NHI Bill ‘calamitous’ all round – experts

As President Cyril Ramaphosa “finally finds his pen” to sign the National Health Insurance (NHI) Bill into law today, medical healthcare professionals – private and public – want to know where the money will come from. Economist Dawie Roodt said it wouldn’t happen.

“Don’t worry, they will try and implement it and it will be a mess,” he said. “There isn’t money. It’s unconstitutional on many levels, and the government won’t be able to implement the Bill. They just don’t have the capacity.”

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Roodt said the moment Ramaphosa signed the Bill he would be taken to court.

“He will get resistance every step of the way,” he said, adding if the president managed to pull it off, it would scare off many health care professionals. “There are too many obstacles,” Roodt said.

Johannesburg-based general practitioner Dr Leon Odendaal said implementing the NHI Bill meant big corporates would gain and the service providers, the doctors, would lose.

“Medical aids, the private sector and patients are going to lose accessibility of services,” he said.

“I’m too old to run away, but will keep my options open.”

The South African Institute of Race Relations (IRR) warned that placing South Africa’s entire health-care system under government control was likely to accelerate middle-class emigration, triggering a calamitous decline in tax revenue.

IRR chief executive John Endres said the NHI concept was badly flawed and posed a grave threat to South Africa’s public finances and economy.

“That the Ramaphosa administration is now pushing ahead with it, while ignoring the constructive criticism and warnings it has received, is concerning,” he said.

“The decision speaks to economic recklessness and a lack of foresight that will impose a high cost on South Africa.”

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Hospital Association of South Africa (Hasa) chief executive Dumisani Bomela said Ramaphosa signing the Bill will show the president and Cabinet have regrettably disregarded their views and advice.

“We sincerely believe the unfortunate consequence is that this version will hamper, rather than promote, access to quality health care for citizens in our country,” he said.

Bomela said Hasa had consistently supported universal access to health care and for years had contributed to research and given expert insight gained from its members’ operations with such systems.

Organisation Undoing Tax Abuse CEO Wayne Duvenhage said the organisation would take a more detailed approach to formulating a possible challenge, if and when the president signed the NHI Bill into law.

“At a high level, it is our view that there is insufficient evidence of a sustainable financial model to make the scheme viable that, in turn, raises a concern of the scheme being a significant threat to the national fiscus.

“In addition, high-level research shows it will give rise to an exodus of critical medical skills. The knock-on effect is a failure of the scheme and the public worse off in the long run,” Duvenhage said.

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Medical expert Dr Angelique Coetzee said the government’s plan for the NHI would most likely take many years to implement, as there was limited scope to funding it with higher taxes.

“The term NHI only refers to funds needed and does not tell us anything about the rest of the services,” she said.

“It’s only a funding model. We all agree the country’s health care system needs reform, but the NHI Bill in its current form is not economically viable. We cannot stress this enough.”

Coetzee said South Africa already had a universal health care system in that everyone was entitled to a limited range of government-funded care.

“But what the NHI will cover is still unclear, and there has been no published attempt of the costing from the national department of health, as required by law,” she said.

“The government has already confirmed that taxpayers will be footing the bill.”

Coetzee said it was impossible in a country with a macro-economy that was slow, very high unemployment levels, diminishing take-home pay, low levels of business and consumer confidence and a declining tax base.