The NHI: Get rid of corruption and maladministration before asking me for more tax

A few years ago, the then Minister of Health, Aaron Motsoaledi, revealed his plan for a National Health Insurance (NHI) at a press conference. When asked how he was going to fund it, he responded that financing wasn’t his problem. He explained that it was his job to present the plan to cabinet. If they agreed it was then their problem to find the money.

This set off major alarm bells for me. It was clear that an NHI would cost billions. Billions, which given the state of the national fiscus, South Africa could ill afford. So, the question was always: “Where would the money come from?”

Well, now we know.

Last week Nicholas Crisp, the deputy director-general for the NHI, told parliament that they would use surcharges on personal income tax, payroll tax, and reallocating funding for medical scheme tax credits.

Let me make it VERY clear from the start. Our public health system is a shameful disaster, which needs to fixed. It is simply unacceptable that so many people in our country, either have no access to good medical care or have to settle for substandard care.

However, it seems to me that those (the very small percentage) of us who are paying taxes are being screwed (pardon my French!) yet again for the mess-up of the government and, particularly, the various health departments.

The NHI is a noble initiative. However, I have lived in two countries (the UK and Ireland) where they have a form of National Health and despite overflowing state coffers and decades of experience, these health systems are still struggling.

There is a lot that we can learn from especially Ireland, but it is important to note that they had to introduce a dual or mixed system of private and public health systems.  Many (if not most) people have some form of private insurance, which takes some of the burden off the public system.

Still, people often have to wait months or years to get urgent appointments or surgeries in the public system. The same is true in the UK. Having just spent two weeks in the UK, I am acutely aware of the frustrations people have with the NHI. Time and time again, I have heard people say: “It is broken.” In fact, while I’m writing this there has been a report on BBC of women with serious gynecological conditions having to wait up to 18 months for surgery.

Why on earth do we think we have the resources – both human and financial- to do better than these two countries?

Our health system was of course badly skewed under Apartheid and was never fair to the majority of people. However, in recent years our public system fell apart - not because of more people accessing it, but through corruption and mismanagement.

We are all aware of the Digital Vibes scandal that rocked the Department of Health and led to Minister Mkize’s resignation. To that, we must have also add all the COVID protective gear tender corruptions.  Let’s also not forget the Esidimeni scandal, where 144 patients died.

Earlier this month, it was reported that the acting head of the Free State Health Department was back at work after R5000 bail was granted to him. He and 10 other officials are facing charges of fraud, corruption, forgery, and money laundering amounting to R8,7 million. This while most public hospitals are barely functioning in that province.

It is also well known that every year recently qualified medical students wait months to get placed for their obligatory three year public service – this, despite enormous shortages of medical personnel in public hospitals.  

I can go on and on.

It is well known that South Africa spends more money on public health than any other African country. Yet, as many reports have shown, the outcomes do not correlate to the money spent. As one report by BMC Health Services Research puts it: “Since the advent of democracy, the South African government has been putting charters, policies, strategies and plans in place in an attempt to strengthen the public health system. However, public programme performance and outcomes remained poor while the burden of disease increased.

I have no reason to believe that this will change under the proposed NHI.

What is even more troubling is that according to the Bill that was tabled in Parliament, it seems that medical insurance would no longer be able to provide cover for services that are to be paid for by the NHI. The Bill does not clarify which services will be covered by the NHI, but I would assume that it will eventually be similar to the Prescribed Minimum Benefit list (a list of 271 serious medical conditions that medical aids have to cover in full). 

That, however, means that it will force everyone into the public system when it comes to these (yet unlisted) conditions. That seems ludicrous.

What really concerns me is that the government through this plan would break down the private system (which would lead to the loss of many world- class health care practitioners), only to (almost certainly) discover that the new initiatives aren’t working.

And we will pay for it.

Those of us who are already spending a fortune on medical insurance will lose our tax credits, lose our access to private health care for certain conditions and pay more tax in order for the government to try and fix a problem that they largely created.

The public system has to be fixed, but not by destroying the private health system and taxing the tax payers to death.

I am willing to pay more tax for everyone to get better health care, but only if I know it won’t go into the lining of the pockets of administrators and officials. So, Minister/s fix the corruption and maladministration, whilst leaving private care intact before you ask me for more tax.