The government’s attempts to push through a politically attractive health plan are being shot down. Pat Sidley reports
THE government’s controversial plans for a national health insurance scheme face a determined challenge from several influential quarters.
A crucial meeting on Monday will determine the nature of an inquiry into the plan, who will join the inquiry, and whether the government can count on the co-operation of some of its most qualified health experts.
The health insurance plan which the government favours was rejected by a finance committee set up by the Department of Health to examine options and make recommendations to the government. The committee had put forward other options for consideration but those appear to have been dumped without further inquiry in favour of short-term political expendience.
What the department apparently wanted was a quick, politically attractive, apparently simple insurance plan available to the electorate — a good vote-getter in an election year which is bound to be fraught with economic problems.
Now, however, the department has been forced to backtrack significantly, and faces the possibility that several of its appointees to the new inquiry will resign if the terms of reference are inadequate. The department has placed a gagging order on its own employees until the issues have been finalised at a meeting on Monday of the “implementation committee”, a group of foreign and local health experts.
To reduce the criticism, the implementation committee needs a broad frame of reference with several options to consider and a much longer time for the debate to be adequately aired.
The committee was to have been chaired by health consultant Dr Jonny Broomberg, but a “co-chair” has emerged: Dr Olive Shisana, the special adviser to the minister of health.
The plan the department favoured had been put forward by Australian health economist Jonathan Deeble, who will be at the meeting. If implemented, the plan would require a payroll tax to fund it and would effectively force all general practitioners into the system wherein the state would pay a flat fee per patient.
The plan appeared to offer both equity and simplicity — a requirement of the department — but has been severely criticised by health-sector experts who are normally seen as supportive of the ANC and who believe there should be some sort of national health system funded by some kind of insurance scheme. It has also attracted vociferous criticism from private-sector representatives who would normally oppose any form of national health system.
In the past month, since the Weekly Mail & Guardian disclosed the “Deeble plan”, the department has gone through several large changes and about-faces:
* In December, Shisana told the WM&G that the process needed at least a year, or perhaps longer, for discussion and debate, as the issues were serious and required major changes. She said a parliamentary debate would be necessary.
* At that stage, the department had received a report from its finance committee which had looked at three options for insurance plans and had roundly rejected the Deeble plan. However, it was known that Shisana and Health Minister Dr Nkosazana Zuma favoured the Deeble option. But so little canvassing had taken place that the director general of the department, Dr Coen Slabber, did not know of Deeble or his plan.
* Key members of the implementation committee were apparently unhappy at the possibility might consider only the Deeble plan instead of canvassing several options.
* Early this week it appeared the department had indeed decided on the Deeble plan without the necessary discussion, debate or transparency. Shisana had become committee co-chair, apparently without key members’ knowledge. And, most significantly, the process had been truncated from what should have been a year into three months. This drew threats from several committee members who threatened to withdraw if the terms of reference were not altered and the timespan made significantly longer.
* By late this week, with criticism mounting from health- sector experts, including several within the ANC fold, the department appeared to be listening. It seemed probable the committee would be broadened to include one or more of the experts who had helped the ANC draw up its early health proposals. The department has declined to give any further information, however, until a decision is made as to how the process will be taken further.
Meanwhile, the air of fear and loathing around the department appears to have intensified. Although the WM&G received its information from several reliable sources, all expressed some fear of retribution for speaking out if their names were in any way drawn into the process.