Feature Article: Government – far from salt of the earth

Hot on the heels of the Department of Health’s announcement that it is considering introducing a sugar tax to curb unhealthy eating habits, Deputy Minister of Health Dr Gwen Ramokgopa has proclaimed that for the government to successfully implement its planned National Health Insurance (NHI) policy, all South Africans will have to leave off the salt. The governments ban on smoking in private bars and restaurants resulting in some of the country’s citizens being treated as lepers reveals the extent to which government is willing to impose itself on ordinary citizens in the name of protecting South Africa’s “collective” health.

The supposed underlying logic being that if government (read taxpayers) is to pay for healthcare, then government should be allowed to tell us, the taxpayers what we must do with our own bodies. This kind of hubris pervades the halls of the Department of Health. One of the main concerns about NHI is that it fuels the erroneous argument that government is the foundational source of our health and prosperity and thus entitled to regulate our behaviour. What is more liberty destroying than a government telling you what you can and cannot do with your own body?

Government cannot adjust to subtle nuances. It sees everyone in “the collective” and if it deems salt, sugar, tobacco, etc, to be bad, it has only one tool at its disposal.  Government doesn’t have carrots to offer like the private sector – its only option is to beat you with a stick and regulate the offending substance or practice. Tobacco has traditionally been a soft target and provided government with an easy entrance into further intrusions on individual liberties. The flavours of the month are currently salt and sugar but government has an insatiable appetite to control more and more aspects of our private lives and the private healthcare sector specifically, before the government’s planned introduction of nationalised healthcare.  

The basic premise of the NHI is to provide free healthcare for all South Africans, but as all economists worth their salt know, There Ain’t No Such Thing As A Free Lunch (TANSTAAFL). No additional information on the NHI has been revealed since the 2011 Green Paper, and it appears that the government is simply going ahead with its plans to introduce NHI without the proper consultations as evidenced by the increasing budgetary allocations to fund NHI pilot sites and other NHI-specific operations.

“Free healthcare for all” may sound good and implementation of the NHI will be encouraged by those who believe that government is responsible for the health of the nation. Considering South Africa’s small tax base, how will the government’s NHI cope, especially, when it is forced, in time, to expand the mandatory package of benefits to include cover for more and more essential procedures and medications? NHI supporters most probably will also believe that because government is administering the funding of the nation’s healthcare, our well-being and prosperity emerge from the policy concerned, which infers that none of us would have any right, or strong grounds on which to stand, to engage in civil disobedience or even to oppose government regulation. Anyone opposing the NHI will be branded as a hypocrite, uncaring and insensitive to the plight of the poor. It is amazing how policymakers always conveniently pay lip-service to the poor in order to demonise anyone who might be opposed to the policies they propose.  Anyway, to avoid a catastrophe that the implementation of the NHI will precipitate by placing medical care in the hands of politicians, people need to be allowed the freedom to take responsibility for their lives.

If government views “health care for all” to be politically essential, it could require the population rather to privately and individually purchase mandatory cover to insure against catastrophic health-related events. Otherwise it should leave people alone to provide for their own and their families’ medical-related and other needs. Furthermore, instead of the government itself undertaking the management of taxpayer-provided funds intended for covering the medical costs of the poor, it should put the task out to tender. In the same way as people have many options to choose from in household insurance, car insurance and myriad other products and services, publicly-funded patients will then have a multiplicity of medical schemes to choose from. Competition between public hospitals and clinics, and with private facilities, to win business from taxpayer-funded public health insurance beneficiaries, will thrive and ensure that the best service for the best price is given.

Being forced to pay premiums commensurate with their risks would give people an incentive to be more careful. Private medical schemes need to be in a position to compete in the market and offer either positive incentives such as reduced premiums or special discounts to members and policyholders who exercise regularly, drink in moderation, or do not smoke, etc, or create disincentives and charge higher premiums to those who do. A healthier and more self-reliant population would emerge and South Africa would be able to consider strong economic growth an attainable possibility.

Source: This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation.


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