Ramaphosa’s NHI Bill: Political strategy or healthcare catastrophe?

There’s a lot of cynicism in play on the part of Cyril Ramaphosa signing into law the National Health Insurance Bill. Also, some astute politicking.

Put aside the fact that the NHI is uncosted by the Treasury and unaffordable according to experts, including Ramaphosa, who previously publicly expressed doubts that the money could be found.

Never mind that the NHI’s intention is not to supplement SA’s worldclass private health care sector but to dismantle it. And never mind that the NHI’s implementation will take not years but decades.

All that matters to the Ramaphosa is weathering the 29 May electoral test. Fortunately for the ANC, one of the advantages of incumbency is being able to schedule state initiatives to best benefit the party.

Hence the recent rash of public announcements of new government initiatives, most of which have been old initiatives dressed up with a new bonnet.

And hence the presidential playacting.

The slow tease started in February, during Ramaphosa’s State of the Nation, when he joked that what was delaying matters was the lack of a writing instrument: “The Bill has arrived on my desk. I am looking for a pen.”

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Consummate actor that the president is, the build continued during his election-trail walkabouts. “There is a Bill, I am going to sign it.”

The eventual theatrical reveal at the signing ceremony came not with a flourish but a taunt. Those opposed to the NHI, declared Ramaphosa, are “fearful whites” and “well-to-do, rich people … [who] don’t want the have-nots to benefit from what they have been having”.

Fearful whites had been so afraid of blacks having the right to vote that they had hoarded tinned food to prepare for calamity, said Ramaphosa. Instead, “only progress” happened. They had been scared also of the right to strike. Instead, the economy grew “almost threefold”.

The same was happening with the right to universal health care (UHC). Those who were fearful should simply remind themselves of the ANC’s “commitment to build a sustainable, growing nation,” declaimed Ramaphosa.

This is a jarringly dishonest and divisive narrative. First, he is overstating the ANC’s economic achievements. As Daily Investor has pointed out, South Africa’s Gross Domestic Product growth, measured in dollars, is up 175% since 1994.

That’s not only substantially lower than our fellow Brics members Brazil, Russia, India and China, but also our African neighbours.

Second, opposition to the NHI has never been racist or frivolous. One of the remarkable aspects has been the commitment across SA society to a sustainable UHC.

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There have been scores of stakeholder proposals genuinely trying to address the NHI’s disastrous combination of unsustainable costs, lack of professional and administrative capacity. None of these modifications was adopted.

The NHI will now be challenged in the courts by all the major opposition parties and an array of civil society organisations.

Aside from pinning their hopes on a successful Constitutional Court challenge, the NHI’s opponents comfort themselves with predictions that it will take a long time to implement.

It’s a false security. The NHI has been wreaking damage on the country’s health sector long before this week’s signing. The exodus of medical professionals has been growing for at least half a dozen years. This will accelerate.

So, too, will the exodus of the taxpayers upon which the ANC’s grand projects depend. Continued access to top-flight private medical care is non-negotiable to those who canemigrate.

One wonders whether it has yet dawned on the NHI-supporting trade unions that they are set to lose their access to private health care.

They will now be queueing from dawn to dusk to access the already overburdened facilities of the state. When they do, the anger of this very large ANC-voting constituency is going to be something to behold.

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