NHI White Paper proposals are simply unaffordable

13 December 2015

The Democratic Alliance (DA) reaffirms the South African nation’s constitutional and ethical obligation to provide all of our citizens and legal residents with “access to health care services, including reproductive health care" and for the state to ‘take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of these rights.” (Bill of Rights, Section 27).

Our initial analysis of the proposals contained in the national government’s National Health Insurance (NHI) scheme, as outlined in the recently released White Paper on National Health Insurance for South Africa, most if not all of which are not new and have been circulating about for two decades now, present some intractable problems that must be solved for the initiative to have any credibility:

The NHI will require a monumental amount of money to run and will be the second largest, after nuclear energy, fiscal risk the nation faces. According to the White Paper an additional R71.9 billion taken at 2010 prices will be required by 2025/2026. To fund it will require additional taxes under circumstances where citizens are groaning under the strain of low growth, unstoppable large-scale plundering of state resources and assets, a growing and unsustainable debt to GDP ratio and spineless fiscal management we expect in the aftermath of Minister Nhlanhla Nene’s sacking, as we hover perilously above junk status ratings.

Centralises decision-making power in structures and individuals who are remote from the day-to-day practical delivery of health services. A highly centralised version of the United Kingdom’s National Health Service (NHS), but without the infrastructure, human resource depth to match, the NHI will be an entity that will both collect and distribute vast sums of money, creating opportunities for corruption and poor governance as is repeatedly demonstrated inability to run state-owned enterprises such as SAA shows. 

By potentially forcing the amalgamation existing medical aid schemes (where the members of medical aid schemes do not agree to do so), appointing pliant trustees who owe their allegiance to the state into positions where they are able to control medical scheme monies, increasing the percentage of funds that must be kept in reserve by schemes, prohibiting some state services from using private medical care and introducing a model that removes the tax breaks for contributions, will give the Health Minister extraordinary powers and create unprecedented opportunity for plundering

To make the NHI work will require more hospitals, clinics, medical doctors, nurses, health professionals and related services which we do not have and cannot get quickly. Presently private medical care caters for millions of members and their dependents and government will be tempted to simply expropriate the infrastructure and skills to cope with the additional load and public outcry if the expectations of the public go predictably unmet. In the world of health it is one thing to build infrastructure. It is quite another to create and plan an adequate pipeline of doctors, nurses and other health professionals.

Failure to find rational, sensible, practical, responsible and progressive solutions to the complex problems associated with what is a breathtaking, high-handed and dangerous effort to socially re-engineer our dysfunctional health system, could easily compromise rather than enhance the access citizens have to healthcare in our country. 

We will carefully study the White Paper to see whether there are opportunities to redesign its core proposals so that taxpayers money is not wasted on a well-intentioned but poorly thought through scheme. The Democratic Alliance will also put its alternative offer – a cheaper, better-run, more decentralized, friendlier and accessible health care system - on the table. There is no doubt that the system needs changing. Let’s get it right the first time we try.

Statement issued by Dr Wilmot James MP, DA Shadow Minister of Health, 12 December 2015