LEON LOUW: Mathematical hooliganism, Dr Motsoaledi? You mean NHI?

Health minister Aaron Motsoaledi has called National Health Insurance (NHI) cost estimates that run above R1-trillion “mathematical hooliganism”. Are they, or is it imposing NHI that amounts to hooliganism? The facts suggest the latter.

Even its name is hooliganism. Instead of providing for health insurance, it prohibits it in favour of amorphous funding of undefined “care” phased in over many years. The costs and benefits of NHI will depend on how ambitious unknowable future ministers and officials might be.

Sometimes current protagonists promise Rolls-Royce healthcare for all, and sometimes inferior care. Rolls-Royce care of the sort funded by medical schemes and insurance would cost at least R1-trillion annually, or half the entire national budget. 

That is what NHI would cost if everyone gets private-quality care. The government promises excellent care for all. When Motsoaledi denies this, he implies that he wants deteriorating care for all. Which of these hooliganisms is it, Dr Motsoaledi?

Incredibly, no-one knows what is intended, or when. The act does not even define “healthcare”. Even the cheapest scenario of R800bn in the Freedom Foundation’s NHI submission would be unaffordable and provide no more than primary care in which all clinics, hospitals, doctors and staff are raised to “ideal” status.

Failure to deliver

The government has promised and failed to deliver this for many years. NHI promises unaffordable costs with minimal benefits for the poor and enormous losses for the rest. At its cheapest and worst, it would add more than a third to the cost of government and private care combined.

What has happened to healthcare in SA since 2000 is actually economic hooliganism, namely deteriorating public care contrasted with world-class private care. Government care has been characterised by neglect, maladministration, corruption, theft and replacing the service ethic with a trade union ethic.

The public sought alternatives such as privately funded care, medical schemes, insurance and alternative, faith-based and traditional care. Since the government opposes what the public wants, it should not be called “public” care. 

The government imposed prohibitions against the popular move from government to private care. Government care lost no funding, and universal access remained. That leaves nothing for NHI to add, apart from improved government care. But NHI means inferior care for those willing to buy superior care. Private care pays taxes for the government to care for those who need it. Instead of celebrating more revenue and reduced demand, NHI seeks to destroy the bountiful benefits of private care. 

Hooliganism includes the perpetual lie that the government serves 84% of the population. Despite this drumbeat being refuted endlessly, it persists. The lie asserts that because 16% of the population have private medical aid cover, then the rest rely on the government. This is manifest nonsense. Part of the obvious absurdity is that not all of the 84% get government care, and all who do get many forms of private care. The government provides less than half of all healthcare.  

The 84% lie is achieved by excluding everyone with insurance (as opposed to medical scheme cover), out-of-pocket, alternative, complementary traditional, Eastern, faith-based, natural, self-medication and other forms of care. 

State care

The World Health Organisation (WHO) reported in 2018 that the government cared for only 72% of the population, which might now be below 70%. Of the remaining population, 16% had medical scheme and 12% out-of-pocket care, a ratio of 72% to 28%. 

According to the 2007 SA Health Review, 75% of the population purchases indigenous traditional care. If unchanged and if traditional practitioners are visited as often as clinics and hospitals, 32.4% of care is traditional. That reduces the government share to 52.5%. With conservative estimates for additional private care such as self-medication, faith-based, Eastern, Hindu, Muslim, organic and other forms of care, the government share tumbles to below 50%. 

The minister and his advisers believe that the money people spend on themselves is available for redistribution as if they will continue paying medical scheme money when forced into government hospitals. It is manifest nonsense.

Many experts have documented the deteriorating government care and facilities. Since NHI will increase the burden on the government, there will be accelerating deterioration, which will be extended to the currently improving private care.

NHI envisages by far the most extreme spending, nationalisation and central planning in SA history. NHI’s architects have learnt nothing from the world’s experience. It exceeds what was attempted in one of the world’s most extreme systems in one of the richest and most advanced countries, the UK.

Inefficient

The British National Health Service (NHS) is facing collapse and is being ratcheted back towards private care. A recent report recommends “Abolish the NHS to save lives”. Similar systems elsewhere are also inefficient and require more investment than available. The SA government will not outperform the governments of the most advance and richest countries given our appalling record by international standards.

NHI advocates are vocal about alleged flaws in the private sector. This is the dirty pot calling the pristine kettle black. How dare they? Were flaws in private care to appear they would be eliminated by competition, especially if the healthcare market is liberalised instead of eliminated. 

The most absurd assumption in the official narrative is that all money now voluntarily invested in medical aids and insurance would become magically available to the government for “full” implementation of NHI one day.

The smoke and mirrors illusion is to add the government’s annual health budget (R281bn) to medical aid spending (R301bn) and presume the total (R582bn) to be at their disposal. Obviously, no-one will pay for care that they are denied. Total healthcare spending will fall by more than half, instead of rising magically to the real NHI cost of well over R1-trillion. 

The government will lose tax revenue, and healthcare will lose private care, along with job losses and retarded economic growth. The real hooligans are Motsoaledi's advisers rather than those providing the minister with rational trillion-rand plus estimates.

• Louw is CEO of the Freedom Foundation. This article was written with consulting statistician Garth Zietsman.