EDITORIAL: Mkhize’s recipe for ruining health care
NHI has remained a noble pipe dream stymied by unachievable ambitions and a funding requirement quite out of reach for a bankrupted country
Even in a country desensitised to bonkers ideas, the mutterings of health minister Zweli Mkhize about SA’s plans for National Health Insurance (NHI) were hard to stomach. For years, NHI has remained a noble pipe dream stymied by unachievable ambitions and a funding requirement quite out of reach for a bankrupted country.
Consider the maths. This year, the government allocated R222.6bn to health care. Most of the budget was earmarked for salaries. And yet NHI, by the most conservative estimates, would cost more than that entire budget. It’s a staggering sum — especially when we don’t know yet whether NHI will work.
Speaking last week, as he revealed the results of 11 NHI pilot studies, Mkhize seemed unchastened by the unconvincing findings. Though the pilots cost more than R4bn, a team evaluating the project said they couldn’t conclude it had improved the health of residents in any district where it was trialled.
Yet Mkhize was adamant: NHI is going ahead — damn the obvious glitches. This is why, last week, an NHI Bill was delivered to parliament.
When pushed on how exactly it would work, Mkhize revealed a disturbing underpin for NHI: the government will bar people who have paid for private health care from seeing specialists, unless there’s a compelling reason. "It is not my right to see a specialist because I can afford it. It is a distortion of how the system should be working," he said.
For Mkhize to begin dictating what medical care you can buy is a slippery slope.
It’s hard to disagree with the Capitalist Party, which argues that it would be outright tyrannical to vest responsibility for deciding who gets critical health care in the people least qualified to make that call: state bureaucrats.
Here, it’s difficult to see too many scenarios in which doctors, nurses and specialists are not encouraged to flee, rather than work in a system held together by a strip of plaster and noble intentions.
During last week’s briefing, Mkhize was visibly frustrated by the questions about the role of the private sector. "Some people say NHI is unaffordable. What is unaffordable is the rising cost of [private] care," he said. He stressed that the public health sector is riddled with corruption and must be fixed.
Now, Mkhize is right that medical aid is increasingly unaffordable. But the government isn’t paying for it — taxpayers who are already paying for the crumbling public system are then paying again for private medical aid out of their own pockets. Why pay more, if the government can’t be bothered to fix what it has?
Mkhize’s unconvincing answer is that the rich should subsidise the poor in the new scheme.
Here again, he gets it horribly wrong. For a project as immense as NHI, you can’t get away with just extracting more from the rich — you’ll have to plunder the middle class too. Rough estimates by finance gurus suggest that NHI could add at least two percentage points to personal income tax, or it would have to be funded by another hike in VAT. It’s risky to think citizens will just calmly accept this.
And, as it is, the wealthy and the middle class already subsidise medical treatment for the poor: where does Mkhize think the R222bn that goes to SA’s public hospitals comes from? In theory, that tax money should buy a thriving public health sector. In practice, it buys a dysfunctional system where theft of resources, crippling inefficiency and accountability-free hospitals are the order of the day.
But marshalling private sector resources into fixing that won’t produce a better result, because this isn’t a money problem. It’s a management problem. Until the government takes a harder line with public sector trade unions, and begins firing people who are incompetent, it won’t get value for its R222bn, or however much it throws at the problem.
Perhaps Mkhize knows this. Perhaps he’s just invoking the politics of desperation by launching a kite that has little hope of remaining in the sky. But abdicating responsibility, and asking the private sector to fix what he won’t, means NHI is doomed to fail.