Health Minister Aaron Motsoaledi has come under scrutiny, after saying that the government of national unity (GNU) could be offered up to the National Health Insurance (NHI) Act.
Motsoaledi was adamant that Section 33 of the Act – which entails the end of medical aids in their current form – would remain, despite opposition from within the GNU, most notably from the DA. “We [the ANC] are not in an alliance with the DA,” said Motsoaledi. “We just went into the GNU because the situation demanded it.” He added that were the GNU to collapse due to “misunderstanding” over the NHI, this would be “their [the DA’s] choice.”
Motsoaledi’s attitude towards the GNU is concerning enough, but it is not merely the GNU he is proposing to sacrifice. In fact, implementing the NHI will sacrifice South Africans’ interests more broadly. The two are intertwined: the GNU represents the democratically expressed will of the people. Disregard for the will of the people is incompatible with pursuing their interests.
People’s right to choose
Put this way, disrespecting people’s right to choose – whether it be their healthcare or their representation in government – is fundamentally at odds with their wellbeing as citizens. Motsoaledi’s contempt for the GNU is a natural continuation of the contempt for choice embedded in the NHI. Implementing the NHI in its current form entails social, economic, and political consequences, all of which will diminish South Africans’ choices in interconnected ways. The breakdown in the choices of South Africans, moreover, will affect their health and financial outcomes.
South Africans understand the stakes at play. A survey by Tax Consulting South Africa found that 50% of respondents believed the NHI would be funded through an increase in taxes, 81% believed it would lead to an exodus of medical professionals, 84% opposed it, and 47% might emigrate were the NHI to be implemented. Clearly, emigration of a significant portion of the tax base could have devastating economic consequences.
Currently, 58.6% of all income tax paid to the fiscus comes from about 862,000 individual taxpayers. These are the individuals whose taxes the NHI would be heavily dependent on. These are also the individuals who are most optimally placed to be able to emigrate. Alienating these individuals is clearly not strategic.
While these may be the individuals who have options, moreover, the majority of South Africans do not. The majority cannot afford an increase in taxes, nor are they able to emigrate. And this majority would see their health harmed – not helped – by implementation of NHI in its current form.
Cost
It’s been estimated that the NHI would cost between R200 billion and R1.3 trillion to implement. Clause 49 of the NHI Bill lists general tax revenue, payroll taxes on both employers and employees, and surcharges on income tax as the means by which the Act would be funded. It’s been determined that, for these sources to meet the needs of the Act, a 6.5% increase in VAT would be required, bringing VAT up to 21.5%, and/or a 31% increase in income tax, and/or a ten times larger increase in payroll tax. These increases would clearly place massive pressure on both businesses and individuals.
It has been estimated that every formally employed individual would have to contribute R1500 to the NHI each month. Many of these individuals are already battling to survive. Increased taxes and an exodus of taxpayers will only add to the burden on the poor. By extension, it will add to the burden on their health.
People cannot thrive in environments where unemployment, poverty, breakdown in basic infrastructure and services, and instability prevail. The economic and political realities of a country are intimately linked to its health and social outcomes. Should the government wish to improve health outcomes, it should pay attention to the contexts in which South Africans live. It would certainly be simplistic to draw an unqualified connection between economic prosperity and positive health outcomes. However, that there is a connection is well established.
Hypocritical
Considering that 27% of South African children under five are stunted due to malnutrition, health and economic outcomes are clearly interlinked in important areas. Measures that increase economic pressures in the name of health are therefore hypocritical.
Motsoaledi’s heavy-handed insistence upon implementation of the NHI has social and political consequences, too. The message being created is that compromise and negotiation with diverging views in the GNU is unimportant to the ANC.
But such compromise and negotiation are the very heart of democracy. If the stability of the GNU can be sacrificed to the demands of ANC policy, then South Africans have reason to be pessimistic about the health of our democracy. Motsoaledi’s utterances can only deepen the demoralization and passivity which plague South Africa’s electorate.
In conclusion, then, Motsoaledi’s insistence upon the NHI and its infamous Section 33 is troubling on several levels. It signals a lack of respect for the choices of South Africans in multiple, interconnected areas. As citizens of a democracy, South Africans should respond to Motsoaledi with an insistence upon our freedom of choice: economic, political, and yes, medical.
The views of the writer are not necessarily the views of the Daily Friend or the IRR.
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