The government will go back to the drawing board on a national health insurance (NHI) scheme, conceding that the quick implementation demanded by the left is unrealistic.
An ANC task team report in February said that an NHI would be funded by mandatory contributions from citizens above certain income levels and by general taxes. It also recommended scrapping tax breaks for medical scheme contributions. Former director general of health Olive Shisana, who led the team, has said the system will be in place within a year.
But when the draft 200-page report was leaked, health experts inside and outside the ANC expressed severe reservations. Positions on both sides then hardened.
Critics of the proposed NHI are ”capitalist vultures which thrive on people’s illness to make huge profits and have to be taught another lesson”, said SACP general secretary and Higher Education Minister Blade Nzimande.
Yet broad support is needed for an NHI to work, said an ANC insider involved in the process. Without that, ”you can’t overcome certain obstacles such as … financing”.
The task team included former Mpumalanga provincial health minister Sibongile Manana, healthcare experts, law professionals and health department officials, including Director General Thami Mseleku.
According to the report the research says its project is sponsored by the Bill and Melinda Gates Foundation, which denies involvement — something Shisana could not explain. ”The ruling party makes policy for the country and this is government policy,” she told the Mail & Guardian. ”I’m not going to talk about who funds it; we are funded by a whole number of organisations.”
The Gates foundation did fund colloquiums on the NHI organised by the Human Sciences Research Council of which Shisana is the chief executive officer, but maintains it has a strict policy of not funding projects for political parties.
A team insider said the lack of expertise among task team members is worrying because ”for something as complicated as the NHI, the more expertise you have, the better. The government has to start from scratch; it needs to take over and come up with a better proposal that can make it into law.”
Said another insider: ”The draft [report] is quite bad. We will need to look for what can be used from that draft.”
The team is understood to have been dominated by Nehawu and SACP members, to whom Shisana was listening, while those who were more critical of the proposals were treated with hostility.
Insiders say trade unions have ”rushed” the process and therefore there was no proper consultation and research.
Nehawu has toned down its demands, saying now it is not realistic for the NHI to be functioning in a year’s time. ”We see the implementation over the next few years,” said Sidney Kgara, Nehawu policy chief.
”There is no place for medical schemes, but there is a role for the private sector, like hospitals and individual practices. We can expect resistance [from medical schemes] because their survival depends on the tax rebate they get from government.”
Kwazulu-Natal Premier Zweli Mkhize, who is chairperson of the ANC’s subcommittee on health, told the M&G that implementation of the NHI would ”take a while” and by the next elections, in 2014, ”we would’ve done quite a lot”.
He emphasised that the revitalisation of the healthcare system, which includes upgrading hospitals, attending to staffing problems and improving management, will receive priority before a NHI fund is set up.
”The private sector must not be abolished,” he added, ”but we must ensure we get collective value for the R110-billion we spend on healthcare.”
‘People are getting nervous’
South Africans have no idea what the ANC’s NHI proposals entail. ”I thought this was just ANC campaign talk,” said Yonela Mbatha, a banker who is a member of the Bankmed medical scheme.
”I wasn’t aware this NHI might actually be imposed on us in the foreseeable future.”
Thandanani Mthembu, who is unemployed and without medical aid, has been following the debate and is keen on the idea of an NHI. But he worries that the lack of public consultation is breeding negativity and will end up dividing South Africans.
”South Africans are getting hot and heavy over this issue because no one understands it well enough,” he said.
Thabelang Mokoena, an auditor who enjoys medical scheme benefits, said he would like to hear what medical aids have to say. ”I suspect they might not be too keen on such a system because it would challenge and possibly kill their industry,” he said.
”The government and the ANC should not continue talking behind closed doors,” he said. ”People are hearing things and everyone is getting really nervous about the future of their health.” — Nosimilo Ndlovu