The National Assembly has passed the contentious National Health Insurance Bill (NHI) following a parliamentary debate on Tuesday.
All ANC members occupying 200 seats voted in favour of the bill and were backed by five other minority party members.
Of the 125 members who voted against the bill, 71 were from DA, 30 from EFF, 12 from IFP, eight from Freedom Front Plus, three from African Christian Democratic Party, and one member from African Transformation Movement.
The bill, which has now been taken to the National Council of Provinces for concurrence, was initially presented to parliament in August 2019 and subsequently referred to the committee for review.
Its main purpose, as stated by the National Assembly, is to achieve universal health coverage for all South Africans.
This entails granting every citizen the right to access comprehensive healthcare services at accredited health facilities including clinics, hospitals, and private practitioners without any financial burden at the point of care.
However, it has been highly contested by opposition parties, healthcare stakeholders, and independent legal services among others, who argue that it will have a potentially detrimental strain on health services.
Defending the bill during the debate, Health Minister Joe Phaahla reiterated that it is in line with the constitution and looks out for the interests of all citizens.
“Honourable members, in simple terms what the NHI seeks to do is stop the two trains – private health and public health traveling on parallel tracks but both surely going toward crashing, while if they can be pooled together there is a good chance of complementing each other,” Phaahla said.
“The NHI seeks to pool resources of those who can only contribute to the fiscus through indirect means such as VAT [value-added tax] and other collections, and those of us who are able and are already making fragmented contributions into 81 different schemes into one pool which can purchase services from both the public health system and private providers from the lowest level of care up to the highest.
“In doing so, we can achieve access, equity, and quality but also drive down costs.”
The minister acknowledged public concerns about how government will fund the bill, stating that finances are not a cause for concern. He based his argument on the success of other countries that have pooled their health services in the past years.
“I know that there are those of you who say the NHI is unaffordable, but you are basing this on the highly inflated costs amongst some of the private providers who are under pressure to keep delivering supper profits even higher than gold and platinum mines.
“Even in major developed countries which have introduced universal health coverage, the prices are determined by the pooled national insurers such as the National Health Service [NHS] in the UK and similar systems in Canada and various Scandinavian countries.
“The NHS in the UK started on 5 July 1948, just three years after World War 2. At that time, many parts of the country were still in ruins, there was not much of an economy to speak of.
“Many of the doctors rejected it and mobilised against it, but today it does not matter whether you have a Labour or Tory government, even the extreme right-wing Torries know that with all its weaknesses, the NHS is the jewel which must be protected.
“No significant private medical insurance exists in the UK. One of the big three private hospital groups making billions of profits here in South Africa could not survive in the UK because prices for private service providers there are determined by the NHS, not the market made from desperate sick people.”
The DA vehemently rejected the bill, stating that it is a shady deal and arguing that there are underlying facts that are not clear such as funding and how health facilities will operate.
The party underscored that when the bill was first introduced, it left an impression that the poor would be granted access to private facilities and that public facilities would be improved.
However, that is not entirely truthful, it said.
“There is a quote from Aldous Huxley that reads: ‘facts do not cease to exist because they are ignored’. And the question is, have you told the truth about the NHI?
“I was on the public hearings, and without a doubt those that came out in support of the NHI were misguided and not told the entire truth,” said DA MP Lindy Wilson.
“There was without a doubt an assumption that once passed, the NHI would allow them to go to any hospital, including private hospitals, and that the lousy clinics they have to attend would be improved straight away.
“There was definitely an impression that abysmal services and crumbling infrastructure and doctor and nursing shortages would be fixed immediately. There was obviously a belief that there would be ambulances for all and that emergency services would no longer be a problem.
“They were convinced that medicine shortages would be a thing of the past and corrected very quickly. So, when exactly will they be told the truth?”
The ANC contended that the bill works in favour of the poor, lambasting the EFF for rejecting the bill. It stated that the red berets should be ashamed because the bill seeks to better the lives of the poor people whom they claim to represent.
ANC national spokesperson Mahlengu Bhengu-Motsiri said in a statement: “Parliament’s passing of the bill will accelerate the overhaul of the medical system that is inclusive and responsive to the needs of the poor.
“This overhaul will lead to improved health infrastructure and a capable and sustainable healthcare service.
“This development is in line with the government’s constitutional imperative of the recognition of healthcare as a fundamental human right and the ANC’s vision of a better life for all.”
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