Zweli Mkhize. Picture: SUNDAY TIMES
Zweli Mkhize. Picture: SUNDAY TIMES

Health minister Zweli Mkhize has the “silver bullet” for the country’s healthcare woes, the parliamentary portfolio committee on health has said.

This silver bullet, a government-avowed panacea, goes by the name National Health Insurance (NHI). And the newly revised NHI bill, having recently been passed by cabinet, is on its way to parliament for approval.

A leaked report obtained by Business Day this week showed that SA is forging ahead with the NHI scheme despite a lack of evidence about its effectiveness from the government’s multibillion-rand pilot programme. 

This contentious piece of legislation proposes a single-payer fund for the financing of a defined set of healthcare services for every citizen. It also requires that many private sector doctors and service providers are nationalised and bound as contractors at fixed NHI prices within this state-imposed monopoly.

The extensive reform, which will also require enormous tax increases, is touted as bringing about universal coverage and ensuring that rich and poor have equal access to state-managed healthcare.

The overwhelming response to public service failures over the past decade has been a brushing aside of what could have been immediate corrective solutions. Instead, politicians have shamelessly proffered such catastrophes as being justification for the “ever-impending” NHI panacea.

This disingenuous technique of evading accountability, while promising nirvana in the future, seems to have taken root in the health department. There is a firm belief that the silver bullet is on its magical way. Meanwhile, public patients suffer intolerably as innumerable cases of neglect and incompetence endure.

Once government officials only take cognisance of grandiose and ideological future solutions to complex problems, as opposed to immediate pragmatic administrative action, they have to start touting their solutions as silver bullets.

Virtually all first-world countries — the US being the only major outlier — and many middle-income countries have achieved universal coverage that does not rely on the patient’s ability to pay

Politicians, otherwise, get caught up in the banal triviality of pesky inquiries that entail exhaustive explicating. Bothersome and annoying questions, such as: How much will NHI cost? Can our narrow tax base raise enough taxes to fund NHI? Does the government have the clinical and administrative proficiency to operate this behemoth? How will the doctor and nurse shortages be dealt with? How will rampant corruption be averted in what will be the country’s biggest SOE with a budget of hundreds of billions annually. Have any alternative, possibly more viable solutions been considered? To date, none of these crucial matters have been contemplated, let alone vigorously investigated — even though NHI was first posited 11 years ago.

Virtually all first-world countries — the US being the only major outlier — and many middle-income countries have achieved universal coverage that does not rely on the patient’s ability to pay. A key aspect of this analysis is that only two countries globally have solely used a single-payer system to ostensibly achieve this — Canada and Cuba.

Cuba, a totalitarian state that traffics their doctors internationally for revenue, often under appalling conditions, can hardly be considered as an aspirational standard.

The woes of the Canadian health system are well documented: rising costs with deteriorating quality — the inevitable outcomes in any centrally controlled monopolised system.

Multipayer systems

More evidence that centralised single-payer systems do not work, is provided by the much-vaunted National Health Service (NHS) in the UK. The UK government realised by the late 1980s that their then 40-year-old single-payer NHS was not working optimally. Setting aside for now some of Britain’s media-hyped hysteria on the “end of the NHS”, over the past three decades the NHS has undergone a substantial metamorphosis into a multipayer system wherein providers and funders compete for the business of the patient.

There has been improvements in outcomes, reductions in waiting times, and greater patient satisfaction. And, while it is still not the best system available, the improvements in these metrics are revealing. Competing multipayer systems, along with providers competing for the funded patients, achieve superior outcomes at lower costs than centrally controlled, single-payer models.

Amid overwhelming international evidence that single-payer funds are ineffectual, let alone the fact that only two countries currently still operate them, one must question why the government did not consider any other options and why it is so adamant that the NHI single-payer system is the only solution.

Is it the universality of socialist ideology — the proposals sound so laudable on paper that the inevitable dystopia cannot be questioned?

• Michael Settas is a member of the Free Market Foundation’s Health Policy Unit.