A calm discussion on how to build universal healthcare is required

Solly Phetoe is the General Secretary of Cosatu. Picture: Doctor Ngcobo / Independent Newspapers.

Solly Phetoe is the General Secretary of Cosatu. Picture: Doctor Ngcobo / Independent Newspapers.

Published May 20, 2024


By Solly Phetoe

South Africa’s health care is not coping. We need a calm discussion on how to build universal health care.

One appreciates that in the excitement to scrounge up votes, opposition parties condemn anything the government does, irrespective of its merit.

Equally, given that the majority of voters have never trusted opposition parties to run anything more than a municipality or the Western Cape Provincial Government, it’s easy for opposition parties to promise voters heaven and earth knowing full well they will never be asked to deliver on their slogans.

South Africa’s government led by the ANC has been discussing how we can fulfil all citizens’ constitutional right to health care, develop a roadmap to universal health care and build a National Health Insurance for many years.

President Cyril Ramaphosa signed the National Health Insurance Act this past week, as he has been signing many other bills passed by Parliament as it reaches the end of its term. This is what he was elected to do!

Most industrialised countries spend 5% of their GDP on health care. South Africa exceeds that at 8.5%. Yet we are not achieving the impact we desire because of the skewed distribution of these resources.

Over half, R280 billion, goes towards private health care catering for the 16% of society able to afford medical aid.

While private health care provides world class health care to those lucky enough to afford it, it is extremely expensive to medical aid members, in particular workers, through exorbitant monthly premiums, out of pocket payments and the depletion of day-to-day benefits early in the year.

Over the past decade, a quarter of medical aids have gone out of business as members can no longer afford the massive price increases imposed by private hospitals driven by profits.

Public health care with a smaller allocation of R279 billion caters for the 84% of society without medical aid, overwhelming working-class families.

While health-care workers try their level best to provide quality health care, it cannot be a surprise that they struggle when critical posts are vacant, nurses and doctors are working double shifts, there’s a shortage of beds, infrastructure is ageing, etc.

Heideveld Day Hospital sees patients queuing from 4am, nurses at Hanover Park Day Hospital are at risk from gang warfare on hospital premises ... the list goes on.

What are the costs of these crises to society?

Workers avoid medical treatment until it is too late because they cannot afford the exorbitant prices charged by the medical and pharmaceutical industries.

Families are left with breadwinners no longer able to work or who have passed away. Company productivity is disrupted due to high absenteeism as workers are too ill to work.

The fiscus is left bleeding from a less productive economy and treating illnesses that could have been identified, prevented, cured or managed through primary healthcare.

South Africa is a major industrial economy, yet Cape Town is the world’s tuberculosis capital. We have witnessed a massive rise in diabetes, obesity among many others. We will not overcome these until we overhaul our health care and ensure an equitable and rational distribution of resources.

What is the National Health Insurance?

It’s not as is hyped up in election baiting TikTok videos by the DA, the end of democracy or life as we know it!

It combines the best elements of universal healthcare built over many years with great success in Canada, Sweden and Norway, among others.

Hardly the stuff that should give the DA voters in Constantia a heart attack! But perhaps it may offend the profit margins of the CEOs of medical companies whose generosity the DA depends upon.

The core elements of the NHI are:

* Universal health care through a single National Health Insurance that all South Africans would be members of.

* Primary health care to ensure all South Africans have access to medical practitioners so diseases and illnesses are routinely screened for, identified, managed and cured. This avoids a scenario where for example cancer goes undetected until it is too late and costly to treat.

* The NHI would be funded by existing public health care expenditure, phasing out medical aid tax rebates and existing money going towards medical aid. So no new costs to workers’ pockets (again take DA electioneering with a bucket of salt).

* The NHI will direct patients to go to the nearest available health-care provider, including private hospitals and private practioners who would be refunded by the NHI.

* Medical tariffs will be capped by a panel of medical experts to balance the need for the private sector to make money with the constitutional right to life of all South Africans, including the pensioner with TB in Manenberg and the expectant mother in Khayelitsha.

This model has worked across Europe. It is based on the best scientific, medical, governance and economic advice from the World Health Organization.

So why the shrill hysteria by some opposition parties that the world is about to come to an end? Besides trying to score votes so they can get cushy seats in Parliament after May 29?

It’s a pity that in the midst of the excitement, mainstream media has ignored the voices of health-care workers, e.g. experts who know firsthand the status quo cannot continue.

Samatu, the medical doctors’ trade union, supports the NHI as the best way to ease the stress on overworked doctors who are abandoning public hospitals for less stressful private practice.

Denosa, the nurses’ union, supports the NHI as the best way to pool resources together to ensure we are able to hire the nurses.

Nehawu, supports the NHI as the best path to ensure the state has the funds to modernise our hospitals and build clinics in rural areas.

Saepu, supports the NHI to ensure all South Africans have access to emergency medical care and not simply the few who can afford medical aid.

Building an NHI will not be an overnight journey, but it is a journey we must embark upon.

We cannot continue to allow young girls to forgo mental health care because their parents cannot afford it. We cannot continue to allow the elderly to die because there was no ambulance to take them to a hospital.

We have the resources and a roadmap. What we need is a sober discussion on the steps to build it. What we cannot do, is to continue as is and expect miracles.

Cosatu is pleased our struggles to build universal health care are after many years, seeing light at the end of the tunnel. Much remains to be done. But we are confident that under the leadership of President Ramaphosa and the ANC, we will get there.

Solly Phetoe is General Secretary of Cosatu.