Star / Pretoria News
17 June 2009
Fikile Majola

Government is preparing to publish the Green Paper on the National Health Insurance (NHI), and as NEHAWU we welcome the fact that it will invite all South Africans to engage with the policy. Let those presumptuous “respected experts” who actually are lobbyists of vested interests, come out of the shadows and transparently table their own alternative proposals that can meet the constitutional imperative and deal with the systemic crisis in our health care system. The likes of Dr Jonathan Broomberg, the head of “strategy and risk management” at Discovery Health and the Neoliberal ideologue Alex van den Heever purport to support the objectives of the NHI whilst over the past few weeks they have effectively been arguing in defence of the status quo.

It may be surprising to many of us as to why a select group of individuals have been given so much leeway in the commercial press, including the extent to which they have routinely vented personalized vile against the new minister and some members of the ANC task team. But, other than these extremes to which they are prepared to go, we are yet to see coherent alternative policy proposals from their part, shorn of the condescending “danger” warnings that they have been putting out against the NHI. The disjointed proposals that they have been putting forward merely seek to tweak aspects of this iniquitous two-tier health system, whilst maintaining the inefficient, wasteful and unsustainable private health care industry intact. Perhaps as a starting point in an attempt to understand the agenda of this lot, it may be advisable to heed the council of no less than Adam Smith himself, in reference to business lobbyists, that their proposals: “ought always to be listened to with great precaution, and ought never to be adopted till after having been long and carefully examined, not only with the most scrupulous, but with the most suspicious attention. It comes from an order of men, whose interest is never exactly the same with that of the public, who have generally an interest to deceive and even to oppress the public, and who accordingly have, upon many occasions, both deceived and oppressed it.” Need we say more, who could know them better!

Apart from their deliberate falsifications of the draft NHI Plan, the “series of articles” churned out by this coterie of business lobbyist are merely organised around five themes:
•    Firstly, it is an attempt to impugn the ANC’s right as a party in government to develop a draft policy to give effect to the broad mandate and support given by the overwhelming majority of the South Africans, before it is published for engagement in the public domain. Perhaps, this may be a hang-over from the recent past when Neoliberal consultants such as van den Heever, were given some leeway to come up with policy directives that effectively vetoed democratic mandates of the voters – with the interests of their paymasters in mind;

•    Secondly, they claim that the woeful state of our health system and its poor outcomes are merely a function of underfunding in public sector. Thus, we are told that “the most fundamental problem ailing our health care system is the failure of the public health care sector to meet the health care needs of citizens”, without even a commonsensical recognition that this is an outcome of the skewed pattern of the distribution of resources. So, despite the fact that the private health sector consumes about 60% of the resources whilst catering for no more than 16% of the population, what they find wrong in is the public health sector itself rather than this irrational pattern of the distribution of resources in which it is burdened with 42 million people with less than 40% of the resources;
•    Thirdly, they argue that South Africa has “a sophisticated and world-class private health care system which should be seen as part of the solution” and therefore left alone. Yet, Broomberg himself admits that for its survival this “world-class private health care system” depends on a staggering “R13 bn provided by the National Treasury as a tax subsidy” which no other health system enjoys. Gavin Mooney, a visiting Australian academic at UCT has this to say on this matter, “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 monstrous.”

•    Fourthly, they resort to the threadbare scare-mongering tactic, typically deployed by the DA with which they are in alliance against the NHI, of making wild claims that the introduction of the NHI is going to cost about R497 billion to the taxpayers. They do not even have the honesty of admitting that this figure is a thumbsuck based on the unsustainably inefficient and wasteful cost structure of the private health industry in SA. Between 1994 and 2007 whereas inflation averaged 6% annually, private health costs increased by 15%, yet service provision has been deteriorating in the private health industry.
•    Fifthly, they pretend as if their arguments and criticism of the NHI are without class interests, and that they are not ideological, describing themselves as “those in the know”, whilst deluding themselves in believing that they could discredit the work of the ANC task team just because it has broadened participation to include “unionists”. Well, in so far as our constitution treats health as a basic right, whilst for the DA, Broomberg and van den Heever in their support of the private health industry health is a commodity and the sick are a market. Therefore, as far as we are concern their “expert” views are very much political and ideological, not least because they have already feverishly come out and stopping at nothing in attacking the draft policy and in defending the historical skewed pattern of resource distribution in our health system even before it is published.
So, in a nutshell what is the status quo that these business lobbyists are defending?
•    Whilst claiming that the NHI is a ‘rich-country’ solution, they choose to turn a blind eye to the fact that our total health spending is so high that it is even favourably comparable to other rich countries – at more than 8% of the GDP. So clearly, the NHI is affordable for South Africa. But, on the other hand we find that the overhead cost of the private health industry is more than twice that of rich countries with publicly administered NHI. For example, administrative costs in private health account for 23% of all health care expenditures in South Africa, in comparison to only 3% in Canada’s publicly administered health care system. In fact, only about two-thirds of medical aid premiums are spent on health care, the rest is wasted by the huge bureaucracies that duplicate each other, including needless things such as advertising, etc.
•    Whilst they strangely claim that “the South Africa’s health sector has much going for it”, therefore there should be no fundamental change; in 2007 the World Health Organisation ranked our health care system the 175th best of 191 countries and last among 17 middle-income countries.
•    Whilst they strangely claim that the problem with the public health system is “its failure to use our scarce public funding efficiently and appropriately”; they would not explain how so, when it is common knowledge that already the public sector has limited resources. In 2007, public sector spending was R1, 423 per person compared to R8, 321 per person in private medical schemes.

•    Whereas in 1994, the private health industry covered about 20% of the population, mostly white, since then it’s been on what appears to be a terminal decline as its costs continues to escalate such that today no more than 16% of the population are covered. Hence, 17% of the population are now forced to use out-pocket expenses for their health care.
The proposals of these rearguard Neoliberal lobbyists such as van den Heever merely amount to measures “identifying correctable systemic failures of the public system, none of which involve changing the funding approach to that of insurance”. Whereas NEHAWU and the broader South African public who have endorsed the transformation of the health system as one of the government’s priorities, are determined to ensure that the NHI is implemented. This transformation in our health system that will ensure that there will be a universal, comprehensive, free national health care system founded on the primary health care approach. Thus, it will be state-mandated and state-administered system ensuring that all persons, irrespective of their financial status have free access to health care at the point of service.