South Africa

Big NHI blunder

Political scientist Frans Cronje said President Cyril Ramaphosa and the ruling party blundered by signing National Health Insurance (NHI) into law before the elections.

On 15 May, Ramaphosa signed the National Health Insurance (NHI) Bill, making it an official law in South Africa despite massive opposition from industry roleplayers.

The NHI Act aims to transform South Africa’s healthcare system to achieve universal coverage for health services.

The ruling African National Congress (ANC) thought it would garner support for the party ahead of the elections. However, it backfired.

Cronje said Ramaphosa’s NHI announcement sent the ruling party’s support into a tailspin. “They miscalculated horribly,” he said.

The ANC thought national health insurance would be seen as a wider support of a social wage theme. However, it wasn’t.

“There is vast private out-of-pocket expenditure on private health care. People respect private medical professionals, even in poor communities,” he said.

“It’s one of the few people you can go and see that you can trust will deliver high-quality service, and the ANC seems to be completely ignorant of aspirations.”

Cronje added that one of the things many South Africans aspire to is the idea of private health insurance.

“Private healthcare includes amazing products that are made available by great South African entrepreneurs like Discovery CEO Adrian Gore,” he said.

“When the ANC went after NHI, it absolutely alienated the established and the aspirational middle class,” he said.

These segments of society, traditionally ANC supporters, were already very weakened, and the NHI announcement saw it dive further.

The ANC’s support plummeted from 57.5% to around 40%, the biggest decline since the first democratic elections in 1994.

The ANC is now forced to partner with the DA, EFF, or MK to gain enough support to form a coalition government or government of national unity.

Many business leaders, including Sygnia CEO Magda Wierzycka, prefer to see a coalition between the ANC and the DA.

Wierzycka said this coalition will strengthen the Rand and make South Africa a more attractive investment destination.

She added that it would help stabilise the business environment and create a better future for the country.

It will also prevent destructive policies like prescribed assets, the NHI, and expropriation without compensation.

Opposition to NHI

Adrian Gore
Discovery CEO Adrian Gore

Apart from the political fallout and the ANC losing support because of NHI, it has also hurt the ruling party’s relationship with business leaders.

Business Leadership South Africa CEO Busi Mavuso slammed the government for enacting the NHI Bill despite widespread criticism from industry players.

Mavuso explained that, rather than combining the best of public and private, this legislation poses a major threat to the private sector.

“The President has chosen to ignore the many recommendations that would have improved the workability of a national health insurance scheme,” she said.

She added that it has no funding and it faces many legal challenges. She expects litigation from various quarters.

Discovery CEO Adrian Gore vowed to fight the recently signed National Health Insurance (NHI) Bill and to take “necessary action as required”.

“In its current form, the NHI Act is not feasible as it rules out private sector collaboration,” he said in a statement.

“The NHI will only be workable if it provides universal access to care for all South Africans while not restricting the rights of medical scheme members.”

Business Unity South Africa CEO Cas Coovadia said that, in response to the NHI becoming law, the organisation would consider its options, including legal action.

“Our subsequent actions will be guided by our belief that it is essential that we get the NHI right through all means still at our disposal, including appropriate legal interventions,” Coovadia said.

Trade union Solidarity has already taken the National Department of Health to court once before over the NHI late last year and promised to challenge it by all means necessary.

South Africa’s main opposition party, the Democratic Alliance, has also said it will sue the government over the implementation of the NHI.


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