Health care, money and feelings


For years the ANC propaganda machine has been spewing out messages that health care should be “free”. Hear how beautiful it sounds!

You don’t want to mix sympathetic terms (such as care, help and health services) with cold and callous terms (such as markets, economics and profit). And who wants to spoil the party by saying that healthcare can’t be free?

On closer examination, this is a really interesting phenomenon: that people have an emotional perception that certain things should be provided for free, and that certain other things should only be provided for payment. With free, in the preceding sentence, obviously does not refer to what is really free, but rather what is presented or perceived as free. Because apart from rain, sunshine and persimmons, nothing is really free.

The “free” things are not equally free for everyone

In general, most products and services are paid for in one of two ways: directly from your pocket to the producer, or with a slight detour – from your pocket to Jan Taks and then in turn to the producer.

In the case where you pay the producer directly, you usually receive the product yourself, unless you have chosen to pay on behalf of someone else. In the event that you have paid Jan Tax, you will hopefully receive something in return, unless the government has decided that you should pay someone else.

That is why it is actually a sly rhetorical move by the government to declare certain goods or services free. It’s like declaring a gravity-free zone – it doesn’t work. A more accurate description is to say “free at the point of delivery”, but even that is a selective description of what actually happens when the government applies forced redistribution. In the end, someone still has to pay.

An additional aspect is that governments often decide not only to levy taxes for the public delivery of a product or service, but then on top of that prohibit or stifle the private delivery of it – as in the case of national health insurance (NHI).

The feeling you have about money

But back to the phenomenon: It feels normal that everyone should pay for some things themselves, but for some other things it feels inhumane to expect everyone to pay for them themselves. Only die-hard socialists would expect all food to be purchased and distributed with tax money, while only die-hard anarchist capitalists would want all roads to be built and used with private money. The rest of us are all happy with people buying food with their own money, but the town’s roads being built with tax money. I emphasize that for most people this is primarily an emotional perception and not a reasoned economic point of view.

However, the emotional perception is not a good foundation for building a country’s economic system. The reason for this is quite a few cases where people’s emotional perception suggests that public provision is the best; however, when the calculations are done, it is clear that private provision is much more efficient.

The feeling you have about health care

Healthcare is exactly such a case. There are a legion of emotional arguments about why it would be cruel if people had to pay for it privately.

What if people are turned away – and die – because they cannot afford a life-saving operation? What if doctors exploit people because they know that the patients are desperate and have no other way out than to pay for the health services? What if certain remote areas do not get any health services because there is not a big enough market for them?

These are the kinds of issues that make NGV popular, but which do not reflect sober economic reasoning.

The joke of NGV

Most people will readily admit that healthcare has evolved by leaps and bounds over the past 150 years, but few observers keep in mind what systems were necessary for this development to occur. Socialists want to ban economic freedom, so that X-rays can be “free” for everyone, but conveniently forget that economic freedom was necessary beforehand for the discovery of the X-ray machine.

The NGV bill, in turn, wants to prohibit private hospitals from being able to turn away any patients, but forgets for the sake of convenience that the freedom to be able to turn away patients was necessary in advance to be able to set up those hospitals: If a small private hospital is busy turning patients away all day helping the minimum wage, there will never be savings that allow for expansion. If innovative specialists are never allowed to turn down an appointment, they may never get the opportunity to develop a technique that brings new hope to sick people.

For every big step forward in health care – whether a boundary-pushing invention or the construction of new infrastructure – there have been a few decisions made that could easily be portrayed as “inhumane” at the wrong time.

To conclude: for health care to function effectively in South Africa, a balance must be found somewhere between money and feelings – and NGV is definitely way off the mark.

  • Louis Boshoff is a campaign officer at AfriForum. He has a BPharm degree in pharmacy (cum laude) and is currently doing a master’s degree in pharmacoeconomics at the NWU. He is co-presenter of Podlytics, reads good Afrikaans literature and is an adventurous rock climber in his spare time. Louis campaigns for the message of the rule of Jesus Christ over all things.