Regardless of what may happen with embattled health minister Zweli Mkhize — a Special Investigating Unit (SIU) probe into the irregular awarding of a R150m Covid-19 communications tender is in play — the proposed National Health Insurance (NHI) is a doomed, flawed concept.
No matter which minister, panel of bureaucrats, or political party happens to be in charge if the NHI ever becomes a reality, the fundamental problem with the idea is the assumption that the management of all health care should be in the hands of the state.
The NHI bill makes provision for the establishment of a board to govern the NHI fund; the board “consists of not more than 11 persons appointed by the minister”.
Despite arguments that the NHI will not fall prey to corruption, these kinds of provisions will only increase the possibility of abuse, political deal-making and favouring people in and outside government with the necessary connections. Over the last 10 years South Africans have seen precisely what happens when the state and economy become intimately intertwined, and the devastating effects of state capture (and looting even during the Covid-19 pandemic) have been felt most keenly by the most vulnerable citizens.
The NHI will simply add layer upon layer of bureaucracy on to the public health-care sector — rendering it more inefficient and opening further avenues for corruption — while failing to address the serious problems in this sector.
In terms of the most pressing problems, see the steady collapse of the public health systems in the Eastern Cape and Gauteng, and the NHI does not go any way towards actually fixing the public sector. The system will also subject the private sector to even more of the stifling red tape of the state, and does not take seriously the recommendations of the health market inquiry.
At any given point it should not matter who the minister of health happens to be; that person should never possess the kind of discretionary powers the NHI will grant.
Free Market Foundation
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