Ray McCauley: The Star
A FEW months ago, Minister of Health Dr Aaron Motsoaledi introduced a green paper on the National Health Insurance (NHI) for public comment. I have followed some of the debate on this matter and am perturbed by some of the responses I have seen.
The proposed NHI is supposed to be a financing system that will make sure that all South Africans are provided with essential health care, regardless of their employment or economic status. Any reasonable South African, particularly those with an understanding of our country’s history will not object to this noble intention.
We have a history of a fragmented health system that was designed along racial lines: a well-resourced health system for whites and an under-resourced one for the black majority. The state has somewhat addressed the disparities of the past, but a new challenge has emerged: a two-tiered health system, public and private, based on the size of your pocket.
While the private sector has a definite role to play in health care, we should not lose sight of the fact that health is supposed to be a public good. If South Africa is not firm on this principle, the healthcare system can easily be handed over to entrepreneurs who will distort healthcare from a public good to a market commodity.
Our constitution provides for the right to healthcare. Universal access is provided for in section 27(1)(a) which states that “Everyone has the right to have access to healthcare services, including reproductive health care…”
Significantly, section 27(1)(b) provides for the state to “take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of the right”. One sees the NHI as one of the “reasonable legislative and other measures”.
The state cannot defer indefinitely efforts for the full realisation of this right simply because there are some who, because of their narrow interests, have reservations about the NHI. SA has to move as expeditiously as possible towards the NHI as it will provide citizens, especially the poor, with the minimum core health entitlements as envisaged in our constitution.
I have heard and read critics of the NHI raise the issue of a possible tax burden on the middle class. While the mode of funding the NHI has not been finalised, it is important to separate the delivery of healthcare from the role of financing. We should first come to an agreement on what we want to provide, then find a way to finance it.
Also, I do worry about the attitudes of some of our commentators – and citizens – toward the poor, who stand to benefit the most from the NHI. One sometimes gets the sense that beneath the criticism lies an attitude of disdain and fear. An attitude that says the poor are dangerous; their condition is their own fault; they are just lazy and deserve no subsidy from those of us who are relatively privileged.
These attitudes are a world away from the South African concept of “ubuntu” and human solidarity. Neediness must arouse from all of us compassion and action. Those familiar with the Bible story of the Good Samaritan, and can relate to it, will understand where I am coming from.
Nothing better guarantees healthcare for 42 million (only 8 million South Africans are covered by medical schemes) newly re-enfranchised citizens who have been excluded by a market-driven healthcare system than the NHI.
While on matters of health care, Thursday, December 1, is World Aids Day. As part our contribution to health awareness as a church, we have organised a wellness day on December 4, encouraging our congregation to participate.
Pastor Ray McCauley is a senior pastor of the Rhema Bible Church, president of International Federation of Christian Churches and co-chairperson of the National Interfaith Council of SA.
