Lehumo Sejaphala | Contributing Author | Free Market Foundation | mail me |
Despite all the opposition and opprobrium, it has attracted, the National Health Insurance (NHI) Bill has finally been signed into an Act of Parliament. On the face of it, the Act seems to be a product of good intentions and benevolence by those in government. But as history has shown, good intentions do not always translate into good outcomes. In fact, the path to evil is always paved with good intentions.
History is replete with examples of how kings and rulers have used taxes to promote the so called “common-good” and in some instances, to sponsor their extravagant lifestyles.
Take for instance the introduction of a tax on all houses—a hut tax to finance a planned railway project in the then colonised Sierra Leone by the Britain colonial government on January 1, 1898, under Governor Frederick Cardew. The chiefs, while proclaiming their loyalty to Queen Victoria, politely protested. As a result some were imprisoned and put to work breaking stones for the refusal to play their role in hut tax collection. A rebellion soon erupted and in repressing it, the British colonial rule ended up burning the very huts they had intended to tax.
Or take for another example, Tsar Peter the Great who in 1698 introduced a beard tax aimed at inducing the nobility to shave and as part of an effort bring Russian society in line with Western models, much like today’s carbon taxes aimed at slowing down global warming. The reader may be tempted to dismiss the above as historical fictional stories with a remote possibility of ever happening in real life or attribute said events to the follies of either the British or Russian monarchy – until his/her attention is drawn to the ANC government’s grand NHI scheme.
South African newspapers and opinion platforms are replete with articles about the ANC’s government proposed NHI and why it’s destined to fail. The case against the scheme has been so well canvassed that not much can be said on the subject. Indeed, it remains enigmatic why Parliament still forged ahead to pass the Bill, and President Ramaphosa resolved to sign it into law despite all the warranted opprobrium it has attracted.
The way to go about ensuring universal access to all basic services is not by dragging the “rich” or the those who can afford down to the level of the poor (the very objective the scheme aims to achieve). Obviously, this objective has not been framed as crudely as I did but in a more sophisticated political language to arouse the necessary emotions from the public. For instance, the preamble to the NHI Bill states that the Bill aims to: “to achieve universal access to quality health care services in the Republic in accordance with section 27 of the Constitution…” as well as “to create mechanisms for the equitable, effective and efficient utilisation of the resources of the Fund to meet the health needs of the population” amongst other things.
It is axiomatic that if the ANC government intended to achieve universal healthcare access, it would simply have improved and invested the necessary resources (capital, human and otherwise) into the public healthcare sector and left the private healthcare to serve the needs of those who can afford. Ultimately, those within public healthcare sector who can afford as their financial position improves will migrate to the private healthcare sector while those who no longer afford would then migrate to the public healthcare sector. Water will indeed always find its own level without anyone’s intervention.
Denuding the private health care sector through legislation as the ANC government seeks to do is not just a violation of the freedom of trade as enshrined in the Constitution but an unjustifiable limitation of the right to freedom of choice. Let’s suppose that the scheme is tried, as it will and ultimately fails, as it’s bound to; all of us would be left in a precarious situation despite some amongst us affording private healthcare access. Until now, people were incentivised to work hard, improving their skills set in order to get better paying jobs so they can afford to access to better services including private health care, and private schools for their children. This is one of the driving forces behind our economy.
Take away all private services, eliminate all free market competition in the name of levelling the playing field and you are likely to wind up with a stagnant society; no one would be incentivised for being innovate, working hard and taking risks. This should be elementary knowledge in any society interested in economic progress. With the advent of the NHI, it is possible that people would suddenly crowd heath care facilities for the treatment all sorts of ailments such as flu, fever, runny noses and tummy aches and foot cramps – the sort of ailments which could easily be treated with home remedies or self-medication/prescription in the absence of universal healthcare access. Naturally, this would detract attention from patients who need the most urgent medical care.
But all is not lost; there are several possible avenues that will be explored to oppose the implementation of the scheme.
The most feasible one at this stage will be to mount a legal challenge on Act by challenging its constitutional validity. More precisely, the extent to which the views of those who were consulted during the process of public participation were allowed to inform the final structure and scope of the scheme. It goes without saying that the legislature ignored not only the views, arguments, and concerns of civil society organisations, but also those of the medical profession.
