Tamar Kahn’s report on business’s take on the National Health Insurance (NHI) reminded me of a conversation with a leading businessman in 2018, who said in the wake of state capture that business had recognised the importance of taking a stand for the public good, as a matter of public and self-interest (“Busa asks government to let medical schemes continue under NHI”, May 4).
Its position on the NHI suggests the contrary. The NHI’s underlying assumption is that pooling health spending into one government-controlled fund will produce huge gains in efficiency and health outcomes. The public sector’s record in recent years should be enough to demonstrate the folly of this thinking.
Even health minister Joe Phaahla concedes: “Many of our public health facilities could perform better if it was not for inefficiency, poor management, neglect of duty due to poor supervision, and unfortunately even outright corruption.”
Perhaps describing the NHI as a new state-owned enterprise (for that is what it will be) with a mandate to collect and spend enormous sums of money, would put the matter into perspective and expose the implications.
The damage that implementation of this policy would inflict on SA without a fundamental overhaul of its administrative capacity and ethical culture cannot be underestimated.
Not only does the NHI risk creating space for extensive corruption and rent-seeking, but it is hard to imagine that it will do anything positive for healthcare. Quite the contrary.
Hardest hit is likely to be the middle class — an appeal for private medical schemes to coexist alongside the NHI will mean little as taxes are hiked, making private cover the domain of the wealthy. Expect this to spur emigration, raise the costs of doing business and generally compound SA’s problems.
Business is failing in whatever moral responsibilities it may have (and ignoring the lessons of state capture) by acquiescing in it, and attempting only to bargain a seat at the table and the amelioration of some of NHI’s features.
But business has not challenged the fundamental trajectory that it is setting the country on. For reasons of public and self-interest, it needs to do so.
Institute of Race Relations
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