The ANC is putting all it has into its defence of the NHI. It realises that its ambitions will be scaled back by the courts and funding constraints, and it wants to prevent this happening on a large scale.
What the NHI policy reveals above anything else is the ANC’s megalomania. It wants state control over all healthcare by a vast and probably unmanageable and unaccountable bureaucracy.
Even in a reduced form due to funding problems and court cases, the NHI could wreck our healthcare system. Imagine if poorly-managed state hospitals are given larger budgets and authority, without improved accountability. What if an expanded system does not have strict procurement controls?
An NHI, even in a watered-down form, threatens to widen the scale of failure.
For its efforts to inject realism into ANC plans, private business has faced exclusion and is now in a standoff with the party. But the ANC’s failure to even listen to different views has given business, the doctors, the medical schemes and hospital groups a backbone in their opposition to the NHI that they have not displayed before. That could change the political struggles over the NHI.
President Cyril Ramaphosa and the Minister of Health, Aaron Motsoaledi, have gone to war to ensure that the NHI is not watered down. Over the past week they pushed through a “social compact”: an agreement backing the NHI by all but the key players. Bodies opposing the scheme, all of which are pretty much vital to healthcare in the country, refused to sign.
Business Unity South Africa, the body which represents the country’s largest corporations, said that there had been no attempt by the Presidency to engage with it on the NHI. In a slap in the face for the ANC, the organisation refused to sign the compact. Most of the groups that signed are ideologically on the state’s side, like the trade union federation Cosatu, the nurses’ trade union and the Medical Research Council, which is funded by the government.
Rather than seriously negotiating, the ANC went ahead with the compact to isolate the dissenters and try to cynically show them up as groups not wanting equal universal health care.
The once ruling party was in no mood to hear alternative suggestions on how universal health care can be achieved without near absolute control of healthcare in the country. What the Health Minister has is the zeal of a true believer.
Listen to Motsoaledi on the NHI. “People who argue that progress should be made in fixing the public health sector before the NHI is launched are making ‘a joke’ or are, ‘so greedy’ that they want to place, ‘an obstacle’ that they know ‘will not be removed’,” the Minister said.
What a pity he was not asked why he expects progress to be made in the removal of the obstacles once the NHI is in place.
Then there was his rejection of the idea of talking to private businesses and the DA about their views on the NHI. “Consultation for what?” the Minister retorted to the suggestion in an interview with the Bhekisisa Centre for Health Journalism.
And the estimate by Momentum that the NHI would cost the country R1.3 trillion, which is about 19 percent of GDP and nearly two-thirds of government spending, was “mathematical hooliganism,” declared the Minister. Despite his outrage at the number, he offered no estimate by his department of the cost of the scheme.
Why has the ANC gone on the warpath to push the NHI?
There are a few reasons for this. With little in the way of success for the ANC project over the past 30 years, the party wants to show that it can do something very big and bold. It is very likely that the NHI is seen as a way to restore the ANC’s confidence and prestige, particularly after it only achieved 40 percent on May 29th. And in a GNU, the ANC still wants to show that it can do big things and has power in the departments it controls.
But there is perhaps one overriding reason for the party’s aggressive pursuit of the scheme. That is because the NHI fits neatly into the National Democratic Revolution (NDR), the stage that follows national liberation in the ANC’s Marxist-Leninist ideology and provides the most direct link to socialism. Jack Bloom, the DA’s Gauteng Shadow Health MEC, says the NDR should be taken seriously because of the great authority in which it is held in ANC thoughts.
All this will make the fight over the NHI into a long and intense one. In the past, business has often been prepared to roll over rather than to take on the ANC. Business has always been worried about what the State might do in retribution, should it fight back too hard.
The ANC probably expected that business would ultimately sign the compact. But now the government has got what it did not want – business with backbone.
But what will those that refuse to sign the compact do now?
The opposition of these groups could be overridden if they do not launch a campaign to thwart the NHI. Up until recently, that is the last thing they wanted to do. But now is the moment to make a loud and clear case for private medicine.
The Minister must be taken on in public, and the myths about the benefits the NHI will mean for healthcare must be challenged. How possibly can the health system improve under government control when the state struggles to deal with the big problems at state hospitals now? Under the NHI, there will be one single point of failure for the entire health system.
It needs to be made clear what the private sector can do to improve public healthcare. State hospitals can be concessioned out for hospital groups to be run on the basis of key performance indicators. Medical schemes need to be allowed to challenge the state’s clampdown on low-cost market-related health insurance products.
The ANC seems not to have wanted the private sector to improve the system, as it would show the state sector up as inefficient. That must change, if the public healthcare system is to be improved.
In the past, doctors in private practice were driven away by the state, as it failed to pay them on time. That was more due to incompetence than design.
In this campaign it also needs to be shown that the private sector can work for the poor. That would help break one of the myths of ANC ideology.
The views of the writer are not necessarily the views of the Daily Friend or the IRR.
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