The government is not the cure, it is the disease

Temba A Nolutshungu, Director, Free Market Foundation.

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This article was first published by Business Day on 21 July 2023 (Paywalled)

The government is not the cure, it is the disease

The enactment of the ill-conceived National Health Insurance Act (NHI) spells unmitigated disaster for the healthcare of the populace. This policy is tantamount to comprehensive nationalisation of the private healthcare sector.
Its adoption defies rationality and flies in the face of overwhelming evidence that nationalisation of any product, service, sector of an economy or an entire economy inevitably results in shortages, poor quality and low productivity, to name a few glaring consequences. All one needs to do to embark on a proper and realistic analysis is to focus on the effects of this policy as opposed to the spelt-out intentions. In such an exercise, one will reach the decision that the NHI should be abrogated. As indeed it should be.
With this in mind it is important we understand the dominant paradigm in governing circles in SA that informs all aspects of public policy, especially as they wreak havoc in the socioeconomic arena. The dirigiste statist, interventionist orientation of the government means we have a command economy. No wonder SA is in such a mess with almost all indicators of socioeconomic welfare pointing to the country degenerating into a failed state, if not already there, as some experts argue. As we contemplate the inevitable consequences of the NHI the chillingly insightful Albert Einstein come to mind: “You cannot solve a problem with the same mind that created it.”
The government healthcare sector is, to say the least, a dismal catalogue of fatal flaws that have exacted a heavy toll in terms of deaths and injuries to patients. To illustrate the point, let me mention only a few issues, in addition to which are related consequences that heralded the conception of the NHI: 

  • About 25,000 skilled professionals leave SA every year, according to Sable International. These results are supported by Induku Consulting Group (ICG) and were published in Businesstech on August 26 2019. Significantly, the ICG notes black professionals are also emigrating.
  • According to the SA Medical Association, 38% of SA’s medical specialists indicated they would emigrate if the NHI were to be enacted.
  • Netcare decries that there is a deficit in nurse availability and that it amounts to a shortage of 62,000 healthcare workers.
  • The Life Healthcare Esidimeni tragic saga ended the lives of 144 psychiatric patients (most sadly with the whereabouts of a further 44 patients unaccounted for), mainly as a result of the most sadistic neglect, starvation, trauma and downright torture. Reportedly, the deaths occurred between October 2015 and September 2016.
  • Newborn infants stored away in boxes.
  • Gladys Bogoshi, the CEO of Charlotte Maxeke Johannesburg Academic Hospital, reportedly acknowledges that 300 prostate cancer cases have to wait for two years for treatment.
  • A total of 100,000 cancer cases are diagnosed annually, according to the 2018 annual census of the SA Society of Clinical and Radiation Oncology. Citing the report, a spokesperson for the organisation says nearly all its members are writing international exams in the UK, Australia and New Zealand.
  • The Juta Medical Brief (February 13 2019) reported there were 20% fewer oncologists than two years previously.
  • A new study shows that as much as 80% of a sample of 384 radiologists are considering emigrating, says Prof Richard Tuft, the head of the Radiology Society of SA.
  • The SA Medical Association agrees that the current physical state of public facilities is disgraceful and not favourable to the delivery of quality health services.
  • In parliament a telling debate is now raging about the issue of an alleged amount of about R57m being paid out to ghost employees over a period of two years, during which time the Orsmond Tuberculosis Hospital in Kariega, Eastern Cape shut down.  

The question also looms large of who will bear the cost of up to R500bn annually to run the NHI malfeasance. It will of course be the beleaguered taxpayer, and the government has unashamedly acknowledged so.
One can be sure that the architects and policymakers will access sophisticated medical care abroad.
Yet there is a rational and feasible alternative that would leave the private sector intact and doing what it does best: delivering good-quality services that is on par with best in the world. The fact that the viable private sector operates on an unsubsidised basis (at no cost to the taxpayer) should be recognised and applauded by the government instead of its dogged determination to destroy it.
The proposal is that the government should purchase medical services from the private sector on behalf of the indigent. This category of patient would be identified on a rigorous means-tested basis. Taxpayers would be happy about such a scenario as it would be good value for money while also deriving satisfaction as a portion of their hard-earned incomes could be easily monitored and accounted for in the best interests of their fellow humans in need.   
In conclusion, I have paraphrased the title of this article from the incisive words of Robert LeFevre: “Government is a disease masquerading as its own cure”.

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