Working class under siege — The rising cost of healthcare and the Gems crisis

There comes a moment in the life of any working-class formation where silence becomes betrayal. That moment is now.

Across the length and breadth of our country, Police and Prisons Civil Rights Union (Popcru) members – those who dedicate their lives to policing our communities, guarding our correctional centres and ensuring public safety –are facing a deepening crisis of survival. At the centre of this crisis lies a painful contradiction: those who serve the public are increasingly unable to afford their own healthcare.

The recent increases in the Government Employees Medical Scheme (Gems) have pushed our members to the brink. In 2025 alone, contributions rose by 13.4%, followed by a further 9.8% increase in January 2026, later adjusted to 9.5% from April 2026. This amounts to a staggering 23.2% increase over two years.

Let us pause and reflect on what this means in real terms.

In the same period, public servants received wage increases of around 5.5% in 2025/26 and roughly 4% in 2026/27. Inflation has hovered around 3–4%. The conclusion is unavoidable: medical aid costs are rising at more than double the rate of wages. This is not just a policy problem – it is a lived crisis.

It means a correctional officer must now choose between medical cover and putting food on the table. It means a police officer must think twice before taking a child to a specialist. It means a traffic officer must fear illness – not because of the disease itself, but because of the cost of treatment.

This is the brutal reality of austerity.

For years, workers have been told to tighten their belts. We have been told that the state must reduce spending, that wages must be contained, that benefits must be “rationalised”. Yet, at the same time, the cost of living continues to rise relentlessly –electricity, food, transport, and now healthcare. Medical scheme costs have become one of the most aggressive drivers of this crisis.

Pressure on Gems

Even within Gems itself, the pressures are evident. The scheme now pays out approximately R180-million in claims per day, serving more than 2.3 million beneficiaries, with utilisation rates far higher than many private schemes.

This tells us two things.

First, workers are using healthcare because they need it – because of the physical and psychological toll of working in the criminal justice system. Second, the system itself is under strain, and instead of addressing structural inefficiencies, the burden is being shifted onto workers.

We must ask: why are workers paying for a crisis they did not create?

The broader medical scheme environment in South Africa paints an even more troubling picture. Healthcare has increasingly become commodified – driven by profit motives, administrative costs and private-sector pricing models that are detached from the realities of working-class households. The very system that should guarantee dignity in times of illness is now reproducing inequality.

Gems was established as a social solidarity instrument – to provide affordable, equitable healthcare to public servants. Today, that founding vision is under threat. When contributions rise beyond affordability, when co-payments increase, when members are forced to downgrade or exit the scheme, we are witnessing the erosion of that social compact.

And the consequences are severe.

Members delay seeking care. Chronic conditions go untreated. Mental health deteriorates. Families fall into debt. In the end, the cost is not only borne by individuals, but by society as a whole, through weakened public service delivery and declining morale among frontline workers.

As Popcru, we refuse to accept this trajectory.

More than a Gems issue

We are clear that this is not merely a Gems issue – it is a working-class issue. It is about the broader political economy of healthcare in South Africa. It is about the failure to align wages, subsidies and social protection with the real cost of living.

That is why we are strengthening our programme of action, not in isolation, but in unity.

As affiliates of the Congress of South African Trade Unions (Cosatu), we are working together with other unions across the federation. But importantly, we also recognise that these challenges cut across organisational lines. Workers in the Federation of Unions of South Africa (Fedusa) face the same crisis. Their members, like ours, are confronted with the same painful reality of declining real incomes and rising healthcare costs.

This is why we must build a united front of workers.

Because whether you wear a Cosatu badge or a Fedusa badge, the debit order deduction does not discriminate. The burden is the same. The pain is the same.

Together, we must confront:

• The unjustifiable escalation of medical scheme contributions above inflation and wage growth;
• The failure of the employer subsidy to adequately cushion workers;
• The lack of transparency and accountability in cost drivers within medical schemes; and
• The broader commodification of healthcare in our country.

We must demand a system that places people before profit. A system that recognises healthcare not as a privilege, but as a right.

The struggle for affordable healthcare is inseparable from the struggle for economic justice. It is inseparable from the fight against austerity. It is inseparable from the broader mission of building a society that values human dignity.

We call on all our members to remain vigilant, organised and mobilised. We call on all workers, across federations, to unite in defence of their livelihoods.

Because the reality is simple:

A worker who cannot afford healthcare is a worker under siege.

And a working class under siege must rise.

Now is the time. DM