By Natasha Venter
Taxpayers should be concerned about the recent announcement by Dr Zweli Mkhize, the minister of health, that the final National Health Insurance Act (NHI) will come into effect before March 2020. The implementation of this law will in effect mean that the ruling ANC will have the power to decide what treatment you need, who should provide it and where you should receive it. It is also widely expected that it will result in a shocking tax increase.
The NHI envisages a national, single-paying health system for South Africa that will dictate the service levels, price and scope of healthcare. According to Mkhize, in terms of the NHI, healthcare will be the same for everyone and healthcare workers will be available to provide services on an equal basis. If this intended equal level were of a high standard, the NHI might not have been so undesirable, but the level of public sector healthcare is so appalling that very few facilities will qualify to provide services in terms of the NHI. According to a report by the Health Standards Compliance Office, only five of 696 state hospitals and clinics that were surveyed in 2016-2017 complied with the health department’s norms and standards to achieve an 80% pass rate.
According to the June 2017 NHI White Paper, this scheme will apply to the treatment of cardiology, dermatology, neurology, oncology, psychiatry, obstetrics, gynaecology, paediatrics, orthopaedics, and surgery – including organ transplants. This means that the ANC will be able decide who a woman’s gynaecologist should be, as well as where and by what method her baby should be born. At the primary healthcare level, the NHI will provide, among other things, sexual and reproductive healthcare, the rehabilitation of oral health, and mental health treatments.
This can mean that the state will decide on your behalf what contraceptive you should use, whether your child needs orthodontics or not, as well as whether you really need to use antidepressants. Is this the type of power we want to put in the hands of the state? Especially in light of the distinction the current government is making between races?
Furthermore, about 8,3% of the population will be obliged to fund the NHI for the benefit of the entire country. According to SARS, in the 2018 tax year there were only 4.8 million registered taxpayers, while South Africa’s population figure (during this period) was 57.7 million. When one considers the high levels of poverty, unemployment and this disproportionate small tax base, it is difficult to imagine how a government-funded system of “free healthcare for all” can work in South Africa. South Africans will be obliged to belong to the NHI system and taxpayers will be required to pay for it, even if they choose to make contributions to a private medical aid fund as well. All health revenue generated by the NHI will be paid into a central fund from which payments will be made.
According to a study by AfriForum, the NHI can cost taxpayers up to R446.8 billion a year (and not R30 billion, as Mkhize argues). Yet, the health minister still cannot explain where this money will come from. His only vague answer is that the NHI is the solution to the current lack of funds in the health system. Considers that the health department received one of the worst audits of all the departments in the 2017/2011 financial year, however, it is clear how these deficits in the healthcare sector came about.
For many poor people, the implementation of the NHI sounds like the answer to their current health problems (by implication, the dire conditions in state hospitals and clinics). By the time people realise that the NHI cannot live up to the health minister’s golden promises, however, the health system in South Africa, as we know it today, will already have been destroyed. This is why citizens should oppose this system with all their might and give civil organisations their mandate to protect free market principles.