Open letter: Do the right thing, Mr President. Don't sign the NHI Bill

9 June 2023

Dear President Ramaphosa,

This open letter serves as an 11th hour plea for rationality and common sense to be used over cheap political tactics.

As you know, the ANC members in the portfolio committee on health recently voted in favour of the National Health Insurance (NHI) Bill, despite overwhelming objections, concerns and questions that were raised – none of which have ever been adequately addressed – from the DA as well as other opposition parties, health stakeholders, general public and even in the form of an adverse legal opinion provided by the independent Parliamentary Legal Services.

Mr President, you would also know that even your own Minister of Finance made it abundantly clear that the country cannot afford the NHI. I can only assume that despite the façade put forward to the rest of South Africa, you and all your ANC comrades know very well that this is the truth. Why else would Health Minister Phaahla and his Department be so staunch in their refusal to respond to even the most basic and reasonable requests, such as requesting that a feasibility study be conducted?

Why else would they all refuse to clarify how the most consequential line item on the country’s financial statements be funded?

The former Health Ombud did not mince his words when his term recently came to an end. Professor Makgoba stated that the ANC government is incapable of solving the public health crisis, likening the Gauteng Department of Health to Eskom, and referring to the respective Departments of the Eastern Cape and Free State as embarrassing and disorderly.

Should the NHI come to pass, health services would collapse. To this day, the Department has never made it clear which health services would be available under the NHI, and which would be out of pocket expenses for patients.

The ANC seems to be labouring under the illusion that South Africans would happily shell out extra money for an already crumbling public health system to be further overburdened when nearly 9 million individuals with medical aids would have to compete for services under universal health care. How can you honestly expect those 9 million South Africans to forfeit their medical aid and then proceed to fund the private health sector without any apparent benefit to them. One day they are receiving immediate medical attention in a private hospital, the next day they are required to travel further away to a public hospital which does not have any beds, sufficient staff and a waiting list of seven years for certain surgeries — it is simply not reasonable.

We can’t even be certain how the taxpayers of South Africa will be funding the NHI because your ANC comrades refuse to provide an explicit answer.

In fact, just by taking away a person’s medical aid will mean that their medical tax savings credit (from having a medical aid) will be removed. The result? Every one of those almost 9 million people with medical aids would now be paying an additional R4 368 of tax every year at a minimum – and this is before any further taxes are levied for the NHI itself.

They also conveniently forget that South Africa already has universal health care. Currently, any individual in need of medical care can go to any public health facility for treatment, either for free or at a nominal fee (this would of course change under the NHI – the Bill excludes asylum seekers despite the constitutional expressly providing otherwise). Private health care came into being due to the failure of the ANC government to provide quality health care. Had the ANC done its job, medical aids and private hospitals would not be a staple in South African society.

Mr President, I understand that the 2024 elections is looming ever closer and that the ANC has nothing tangible to offer the electorate. There is no hiding behind fancy words or phrases, Mr President. We all know that the NHI is a last-ditch effort to fool the public into thinking the ANC actually cares and that despite years of horrendous abuse, this time it will be different.

That this time the ANC will have seen the error of its ways.

That this time you will employ competent CEOs and managers.

That this time you will fill the posts for doctors and nurses.

That this time you will maintain and develop hospitals and equipment.

That this time you will ensure that critical funds are safe from sticky fingers of corrupt ANC cadres.

But we’ve heard it all before.

Mr President, the NHI will bankrupt this country beyond measure, thousands will die and any skilled medical practitioner worth their salt will leave this country for better conditions.

Mr President, my request is simple: do not allow cheap political gain to cloud your judgment. You took an oath to protect this country.

When the NHI Bill inevitably comes across your desk, please, for all South Africans, do not sign it. For once put your country above your comrades – your actions will either save lives or destroy thousands.

Best regards,

Michele Clarke

DA Shadow Minister for Health