Jonathan Broomberg. Picture: SUNDAY TIMES
Jonathan Broomberg. Picture: SUNDAY TIMES

What role will medical aids and private health care have under the proposed National Health Insurance (NHI) plan? And can the stretched middle class take yet another tax? We asked Discovery Health CEO Jonathan Broomberg if he thinks there will be a major new cost for South Africans.

I think that most economists would agree, I hope, with what I’m about to say: we’re in a period for this country, which sadly lasts quite long into the future, of tremendous fiscal constraint.

Not only is there no real capacity to raise new taxes, but what we need, to ensure that we are not in the arms of the International Monetary Fund in the next few years, is to retrench public expenditure and not increase it. Even if the ministry of finance and the National Treasury determine that there’s space for more taxes in the next few years, I can’t imagine that the first call on new tax revenue is a new health budget.

Surely it is settling debt, settling Eskom’s debt and stabilising the state-owned enterprises.

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That’s a rational response, but there seems an intent to drive NHI through, which is palpably at odds with our financial reality.

Looked at purely rationally, sometimes it’s hard to add everything up.

We have to take seriously that the people talking about this are politicians; a very serious promise has been made and I do think what you’ve seen with the new minister [Zweli Mkhize] is a minister who says we’ve been talking about this for 10 years, let’s get some action going.

But that doesn’t mean that every single thing that’s been said will be implemented willy-nilly. Reality is going to constrain what can actually be done.

Do you have to play a political game to have the ear of the health minister? John Kane-Berman, former CEO of the Institute of Race Relations, has urged the private sector to oppose the bill in its entirety, for example.

No, to be very honest it’s not a diplomatic game that we’re playing here. We understand that there’s tremendous inequality economically in our country and that’s reflected in health care as it is in many other areas.

We understand and support that a democratically elected government feels it critical to tackle that, and over a long period of time it has come up with a particular policy approach to health-care reform.

Certainly, if one wanted t

o rewind the clock there are other ways to do this. But our view is, this government has selected this pathway and we should put our shoulder to the wheel and make it work.

Now, those who criticise it root and branch, we think it’s a pointless exercise, it’s tilting at windmills. It means you do not ever participate in the debate, you’re labelled as an enemy and you’re outside the discussion. So our view is, don’t tackle the entire thing at an existential level, actually try and make it work. So we’re going to work as hard as we can to get the improvements the public system definitely needs, but then to optimise the bill, remove its most damaging provisions.

You say there are other ways to do it? The quality of public health care is mostly terrible — how would you have gone about fixing those problems rather than going with the NHI Bill as it is?

Well, I think those two are not mutually incompatible.

So the NHI bill talks about some big changes — both new money, if that’s possible, but also changing the way money flows into the system. And there’s a lot of evidence from other health-care systems that when you create a split between the purchaser — the fund — and the providers — the doctors and nurses — that, well implemented, can introduce transparency and accountability. So there’s nothing deeply wrong with the basic idea at all.

Is our biggest problem in public health care not simply bad management, rather than lack of funds?

Agreed. I do not think throwing more money at the public sector today would make any difference. Certainly, there are many posts frozen, and if you could employ more doctors it would make a big impact. But the fundamental problem is management, governance, corruption. What I hear from the new minister is a lot about let’s fix the public sector, so it’s not one or the other. Our view is use the energy around this NHI to drive change.

What are medical professionals saying?

This worries us a lot because there is tremendous anxiety among the doctors we speak to. There is chatter about leaving. And I think that filters all the way down: young kids now may, at the margin, not go to med school and those coming though med school may have more consideration about leaving.