NHI a step in the right direction to address inequality

The NHI Bill has been adopted by the National Council of Provinces. Picture: Armand Hough/Independent Newspapers

The NHI Bill has been adopted by the National Council of Provinces. Picture: Armand Hough/Independent Newspapers

Published Dec 16, 2023


Trevor Ngwane

Last-minute lobbying by the business sector led to a week-long delay in the passing of the National Health Insurance (NHI) Bill by the National Council of Provinces last week.

This rather unedifying last-minute loss of nerve by the country’s legislators, particularly the ANC parliamentarians, revealed not so much the contentious nature of the proposed new health system in South Africa but the poor and pusillanimous leadership of the ANC.

Cosatu lamented in a statement on behalf of labour, that government “wilted like a cheap suit” under pressure from a little bit of lobbying by business.

Nevertheless, the bill was passed despite the very loud objections and threats by the business sector.

As the statement, issued by Cas Coovadia on behalf of Business Unity South Africa (Busa) and Business for South Africa (B4SA), thundered: “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.”

Those opposed to the NHI Bill, including the DA, EFF, IFP and other opposition parties, are threatening fire and brimstone if President Cyril Ramaphosa signs it into law. Some say they will take the matter to the courts.

The ball is now firmly in Ramaphosa’s court. What will he do? What must he do? This monumental decision and political hot potato have been in the making for the past decade or so.

In its 2010 Durban National General Council, the ANC passed a resolution committing itself to changing South Africa’s health system from its current two-tier form to universal health access.

Ramaphosa has no choice but to sign off on the bill, according to Cosatu, because “the NHI is an ANC policy mandate, not some seasonal slogan”. Furthermore, it added: “The majority of workers are in support of an NHI… that will guarantee quality, accessible and affordable universal health coverage for all South Africans.”

With the 2024 elections coming up, the ANC cannot afford to alienate its chief ally, Cosatu. Nor can it simply abandon a plan that is designed to rid the country of an unequal healthcare system that discriminates on race, class, gender, nationality and geographical lines.

The dysfunctional and underfunded public health sector serves about 85% of people, while only about 15% of South Africans are members of private medical aid schemes and enjoy much better service.

The coincidence of race and class in South Africa means that most of those who suffered exploitation, oppression and poor healthcare services under apartheid continue to do so.

It is not just the long queues and poor treatment they receive in public clinics and hospitals that working class people complain about; it is that the results are often unnecessary and avoidable deaths. Indeed, in the townships they call the biggest hospital in the country, Chris Hani Baragwanath hospital, the “slaghuis” (slaughterhouse).

Many families must exert themselves persuading sick relatives, especially the elderly, to agree to be admitted to hospital because the patients fear that sleeping there is a death penalty.

Despite the visible hardship and suffering caused by the two-tier healthcare system, people resist the NHI largely because of a history of privilege and entitlement underpinned by racism and classism.

Dr Nicholas Crisp, deputy director-general in the Health Department, once quipped: ‘You’ll get the lady in Dainfern who can’t handle the fact that she may end up in the same ward as her gardener from Diepsloot.“

Crisp believes that South Africa has two parallel health systems, public and private, “neither of which are functioning well… the one just looks prettier than the other”.

Indeed, the commodification of medicines and the unregulated market for medicines arguably results in what amounts to price gouging by the private healthcare sector. There is poor regulation of a hugely fragmented system characterised by 76 different medical schemes whose administration makes it expensive to run.

Those who enjoy private healthcare, despite its shortcomings, dread the thought of using the dilapidated and poorly-run public healthcare facilities. Unfortunately, it is policymakers, professionals, businesspeople, and other leading members of society who enjoy private healthcare but are arguably doing very little to alleviate the suffering of the millions who are subjected to the public system.

In one of its better moments, the EFF was once inspired to make its members of Parliament to commit themselves to the Sankara Code whereby politicians and civil servants eschew the private and use public services. The logic is that those with the power and knowledge, instead of being cushioned by privatisation, will be compelled to improve public services to the benefit of all because they too use them.

Deprivation of quality healthcare because of a person’s socio-economic status is what the NHI seeks to eradicate. It seeks to create one public health fund that will meet the needs of the entire population not just a selected few.

There must be universal health coverage in South Africa irrespective of how rich or poor you are and whether you live in a rural or urban area. The cost of healthcare, which is among the highest in the world, must be significantly reduced.

If successfully implemented, the NHI will cover the costs of medical care in the same way medical aids do for their members, without paying a fee.

There is an urgent need to reduce the inequality in the standards of healthcare enjoyed by people. The NHI has an inbuilt solidarity mechanism whereby the rich subsidise the poor, the privileged share with the deprived.

Ramaphosa has no choice but to sign the NHI Bill into law. Not doing so would be a betrayal of the working class and the poor. It would condemn millions to unnecessary death, illness and suffering. He must not bend to the will of those who have no problem with enjoying a good life amid hardship and suffering.

The shortcomings they point out in the bill can be sorted later and they are in any case excuses by people who fear change. Things must change. Change is pain.

* Ngwane is the director of the Centre for Sociological Research and Practice at the University of Johannesburg.

**The views expressed do not necessarily reflect the views of Independent Media or IOL.