THE recent pronouncements by deputy health minister, Molefi Sefaluro, indicating that legislation for a National Health Insurance (NHI) will be ready by April 2010 should set alarm bells ringing. This revised timeline makes it patently clear that the ANC government is determined to ram the NHI proposal through parliament with as little public consultation or debate as possible. Clearly the ANC's ideological obsession and political populism is clouding their better judgment on this crucial issue. The timeline indicated by Sefaluro and published on the governments website, can only be described as reckless. Governments approach on this issue is rather like unleashing a bullet train on a journey where the track is not complete and the final destination unknown.
In the United States a debate is currently raging over president Obama's universal health care proposals. Detailed documents are available and politicians from all parties are fanning out across America to debate these with the citizens. The debate may be robust and heated, but it is certainly healthy with both sides airing their views and interrogating these proposals. One would have thought that our own NHI legislation, the most important since 1994, would be subjected to rigorous public consultation but sadly this is not the case. It has been extremely irresponsible for the government to continuously make cryptic public pronouncements on this matter in the absence of concrete policy proposals.
The government appears to have chosen the dripping tap method of communication by releasing information in obscure droplets instead of allowing a free-flow of information. In June this year Health Minister, Aaron Motsoaledi, promised that the documents would "be released within two months" this deadline has long since passed and the documents have still not been produced. The parliamentary portfolio committee on health has only met a derisory eight times this parliamentary session; not a single meeting has dealt with the NHI, arguably the most important issue which this committee should be dealing with. This approach is decidedly disquieting and surely not the mark of a government that is confident about the viability and sustainability of its own proposal?
The absence of concrete information such as, scenario planning, cost-benefit analyses, funding proposals, sustainability and viability has created a vacuum which has been firmly occupied by doubt, suspicion and mistrust.. Government is constantly bemoaning the existence of "misinformation" and "distortions" yet they must bear the full responsibility for these as they are a product of their own clandestine approach on the matter. Instead of promoting discussion, government seems intent on stifling the debate and avoiding the hard questions which need to be answered about NHI. This is further borne out by the blunt threats from cabinet minister, Blade Nzimande, who threatened to "meet the capitalists in the streets" on this matter.
This bluster can hardly be construed as a welcoming invitation from government to engage on the matter! The lack of information has also created a great deal of uncertainty for medical personnel in South Africa .. Our country has already lost thousands of professionals who have left to escape the appalling public health system. Uncertainty about a future for medical professionals under the NHI can only lead to further flight as these professional seek overseas refuge from further government bureaucracy and mismanagement.
A thorough and considered debate on NHI is essential; it cannot be substituted with posturing and ideological bullying. If government thinks the NHI will serve as some magical elixir to cure the ills of the South African health system then they are desperately wrong. Respected medical journal, The Lancet, recently pointed out that South Africa currently spends more on health than any other country on the continent as well as a number of foreign countries yet is one of only a handful of countries where the child mortality rate has steadily increased since 1990. On an almost daily basis the media highlights horror stories portraying the shocking state of public hospitals and the appalling treatment meted out to patients. This clearly points to deep and fundamental flaws in the public health system. It should be a no-brainer that the executive focus must be on addressing these fundamental problems first before rushing ahead with more grandiose schemes. The public health system was once highly regarded by patients and specialists. However fifteen years of ANC bungling and cronyism in the health system have led to a wholesale erosion of confidence in our public hospitals which are desperately short-staffed and under resourced. Energy would be far better spent reforming these problems and introducing private sector efficiencies and even partnerships with the private sector to assist in managing public health facilities.
Government's rush-job approach will not only do the NHI debate a grave disservice but also has the real potential to plunge the South African health-care system into even further crisis. Sweeping promises about free health care and the feted ideological nirvana of the NHI must be tempered by the economic and social realities we face in our country. Instead of pushing ahead blinded by ideology and emboldened by rhetoric, government would do well to take a step back and listen carefully, not only to the industry players, but also to the very people who will ultimately be paying for and utilizing the system.
John Steenhuisen is the DA Caucus Leader in the KZN Legislature and the party's spokesperson for health in the province.
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