NHI: ‘Yet another act in a pantomime’

The passing of the National Health Insurance Bill by parliament last week is yet another act in a pantomime that government seems intent on performing. This bill is unworkable – there is no implementation plan (because implementation is impossible) and there is no funding plan (because funding it is impossible). It is as if government is intent to stride forward, somehow ignoring that eventually the whole charade will collapse.

Read: NHI possibly 15 years away from implementation

The lack of outcry over the passing of the bill last week indicates to me that many people have simply given up caring about it. They know the emperor is wearing no clothes, but scarcely anyone considers that remarkable. They will go about their business content that this performance will come to an end with South Africa no further down the line in improving access to healthcare for all.

The problem is that the NHI Bill does have negative consequences. The world it envisages – in which almost all of the private healthcare system is shut down and replaced with a government scheme – is impossible. For anyone considering a future exposure to the South African health system, whether as a worker in it, an investor in it, or indeed anyone concerned about their future access to healthcare, this is a blow to confidence.

Read: Lawmakers pass contentious NHI Bill

I wrote two weeks ago about how we could be confronting the healthcare challenges we have as a country. Key to it is a partnership between the public and private sectors, in which both sides bring their strengths to the table. The kind of partnership that allowed us to confront the Covid crisis and is now bearing fruit in dealing with the electricity crisis. In my view, organised business is strongly in favour of universal health coverage, but we need a workable plan to deliver it.

Read: Is NHI the straw that will break Treasury’s back?

The frustration I feel is that somehow workability is just not part of the government thinking about this. It appears to rather be about signalling, in which some parts of government seem to think that putting the bill into our law books will be seen positively by an important constituency, and that is enough.

The problem is that once it is on the books, we will then enter a painful period which will do no good for either the health system or government. National Treasury will be forced to appear to be attempting to find a way to fund it, despite the fact that there are myriad other demands on it for funding that cannot be satisfied as it is. The health system will be forced to appear to be implementing it, setting up the required boards and committees, despite the fact that its existing facilities are in urgent need of attention and most of them fail to meet basic standards. This will be destructive to government functioning as scapegoating breaks out amid frustration with delays. On top of that, there is inevitably going to be a raft of court cases as people and businesses affected take action to protect their rights.

Read: The currently conceived NHI ‘will leave South Africans worse off’

There have been many attempts in the past to inculcate socioeconomic impact assessments into our process of law-making. Such a culture has certainly not taken hold, and when assessments are done, they are often perfunctory and meaningless. It is not clear from the parliamentary deliberations whether such an assessment was undertaken or considered. The parliamentary health committee did obtain legal opinions from the State Law Advisor and the Parliamentary Legal Advisor. A third opinion was obtained by the Freedom Front Plus. These three opinions all pointed out areas where the bill falls short of Constitutional requirements. Despite some subsequent amendments, the final form of the bill was rejected by several opposition parties as not having resolved these Constitutional problems.

The bill must now proceed through the National Council of Provinces and, ultimately, the Presidency to be signed off. Perhaps it will obtain a dose of realism at these stages.

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Business has proven it is a capable and willing partner to government to deal with the healthcare challenges we face as a country. We are willing to work with government to find the best possible way to put our scarce resources to work in improving health access for all. A plan that is backed by a consensus view across business and government would galvanise all partners to drive its implementation. That is the scenario for our health system that I hope we can realise.

Listen to Moneyweb@MIDDAY host Jeremy Maggs and SA Medical Association chair, Dr Mvuyisi Mzukwa discuss the topic.

You can also listen to this podcast on iono.fm here.

Busi Mavuso is BLSA CEO.