EDITORIAL: Riding roughshod over NHI critics just won’t work

Doctors and other healthcare professionals do not want to be told where to work. They want the freedom to choose whether to apply for a job with the state or set up an independent practice, be it in their home town or further afield, and they want to be sure that once they have established a business and set down roots they can stay put for as long as they wish.

They have thus fought tooth and nail against the health department’s attempts to control the geographic spread of health establishments, as have private hospital groups, which do not want to be instructed by the government where to build new facilities or add extra wards.

They won an important legal victory last week when the Pretoria high court scrapped the National Health Act’s Certificate of Need (CoN) provisions that say healthcare establishments must obtain permission to operate in specific geographic localities on the grounds that they are irrational and unconstitutional. The judge found the CoN trampled on many many rights, including the rights to human dignity, freedom of movement and residence, to choose a trade or profession and not to be  deprived of property arbitrarily.

The judgment still needs to be confirmed by the Constitutional Court and does not directly affect the National Health Insurance (NHI) Act, but nevertheless has important implications for how the ANC goes about implementing its ambitions for universal healthcare coverage.

Not only does it challenge the kind of central planning that is core to NHI, but it highlights the dangers of trying to impose an authoritarian intervention without paying heed to the views of key actors.

The previous ANC administration rode roughshod over the opinions of doctors and private hospitals when they voiced concern about the CoN, and instead of figuring out a way to provide them with incentives to operate in underserviced areas, it went all stick and no carrot. It took a similar approach in driving the NHI act, largely ignoring public input and dismissing parliament’s legal advice that it was unconstitutional.

Now that the ANC no longer has an outright majority and is governing in partnership with parties that voted against the NHI bill when it was before parliament, there should be an opportunity for a more moderate approach to NHI. Unfortunately health minister Aaron Motsoaledi, back in the portfolio after a five-year stint at home affairs, is hardly in conciliatory mode.

In stark contrast to President Cyril Ramaphosa’s opening of parliament address last month, in which he expressed confidence that the government could bring stakeholders together to resolve their differences on NHI, Motsoaledi is breathing fire and brimstone.

He issued a seven-page midnight screed in response to the CoN judgment, comparing media reports that it threatened NHI to the malign work of the Bell Pottinger PR agency during the state-capture era.

It is worth remembering that polling by the Social Research Foundation before the May 29 election saw a marked drop in support for the ANC after Ramaphosa signed the NHI bill. That would suggest many previously ANC-supporting public servants did not look kindly on the threat NHI poses to their medical scheme membership.

Whether Motsoaledi likes it or not, the ANC is no longer in charge and NHI is not as popular as he might like to believe. He would do well to start building some bridges.