Mobilise for health care for all and defeat capitalist greed in the health sector

As the SACP we correctly predicted since the public release of the ANC's Election Manifesto on 10 January 2009 in East London, and throughout our election campaign in support of an ANC overwhelming electoral victory, the capitalist vultures in the private health care sector would leave no stone unturned to oppose the introduction of a National Health Insurance Scheme (NHI) for the benefit of the overwhelming majority of the workers and the poor of our country.

Indeed in recent weeks, reels and reels of columns - written largely by beneficiaries, ideologues and parasites to the highly exploitative private health care and medical aid systems - are regularly appearing in some of the major newspapers of our country.

These capitalist vultures, which thrive on people's illness to make huge profits, have to be taught another lesson, as was the case with the recent April 22 elections. In the run up to these elections, the mainstream media tried by all means to manufacture 'public opinion' purporting to show that the mass of the people of our country will abandon the ANC and its allies, and instead vote for the opposition parties, especially its new-found darling, COPE. Popular opinion, as opposed to the media's 'public opinion' won the day, as our people overwhelming endorsed the ANC with a near two-thirds majority!

It is therefore of utmost importance that we mobilize popular actions and opinion in support of the introduction of the NHI in order to discredit and defeat attempts to yet again manufacture 'public opinion' against a system that stands to benefit the overwhelming majority of our people.

On 2 June 2009, writing in the Cape Times in an article headed "Health reform must not destroy private sector", Jonathan Broomberg, head of Strategy and Risk Management at Discovery Health states that "Proponents of the NHI seem to see the private health sector as the root of all problems, and many of the proposals seem aimed at damaging private health care, rather than improving the public system ..... The fact is, while the private health care system can certainly be improved and made more efficient, it is an effective, high quality, self-sustaining system, funded by the voluntary contributions of the public".

What this capitalist ideologue conveniently fails to mention is the fact that this so-called 'effective, high quality, self sustaining system' is only for the benefit of a tiny and relatively better paid, if not filthy rich, minority of our population.

Of course it is clear why the private sector does not want any interference with its private health care system. From its point of view, there are good reasons for this. But let us set the record straight:

Why the public sector does not do well? What share of the spending on health does the private sector get?

The current system of funding health care in South Africa is a two-tier system which grossly discriminates against the working class and the poor in favour of the rich and propertied classes.

In the words of Minister Aaron Motsoaledi in the recent debate on the State of the Nation address "..... one of the most glaring and obvious reasons why the public sector is not doing well, is what the people who have started engaging are trying their best to hide. This is the manner in which this 8.5% of the GDP (allocated to health) is distributed among the population of our country:

• 5% (of health expenditure) goes to (only) 14% of the population
• the remaining 3.5% goes to the 86% of the population.

"To simplify it in this beautiful country of ours 7 million people (who benefit from private medical aid cover) enjoy 5% of the GDP to take care of their health and a whopping 42 million (who are predominantly poor and unemployed citizens depend on a public health system for their healthcare needs) will have to do with the remaining 3.5% of the GDP."

"A staggering R13 billion is provided by the National Treasury as a tax subsidy. No other health system in the world allows this. Gavin Mooney, a visiting Australian academic states 'on the tax breaks in the private schemes, as seen through the eyes of a foreign health economist, these are not just of monstrous proportions, but it is monstrous."

Our private medical scheme industry is tax-subsidised. Money that individuals or private employers pay directly to medical aids would be classified as "private"-with one important caveat: that many of these "private" payments are subsidised by taxes. The tax subsidy in the form of tax deductibles from medical aid contributions accounts for between R5 and R10 billion or more annually. This subsidy contributes to inequalities in the system. It does not make sense to subsidise the wealthy who largely benefit more from this subsidy. The high income earners tend to benefit more since they are in high income tax brackets than lower and modest income workers.

Despite the above, which the apologists of private health care are conveniently silent about, the private sector insists that government must not interfere with the private health care system!

What happens to the share of the money which the private medical aid schemes receive?

The rising costs of contributions to private medical aid schemes make it unaffordable for many people to continue their membership of private medical aids or to use private healthcare services, let alone the millions who cannot afford to subscribe to such schemes. Medical aid schemes membership grew dramatically during the 1980s-90s, mainly as a result of the gains made by trade unions, but it has declined since. Nor are these schemes prepared to extend their cover to larger numbers of low income people, especially those suffering from ill health.

There are three major companies who specialise in the administration of medical aid schemes. These are Discovery, Medscheme and Metropolitan.

Even the capitalist US is seriously considering introducing some kind of national health insurance scheme, as recently captured in President Obama's speech on 11 June 2009 in Wisconsin. People's Weekly, the official organ of the Communist Party of the USA, captures President Obama's concerns and plans in the following manner:

"President Obama reminded Americans about the necessity of passing health reform as soon as possible. 'We have the most expensive health care system in the world, bar none,, he said. 'We spend almost 50 percent more per person on health care than the next most expensive nation - 50 percent more. But here's the thing, Green Bay: We're not any healthier for it.,

"The president further reiterated his support for including a public option in the final healthcare reform package. 'I also strongly believe that one of the options ... should be a public insurance option,' Obama stated. 'And the reason is not because we want a government takeover of health care - I've already said if you've got a private plan that works for you, that's great.'

"Competition and choices about which kind of insurance consumers have access to is the key reason for including a public option, the President explained. 'We want some competition. If the private insurance companies have to compete with a public option, it'll keep them honest and it'll help keep their prices down.'

"The draft proposals produced by congressional Democrats have included a public option. Early analysis of the Senate concept, which was drafted by the Senate Health Committee chaired by Sen. Ted Kennedy, D-Mass., showed it would provide a choice of private or public health coverage, an employer mandate and a guarantee against insurance companies refusing coverage for pre-existing conditions".

The above example is by no means an attempt to justify the introduction of the NHI on the basis of what the US does, but to refute the arguments of some of the capitalist apologists that such a scheme is something unusual.

By way of example, the administrative costs in the private health sector account for 23% of all health care expenditure in South Africa, in comparison to only 3% in Canada's publicly administered health care system. In other words, almost a quarter of the money paid to medical aid goes to administrators - the 'middle men and women' - who provide no health service whatsoever, but live like parasites on the moneys paid by members of the medical aid schemes.

How much of this money goes to the health practitioners? Out of every R100.00 contributed to medical aid schemes, only R3.00 goes to medical practitioners and a little more than R3.00 goes to the specialists.

Yet the apologists and capitalist beneficiaries from the private health care system still insist that government must not interfere with the private medical aid system!

How efficient is the private health care sector?

The seeming efficiency of the private sector hospitals is questionable and cannot be ascertained as there is little or no transparency about their costs; yet they stridently demand transparency on the part of government.

What we do know for a fact is that in 2006 the breakdown of health care costs in South Africa was as follows:

Total Expenditure - R116.9 bn
By the Public Sector - R57.3 bn
By private Medical Aid Schemes - R59.6 bn

Translated into population figures the picture is even more grimmer:

Total Population - 47 391 029
Population served by the Public Sector - 40 263 686
Population served by the Medical Aids - 7 127 343

The above translates into the following expenditure per person:

Average public sector and medical aids - R2 467
Public Sector - R1 423
Private Sector - R8 361

In the same year, 2006 only R2 645 was spent on each public sector patient, whilst money spent on each medical aid patient was R9 349. The same pattern obtains at primary health care level where only R387-00 was spent on each public sector patient as opposed to R725-00 per medical aid patient. The disparities are even more outrageous when it comes to dental services, where only R65-00 was spent per public sector patient, as opposed to R1 004-00 per medical aid patient.

What all the above translates into is that the richest 20% of the population received 36% of total benefits while the poorest 20% receive only 12.5% of the benefits.

It is a well known fact that it is the poor who suffer from multiple illnesses due to poverty and lack of access to basic services like clean drinking water and sanitation, live in dirty surroundings, work under unsafe conditions exposed to human and industrial waste, do not have a basic education, and many other similar circumstances. The workers and the poor are also subjected to numerous other socio-psychological conditions like stress due to unemployment and underemployment as well as daily exposure to many forms of violence including rape, assault and murder. These are all conditions created by the very insatiable drive by capitalism to maximise profits for a minority at the expense of the poor.

So it is the poorest 25% that should receive 36% of the benefits and not the richest 20% as happens now.

But the private sector still insists that government must not interfere with the private medical aid and health care systems!

Where are the doctors and nurses working?

According to the Health Sector Road Map of November 2008, there is a large gap between the key human resources in the public and private sector.

The figures below indicate numbers per 10 000 people in the population

Doctors
Private - 12.5 for every 10 000 of the population
Public - 2.7 for every 10 000 of the population

Nurses
Private - 56.9 for every 10 000 of the population
Public - 37.5 for every 10 000 of the population

Pharmacists
Private - 12.6 for every 10 000 of the population
Public - 0.3 for every 10 000 of the population

 Hospital Beds
Private - 54.8 for every 10 000 of the population
Public - 37.5 for every 10 000 of the population

Of course the capitalist vultures and their apologists say that government must not interfere with the private health and medical aid systems!

How does the South African Health system compare internationally?

In 2007 the World Health Organisation ranked our health care system the 175th best of 191 countries and last among 17 middle-income countries!

South Africa is 32nd in the schedule of how much of the national income is spent on Health - it is 8.5%

Yet, despite these vast and frankly scandalous inequalities 15 years into our democracy, the capitalist bosses in the health sector are totally opposed to the introduction of a system that aims to reverse these injustices.

The NHI - Accessible, quality and affordable health care for all

Much as we all eagerly await the release of government proposals on the proposed NHI, our understanding is that at the core of such a system is that all South Africans will be eligible to join this scheme, pay according to their levels of income, and ensure that all are covered to receive health care in institutions of their choice, public or private, without any upfront payment. The poor will obviously have to be covered through a new comprehensive social security net which will have to include membership of the NHI.

The SACP is indeed not blind to the fact that one of the key prerequisites for a viable NHI will be the upgrading of public health institutions including hospitals and community clinics. This will have to include training larger numbers of doctors, nurses and support staff for hospitals and other health-care facilities, including the upgrading of skills for community health workers. As part of campaigning for the NHI, the SACP will revive its campaign for an affordable public health system, including the halting and reversal of outsourcing and privatisation of public health services.

A scare tactic is being used by the bourgeois apologists for private health care by arguing that government will have to increase taxes to raise an amount of about R100bn. It might as well be the case, but such taxes will at the very worst be not more than the exorbitant charges paid into the insatiable appetite of the greedy capitalist medical aid schemes, private hospitals and clinics.

Communist cadres to the front... to mobilise for national health insurance for all!

The SACP, together with progressive health unions, health NGOs, and other mass formations, will in the coming weeks be embarking on massive mobilisation and education campaign in support of the NHI and in the process exposing the hypocrisy and greediness of private capitalist health providers wherever they are, both inside and outside our own movement and government.

During the course of 2009 the SACP will be convening thousands of localised red health forums to mobilise our people to roll back the greed of private capitalist health providers and explain the benefits of the NHI to the overwhelming majority of our people. In addition the SACP will be mobilising marches and demonstrations to expose capitalist greed in the health sector, as part of a working class led struggle to secure health care for all.

As we have done in all our other mass campaigns, we are convinced that popular opinion will triumph over a media driven capitalist 'public opinion'! We shall turn our red health forums into the people's popular media in order to roll back and defeat the commodification of health services.

Asikhulume!!!

This article by SACP General Secretary, Blade Nzimande, first appeared in the Party's online journal, Umsebenzi Online, June 17 2009

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