Why on earth would South Africans reflexively distrust the idea of nationalising and centralising healthcare?
The Financial Mail recently reported (paywalled article) that cardiologists at the South African Heart Congress last month raised the question of trust in the government’s ability to run a National Health Insurance (NHI) scheme.
Due to become law next month, the scheme would create a centralised single-payer universal healthcare system in which the government decides what care patients will receive and when, and private care and insurance are outlawed except for extraordinary treatments that are not covered by the NHI.
According to the report, Darryl Smith, a cardiologist at Linksfield Clinic who works sessions at Charlotte Maxeke Johannesburg Academic Hospital, called the matter of trust in the government’s ability to administer an NHI ‘an elephant in the room’.
‘Why should we trust the government with our money when there are no successful blueprints?’ the FM quoted Smith. ‘Money has been poured into Chris Hani Baragwanath Hospital and Charlotte Maxeke — only for these hospitals to return to their former state. We have to ask why we must trust the government, not just with money, but with aptitude and ability.’
Stop the distrust
Instead of explaining why we must trust the government, Dr. Nicholas Crisp, deputy director-general in the Department of Health and the government’s NHI champion, said: ‘This pervasive distrust has to stop.’
At the risk of repeating the question, one wonders, on what grounds, Dr Crisp?
Trust is earned. When doctors, or patients, consider whether or not to trust the government to deliver decent healthcare for all, at what evidence would you point?
Is there any large-scale government function, any function at all, that is centralised at national level, with only operational duties devolved to the provinces, that actually works?
This isn’t even a 50/50 chance people are taking with the government. No, this government has comprehensively failed at delivering every social service that is required of it. Water. Electricity. Transport infrastructure. Policing. Prosecution. Post. Permits. Digital infrastructure. Education. Land reform. Home Affairs. Social grant payments.
It is no exaggeration to say that everything the present government touches turns, if you’ll pardon the phrase, to shit.
It has not only failed to deliver adequate services, but it has allowed infrastructure and capabilities to deteriorate to such an extent that services will be extremely hard to restore to an adequate level.
The reasons for these failures are rarely a lack of funding, as Smith pointed out. It is a dearth of skills and experience, which is a consequences of cadre deployment and aggressive affirmative action. It is an ingrained culture of grand and petty corruption that touches every government contract. It is a total lack of interest in serving the people of South Africa, instead of lining the pockets of connected comrades.
Centralised buying
Crisp says that the NHI will centralise buying, in order to reduce costs. But Eskom’s R200 000 mop and R80 000 for knee guards are not aberrations. This happens throughout government, at all levels.
Everything is procured at a massive premium. Sometimes this involves deliberate corruption, allowing suppliers or their ‘facilitators’ to skim money off the top. Sometimes it involves mere incompetence, being unable to tell when a private supplier is taking them for a ride. Usually, it is just an ‘empowerment premium’ that goes to middlemen who do nothing to earn it.
What guarantee can Crisp give us that the NHI will be relatively free of corruption, will be relatively competently managed, will buy supplies at competitive prices, and will efficiently provide quality healthcare to all 62 million South Africans?
When a supplier can only sell to the NHI, how will the purchasing bureaucrats know whether they are being offered a bulk discount, as Crisp appears to expect, or are being charged an opportunistic premium?
Crisp, after a little incomprehensible ranting, offered the conference the non-sequitur, ‘The only enemy is ill health – and we need to deal with it.’
National control
After some more impenetrable balderdash, the FM reports that Crisp told the cardiologists the NHI will do away with provincial autonomy. ‘At present the health minister controls only 1% of the health budget. Under the NHI there will be central control, with the budget being allocated to the nine provinces, municipalities, the military, and public and private health-care sectors.’
Crisp continued: ‘You can’t have the private sector, which serves about 15% of the people, consuming 51% of health spend. How do we make the 67% of doctors working in the private sector available to the public – and ensure everybody gets health care when and where they need it without [them suffering] financial hardship?’
Private property
He makes the grievous mistake of presuming that the after-tax income that people spend on private healthcare actually belongs to the government.
It doesn’t belong to the government at all. The private sector consumes not 51% of the government’s ‘health spend’, but 0%.
It uses privately owned money, for which people have worked, and on which they paid taxes to, inter alia, fund the public healthcare system. They could spend it on a house, or a car, or a holiday, or food, but instead they choose to spend it on private healthcare because the public system is inadequate.
According to the FM, Crisp says resources are ‘locked up’ in private providers that exist because private funders can pay them. But they’re ‘locked up’ because they are private property. They’re locked up because those resources don’t belong to the government. They belong to the people who have chosen to pay for them.
The government ought to thank people with private insurance for relieving – at great personal expense – some 15% of the pressure on the public health system.
Instead, the NHI Bill proposes to punish them by expropriating their medical scheme contributions and prohibiting choice in healthcare services.
Greener pastures
‘The key,’ Crisp told the FM, ‘is bringing the public and the private providers into the same payment model. That means not only the clinics and the community health workers, but the 11 000 general practitioners, who have been neglected and undervalued in the health system for far too long.’
If the 11 000 GPs actually were undervalued, they would have left for greener pastures long ago. The fact that they are still practising proves that they are not undervalued. Instead, the ominous prospect of the NHI is forcing them to consider emigration.
Emulating others
Single-payer universal healthcare systems exist in only a handful of countries, the poorest of which, Portugal, is three times as wealthy as South Africa. Only Japan and the UK have systems that cover more people than South Africa’s NHI proposes to cover.
The NHI will be a single-payer universal coverage system just like the NHS. And, as I’ve written before, emulating the NHS is a bad idea. (For the record, Crisp strongly disagrees with me, and claims the NHI doesn’t emulate anyone.)
The NHS is funded by eight times the sum of public and private healthcare expenditure in South Africa, and yet it suffers worsening problems with rationing, delays, and queues.
It takes three weeks to get a doctor’s appointment in the UK. It can take nine months or longer to begin cancer treatment. Some people have been on surgery waiting lists for two years.
What hope do we have in South Africa, with a relatively underfunded NHI administered by a government that cannot get anything right?
Ideological issues
That’s not to mention the grave ideological issues socialist centralisation raises, most notably the eradication of choice and competition in the market.
Under the NHI, you will no longer be able to buy the treatment you prefer. You will be required to accept the treatment government bureaucrats decide you merit. You will no longer be able to shop around for better coverage. You’ll be taxed, and you’ll say thank you for what you get for your tax, and you will stop the ‘pervasive distrust’, as Crisp orders.
A major reason why the poor cannot afford private healthcare in South Africa is because it is literally illegal to offer the poor healthcare insurance coverage they can afford. So, unless they can pay cash, they are doomed to the tender mercies of government clinics and hospitals, where you can sit all day to have a sore throat treated.
Strategy
This is, of course, all a deliberate strategy of the socialist government. Not only do they want to drag the rich down to a low common denominator in the name of material equality, but if they can engineer something they can blame on a ‘market failure’, they ride to the rescue of the people by taking control and extinguishing the private sector altogether.
This is why the NHI is a crucial step on the way to the socialist revolution that the ANC has pursued for decades.
It is no mere slip-up that the government ignored the private sector comments on the NHI. Business Unity South Africa was comically naïve to think that its proposed changes would be considered. The government doesn’t mean to accommodate the private sector. It has no respect for private property, and means to eliminate the private sector.
But, commands despot Crisp, the ‘pervasive distrust has to stop’.
Show respect to your leaders and do as you’re told, vile peasants!
The views of the writer are not necessarily the views of the Daily Friend or the IRR
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Image by Klaus Hausmann from Pixabay