South Africa

NHI will take away your choice – which is unconstitutional

Alex van den Heever

The National Health Insurance (NHI) Bill is incoherent, unconstitutional, and will limit people’s access to healthcare. It is also highly unlikely to be implemented.

This is the warning from Professor Alex van den Heever from the Wits Social Security Systems Administration and Management studies.

Van den Heever’s comments followed the National Council of Provinces passing the NHI Bill at a sitting in Cape Town.

The NHI seeks to ensure all South Africans have access to quality healthcare services and provide for establishing a fund for this purpose.

The NHI fund will be used to pay for almost all treatment from accredited providers, with rates to be set by the state.

Private medical aid providers can only pay for products and services the fund does not cover.

Van den Heever said while universal healthcare is a noble objective, it should not prevent people from covering themselves.

He said the plan to create one system to serve everyone in the country has not been done anywhere and is unfeasible in a developing economy.

“The NHI Bill is incoherent and is inconsistent with equity and coherent institutional design. It is just not going to happen,” he said.

He added that the ruling ANC knows the NHI will not happen, so they say it will take a very long time to implement.

He added that the NHI Bill is unconstitutional as it undermines people’s right to choose healthcare.

“There is nothing wrong with somebody purchasing their own healthcare at the level at which they want to, as long as it does not affect another person’s healthcare,” he said.

“We do it in education and housing. We implemented no framework in South Africa that prohibits you from using private services when public services are available.”

For example, people can not be stopped from using private security when there is a public police force to protect them.

Van den Heever said it makes no sense to implement a law to prohibit you from paying for private healthcare should you desire.

World-renowned economist Thomas Sowell said it is not up to the state to decide what a person needs or doesn’t need.

If a person has the money to pay for something, they should be free to buy what they want, including healthcare.

The NHI Bill will restrict a person’s choice because it will control the full healthcare system in the country.

For example, if the state healthcare system decides you don’t need a certain procedure, you cannot pay for it privately.

It, therefore, severely restricts your choice and access to healthcare, which is unlikely to pass constitutional muster.


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