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John Steenhuisen | Why we are going to court to stop the NHI from destroying healthcare

President Cyril Ramaphosa may as well have signed the death warrant of healthcare in South Africa when he signed the NHI Bill into law, and provided the ANC with a licence to loot on a scale that makes their thievery at Eskom look like shoplifting, writes John Steenhuisen. 


Some years ago, a bedridden friend went to Paarl District Hospital in the DA-run Western Cape for double hip replacement surgery. She was deeply impressed by the hospital’s cleanliness, professionalism and “five-star service”. She has been out of pain and back at work ever since.

A visit to any public hospital in the Western Cape will show that the DA is delivering high-quality, taxpayer-funded healthcare services where we govern, despite budget cuts and all manner of other obstacles thrown in our way by the ANC national government. 

The province achieves substantially better health outcomes than other provinces, with zero medical malpractice claims against it, compared with over R80 billion for the rest of South Africa.

The DA is committed to realising the constitutional right to quality healthcare for everyone in South Africa. We have a workable plan to realise this vision, the essence of which is to improve the quality of public healthcare while expanding access to private healthcare. This is the quickest, most affordable route to achieving universal coverage.

Switching lives off 

By contrast, the ANC’s National Health Insurance (NHI) plan will destroy the country’s healthcare sector and any prospects for fixing it.

President Cyril Ramaphosa knows this. Nonetheless, he signed the NHI Bill into law on Wednesday. He may as well have signed the death warrant of healthcare in South Africa, and provided the ANC with a licence to loot on a scale that makes their thievery at Eskom look like shoplifting.

Not content with switching South African lights off, the ANC is now switching lives off, too, to keep the patronage taps flowing and to score cheap political points by manipulating voters into thinking they will get better healthcare.

In response, the DA will file a legal challenge and fight this treacherous legislation all the way to the Constitutional Court, using every means at our disposal.

We invite the SA Medical Association, the Health Funders Association, the Board of Healthcare Funders, the SA Health Professionals Collaboration, Solidarity, the Private Practioners Forum and any organisations or individuals, who wish to mount a legal challenge to this Act, to join our court case. 

READ | ‘Rushed through’: Medical community rejects NHI Bill, doctors threaten to leave SA

NHI will be a state-run monopoly that centralises control of the health budget in the hands of ANC cadres who know and care nothing about healthcare, but who are highly adept at syphoning off taxpayers’ money. 

For a taste of the feeding frenzy that NHI will unleash, recall Ramaphosa-appointed health minister Zweli Mkhize’s heartless looting of public health funds through the R150-million Digital Vibes scandal during the Covid-19 lockdown or the R14.8 billion in irregular contracts for PPE procurement, which cost taxpayers a further R350 million for the SIU to investigate.

By nationalising healthcare, the NHI will destroy South Africa’s private healthcare system and thereby sabotage any chance of fixing our public health system. Doctors and nurses will flee our shores as the sector collapses and their job prospects evaporate. Just this week, nine healthcare associations, representing 25 000 healthcare professionals, pronounced NHI “unworkable”. 

It is estimated that NHI will cost South Africans at least R200 billion more per year, the equivalent of increasing VAT to 21.5%, a figure which would need to rise further as the tax base shrinks through capital and skills flight. 

Depoliticise and decentralise control

It will have a devastating impact on the emerging middle class who have pulled themselves up by their bootstraps only to now be kicked down again through unbearable tax increases and the expropriation of their medical aid contributions.

Nor will it help the 30 million South Africans living in poverty, because it was not designed to serve them. It was designed to serve the ANC elite, who will jet off to Switzerland or Russia for private healthcare in true “champagne socialist” style.

In direct contrast to the NHI, the DA’s approach to achieving universal access is to depoliticise and decentralise control over the health system, with the aim of improving the quality of public healthcare while expanding access to private healthcare.

The private health sector can play a big role in achieving universal health coverage for South Africa. To enable far greater access to private healthcare, the DA’s manifesto pledges to introduce a public secondary insurer for all medical aid schemes. 

This will maintain the private health insurance market, while also achieving the goal of bringing together risks into one larger public insurance fund. This will lower the barriers to entry for new medical schemes into the market, increasing competition and thereby lowering costs, which will make it more affordable for more people.

At the same time as expanding access to private healthcare, we would implement measures to vastly improve the quality of public healthcare. These include strengthening governance by replacing cadre deployment with merit-based appointments and establishing a strong accountability framework to root out corruption and improve service delivery.

READ | Does your party take health seriously? Use this tool to find out

We will improve the management of public hospitals, clinics and other entities by granting them autonomy, subject to the accountability framework. All hospital chief executives will exercise full authority over all aspects of their hospital, including finance, procurement, human resource planning and implementation, and capital expenditure. They will be overseen by a dedicated supervisory board (Watchdog) staffed by professionals who will be nominated, appointed, and removed by an independent authority and not politicians. 

We will improve the quality of public health infrastructure by ensuring all capital expenditure is directly financed and controlled by facility administrators rather than by the public works department. All revenues raised by hospitals, outside of budgeted allocations, will be retained and managed by the relevant hospital and deployed in accordance with their needs.

We will increase the number of doctors and nurses in the public health sector by allocating more funding towards medical degrees to support local skills development in the medical sector, by reforming the internship placement system, by including medical professionals in the Department of Home Affairs’ “scarce skills” list to promote the migration of doctors and nurses to South Africa, by offering two-to-four-year working visas for medical professionals, and by incentivising medical professionals to work in under-served areas in predominantly rural provinces.

This is the most direct, sensible and affordable route to delivering quality healthcare for all within a system that puts people, and not politicians, first. 

– John Steenhuisen is the leader of the DA. 


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