To whom it may concern at the Portfolio Committee on Health:

I am writing to share my deep concern about the government’s plans for the NHI scheme. While I agree that in principle, all South Africans should have access to world-class health care paid for by the state, South Africans on average live in want for many things including employment, education, and food. We unfortunately cannot afford policies built on principles rather than pragmatism. The NHI, as currently proposed, to subsume private medical aids and become the sole purchaser of health services is a disaster waiting to happen.

Please consider the state’s ability to implement and deliver. Look at almost any parastatal in the country and examine how they are run, in particular, their fiscal responsibility. There should be no confidence or optimism that an NHI scheme would some how be different. The state has simply not proven capable of managing funds at scale, and avoiding irregular expenditure.

By absorbing medical aids as we know it, making all South Africans reliant upon the state for health care will further erode the quality of life of skilled professionals who have been able to access high quality medical care through the private sector. While it is certainly not fair that poor South Africans do not have such cover, one must ask whether the added risk of continued brain drain in this country, through the elimination of the security that the middle classes and wealthier enjoy, is worth it. For the tax the wealthy pay in South Africa, citizens in other countries generally have access to comprehensive state-provided healthcare, but that’s predicated on a much larger tax base than we have. The same is simply not true in South Africa, given our small tax base, which the state continues to add more pressure onto, with plans for an NHI scheme.

Were any more realistic alternative plans considered, such as improving the existing public health system? Also, while poor South Africans certainly must be healthy enough to become engaged in the labour market, first and foremost, there must be jobs to absorb them. I understand health is a separate portfolio, but to whatever degree the health of poor South Africans can be improved, the most concerning diseases in this country are poverty and joblessness. It is hard for me to understand how an NHI scheme is such a priority compared to economic stimulus and development.

I implore you to consider the risks, the practicality, and likely outcomes of such move. Think of the impact on tax payers and the poor. Is this really the best plan for the country? I don’t think so, and I feel you should pay more close attention and respond to the voices of the NHI’s more reasonable critics. How will the management of an NHI scheme be different? How will irregular expenditure be prevented? How will the quality of care provided by the private sector today not eroded?

Please address questions like these the public forum.

Best regards,
Amrik Cooper
(A resident of Cape Town)