The global trend concerning public health is to move towards providing universal health care. It is crucial that SA follows suit.
With an accumulative budget of more than R222bn across all provincial departments and their entities, this is a possibility for our country, but the devil is in the detail.
In addition to the complexities of delivering public health care in a constrained financial environment is our country's history of segregation and subsequent legacy of inequalities.
This has meant that the millions of South Africans who make use of the public health-care system form more than 80% of the country's population. This has also meant that most of those who have no choice but to surrender themselves to this public health service are poor black South Africans.
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Public health care in this country has become a microcosm of SA's legacy of insiders and outsiders. The deep inequalities that exist in our country play themselves out painfully in the health system.
A majority of South Africans make use of public health facilities, which are overly burdened, with crumbling infrastructure, often with critical medication shortages, long waiting times in queues and public health-care professionals who are evidently over-stretched.
On the other hand, the 16% of South Africans who rely on the private health-care system do so at increasingly high rates, which lock more people out of medical schemes.
This week, minister of health Dr Zweli Mkhize announced that the cabinet had approved the National Health Insurance (NHI) Bill, which was plagued with problematic elements when it was first touted a couple of years ago.
There are four main issues that the DA has identified with this bill:
NATIONALISATION OF HEALTH CARE
The NHI bill as it was first introduced, and as we suspect is still the case, enables the establishment of a state-owned enterprise (SOE) that will pool funds within the public and private health system. This means that, once again, billions of rands in public money will be in the hands of a few politically connected individuals.
What the past 25 years have demonstrated to us is that SOEs have become the perfect breeding ground for large-scale corruption, as the Zondo judicial commission has demonstrated.
NO SUSTAINABLE FUNDING MODEL
Nothing illustrates poor planning and the pursuit of narrow ideological gains like the almost total lack of detail on how this giant state fund will be managed and how we will obtain the money needed.
The previous health minister, Dr Aaron Motsoaledi, admitted that the initially envisioned R249bn identified as needed for NHI was in fact a guesstimate. The minister had no idea then. It is clear that the current minister has no idea now.
We cannot afford to simply fund a bottomless pit that will never trickle down to people in the form of service delivery. To date, we are still unclear how much it would cost the South African taxpayer to implement a system that is being rolled out in piecemeal fashion.
Besides the fact that SA cannot afford to fund billions of rands from the current fiscal reality, the DA is of the view that this route will not yield the success that millions desperately need.
PROVINCIAL SERVICE DELIVERY THREATENED
According to the National Health Act of 2003, the national department of health sets policy and governance structures and the provinces become the implementing agents of public health care.
As the bill stands, powers relegated to provinces will be centralised in an unprecedented manner. There has been no constructive engagement with provinces at the National Health Council, as the agents that will be rolling out NHI.
The road to universal health care does not have to be paved with fundamentally bad policy proposals and failed and expensive interventions
Instead, there has been a reduction in investment into primary health care across all provinces.
UNIVERSAL HEALTH CARE
The DA understands the imperative to roll out universal health care to the people of SA.
However, the road to universal health care does not have to be paved with fundamentally bad policy proposals and failed and expensive interventions.
Because the DA understands the urgency of the task at hand, we would roll out universal health care in five to eight years, within the current budget envelope. It would be delivered through restructuring and reprioritisation of the current health budget through a two-phased approach.
We would remove the medical aid tax benefit afforded to medical aid clients, which would immediately avail R17bn to the public health system in order to invest in improving primary health care, maternal and child health and the provision of emergency services.
With those interventions alone, the health system would drastically improve.
The second phase of the DA's plan would be to assign every single eligible South African a subsidy that would afford them a standard but comprehensive health package.
This would afford every single citizen access to quality health care, whether they are a private or public health-care patient. Existing medical aid clients would be able to use their cover as a top-up scheme on top of the government-sponsored medical aid subsidy.
It is clear that the ANC government is pursuing the NHI bill under the guise of providing quality health care for all.
However, this bill will not improve the current system and will introduce yet another state-owned entity that will allow the greedy to steal from an already financially strained environment.
The DA will fight for universal health care for SA. We will do so in a way that is responsible and affordable, and that will bring real change to the lives of millions.
• Siviwe Gwarube is the DA's health spokesperson
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