KAMOGELO MMAMABOLO
It has been 1 year and 5 months since President Ramaphosa signed the National Health Insurance (NHI) Bill, with the prospects to improve the South African healthcare system for “all people to have access to full range quality health care, when and where they need it, without financial hardships”. Divided into two phases to track its effectiveness, come year end half of its first phase will be completed though to date a little to nothing has been done for effective implementation of this bill.
The country's citizens hoped for better public healthcare but their hopes were dashed. Just recently it was reported that the late South African gospel icon, Solomon Majafela Molokoane, popularly known as Solly Moholo suffered a stroke and multiple organ failure, on August 25, 2024. According to his family, they were left with a financial burden of about R700 000 in medical costs for a private hospital and about R90 000 for a public hospital. This prompts one to ask whether this bill is a genuine effort made by the government to address medical disparities or it is just one of the government's illusionary initiatives? The late singer and other victims could have benefited from decent health care provided under the NHI. Such issues are alarming given that during the festive season, the public health system is under strain due to the high number of accidents, as most people cannot afford private healthcare.
Did the ANC introduce the bill as a campaign tool to lure voters amid the decline in voter confidence before the 2024 provincial and national elections? Considering that the limping ANC received less than 45% of the votes in the elections, the bill could be described as a Keynesianism Act to save the party.
Keynesianism is a political and economic strategy by capitalist states which aims to reduce the extreme effects of capitalism, which results in socio-economic inequality in the country. Given that South Africa is a capitalist state as its major economic blocs are owned by a few elitists, this deepens inequality as selected few become richer while the majority persist in conditions of poverty. The failure of the ANC-led government to address the socio-economic inequalities emanating from the apartheid has encouraged the government to now use the Keynesianism strategy. The interventions come in the form of social welfare programmes like the NHI which can be viewed as a nationalist element incorporated in capitalist states to avoid resistance by the poor majority.
It remains to be seen if the Bill will ever be implemented, particularly under a Government of National Unity (GNU) with too many cracks and uncertainties. The leading parties in the GNU, the ANC and the DA are engaging in constant battles over the direction that the country should take both at home and abroad. The leading figure in these battles, the DA’s Federal Council chairperson, Helen Zille, is accusing the ANC of sidelining her party in many policy issues both at home and abroad. The deepening ideological differences between the two parties saw the DA distancing itself from President Cyril Ramaphosa’s pronouncement of Russia as an ally to South Africa.
Given that the NHI Bill is grounded on the ANC socialist approach relative to the DA’s capitalism preferred policies, the implementation would be difficult. However, the citizens' needs and interests should take precedence rather than the parties' policy outlook. Parties represented in the GNU should promote and implement the policy as part of improving the deteriorating public health services.
Turning to the ongoing challenges, the NHI Bill highlighted that it would cater to all those living in South Africa. However, it overlooks the existing issues such as the strain brought by unregistered foreign nationals on the country's public health facilities pointed out by former MEC of Limpopo Dr Phophi Ramathuba. This cannot be ignored and it shows some of the things that the bill has failed to consider. If the bill will cater to everyone in the country, how will the government deal with the conundrum of unregistered foreign nationals? Are undocumented foreigners going to access the NHI-funded health facilities? If so, how is the government going to make a sustainable budget for the undocumented population? It is not far-fetched that the budget will fail to cover the much-needed health needs of the eligible poor South Africans.
The pressure will be on the already burdened taxpayers who serve as the de facto funders of the government initiatives including the proposed NHI. Given that 40% of the country’s working-age population is unemployed, the government would increase taxes and overstretch taxpayers. The government ought to plan thoroughly for this bill. In view of the above, the NHI is a good initiative to address socio-economic disparities. This requires the government to build health infrastructure in rural areas and deal decisively with endemic corruption. Without addressing this and other challenges mentioned earlier, the NHI could reflect another bloated and incompetent government, now the GNU. Parties in the GNU should speak in one voice and priorities the needs of South Africa rather than being drawn by political egoism.
Kamogelo Mmamabolo is with the North-west University, Mafikeng Campus.
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