In a twist of bitter irony, Phala Phala billionaire President Cyril Ramaphosa stood in Parliament and quoted Marie Antoinette’s “Let them eat cake” to accuse his opposition of indifference to the poor. He has dismissed critics of the NHI Act as “haves who don’t want the have-nots to benefit from what they have been having”. This retort echoes the stance of other multi-millionaire pro-NHI politicians and is designed to frame any criticism as a selfish defence of class privilege.
On the other hand, right-wing and liberal opposition has framed the NHI as a totalitarian socialist scheme lifted from the Soviet playbook. This rhetoric has dedicated itself to mobilising middle-class and white constituents on the basis of fear rather than evidence.
ANC has given little clarity
In fact, very little has been said or done by the ANC government to inspire faith in the NHI. Between April 2024 and February 2025, the Department of Health spent R28m on an advertising campaign on highway billboards and social media. But it did little to clarify how the NHI would work or give South Africans workable information. Instead, the ads focused on establishing that healthcare is a fundamental human right and appealing to citizens’ sense of camaraderie and solidarity.
Most taxpayers still have no idea how much it would actually cost them to launch the scheme, what the different phases of implementation mean for them, or even when they can expect to see changes.
Opposition relies on misinformation
Equally damning is the red-scare tactics on the opposite end of the field. Opposition to the NHI has been led by the DA, Afriforum, FF+, the Free Market Foundation and other self-appointed ‘defenders of freedom’. It has depended on misinformation to demand a similar blindness from its constituents. These organisations have put out statements after articles proclaiming that the NHI is unworkable, unaffordable and unconstitutional. They claim that it threatens the future of the private healthcare sector, the autonomy of healthcare professionals and the financial security of taxpayers.
These baseless claims have persisted despite the Health Department’s website explaining that private practices or hospitals will continue to exist as additional service providers that users can opt into voluntarily. In addition, the Constitutional Court has ruled that healthcare workers cannot be told where and where not to work. Regardless, this rhetoric has been especially effective in middle-class to upper-class circles, who have long been frustrated by the misuse of their tax dollars.
Meanwhile healthcare crumbles
While the moral ping-pong goes on, South African residents continue to suffer from a crumbling healthcare system. For most people, access to healthcare is either an exhausting and humiliating experience at the end of a snaking line or an exorbitantly expensive one by way of a stinging debit order. The public sector is drowning:
As of early 2025, there were over 27,000 vacancies in public hospitals—more than 2,000 for doctors and nearly 17,000 for nurses.
In the Free State and the Eastern Cape, vacancy rates in hospitals go up to 28%.
As it stands, South Africa has about 5 ICU beds per 100,000 people in the population, and every single day, a community mourns a preventable death as a result.
Only 14.6% of South Africans are subscribed to a medical aid scheme, and yet in 2024, they still spent R43 billion in out-of-pocket costs. On average, annual beneficiary cover costs about R30,000, but that number spikes for anyone aged over 44 and peaks at R96,000 for those aged 85 and older. This effectively means that there are whole communities who may not afford the simple human leisure of growing old.
These problems require earnest discourse and accountability to resolve. The current rhetoric does more than simply obscure facts with click-baity, under-researched headlines. It has real sociopolitical consequences that are not even borne by those who utter the words from the comfort of their money-stuffed couches.
Accessible healthcare is an ideal worth fighting for, but it must come with solutions to the immediate failings of the system.
The NHI debate should be more than just a virtue-signalling tug-of-war for voters’ brownie points. It should be an empathetic, practical assessment of the material conditions of real people, whose suffering is not merely ideological.
We must resist being dragged into a token battle between haves and have-nots, especially when it is instigated by the have-everythings.
Rea Mmethi is a South African word-weaver and Health Sciences student who writes at the intersection of care, language, and socialist practice. Their work seeks to embed socialist ideology into everyday politics.
*Featured Image by GCIS
