NHI debate enough to make you ill, but experts say don’t panic

NICOLA MILTZ

The recent introduction to parliament of the NHI Bill sent shock waves through the community. People’s imaginations went wild, with haunting images of endless queues at appalling state-run hospitals – recently described as “crime scenes” – being played out around the country.

Industry insiders this week called for calm as more and more of the NHI plan, while seemingly noble in theory, appears “far-fetched” in reality.

One medical-scheme industry insider told the SA Jewish Report that, on a careful reading of the Bill, medical aids would continue to exist. “The media has jumped on the idea that healthcare is to be nationalised, but this isn’t the case.”

Simply put, the NHI plan aims to place all healthcare and medical services under state control. The NHI will run as a “giant state-run medical aid”, as described by former Health Minister Dr Aaron Motsoaledi.

The idea is to address the country’s extreme healthcare inequalities, and provide 58 million South Africans with quality health services.

The decision to implement the NHI was taken by majority vote at the African National Congress’s conference at Nasrec in 2017.

Under the NHI, the state will decide on the healthcare services to be covered, according to the Institute of Race Relations (IRR). It will also decide the fees to be paid to doctors, specialists, and other providers; the medicines to be prescribed; the blood tests to be allowed; the medical equipment to be used; the health technologies to be permitted; and the prices to be paid for every item, from aspirins and ARVs (antiretrovirals) to sutures and a CAT scan.

“The NHI is wildly ambitious, and going to take decades at best to manifest,” said one medical expert who asked not to be identified for professional reasons.

“It’s a political promise that may yield some benefits, but it will happen far more slowly and result in far fewer changes than the government is promising.

“There is simply no money for it,” he said. “There is no new money for public health. The only way to raise money is through tax, and you can’t raise that much new tax.”

Alex van den Heever, adjunct professor in the school of governance at the University of the Witwatersrand, described the NHI plan as “deeply flawed” and unaffordable.

He wrote on Politicsweb that the NHI proposal envisaged raising tax revenue upward of 3% of gross domestic product to cover medical-scheme members through a public scheme. “This would be equivalent to a 31% increase in personal income tax or a 63% increase in corporate taxes.”

Another knowledgeable insider told the SA Jewish Report, “I can’t see the healthcare landscape making any substantial changes in the foreseeable future. No one can be forced to join a state-run medical aid – it’s unconstitutional.” The only way the NHI can work, he said, is if the government demands far more tax, but if it had that tax revenue, it would have to be utilised in other more pressing areas.

“Health Minister Zweli Mkhize said there wouldn’t be changes to tax for at least the next three years. How then can the government accumulate enough funds to implement the NHI by 2026?” he asked.

The share prices of private healthcare companies plunged after the Bill was introduced in parliament.

Medical-aid schemes took centre stage, with questions about the future of their business, as well as what kind of cover they would be expected to provide under the NHI.

This is because the Bill is unclear about their role, stating that once the NHI is fully implemented in 2026, medical schemes can offer only “complementary cover” not provided under the NHI.

Discovery said it was seeking clarity on the potential impact of NHI on the future role of private healthcare and medical schemes.

“The Bill creates clear room for interpretation and debate on this issue,” it said, pointing out that it would play a “constructive role” in the debate aimed at achieving a sustainable future for private healthcare and medical schemes.

Discovery Health Chief Executive Dr Jonny Broomberg said, “Our view is that substantially limiting the role of medical schemes would be counterproductive to the NHI because there are simply insufficient resources to meet the needs of all South Africans.

“Limiting people from purchasing the medical scheme coverage they need will seriously curtail their rights, and this could have a serious impact on the sustainability of private healthcare, as well as skills, the economy, and sentiment.

“Crucially, by preventing those who can afford it from using their medical-scheme cover, this approach will also have the effect of increasing the burden on the NHI, and will drain the very resources that must be used for people in most need,” Discovery said.

Another insider said private health and medical schemes were not being outlawed. “Nothing is going to change in the next few years, there are processes to go through. People should just calm down.”

Another told the SA Jewish Report, “Clearly the system is broken, but you can’t turn it on its head overnight, there are processes and vested interests. It’s a massive industry that isn’t going to change without objection.”

NHI is expected to be implemented in full only by 2026 following three separate phases. The Bill will have to go through the normal parliamentary process, which will include a public-participation phase. This might inform some changes before it is put before the national assembly for a vote. If the assembly passes it, it will be referred to the national council of provinces (NCOP), and then to the president who must sign it into existence.

Those in favour of the NHI say the plan will address the massive inequalities faced by the majority of South Africans seeking access to quality healthcare. Those against it cite the enormous cost implications for the taxpayer, the impracticalities of its implementation, and the country’s justifiable fear of state-run enterprises. Add to that the fear that the NHI will not fix the already strained public-healthcare system.

They also argue that it will ruin successful private medical services, and result in a medical brain drain, skills deficit, increased taxes, and lower healthcare standards.

According to the Democratic Alliance (DA), the Bill in its current form threatens not only to collapse the county’s health sector, but places the entire economy at risk.

Jack Bloom, Gauteng DA shadow health member of the executive committee, said the NHI was scaring a lot of people in the industry, and questioned whether President Cyril Ramaphosa was playing to the political gallery.

“The economy is in the doldrums, there’s no extra budget for it, the government mismanages everything it touches. It’s really misinspired and dangerous.”