Itís a class thing

by Aug 1, 2011All Articles

editorial10AMANDLA ISSUE 10 | EDITORIAL : The proposal for the establishment of a National Health Insurance Fund is one of the most significant reforms proposed by the ANC since it came to power in 1994. It reverses many years of neoliberal reforms and policies. The proposed NHI promises universal access to healthcare, does a way with user fees at the point of service and proposes that the burden of the cost should be on the rich through taxation and a specific NHI contribution that all people earning above a certain level must make on a sliding scale. It is one of the few reforms that addresses the widening of social inequality that has occurred since the ending of apartheid.
It is worth noting that since 1994 and as a result of capitalist restructuring and the liberalisation of the economy, South Africa has become one of the most unequal countries in the world. Based on the Gini co-efficient inequality has worsened from 0,56 in 1995 to 0,73 in 2005 (where 0 represents absolute equality and 1 absolute inequality.) Moreover the richest 10% of the population have 51% of all income while the poorest 10% share of income is just 0.2%. Even more alarming is the major shift (representing billions of rands) that  has occurred in the share of national income that goes to capital at the expense of labour. Wages in the national income has fallen from 55% in 1994 to 48% today while profits have risen from 45% to 52%.

Inequality in the health sector is just as stark and is expressed between expenditure in the public sector versus private health. The state spends 40% of total health expenditure servicing 80% of the population while private health care expenditure accounts for 60% of the total while catering for less than 20% of the population. The disparity and injustice of the current situation is well captured by the fact that of all the medical doctors employed 70% work in the private health sector serving just 16% of the population.

And yet in face of a huge increase in the burden of disease, partly as a result of the AIDS and TB pandemics, as well of course as a result of the impact of poverty on health, the rich bulk at paying more tax to fund the renewal of the public health system. Nazmeera Moola, Financil Mail columnist captures and represents the hysteria of the empowered classes when she titles her column ëNHI spells emigrateí and goes on to say ëthere are few things that would make me consider leaving SA; NHI in its original form is oneí. Various so-called academics have started to play the numbers game coming up with absolutely ridiculous figures on what an NHI would cost so as to terrify us out of the idea. As Patrick Bond reports on how Pretoria University economist Koch admitted overestimating the costs of NHI to induce a ëwow factorí.

The public hysteria will form part of a concerted campaign to cripple the progressive content of the proposed NHI. If popular movements, trade unions and other forces representing poor and working class constituencies fail to mobilize in support of the NHI it could very well be turned into its opposite, i.e. instead of bailing out the poor it will be made to bail out the struggling private healthcare sector.  But campaigning for the NHI does not mean giving government a blank cheque. Instead it requires ensuring that integral to the establishment of an NHI  is the rapid renewal of the public health care system, employing the 80,000 or so healthcare workers desperately needed, a strategy to redress poor management in the public health sector, addressing the lack of health facilities in the rural areas and curtailing the for profit component of healthcare in our country not least the pharmaceutical industry.

In the opposite policy direction to the NHI stands the BRT, the Bus Rapid Transit system. Rea Vaya, its flagship, was launched with much fanfare by the Johannesburg City Council at the beginning of September. This system, while it aims to improve the publicís access to an efficient transport system envisages this on a privatised basis. However, this privatised-public transport system (confusing we know) will be built and run with taxpayerís money. More alarming is the decision to hand over the operation and ownership to the taxi industry, the defining example of the concept lumpen bourgeoisie. Whereas the soldiers protesting poor wages and working conditions are treated as pariahs, the taxi industry, that has made the lives of commuters miserable and threatened civil war, are treated with kid gloves.

This is because the taxi industry is the originators of black economic empowerment. Capital that has emerged out of the taxi industry has powerful influences in the ANC and other political movements. It is this power and its capacity to disrupt daily life that made Zuma, on the eve of the elections, agree to further engagement over implementation of the BRT. Failure to confront capital since the advent of democracy has ensured that capital calls the shots in post-apartheid SA and the promises of a better life for all remains unrealised. Failure to deal with the taxi industry yesterday is forcing a range of compromises that will have telling consequences tomorrow ñ not just for public transport. Making informal branches of the economy formal must not be a golden opportunity for lumpen managers to formalize super exploitation with the blessing of the state. Instead it should be a golden opportunity for the workers to elevate their position in the economy and increase the value of their labour in the country.

In respect to both health and transport itís a class issue requiring popular mobilisation and solidarity.

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