According to last week’s Sunday Times (Ramaphosa “open” to more NHI talks), top business figures were shocked by President Ramaphosa’s signing of the National Health Insurance Act, and particularly “its timing less than two weeks before the May 29 elections”.
The IRR has often expressed concern about the naïvety of the big business sector. Perhaps, having access to those in political power reduces the ability to see the perfidy of the political classes − a sort of ‘not seeing the wood for the trees’ scenario.
There are two rules regarding the behaviour of the political class: first, observe what they do rather than what they say, and second, listen to what they say to their political base, not to you.
It was always possible that the pre-election surge by the ANC would include signing the NHI into law. The ANC has the advantages of incumbency to do things with popular appeal that is just not open to any other political party.
The ANC faces the first election result that may see it lose its majority. Why would Ramaphosa, as a populist pre-election gesture, not sign into law a whole of bills which have been mouldering on his desk for months, in order to gain electoral advantage?
The article says that representatives of big business, who have close ties with the President, said they were under the impression that Ramaphosa would not sign the bill until their concerns had been met. You’ve been suckered, ladies and gentlemen.
The Electoral Matters Amendment (8 May 2024) which had to be signed into law to allow independents to contest the elections, also contained an amendment to change the funding formula for political parties. This resulted in the ANC receiving an additional R52-million for the election at the expense of other parties. It’s been described as “unconstitutional and poses a grave threat to our democracy”. Same old, same old.
The Prevention and Combating of Hate Crimes and Hate Speech Act (9 May 2024) criminalises hate speech, which impacts on our freedom of speech. It has been criticised for being unconstitutional, but outlawing hate speech has a nice, humanitarian sound to it.
Ostentatious showiness
The Expropriation Bill of 2020 was passed by Parliament in March, and needs only President Cyril Ramaphosa’s signature to become law. It has also been criticised for being unconstitutional, but unconstitutionality did not stop Ramaphosa signing NHI into law with ostentatious showiness. So, why not the Expropriation Bill? We only have a few days left before the election.
One business leader, who attended consultative meetings with the President, said he and his colleagues had left the meetings “strongly” believing the bill was not going to be signed in its current version. Sorry, but Ramaphosa is a liar (see here and here)
In response to questions from the Sunday Times, Ramaphosa struck a conciliatory tone, indicating the phasing-in of NHI would be a consultative process in which big business could raise its concerns. Presidency spokesperson Vincent Magwenya said Ramaphosa was “giving thought to a mechanism that will allow for more engagement and collaboration with business, labour and other social partners’’.
This is another slippery political sop to the business community which, has amongst its members, some who are shocked that the President could do this to them.
Perhaps, as Niccolo Machiavelli said: “One who deceives will always find those who allow themselves to be deceived”.
Envy
Ramaphosa has relied on the good graces of the business sector in his attempts to turn around energy and logistics challenges that have weighed heavily on economic performance. The possibility of this not meaning anything to the ANC at election time should always be seen as a possibility. This is the ANC we’re talking about; its distrust of the private sector persists, or maybe it’s not actually distrust anymore; it’s envy, which is more dangerous.
Business Unity South Africa CEO Cas Coovadia said: “We fully support the objective of universal health coverage, however, the [legislation] in its current form is unworkable, unaffordable, and not in line with the Constitution. What is especially troubling is that the President is proceeding despite extensive constructive inputs made by a wide range of stakeholders, including doctors and health-care professionals, civil society, public sector unions, academics and business. The unfortunate consequence is that this version will hamper, rather than promote, access to quality health care for all citizens in our country.” Coovadia nails it.
But for the ordinary, unconnected citizens of this country, what Martin Kingston of Business for South Africa (B4SA) said was distinctly disturbing: “None of us have a choice. We need to fix and address defects in the legislation and ensure it is fit for purpose. Currently it is not. The best way to achieve that is to engage openly and transparently.”
And he said that business, “rather than immediately going to court like the DA”, would seek to work with the government to correct provisions it believes are unworkable. Nice dig at the opposition there.
“Aware”
“We have met consistently with the President and his colleagues involved in NHI. He has indicated that he is aware of our concerns. Not just big business but the private sector much more broadly.”
What Kingston is saying is that a highly unworkable, unaffordable and unconstitutional piece of legislation may be made more palatable by tinkering with some amendments. This is what big business (and others) generally do − they fall into the obvious trap of trying to tamper with bad law so the ANC ultimately gets more or less what it wants, when the law, in fact, should be opposed in its entirety.
Presidency spokesperson Magwenya continues to pour emollience on all this: “President Ramaphosa continues to lead a government that listens, that is engaging and that is collaborative. The President is giving thought to a mechanism that will allow for more engagement and collaboration with business, labour and other social partners as we begin to roll out the implementation of the NHI.” The crass hypocrisy is stunning.
But we’ve had that already. Well over 100,000 submissions have been made by South Africans on the Act since 2019. These included NGOs who are not the idea of Ramaphosa’s social partners, businesses and business groups, health professionals, medical aids, and more. Many submissions made alternative suggestions to this behemoth.
Yet finance minister Enoch Godongwana told the Sunday Times that the criticism of the NHI was premature, as the government was yet to outline its implementation plan and the cost of implementing each phase. Note that the scheme has never been costed by the government in over the decade that this proposal was mooted. So Godongwana seeks to put the cart before the horse.
We are the customers, remember?
Big business needs to remember that it has no right to speak on behalf of us. It is our money, not just theirs, that is spent on public and private health care. And those in the medical aid industry owe it to its members not to decide what is good for us. We are the customers, remember?
The only thing that Magwenya said that wasn’t insulting was that focus should be shifted to improving public hospitals in preparation for the implementation of the NHI. Since over 80% of state hospitals are not fit for NHI purpose, this alone would improve the basic universal health care that South Africa already has.
In the end, the last word should be reserved by the ANC’s national chair, Gwede Mantashe. In his usual contemptuous way, he rejected accusations that the Act was passed to improve the ANC’s chances of retaining power in the elections.
“How many years did they discuss NHI? How many years? Now you can’t debate a policy for years and years [and] when you implement it, they say it’s elections − it doesn’t work that way. Elections or no elections, that policy has been discussed for a long time.”
Mantashe’s right. Of course it has been debated … for 17 long years. And after all that time the government has been deaf to the objections to those who understand health care.
We have also been told not to anticipate corruption in the NHI. The government will be the sole purchaser and distributor of medical care and drugs to the population. The size of the NHI, financially and bureaucratically will be bigger than anything we have seen before.
What could possibly go wrong?
There will be an increase by an order of magnitude of preferential procurement in government contracting. What could possibly go wrong?
Adrian Gore, the founder and CEO of Discovery, South Africa’s biggest medical scheme, says in a message to his thousands of members that Discovery unequivocally supports universal health care coverage and believes that a workable NHI is central to achieving this. However, in its current form, the NHI Act is not feasible as it rules out private sector collaboration.
Most experts do not think that the NHI is feasible. Government should harness the wealth of knowledge and success in the private health sector. “Collaboration” is a weirdly strange word to use in the circumstances.
Gore says that only once the NHI is “fully implemented” will medical schemes be limited in the cover they provide to medical scheme members.
Gore promises that, until this point (our underlining), there will be no change to Discovery members’ medical scheme cover, and it will take a long time – a decade at least – to achieve “full implementation”, given the scale and complexity of reforms needed.
But that is the point: dismissing it as a future inevitability does enormous harm: it sends out a message that is destructive of the growth and investment we so desperately need. The damage is already being done.
Gore notes: “Importantly, a workable NHI requires the public sector to be strengthened, not the private sector to be weakened. We need both to be strong and working together effectively.”
Exactly, but it’s not the task an ANC government is geared up for.
“Still to be navigated”
Gore ends by saying: “We understand that President Ramaphosa’s signing of the NHI Act has caused anxiety. However, with full implementation a long way out and many matters still to be navigated, I urge you to focus on the facts.
“Rest assured that we will do the right thing for you, the healthcare system and for all South Africans.”
I hope Discovery’s members are reassured.
[Image: StockSnap from Pixabay]
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