NHI: A Misguided Attempt at Equality
"HAITU’s view is that the roll out of the NHI must be intentional. We share the concerns of the minister of the parasitic nature of privately owned medical aids and how the private sector has milked state coffers, for the benefit of a tiny (portion of the) population at the expense of the majority of people,” said Lerato Mthunzi, Secretary General of HAITA. She is the wife of Dr. Mthunzi, former CEO of Tembisa Hospital. The remainder of the story is well-known.
Returning to the statement, the line that caught my attention is the following:" … parasitic nature of privately owned medical aids and how the private sector has milked state coffers, for the benefit of a tiny (portion of the) population at the expense of the majority of people". Outrageous? Perhaps. Unhinged? Possibly.
This line is straight from Minister Motsoaledi's talking points. He has repeated it so often that he believes it to be true. But what is the truth? Does anyone care? Is the truth even necessary when you have a narrative?
Here is Minister Motsoaledi himself, Mokone, speaking in front of Parliament regarding what they call government subsidies to private healthcare:
"...this comes in the form of medical aid subsidies in our salaries. And any person in our country who is on medical aid, regardless of who their employer is, gets tax rebates from South African Revenue Service. And I am made to believe that these tax rebates amount to R30 billion ($1.67 billion).“Hence it’s R100 billion ($5.55 billion) that goes out to subsidise us the rich and leave the poor out; and we all know that at the end of the day, we know that this money gets exhausted somewhere around at the end of September/October. And we the rich go back to the public healthcare system at no cost and demand help. “But a poor person who doesn’t have a medical aid, even if they have the need, which is in the private sector, they cannot go there. So, we the rich are double dipping. ”
Well, where do we start? The issue of 'dumbing patients' seems like a lingering ghost in the debate. Despite being refuted with facts, it persists among the public. Professor Alex Van den Heever stated that this is impossible, as the majority of medical scheme claims are covered by the 'prescribed minimum benefits', which schemes are legally required to fully cover. The government still cannot provide statistics on the people who are purportedly turned away from private hospitals due to exhausted medical aid. As the saying goes, without data, you're just another person with an opinion!
And what about double dipping? Medical aid members pay taxes that fund the public sector. A significant portion of their income goes towards public services that they rarely utilize. This principle also applies to education. Therefore, if, in the unlikely event, they do use a public service, it's fair since they've already paid for it
Mokone was just warming up! The next part was delivered with such religious vigor that I nearly said amen.
"NHI is a health financing system, called Universal Health Coverage (UHC) by the WHO. It is a health financing system, which is meant to be an equalizer between the rich and the poor. About 1.3-million public servants plus all Members of Parliament, honourable members standing in front of whom I’m standing and honourable members and legislatures, and all the judges of our country are subsidized by the fiscus of this country to the tune of R70 billion ($3.89 billion) per annum.“
National Health Insurance (NHI) and Universal Health Coverage (UHC) are not the same thing. NHI is one of the ways to achieve UHC. The World Health Organization (WHO) describes Universal Health Coverage (UHC) as a system where all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. This means our public service already operates under UHC principles.
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There is an open debate about whether the government should eliminate those 'subsidies' and tax rebates. Some estimates suggest that about one million people might be affected. However, if an additional R100 billion can improve public healthcare, then by all means, take it, but allow those who prefer private health to retain their choice.
At the end of the day, it's about freedoms. The idea of the government telling you where to live, study, or seek healthcare sounds communist to me. I prefer my government to act as the insurer of last resort—being there for the unfortunate, extending resources to the poor, while allowing people to get on with their lives. If rich people spend millions building mansions, should we confiscate them? Similarly, if people with money spend crazy amounts on healthcare, let them be. Our task should be to assist those who cannot access quality care from public hospitals.
If the goal is to achieve equality, then they will achieve it. We will all be equally poor.
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Health Policy Analyst @ Council for Medical Schemes | Health Economics, Health Policy
4 个月NHI, the proposed health financing model for South Africa is to address the failure of the current health finacing model of a tax funded public sector and a parallel not-for-profit .mutual benefit society model that has not reached it's full potential. The insinuation that NHI is introduced to ensure equality is incorrect. The proposed health financing model is to address inequity in health and access in healthcare in South Africa.