South Africa should not be overly concerned about the National Health Insurance Bill, since the President would not ‘sign it as a given.’ This is the word from the spokesperson for the Presidency Vincent Magwenya. 

He was addressing a media briefing, shortly before the National Council of Provinces was due to vote on the Bill. The vote was cancelled at short notice and rescheduled for next week. 

Business organisations had written to Deputy President Paul Mashatile calling for the Bill to be halted. Magwenya said: ‘Concerns have been expressed directly to the president [about] certain parts of the Bill. Once the Bill has been passed, the president still has a constitutional imperative in processing that Bill before he signs it. He will look at the process. One of the things he will look at is, has there been sufficient consultation and if so, have those consultations sufficiently addressed the issues of concern.’  

He went on to say that the passage of a Bill through the legislative process would not necessarily mean that it would become a law: ‘The passing of the Bill doesn’t necessarily mark the conclusion of the process. The president does not, each time he receives a Bill, just sign it as a given. If he so desires, he can open another round of consultation to satisfy himself that what he will sign will not be subjected to endless litigation.’ 

The NHI would effectively end the current system of private medical insurance, establishing a single fund that would operate as a state monopsony on a range of healthcare services. It will not be possible for any South African to opt out, and medical aids would be limited to providing complementary services. There is widespread fear that this would be characterised by massive corruption with a knock-on effect on healthcare provision, particularly for the country’s middle class.