Health minister Dr Aaron Motsoaledi last week reiterated his call for legislators to use public health facilities when they are ill.
The quality of service in public facilities is a function of who uses those facilities. Put differently, if all public representatives in the country were not allowed to use private health facilities, the public healthcare system would improve.
In other parts of the continent, top leaders go to Europe and Asia to receive medical treatment because they know that they have done little to improve the quality of health care in their countries.
While the call by the health minister for public representatives should be supported, what will make more sense is for those in parliament to support a motion that will stop the subsidisation of the rich by the poor. This is done through tax rebates amounting to R70-billion a year that are allocated to the private healthcare system.
So, instead of making a politically correct statement that public representatives should use public healthcare, it would be more useful for them to stop the R70-billion subsidy to the private healthcare system and channel the money to the public healthcare system. More doctors and other healthcare professionals can be employed, thus improving the quality of healthcare in public facilities.
About two weeks ago, the Azanian People’s Organisation (Azapo) adopted a resolution supporting the National Health Insurance (NHI) at its 27th national congress in Mangaung.
The congress was a watershed event in that it repositioned Azapo to play a more active role in championing the cause of black people, whose interests and aspirations have taken a back seat as the leading party in the government of national unity (GNU), the ANC, bends backwards to nurse the fragile government of national unity.
The congress, under the theme “galvanise to defeat neo-colonialism”, deliberated the apparent moves by the government to accelerate its gravitation towards the right of the political spectrum, thus reversing the gains of liberation and freedom, as the GNU is being used to protect white monopoly capital and benefit the ruling elite.
The congress resolved to use any means necessary to force the government to get back to programmes geared at addressing the legacy of apartheid and colonialism.
It is not difficult to appreciate why the congress singled out the NHI as an example of how the current government has been hijacked to work against the interests of the poor.
The NHI bill was passed on the eve of the last national and provincial elections. Observers could be forgiven for concluding that the passing of the NHI by parliament was a political gimmick, designed to garner support for the ruling ANC.
Azapo is convinced that there is no political will to actually implement the NHI, which is the country’s plan to attain universal health coverage. Much more than that, the NHI is the most potent tool to end the unjust and unequal healthcare systems in the country. South Africa is the most unequal society in the world, and there is no better example of that inequality than the manner in which healthcare resources are distributed.
It is obvious that some members of the ruling elite are opposed to the implementation of the NHI because they benefit from the current system. Here are a few points to consider:
- Cabinet members, MPs, members of provincial legislatures and the judiciary are the biggest beneficiaries of the current system.
- The political elite belong to Parmed, a medical aid scheme, with the best cover in the country.
- When Parmed members go on retirement, they are only required to pay 20% of what they used to pay when they were still employed by the state. However, they retain all their benefits, which enable them to use private health-care facilities.
- In theory, ministers, MPs and judges may pretend to support the NHI, but in practice, they oppose it because they are fully aware that its implementation will mean that their exclusive ticket, Parmed, will end.
- There are several groups, mainly healthcare providers, who have launched court applications to stop the implementation of the NHI. Their opposition is understandable because they make billions of rands from the commodification of health.
- However, when these applications are submitted in the high courts, judges hearing these cases are conflicted.
- While the Department of Health appears to be eager to roll out the NHI, Treasury appears to oppose it, citing costs.
- It is obvious that while there is no open collaboration between the ruling elite and the healthcare providers, the elite will conveniently hide behind endless court applications to delay and possibly stop its implementation.
The Azapo congress has observed that the ruling elite and the owners of capital are conniving to frustrate programmes to address the legacy of apartheid and colonialism, which also affects education, land reform and the failing attempts to transform the economy.
Congress has urged the Azapo leadership to prioritise the implementation of the NHI because health is the ultimate dividend of democracy.
The apartheid in the provision of healthcare, where mainly the poor and black are forced to use under-funded, under-staffed and under-serviced public healthcare facilities, cannot be allowed to continue, three decades after the attainment of democracy.
- Qekema is the president of Azapo
