Medical aids in their current form are out under NHI — even if it means the end of the GNU, says Motsoaledi
Even if it means the end of the Government of National Unity, the bit in the NHI Act that says medical aids will effectively cease to exist won’t be scrapped, says Health Minister Aaron Motsoaledi. But the act could be adapted to allow everyone — including asylum seekers and undocumented migrants — to get HIV treatment.
Section 33 of the NHI Act will not be scrapped, says Health Minister Aaron Motsoaledi, even if it means the end of the Government of National Unity. (Photo: Justin Barlow)
Section 33 of the National Health Insurance (NHI) Act— the part that says medical aids in their current form will be scrapped, as they won’t be allowed to cover the same services as the NHI — is staying as is, even if it costs South Africa its Government of National Unity (GNU), Health Minister Aaron Motsoaledi
style="font-weight: 400;">told Bhekisisa.
“You can’t come and tell me ‘I support this universal coverage, but it (section 33) must go.’ It’s like supporting a house, but the foundation must go. Don’t you know it’s going to collapse?” Motsoaledi
style="font-weight: 400;">said in an interview for Health Beat, Bhekisisa’s TV show.
Once the NHI, which aims to give rich and poor the same health services, is fully rolled out, medical aids will only be allowed to cover top-up services that the NHI doesn’t pay for. The logic behind it is for the total amount of money that South Africa spends on health — 8.24% of GDP — to be more equitably distributed: about half of the funds are spent on the benefits of patients with medical aid cover (15%) and the other half on the remaining 85% who rely on government hospitals and clinics.
But it’s one of the issues that parties in the GNU who don’t support the NHI in its current form — only four of the 10 parties do — are most concerned about. They view it as a potentially unconstitutional condition, because it deprives the medical aid industry of the right to trade, and takes away consumers’ choice to buy health cover from a preferred source. They also fear such a move will destroy the private healthcare industry.
For the DA, the GNU’s second largest party, section 33 is a dealbreaker; in fact, expanded access to private medical aids forms the backbone of the party’s health plan included in its 2024 election manifesto. And, in its submission before the parliamentary portfolio committee on health in 2022, the DA said: “The NHI Bill completely removes the choice for South Africans to choose where to get their healthcare and could effectively outlaw medical aids.”
The DA’s spokesperson, Matt Cuthbert, told Bhekisisa “it was clear in the negotiation (process) with the GNU that a relook at the problematic clauses (of the NHI Act) would be essential to the GNU formation and its sustainability”. Cuthbert says that in Cabinet discussions “it was agreed that a subcommittee would be established to process the views and alternatives”.
But Motsoaledi stands firm: “We (the ANC) are not in an alliance with the DA; we just went into the GNU because the situation demanded it… If anyone believes because of this misunderstanding the GNU should collapse, that will be very unfortunate.
“But what can we do, that will have been their choice?”
A health compact is an agreement among sectors — for example, business, government, labour, patient groups, civil society, health professions organisations, statutory bodies and academia — to work towards a common goal, and sets out what each industry has to bring.
The country’s first health compact, of which the goal was to better equip “the South African health system towards an integrated and unified health system”, was signed in 2019, and had remarkable cooperation from many sectors outside the government.
Of the 363 partners, only 16 were state departments. Organisations such as Business Unity South Africa, the South African Medical Association and the Progressive Health Forum served on the steering committee, and they helped to lobby other organisations in their fields to participate, too.
For example, Business Unity South Africa got 48 business organisations to commit to the agreement and coordinated the private sector’s contributions. The South African Medical Association, in turn, got 76 health professional organisations involved and managed input relating to primary healthcare services.
‘The NHI was pushed down our throats’
But this time around, only 13 partners signed the compact, of which three were the president, health minister and minister of science and innovation, because organisations such as the South African Medical Association and Business Unity South Africa argued that the NHI, in its current form, was essentially pushed down their throats.
“It (the compact document) has been unilaterally amended by the government, transforming its original intent and objectives into an explicit pledge of support for the NHI Act. These changes to the health compact were made without consultation,” Business Unity South Africa said in a press release.
The implication is that there are fewer partners to formally work together to improve the country’s health system. As Olive Shisana, the president’s social policy special advisor, put it in her closing speech entitled “Why we need the second presidential health compact”, at the 2019 event: “The state, as the main provider of healthcare services, cannot address all the health challenges on its own, and it needs the support of other stakeholders… A health compact can help to establish a shared vision and goals for the health system and provide a framework for collaboration.”
Although the media was invited to the signing event, copies of the final document hadn’t been made available at the time of publication. Read the draft copy that was circulated here.
One of the solutions to the medical aid issue, suggested by the country’s largest private scheme, Discovery Health, would be amending section 33 to say “that the role of medical schemes will be determined at a later time through a collaborative and a consultative process”.
ARVs for asylum seekers and undocumented migrants?
Motsoaledi says although he’s not prepared to negotiate on section 33, there are other parts of the NHI Act, such as the one about who will have access to HIV treatment, that could potentially change.
Section 4 of the act says asylum seekers (people who have applied for refugee status but are still awaiting the outcome of the government’s decision) and “illegal foreigners” (undocumented migrants) can only get treatment for emergencies or notifiable diseases. A notifiable disease is an illness that can lead to an epidemic-like outbreak and cause many deaths, thereby posing a threat to the health of everyone in a country, like Covid-19 or Ebola.
This section of the Act has previously caused outrage among health activists, because HIV is not a notifiable disease in South Africa and asylum seekers and undocumented migrants with HIV will therefore not be able to access antiretroviral treatment.
Not treating everyone with HIV in a country doesn’t make sense, research has shown, because antiretrovirals, when used correctly, bring down the levels of HIV in an infected person’s body to such low levels that it becomes scientifically impossible for them to transmit the virus during sex. Treatment, therefore, not only keeps people healthy, but also slows down the spread of the virus.
With this strategy, Motsoaledi says, he agrees, and if “there’s a mistake in the NHI Act about that, it needs to be corrected”.
“If you refuse people with highly infectious diseases, like HIV, treatment, it’s going to spread around. Then you’re working in reverse. Because otherwise (without offering treatment), I don’t think we’d be able to defeat the disease.”
In fact, Motsoaledi says, laws are often amended. But in the case of the NHI, he will only sit down to listen to those who are open to change, and who have constructive suggestions.
“I’ve been in government for ages now. I’ve never seen an act on Earth that is never amended,” he says. “But I’ve learned, from home affairs, everything people don’t like, just by not liking it, they’ve given it a new name: unconstitutional.” DM
Watch the full Aaron Motsoaledi interview on Health Beat on eNCA on Sunday, 25 August at 5.30pm or from Monday, 26 August on Bhekisisa’s YouTube channel.
One man's blind ideology and foolish dreams should not be allowed to destroy a nation.
Vote this man and his destructive party out of power at the next elections.
Ajay SanAug 26, 2024, 12:43 PM
Well said
Confucious SaysAug 25, 2024, 08:15 PM
The more Aaron speaks, the more he becomes a turkey! Blind, uninformed, incompetent! Perhaps he's mole?
Philemon SolomonAug 25, 2024, 10:44 PM
Oh I didn't realise he was the boss of the whole GNU...
Beyond FedupAug 26, 2024, 05:12 AM
What an absolute idiot! Whatever this moron touches or gets involved in, ends up in failure and misery. How this incompetent party hack is still around just confirms the total ineptness and stupidity of the anc.
CachunkAug 26, 2024, 07:36 AM
You took the words out of my mouth!
D'Esprit DanAug 26, 2024, 09:45 AM
Spot on. An absolute imbecile who has no place in a position of authority. Between Motsoaledi, Mantashe and Motshekga, they have done more to destroy the future of the poor than anyone else post-apartheid.
Ben HawkinsAug 26, 2024, 08:32 PM
On Point
Donald bemaxAug 27, 2024, 10:11 AM
Ask this idiot what on earth our taxes are supposed to be used for...get the asset forfeiture unit to allocate ill-gontion gains to rebuild the health service
Donald bemaxAug 27, 2024, 10:11 AM
Ask this idiot what on earth our taxes are supposed to be used for...get the asset forfeiture unit to allocate ill-gontion gains to rebuild the health service
Michael ThomlinsonAug 27, 2024, 01:33 PM
This blind cadre can't figure out that the ANC's hell bent drive to push the NHI has resulted in their poor performance in the last election. He can't figure out that public servants and any other employees that have managed to get onto medical aid do not want to give it up.
geoffry.healdAug 26, 2024, 06:43 AM
Motsoledi is now inflicting his disastrous “leadership” that he spewed on South Africans and foreigners alike, when he was Minister of Home Affairs onto the health of all South Africans. He and his fellow ANC ministers & families should be forbidden from medical aid and compelled to use state hospitals
D'Esprit DanAug 26, 2024, 09:47 AM
Motsoaledi was Health Minister from 2009 to 2019 - coinciding with the collapse of the public healthcare system and the related rise of massive fraud and corruption in the system. He's the worst post-apartheid health minister we've had.
graAug 26, 2024, 06:47 AM
Hopefully when the ANC government ministers feel poorly they will seek treatment under the NHI rather than scuttle off to Russia, Singapore or Cuba for their hospital stays.
Tony ReillyAug 26, 2024, 06:53 AM
The man is a walking disaster.
Walter SpatulaAug 26, 2024, 07:13 AM
Fantastic arrogance from a party that has 14% national support.
Keith WilsonAug 26, 2024, 07:31 AM
Maybe I haven't been following this closely enough, but some questions:
If we stop buying medical cover what happens to the Medical Aid providers?
How do the Private Hospitals survive? Or will they be "Nationalised"?
Do we pay more tax?
This is surely just another Rape & Pillage scheme?
Ken RandellAug 26, 2024, 12:31 PM
1. Yes - Out of business
2. Yes - become part of NHI (State)
3. Yes - probably payroll based
4. Yes - no competence to run such a scheme
MGHMOOS
Scott GordonAug 27, 2024, 08:22 PM
Same here , would be happy paying nothing :-) Med Aids will cease to exist . Those in private healthcare will continue to emigrate . Guess this will get to Con Court one day soon .
Aug 26, 2024, 07:36 AM
Be fair to Motsoaledi. The architect is Dr Crisp. He and other socialists think, “look how much private people spend on medical aid” - ignoring this is because much public health, that he is responsible for, is disfunctional - and simplistically say - let’s take it and put it into public health.
D'Esprit DanAug 26, 2024, 09:50 AM
Don't be fair to Motsoaledi, he's paid millions to lead the ministry. Crisp is an odious character, who repeats blatant, racist lies about access to healthcare simply to shove this down our throats.
Ken RandellAug 26, 2024, 12:34 PM
He is the accountable Minister - but the ANC has touted this since inception and parroted the usual BS
Mark HammickAug 26, 2024, 07:37 AM
In preparation for the NHI I suggest that all cANCer members use the current state facilities that are available to the citizens of South Africa
Jennifer DAug 26, 2024, 08:13 AM
So the question is “where do Motsoaledi and Ramaphosa go for medical treatment?” Find out and publish an article on ministers treated in public hospitals.
With no competition, public healthcare will go further down the corruption hole.
Lynda TyrerAug 26, 2024, 08:52 AM
Ramaphonsa gets his through the Military , not sure why its done that way he too needs to be forced to use state hospitals.
Rod MacLeodAug 26, 2024, 07:39 AM
Take note on these GNU utterances. The GNU is a Ramaphosa masterstroke - it's a ventilator to keep the ANC corpse breathing while they try to revive and cure it. The ANC does not see it as anything more than an interim, salty tasting interruption in their lives.
Sydney KayeAug 26, 2024, 07:47 AM
Does he know that in 2011 private and public hospitals accounted for 38.4% and 61.6% of all hospitals in China, respectively. By 2021, these numbers nearly reversed with private hospitals outnumbering public hospitals by a ratio of 2.1–1.0. Isn't China the ANC role model?
D'Esprit DanAug 26, 2024, 09:54 AM
Just come back from a fabulous holiday in Vietnam, where I needed emergency medical treatment due to my own stupidity. They have fantastic private hospitals in communist Vietnam - my son, who lives there, noted that the government is socialist 'but pragmatic' if something works. Spot the difference.
Ian McGillAug 26, 2024, 08:05 AM
Breathtaking arrogance from a moron, earflaps closed, a loyal comrade out to destroy something that works? He must be an ANC cadre!
Aug 26, 2024, 08:22 AM
R3 billion (BILLION) syphoned off by crooks in Tembisa Hospital alone via around 5000 channels of smoke and mirrors contracts/admin transactions. Imagine all state hospitals and medicine on NHI's estimated R4 billion admin income p.a. What a juicy cash cow for Motsoaledi and his cohorts.
Zamfoot 1 1Aug 26, 2024, 10:50 PM
This .............lacks understanding period !!
Zamfoot 1 1Aug 26, 2024, 10:50 PM
This .............lacks understanding period !!
Jon QuirkAug 26, 2024, 08:23 AM
Motsoaledi clearly has no understanding as to the "ownership" of Medical Aid funds, held in trust for the benefit of insured individuals who have paid these funds into the medical aid, Trustee arrangements. Is theft no GNU government policy? Sort out the parts actually under your control control.
Miss JellybeanAug 26, 2024, 08:31 AM
Arrogant Aaron needs to put his money where his mouth is & start using government facilities. Even better get rid of the government medical aid & see the backlash from public servants
John PAug 26, 2024, 08:35 AM
The minister seems to think that collapsing the GNU will leave the ANC in power. Perhaps his advisors should tell him that the ANC will need to either negotiate a new multi party government or call new elections?
Lynda TyrerAug 26, 2024, 08:49 AM
What an arrogant man he is and seems to think he is head of this country. Time he was removed from this post. I trust he is hit with all the court costs involved in fighting this nonsensical idea of NHI in a 3rd or even 4th world country.
Elizabeth LouwAug 26, 2024, 08:50 AM
Ag liewe Here Hoe het die man weer die minister van gesondheid geword?
David FarrellAug 26, 2024, 08:51 AM
government medical aids including polmed etc must close their doors immediately, all funds must be handed over to the health department, as funding NHI, and no politician or member of the anc must be permitted to seek medical attention at any facility other than a government operated health facility
Tim BesterAug 26, 2024, 09:00 AM
This man is proof that to be a Marxist socialist you have to be stupid.
Johannes Hendrik JansenAug 26, 2024, 09:03 AM
So this is the new political landscape.... It is MY way, or nobody's way
And if you do not like it...well then we bring the house of cards down
FOOLISH, CHILDISH AND UTTERLY CONTEMTABLE
Miss JellybeanAug 26, 2024, 10:41 AM
Arrogant Aaron is the most childish, inept disaster of a minister (yes he out does Mantashe). He messes up every department he touches & wastes millions defending the indefensible in court.
brintonclementsAug 26, 2024, 09:13 AM
What a fool... Can we really risk another setback in the progress we're making to get the country back on track? Absolutely not. Aaron will have access to private healthcare abroad, while we’ll be left without even basic pain medication.
D'Esprit DanAug 26, 2024, 09:35 AM
Motsoaledi destroyed public healthcare as a Zuma minister, before being shoved off to Home Affairs, which he destroyed as well. Now back to finish off private healthcare too. He is singularly useless, unfit for office and a threat to South Africa's future, but Cyril is too aloof to see this.
Naas ViljoenAug 26, 2024, 09:36 AM
It would be easier just to get rid of this comrade and his lapdog Nicholis Crisp than to debate a disaster like NHI.
operator .Aug 26, 2024, 09:54 AM
Finally, the mask is removed and his faction revealed.
Rob BaylissAug 26, 2024, 10:00 AM
NH or collapse GNU. Is this ANC policy, the minister's policy, or what?
Johan BuysAug 26, 2024, 11:03 AM
Relax : this is the same government that cannot eliminate pit toilets. It will take eleventy dozen years to implement. Maybe more when the implementers are also on private medical aids and don’t like what they see happening in the public health system that they are running right now.
Louise WilkinsAug 26, 2024, 11:08 AM
He won't be getting my medical aid money. I'll give it up before that happens.
Alan SalmonAug 26, 2024, 11:11 AM
I very much doubt that this attempt to disband medical aids would pass the constitutional requirement of freedom of choice for all citizens. I accept that private care is very expensive and the tax deduction for private care would probably have to be phased out, but the right to see a health worker of your choice cannot be denied.
Carsten RaschAug 26, 2024, 11:22 AM
we just went into the GNU because the situation demanded it…” yes, Aaron, you. LOST THE ELECTION. I’m shouting because you are hard of hearing, and you seem to be in pathological denial of that. There is no way, regardless of whether its a good idea or not, that this administration, and especially your failing ministry, can implement or even start to implement the NHI.
Indeed JhbAug 26, 2024, 02:16 PM
Be a hero Minister, clean up the current Health Services. There is enough money i.e.R100bill in medico legal claims can be saved plus the salaries of negligent doctors, nurses etc. How much can be saved if medicine is not stolen, another few R bill. Then lets talk NHI you are wasting your 85% !
Middle aged MikeAug 26, 2024, 02:21 PM
Getting high on your own supply for 30 years makes it to to distinguish between fantasy and reality. Shem.
Robert KAug 26, 2024, 02:51 PM
Before we get excited about this poor wretch, let's first find out of which end of his body is he releasing this drivel.
Ben HawkinsAug 26, 2024, 08:30 PM
Voetsek, you all leaking your lips to defraud the coffers of billions, that's what this is about
Ivan van HeerdenAug 27, 2024, 09:29 AM
The arrogance of Motsaledi is simply staggering. His first priority should be to fix the failed public healthcare system which has collapsed from world class before 1994 to an absolute shambles thanks to ANC incompetence, cadre deployment not to mention unrestrained thievery by "Comrades.
I am in favour of NHI but that only works when the public healthcare system is functioning. The medical aids rip off their clients at a biblical pace so I would be in favour of the NHI for that reason alone, HOWEVER NHI in it's current form will only cause the collapse of the entire medical system not to mention a mass migration of doctors to other countries.
Someone should ask the minister when last he went to a state owned hospital for treatment??
Steuart PenningtonSep 12, 2024, 04:12 PM
We have 3479 Clinics/Community Centres, 45% of which are dysfunctional; 364 State Hospitals 60% of which are the same. We have 200 functional private hospitals with 76 Medical schemes serving 9 699 000 members, over half of which are black. Private sector collaboration the only way forward.
Roger SheppardSep 12, 2024, 04:55 PM
Motsoaledi - the animal in the room! Disgusting! ...and damnedly dangerous, an epithet he would love!
Roger SheppardSep 12, 2024, 04:55 PM
Motsoaledi - the animal in the room! Disgusting! ...and damnedly dangerous, an epithet he would love!