcare. Under the NHI, access to quality care would be determined by need, not by the ability to pay and this would produce better health outcomes and prevent avoidable deaths, he said.

The NHI was an important instrument to tackle poverty, Ramaphosa said.

“The rising cost of healthcare makes families poor. Healthcare provided through the NHI will free up resources to poorer families for other essential needs, and through this we will be able to reduce poverty, we will be able to reduce inequality and this is an essential step on our journey as a nation to make the lives of people better,” Ramaphosa said.

“The NHI is an opportunity to make a break with inequality, inequity and inefficiency that has long characterised our approach to health. The NHI is here, l have found my pen.” DM 

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  • phil Osipha says:

    “Those who are fearful, those who are afraid, I say, just think about the commitment that the governing party has always had to building South Africa as a sustainable growing nation.

    Yes, Cyril. That fills me with joyous confidence. The way the governing party built up Eskom, Transnet and the rest of our amazing parastatals is a shining beacon. I’m sure we can sleep easy knowing they will produce similar stellar results from a nationalised health service.

    One thing I don’t doubt though: We WILL all have equally poor healthcare. Yay for us 🙁

    • Lyle Ferrett says:

      Cyril’s comments are a complete denial of State Capture. Why isn’t the media pressing the ANC more to implement the Zondo commission? It seems that voters are completely clueless about the serious damage the ANC-government has done in the last 15-years.

      Could the media be “captured” too? Honestly, I’m not convinced otherwise.

      • D'Esprit Dan says:

        Without the investigative media in South Africa, we’d be complete toast already. Come on, seriously, all the work that DM, Ground Up, Amabhungane and others do is part of a ‘captured media’?

    • Pieter Badenhorst says:

      Well said. I’m afraid we’ll be lucky if we end up with a Trabant in the place of the imaginary Rolls-Royce.

    • Lysergic Acid says:

      Sjoe Phil, you took the keys right off my keyboard with that one. Couldn’t agree more with you on this.

    • Lysergic Acid says:

      Unfortunately in South Africa we pay money to recover from ill health instead of spending resources on preserving and maintaining good health. The worse mistake we made regarding healthcare was to monetize the service and use a business model as is the case in private healthcare, where the patient is seen as a customer. This has resulted in financial status being the determinant of good healthcare. If you’re rich you get great care, if you’re poor then tough luck. This capitalist approach is fine in the developed world but with the levels of inequality in SA this issue results in the vast majority of South African’s falling into horrific state healthcare. I think health workers across the board are terrified as they feel the public health system’s weak points will drag down the quality associated with private care. But, at the same time if we try to please everyone we end up pleasing nobody.

      • D'Esprit Dan says:

        Public healthcare can and does work well in pockets in South Africa, it’s just that there is absolutely will in ANC cadre-deployed hospital management structures to stop the plunder of resources that should be used to provide very good basic healthcare. Take out the corrupt scum, put in medical professionals who actually work according to the Hippocratic Oath, and you’d be amazed at how good healthcare can be. All that NHI is doing is creating a bigger pot to be plundered by the scum in power.

    • Is there hope South Africa? says:

      I agree with you.
      The saddest part of all of this is that there are going to be many people who fall for these lies. And their lives are not going to change for the better, just as their lives have never changed for better under this corrupt ANC government.

  • Barrie Lewis says:

    Those politicians all look so pleased with themselves, as if the “Rolls Royce NHI” is already a paid for and operational programme. How many of them will do their utmost to hang onto excellent privately provided health care?

    • Mike SA says:

      The only people that can afford Rolls Royce’s are the BEE tenderpreneur’s and that will be the same with this NHI.

    • Graeme J says:

      How ironic that the ANC wishes to build a British (colonialist) “Rolls-Royce healthcare system”.

      • Rod H MacLeod says:

        Actually, the greater irony in his statement is that Rolls-Royce has not only been through a number of liquidations and bail-outs, but has also faced a number of bribery and corruption charges stemming from contract solicitation. So perhaps the couch potato-head had a premonition.

  • Wendy Dewberry says:

    CYRIL Mr ANC you say society must ignore the doom sayers but thats so illogical. Society needs to ask how your track record in public Healthcare that has resulted in death corridors for the most poor must just be swept under the carpet ? It is YOU who has failed the poor on every level of governance. Our general society has worked their buts off toward equitable housing, transport, education, Healthcare, electricity, employment… and it is YOU of the ANC that’s has failed the people. So please don’t try shut the people up when we have concerns. It is YOU the ANC that needs to listen to the hard workers of the society. It is YOU that has failed the poor. YOU are the doom. We need you out so we can rebuild and get out of your doom.

    • Thinker and Doer says:

      Very well said, thank you!

    • Hermanus Geyer says:

      Before we all get so tired and Siener Van Rensburg’s prophecies come true, just remember Ramapoes, the prophecy does not look good for you. Ramapopo is an idiot with evil snake eyes, he is scary to look it, he is not a Mandela, he has the eyes of Mugabe. Ramapopo is pushing for state capture. In the prophecy the civilians get sick and tired of the ANC government and it means war. Ramapopo is clearly pushing very hard for it

    • Hermanus Geyer says:

      Satan’s tool, Ramaphosa, the one that wants Siener’s prophecies to spill his own guts on the floor. Stop poking us with sticks Ramaphopo, we know how to open our cages, we just love our families, but be VERY CAREFUL, we LOVE our families. And you Ramapoes, have messed with ours for WAY too long. You will choke on BBE and die in vain as a leader resembling Mugabe

    • Wikus Otto says:

      Well said!

  • Andrew R says:

    “We are achieving that dream 81 years later and that is why I am going to sign this Bill”
    No, you are signing this bill because it is prudent electioneering, nothing more, nothing less. I once had a lot of respect for Cyril, now only contempt.

    • Deirdré Lubbe says:

      How about fact checking this piece of propaganda DM? Some reference to looting and mal-administration by the ANC, our previous Minister of Health resigned in shame, for goodness sakes. Yes, healthcare is in a poor state. But how did it get there?

  • virginia crawford says:

    This from a government that has ruined very good hospitals and clinics, while enjoying private health care themselves.

    • Stephanie West says:

      Spot on. Fix what you have, before riding on the private sector to hand you fake competency on a plate – again. See: Eskom vs. solar and eventually permitting privatising. You and the RET have EFF’d up the existing hospitals, why on earth do you think you’ll do better with more and more complicated hospitals?

  • Wilhelm Boshoff says:

    We want to build a Rolls-Royce healthcare system for all… I think he meant every tenderpreneur & cadre wants to buy a Rolls-Royce.

    • Michael Thomlinson says:

      Yes, Cyril, you want to buy a Rolls Royce for every cadre in the ANC. Just like Robert Mugabe’s son did in Zimbabwe.

  • NR BENJAMIN says:

    How do they reason that the NHI is going to somehow, magically, afford healthcare for everyone in South Africa when, factually, any services delivery reliant on government is appalling/broken or non-existent. If they can’t get the public health sector working, riddled with corruption and ineptitude, how do they envisage the NHI bill to be any different? Promising people something they are not able to deliver on to garner votes is really sad. I so wish I was wrong, because this is a novel concept, but impossible to achieve with the ANC at the helm.

  • EK SÊ says:

    Mr President
    The Rolls Royce is a luxury. It’s the symbol of extreme inequality.
    It is chauffeur driven.
    A Quantumn does more for less.
    And that Rolls needs a lot of fuel, the maintenance cost is very specialized and costly and lastly, with the insurance on that car, one can buy a newbudget car.
    You’re paycheck is up there with Rolls Royce owners. Let’s see you downgrade your salary and benefits to the same mediocrity you force on private citizens. You speak of inequality, but not as an equal.

    • Brett Redelinghuys says:

      Edzakery…. Well said..Sell a buffalo, clean out your couches, get rid of your GEMS membership paid for by us tax payers…
      But no, you expect us to “do as I say, not as I do…”.

      • Pieter van de Venter says:

        Nooooo, these politicians shave their own closed medical aid. Parmed. I guess it includes treatment in Russia, Thailand, Singapore, etc. Inclusive of private jet usage and meals at R 23,000 a head.

      • Michael Thomlinson says:

        I think that parliamentarians have their own special medical aid that pays for everything. Now they will probably have their own special hospitals or set them up in Russia.

  • Lyle Ferrett says:

    If a “Boer maak ‘n plan”, I wonder what the ANC makes? 🤔

  • Denise Smit says:

    I think he meant a rickshaw. It is not good for socialists to talk about capitalist aspirations like Rolls Royces

  • Middle aged Mike says:

    Viva the new dawn Viva! Remember how much swooning there was when this lubed up lizard and his dot connecting gimp were doing their routine before the last elections. Venezuela is going to be looking like an attractive emigration destination before these characters are done with the country.

  • Derek Jones says:

    How many thousands of lives will be lost if this is implemented. Everything the ANC has touched turns bad, inefficient and corrupt. The reason the ANC chose to try it on two weeks before elections will not go unnoticed by most thinking people. It is yet another promise that will inevitably be broken by a party and individuals I have now come to despise.

  • Middle aged Mike says:

    Dollar couch guy didn’t err in referring to Rolls-Royces which long been popular amongst the kleptocommie class. Lenin had a Silver Ghost equipped with caterpillar tracks before the october revolution was cold. He’d apparently been through nine Rollers before he snuffed.

  • Confused Citizen says:

    CR, are you delusional? Asking the citizens to have confidence in the coming Rolls-Royce based on thr ANC’s track record when the ANC has largely collapsed all infrastructure over the last 30 years!

    Spreading die spending of the 15% + 85% over 100% is NEVER going to provide a R-R for all! Nevermind the incapability and lack of diligence and care in most of the 85% system! Can’t you do maths? Even if not a cent is stolen or wasted, the total funding spread over 69m people will produce a Hyundai i10, at best for everyone at a TERRIBLE TAX expense for 7.4m taxpayers!

    Furthermore, how is me spending my own after-tax (already high rate) on a medical aid and co-payments for private doctors & hospitals taking away from the healthcare of others in the public sector? Makes no sense!

    • Geoff Krige says:

      No, Confused Citizen. You are wrong. In the hands of the ANC the total funding will not provide a Hyundai i10. It will struggle to provide a broken bicycle.

      • Reasonable Observer says:

        It will not even deliver a broken bicycle, which would be a small net gain. Current projections are that it will deliver massive net destruction.

        It is more likely to not deliver anything of value (not even a broken bicycle that can be used for parts) at all, but it might replace a fleet of Toyotas with a single broken bicycle.

  • Robert Gill says:

    “We cannot have a situation where there is a portion of the South African population that continues to live under an unequal system, while the others continue to live in another privileged type of system — this is completely against what the ethos of our democracy is,” he said.

    Oh, the irony! The most privileged (the President and his government cronies) speaking as if he is not the beneficiary of private health care. I’m sure he arrives for his medical checkups in a Rolls-Royce. When socialism morphs into capitalism … but will most South Africans notice and care about this disconnect?

    • Hidden Name says:

      I think you mean they get flown to Russia, on the tax payers dime, for treatment. So it’s even worse, actually. Damned fools are going to harm or outright kill a lot of people with this. And don’t get me started on the economic impacts of the tax increases required. An extra 2000 or so Rand from everyone paying income tax, or a 7.5 (was it?) increase in VAT will utterly tank us. We cannot afford this fools dream.

  • Agf Agf says:

    A Rolls Royce system? I think not. More like a broken down Citi Golf sonder wiele.

  • Lynda Tyrer says:

    Confidence does not go with the anc, they have achieved nothing over the past 30 years other than destroying and looting so no thanks his lies about this NHI can stay just that another smart city bullet train fantasy whether its signed or not.

  • Bob D says:

    The ANC politicians already travel to Russia for their medical care. Do you think they will wait 2 years for their hernia operation?
    Some semi-literate nurse deciding if you can see a specialist. This will be the final nail in SA economy as we know it. Zimbabwe will look like Nirvana once they are done with our economy. Screw up whatever works well so we can all wallow with the pigs.

  • Hermanus Geyer says:

    Somebody get that idiot away from a pen before he signs ANYTHING ELSE. Ramapopopoesa, the dickhead that ruined South Africa even more than Zuma. And idiots still vote for them! They messed with our power, we got solar, they messed with our water we got borehole, they ruined our police we got security. Now they want to mess with our HEALTH!?!? Ramapoes, you are Satan’s tool my guy

  • ST ST says:

    Disingenuous Bill by a disingenuous government. Disingenuous complaints from some of the ~14% who are mainly made up of one group of beneficiaries, the insurers and providers who likely only care about what they stand to loose.

    Yes we need affordable equitable universal healthcare. An ideal which is an already infinite struggle for well to do countries. But a great one nonetheless.

    We have ‘universal’ healthcare. It was inequitable during apartheid but has been made unbearable by the ANC. Fix that, make it more attractive and no one will volunteer to pay exorbitant amounts for limited private healthcare.

    We had some of the best medical and nursing etc training. Once and still sometimes the envy of more advanced countries. Private providers likely have gone through this public system first.

    Yes, the US style healthcare practiced in SA is unsustainable for even the current medical aid holders. It doesn’t go very far if you’ve a long term or prolonged care need. But you can’t stop people having a right to have private care if they choose.

    What you can do/should have done is not fund yourself as the government and your employees to use your competition (public v private) as the main provider. Letting the public services deteriorate is what led to private healthcare to be 1st choice. That and funding it led it to thrive, they will not let go without a fight.

    Public services at best e.g Bara, King Edward, Groote Schuur can and do provide excellent care. Private healthcare doesn’t necessarily equal better quality. I’ve seen that in SA and elsewhere. Yes the UK style has its issues (eg waiting lists). But for most diseases, you get the best on offer regardless of who you are. An ambulance will pick you up from an accident without first checking if you’re covered. That is very reassuring. In any care, all systems have issues.

    Our issue here is the lack of funds for this system at the moment. Chiefly, the government who claims to be able to run it have a terrifying terrible reputation. Those are the only legitimate arguments.

    • Pieter van de Venter says:

      What is the provincial hospitals and municipal clinics supposed to be?? Just placeholders or in fact free healthcare for all that want to use it?

    • Mike SA says:

      I suggest you read The Daily Mail to keep up to date with the British NHI because recently they reported on an elderly woman that lay in the street for five hours covered with cardboard before an ambulance picked her up.

    • Jax Cape says:

      As I lie in a private hospital bed I overhear a young south african couple discuss NHI . The man gently explains to his ill wife ” its simple, this is like a man buying a house, without a job and with no means to pay for it” ” it may mean we could pay so much less for Healthcare but you my Darling will not enjoy this type of care you are experiencing when our government finally ruins what we know as good medical care”

      • ST ST says:

        To everyone on this comment, although am not sure if Jax’s is just a general chat. I think the replies are made under the assumption that I’m for NHI and or I’m clueless. Neither.

        I have lived and worked abroad for a while. I don’t need the Daily Mail. I have family in SA who have needed extensive healthcare both with and without medical aid. So I do know what I’m talking about.

        Also there is no such thing as free healthcare. It may be ‘free at the point of use’ like in UK. And there no such thing as British NHI. They have a national health service which is a ‘system’. Unlike NHI which a fund. You can say it’s similar in terms of having the government as the intended single payer. But even in UK you still pay a bit out of pocket eg for dentists.

        There’s a variety of ways to achieve universal coverage. No formula is perfect. Researchers have confirmed it. But then you have to define universal coverage’, ‘access’, equity etc. then we’d be getting somewhere

  • michael james says:

    I wish the members of the ANC had skin in the game. When the bill is foud to be badly flawed they return their salaries and wasted costs to the fiscus

    • Donald bemax says:

      The only skin the ANC ever had… or will have in the game is the skinning of the Taxpayers.
      Ho hum.. the phase one will take another 20 years to complete.. by that time we won’t have any medical skills left..maybe the entire health service will be run by witch doctors.

  • Peter Oosthuizen says:

    Once again, the president’s confidence grossly exceeds his, and his henchmen’s, competence.

  • R S says:

    Is this a puff piece? Basically just one side of the story.

  • R S says:

    Cyril has dropped his mask. I hope those of you who got duped by Ramaphoria don’t make the same mistake this time.

  • Middle aged Mike says:

    Does anybody really buy the idea that this is anything other than the latest in a long list of rent extracting schemes cooked up by the glorious liberation movement?

  • veridion says:

    There will be a cost saving when the government announces that it will be removing all medical aid payments for state employees. I am waiting for all politicians to quit their medical aids and to prohibit foreign travel, at state expense, for medical procedures.
    The above announcements have not been made.

    • William Dryden says:

      Well said Veridion, I will also wait to see if all the politicians quit their medical aids and for the government to cancel all medical aid payments for state employees. And you are correct there should be no foreign paid travel expenses for overseas medical procedures of any kind.

  • FRU Uck says:

    ANC cannot even maintain a current wheelbarrow medical system, how on earth will they develop a Rolls-Royce healthcare system and maintain it? After 30 years of mismanagement, only stupid people wall fall for this lie.

  • Geoff Krige says:

    I find one glimmer of hope in Ramaphosa’s statements “If you are afraid of the NHI, take heart and courage from the fact that we are going to implement NHI in a phased manner, so as to ensure that every sub-milestone becomes an important one to make the NHI much more effective.” Given the record of the ANC they won’t make it to the first sub-milestone, so the whole idea will fall apart. The glimmer of hope is that this happens before too much damage is done to private sector health care.

  • Reasonable Observer says:

    What is easier? Getting the 10111 emergency number to work again, during his presidency, as it used to? One would think in a country like ours with the problems we are having, a government would ensure that the emergency number would work better than in any other country. But good luck dialing it. Kids don’t even learn the number at school – it would be foolish to bother.

    Or keeping the metro rail running (which was still running, albeit neglected, at the start of his presidency, but is no non existent in many cities)?

    So he couldn’t and wouldn’t do any of that, but he’s gonna deliver the fancy things he says now..

    We can take one example. The UK has an NHI (delivered by the NHS), but it is showing many cracks, and even falling apart at the seams. And they have many more tax payers per patient than we do, and yet they are struggling to hack it. True probably not the number one best organised country on Earth, but not the worst. It is after all a country where the emergency number (999) works. So what is he going to do better?

    If anybody who defends this can answer this…

  • Geoff Coles says:

    Wonderful opportunities for the cadres, even not doing the medicine and direct health care side…… buildings, basic infrastructure, tenderpreneurs galore, R1000 sheets, R100 toilet rolls etc, BEE in the forefront

  • Geoff Krige says:

    The day that Prasa runs smoothly on time providing safe and cost-efficient transport, the day I can proudly book a seat on SAA knowing I will get first class service, the day I can safely drive from my home to anywhere in South Africa without potholes or fear of hijacking, the day I can post a letter confident that it will be delivered within two days, the day I see every person implicated in corruption facing trial and spending time in prison, the day I have no fear of dry taps or dead electrical points, the day I see every child in school with good teachers and adequately fed, that is the day I have hope that NHI can be an excellent solution for quality health for all. But that day will not come as long as the ANC is in power.

  • Malcolm McManus says:

    The problem with the ANC is that they have a history of trying to bring down a certain more privileged group (Of all races), instead of uplifting the larger less privileged group. We don’t need people to be downgraded in order to upgrade other people. At the end of the day the ANC doesn’t look before it leaps and ends up downgrading everybody in the process. Other than trying to obtain votes, few of their ideas bear sustainable fruit.

  • D Rod says:

    The only thing these muppets can build is a donkey cart. Made from chopped of Nissan bakkie. And they will charge you the price of Rolls Royce.

  • Anne Joubert says:

    State hospitals are xxxxx dirty and no houekeeping is being done. Cats are entering the buildings and removing scraps from open dustbins. Shocked by the dirt in bathrooms and toilets. No cloves are being used when doing a procedure. Family member in hospital for 3 days and ward was not cleaned once. Bedside lockers…cannot even commenting.

  • Mahomed Sader says:

    South Africa has the best constitution in the world, we still have inequality. We have the best Labour laws in the world, we still have an underresourced judiciary.
    We are brilliant at enacting legislation with the best of intent, we fail hopelessly at implementation.

    NHI is in keeping with socialist revolution we fought for, unfortunately the current crop of politicians are beholden to neoliberalism, so don’t hold your breath that the NHI will actually work.

    • D'Esprit Dan says:

      Neoliberalism isn’t responsible for the destruction of the current public healthcare system: corruption and the deployment of completely unsuitable people into key management positions is. You’re flogging the wrong horse here.

  • MIKE SMITH says:

    Build a Rolls-Royce????
    The ANC cant even repair the dinky toys they inherited let alone build a go-cart.

  • Charles Parr says:

    Aaah, the real McCoy Other Peoples Money politician has spoken so it must be true.

  • Teri Abergel says:

    Anc just want to come up with another coffer they can rob blind. NHI wil never work. You are crippeling our economy and country. Voetsek

  • Bob Dubery says:

    Eish people! We’re asked to moderate other comments on whether or not they are civil, uncivil, or misinformation. That doesn’t mean you have to LIKE the comment, it just has to fit into one of those categories. Yet we see the must vulgar word in the Afrikaans language popping up here. Crude insults are not civil and should be refused approval on those grounds.

    I’m not surprised. I was presented with one of those comments and disapproved it. But nobody’s thinking about civility or any other attributes of the post, they’re thinking about whether or not they like what is said.

    The ability to comment should be confined to paid subscribers only.

  • Trudi Schwartz says:

    I was listening to Dr Nicholas Crisp this morning trying to convince everyone that this Bill is going to work. Probably like all the Covid-19 funding that never reached the people

  • anton kleinschmidt says:

    The thing to watch is the funding model(s) and whether it lends itself to a full blown tax revolt

  • Pieter van de Venter says:

    Cyril, you must expect a call from Putin. How can you be so colonial to refer to a Rolls Royce!!! Surely you meant Aurus Senat???

    Well, you will not even have a wheelbarrow if you keep on disrespecting the 10% of the population and whites that pays taxes and municipal accounts. Good luck funding this next waterhole for ANC cadres from money collected from the poorest of the poor. I have no idea how everything that the ANC can think of, is apartheid.

    The eone day you ask private enterprise and the white community to trust the ANC and to help rebuild the country. The next, when it suits you, you insult and kick the the same communities in the nuts.

    Are are you hoping that Russia/Iran will pay the shortfall of this lootingpot once the hated “privileged” or white people have left for greener pastures with their taxe paying abilities?

    By the way, what is the provincial hospitals and municipal clinics but Universal Healthcare as defined by the WHO?? Or at least it was, until the comrades ate, and ate, and ate,………

  • Miss Jellybean says:

    Close down the government employees medical aid & make all government employees (including politicians) use public facilities watch how suddenly the quality improves. Is it not a bit two-faced to have a medical aid for government employees that doctors, nurses, etc in public health belong to?

    • Bob Dubery says:

      Those medical aids are not directly run or administered by Government. They are administered by existing private medical aid administrators. So they should fall under the same rules as all other medical aids.

      • Chris Mill says:

        Agreed. If run by this government they would be bankrupt within days.
        I was under the impression the South African president was treated at a military hospital. It would be amusing to see the medical records of the present incumbent. Willing to bet this champagne communist never gets treated in the same place his soldiers receive their treatment.

  • Reading what the goverment wants to achieve with the NHI, I want to stay positive, start to believe things must get better in this country, I have nowhere else to go, pension not enough, cutting back, medical help very expensive, for now, tired of all negative, crime, not feeling safe, so I want to start believing that all will get better, be happy with what I have, trust in the Lord, no matter what, I believe , my country is to beautiful to be negative all the time, I have hope

  • Philemon Solomon says:

    ‘Cmon DM tell us again about how evil DA made an advert with a burning flag… Surely that will still sell more clicks than this? Who cares about the future of our country anyway…?

  • Ben Hawkins says:

    And he will find health care abroad, probably by the same South African doctor he caused to leave this country, shame on you

  • Bob Dubery says:

    Y’all remember, I’m sure, Act 90 which fixed the wholesale and retail prices of scheduled medicines and which, experts and doomsayers said, was going to do severe damage to private healthcare and wreck the pharmacy business. I don’t want to say that nothing changed, but how did it work out? Apart, that is, from the price of a lot of prescribed medicines coming down?

    • Middle aged Mike says:

      More than 100 small independent pharmacies closed down as a result of the act in the first year of it coming into effect in 2006.

      • Bob Dubery says:

        A lot of them sold to the likes of Clicks and Dischem. Those big companies had an advantage in that they had the warehouse facilities to act as wholesalers, and so they could legally mark up twice – as wholesaler and as retailer. But of course they needed as many retail outlets as possible, so they bought up and rebranded existing pharmacies. In many cases the pharmacist was kept on and was still behind the counter.

        Government we sufficiently concerned by reports of shitdowns that they tested it by getting a list of pharmacies that had allegedly been forced to close and calling them on the phone to see if they were open. In most cases they got a positive answer.

        I did allow that there were changes, but I also asked if the foretold collapse of the industry happened. We all know the answer.

  • T'Plana Hath says:

    Kill Bill: Volume III

  • Jon Quirk says:

    I imagine every single enterprise operating in South Africa, not just Anglo-America, will be re-considering their investment strategies, and hiring strategies, in the light of the extraordinary NHI statements and actions.

    Mass lay-offs, and plant and factory closures must be on the cards, and I imagine international bookings will soon evaporate.

    Beware, Mr President, of unforeseen consequences; it is not just the mass emigration of health officials and others you have to fear.

    You just may have self-torpedoed, below the waterline, SS South Africa. Still, you will be able to comfort yourself with the applause, at least for now, of fellow ANC cadres – at least the senior ones immune from a capsizing economy.

    • Mike SA says:

      this will not go down well with the AGOA agreement where you must demonstrate that you as the government respect property rights. I refer specifically to the fact that the ANC has there eyes on the reserves of the Medical Aids, such reserves are in fact member savings.

      • Bob Dubery says:

        Indeed, and the ANC Government has previously moved to protect those savings after a couple of badly run medical aids went belly up and left their members liable for costs. Government wasn’t going to stop any badly run fund going under, but they did legislate that each funder had to have a cash reserve sufficient to cover their members recent medical costs in the case of the fund collapsing.

        One hilarious side note to this was the CEO of Discovery on one of the early evening business news radio shows getting into an argument with the Minister of Health about the meaning of the word “cash”.

  • Kathleen Olivier says:

    Well anyone who believes this is very gullible. He talks about a Rolls Royce, I remember they once bought tuk tuk scooters to use as ambulances in a rural area spent millions on buying them. Those disappeared speedily, that community is no doubt still encountering the same problems. I’m not holding my breath that the NHS will improve services for anybody

  • Albertus Ziervogel says:

    RR = Draadkar

  • The Disgruntled says:

    I have lost two relatives to the public Healthcare system, my aunt passed after sitting in the waiting room for 15 HOURS with no one to check on her

    My uncle died of an infection he picked up in Helen Joseph hospital in post op care.
    People are already suffering under the current model, how would taking the option for quality Healthcare help anyone?

  • Alan Downing says:

    Ask why there are so many HIV/AIDS orphans in SA. I seem to remember it was because beetroot juice was deemed more effective than anti retroviral drugs.

  • Alan Downing says:

    Ask why there are so many HIV/AIDS orphans in SA. I seem to remember it was because beetroot juice was deemed more effective than anti retroviral drugs.

  • eish Effedup says:

    Nationalising the private hospitals is not going to improve anything. Do you think that they will keep up the standards of care after being paid peanuts and told what to do and not and who to treat for what and when? Same with the doctors… The cANCer will just spread to the private hospitals and we will be back to square one.

  • D'Esprit Dan says:

    Dear President Ramaphosa, you’re no doubt far more familiar than I am with the interior of a Rolls Royce, so you should be aware that in order to build one, you have to do the following:
    1) Have the best design engineers money can buy, and charge them with designing a great vehicle.
    2) Ensure that the factory is world-class and kept in mint condition to be able to roll out the, well, Rolls.
    3) Procure the best parts at the best prices, with the best workers to put it all together.
    4) Have superb oversight, with dedicated, proud, selfless and honest managers whose only concern is producing the best possible vehicle for their clients.
    5) Put all of this together and you’ve got your Rolls Royce.

    What do we have?
    1) Intellectually dishonest ‘engineers’ concerned only with a chop operation to stick a Rolls Royce grill and emblem onto a battered Trabant and tell us they’ve engineered a miracle.
    2) State-owned ‘factories’ that couldn’t build a wire bicycle that hawkers sell on the side of the road.
    3) Materials paid for (delivery is optional) to said engineers’ buddies at the local grey parts aftermarket that neither work nor are appropriate (tall trains, PPE scandals anyone?)
    4) Thieves and murderers who steal all the critical parts or deliver sub-standard ones at vastly inflated prices and kill anyone (Babita Deokoran is the prime example) who gets in the way.
    5) No service delivery, so it’s a donkey cart with a middle finger to the consumer, instead of the Rolls Lady.

  • Notinmyname Fang says:

    Can’t wait to meet Cyril and Tshepo on the benches @ Bara

  • chilitree1 says:

    Really ? What makes these greedy idiots blow their horns ? Please look at the “wonderful” job they did with every soes and you still have hope that hey will not pillage HNI too? Itelligence is lacking

  • Stephen Mcbride says:

    Whilst we all would agree that all need adequate medical protection (I think).
    At present we have hospitals that are mainly paid from state funds that cater for this (small fees commensurate with your ability to pay is charged – sometimes nothing).
    My parents qualified for attending state hospitals and were adequately treated but with long waiting times and makeshift resources (bed in corridors).
    Reading the bill it does not mention how it is going to solve this problem. Making more hospitals available saves on costs initially but the running costs remain the same. This will need to be supported from the fiscus. The bill says it will be supported by general tax revenue, including the shifting funds from the provincial
    equitable share and conditional grants into the Fund, reallocation of funding for medical scheme tax credits paid to various medical schemes towards the funding of National Health Insurance, payroll tax , surcharge on personal income tax so in general tax and extra tax.
    No mention is made of the medical aid contribution currently. Will that “leave the system”.
    Also not mentioned in the bill is what is going to be covered by the NHI.
    Would be wonderful if they trained more people for house visits to ensure primary care. More people to clean up the poorer areas. More people going out to hand out chronic medication. But this is not mentioned in the bill. All the bill says is that the current private will become public. Short term gain.

  • anton meyer says:

    The one comment I found intriguing and or interesting was where Ramaphosa is quoted to have said; “It will scare white people!”
    The NHI that is!
    Would Daily Maverick fact check that please???
    Poor man, I feel so sorry for him, that it pleases him to refer to +-5% of the population, “scaring them gives him pleasure????”
    Is he tribalism, xenophobic, racist or just plain unintelligent????

  • Bryan Shepstone says:

    Doesn’t Squirrel know that we already have free public healthcare? 🤔 I know he’s never used it but….

  • Martin Engelbrecht says:

    I don’t want to take away the enormous victory this is for the people of South Africa. Equal health care. Indeed a milestone of note. Mr president signing a law into being is unfortunately the easy part, you will have to get most of state hospitals on par so that they can be part of the system, funding, and other issues. You know what happens to politicians who don’t deliver.

  • Random Comment says:

    I am often surprised by the raw, unbridled malice in the ANC’s actions – decisions and polices that are contrary to the best interests of ALL South Africans.

    Anecdotally, many professional people (doctors, lawyers, bankers, financial services experts) have emigrated after COVID. I expect another cohort of taxpayers to be expediting their plans to escape the socialist dystopia the ANC has planned for us all. The remaining the frogs in the Mzansi pot shall be boiled alive, unfortunately.

  • Mordechai Yitzchak says:

    Meant to say “This is how me and my buddies each get a Rolls Royce”

  • M E says:

    Make it law that any and all public workers, including especially these ministers and president Rama, may only use public health and school services. Let’s see what they have to say then!

  • Hello There says:

    Rolls Royce Health Care system… Hilarious!

  • Andre Aysen says:

    “We want to build a Rolls-Royce healthcare system for all”. Building or simply restructuring that what was already there and paid for by proper Financial management found in these entities such Afrox Health care Services, NetCare and so forth. You are, once again BUILDING NOTHING but as usual taking that which works and simply renaming to mislead the public

  • Raj Pillay says:

    To our honourable President and Health Minister

    Please be honest when you talk about NHI

    Always advise the people of the reality of NHI

    NHI is the National Health Insurance which will be managed by government.
    As such, all South Africans will have no choice but to register on the NHI database to qualify for medical assistance
    Private medical aid will be banned (in terms o offering any medical assistance provided for by the NHI)
    Hence, private hospitals will shut their doors (not only because they are banned but also due to the low tariffs the NHI will offer for various services)
    All South Africans that belong to medical aids currently, will be forced to use the public hospitals, thereby increasing the number of patients at the already overburdened public hospitals
    There will be no change in the levels of service or number of medical staff or levels of corruption at these public hospitals (as demonstrated over the past 30 years)

    If you both truly believe in the NHI, I have a challenge for you:

    As a first step to move across onto an NHI platform, move the entire government employee team (including both of you and all the other ministers and their families) the NHI system
    This move must include provincial and local government employees
    Do not use private medical care or foreign medical care (Thailand or Russia) as s currently the case
    Ensure that all wait in the queues like the common folk (no favouritism please)

    LEAD BY EXAMPLE AND WE WILL FOLLOW

  • Bill Gild says:

    And so, the ANC/SACP plod on, leaving in its wake devastation, rising inequality, rising unemployment, and a government health system (with a few notable exceptions) in tatters.

    The ANC/SACP cannot, and will never be able to, govern. Period.

  • Rae Earl says:

    Shows how disconnected and out of touch our dithering excuse for a president is. Rolls Royce cars are made in England, home of a hopelessly defunct National Health Scheme. The question Ramaphosa is this, was that the best comparison country you could come up with to indicate where the NHI is headed? Which it is.

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