Where soft ideology and hard reality collide


By Mihan van Zyl

The National Council of Provinces’ recent adoption of the National Health Insurance (NHI) Bill puts this policy in the spotlight of the public political debate.

However, South African citizens must be careful not to be led astray by false promises, seemingly noble intentions and nice words.

The bill intends to make health care in South Africa more accessible by means of a fund for national health insurance that will centralize the financing of health care. Private medical schemes will be limited to medical procedures that fall outside the scope of NHI.

This is clearly a far-reaching limitation of citizens’ right to free choice about their health care. At the same time, we face a possible drastic increase in taxes to cover the increase in medical expenses that this policy will result in for the government.

The biggest gap in this bill becomes clear when we look at the malfunctioning of other government agencies such as Transnet, Eskom and SAA. However, this systemic problem is usually the result of mismanagement rather than a lack of funds. The ANC’s proverbial root of more accessible health care is therefore not exactly reassuring when one looks at the poor standard of public service delivery.

We can all agree that a world in which everyone can enjoy free, high-quality healthcare is a noble ideal. This is not only true from the ANC’s ideological perspective, but also from many of our own perspectives. However, NGV is unfortunately another example of how the road to hell is often paved with good intentions.

The question we have to ask ourselves in the South African context is what the practical implications of such a policy will be, rather than just focusing on the well-intentioned ideological foundation from which it stems. In this way, we can prevent us from implementing policies that are simply based on impractical ideological loyalty – and at the same time prevent us from rejecting workable policies simply because they might conflict with ideology.

It does not require a certain ideological view of life to realize that the lights are sometimes switched off for six hours a day; to know that our rail networks are managed in the ground; or to feel how your car jerks when it hits a pothole. The government is simply unable to effectively attend to citizens’ needs. The core question must be: How efficiently will this government-controlled health care system run if the sneaker hits the tarmac?

Opposing NHI also does not mean that you are arguing that everyone should suddenly take out private health insurance. For donkey’s years before NGV, South Africa already had a free public health care system. Over the years, however, this system, like other government departments, has systematically weakened.

If we take off the ideological glasses and then look at NHI, we can clearly see that legal restrictions on private health insurance and increased taxes will not improve the quality of public health care. Rather, we will have to straighten out the management of the existing public system before we really get closer to equal access to medical services.

NGV is just one example of ideological obsession that can easily lead us astray. South Africa deserves to be steered on a practical course, which will lead to a better future for all our people. A good ship captain not only considers the shortest route on the map, but also keeps an eye on the weather and constantly looks for lighthouses that offer warning against the hard rocks of reality.

  • Mihan van Zyl is a final year student in a two-year postgraduate LLB program at Stellenbosch University. He completed a BA (Law) degree in 2022.

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