Young South Africans, do you know what the proposed National Health Insurance (NHI) has in store for you? You are fit and healthy; old age and infirmity lie in the distant future and you don’t want to think about such things. But you need to take a special interest in the debate about National Health Insurance and the shenanigans politicians and government officials are getting up to. They are going to have a drastic impact on your future. 

A nurse attends to a patient         Photo:Courtesy

The NHI proposals are not yet out but, from pronouncements that have been made on the subject, the basics are clear. First, it’s you, the young go-getter, who’ll be lumbered with the major part of the cost of providing health care for the aged, sick and poor. No way will you be able to duck out on health care costs because you’re young, fit and healthy. Why? Because your ‘representatives’ (reps) believe that the young, fit and healthy should help cover the costs of the not so young, fit and healthy. Your reps believe that they’re better at making personal decisions for you about your own life. In their system, you WILL have socialised (meaning government-dominated) health care. You will not be able to choose between it and private health-care. In a communist and socialist world, the word ‘democratic’ means that someone else decides for you, on everything, even whether you live or die. 

Second, if you’re a member of a medical scheme already and are happy with the cover you have, don’t think that your reps are pleased. For some years, they’ve had their eyes on the money you pay to a medical scheme to cover your own health care costs. I know, that means they should be happy because you’re not a burden on the public health care system, and there’s more money to care for the destitute, but your reps just don’t see things that way. Yes, I understand too that you and all the other taxpayers are already paying ALL the costs of public health care, but your reps can’t seem to get that one either. 

Third, they try to shame you by saying that if you exhaust your medical scheme benefits, you will be ‘dumped’ onto the public health care system. So? What’s wrong with that? At least you will have been paying your way up to that point. 

What your reps are talking about is a ‘Single-Payer health insurance fund’, which means you pay the government and they dish out the cash. 

They propose that instead of the money being collected by the Treasury through taxes, a new government bureaucracy will collect it. This way they can sock the higher earners even more than they do now and pretend it’s not merely an extra tax. They can also collect money from low-income people and pretend that they’re not taxing them at all!

All the money collected will go into one big pot. It will be like a huge honey jar attracting all kinds of bees trying to get their fair and unfair share. Can you expect efficiency levels to be better than the current handling of the Road Accident Fund or welfare payments? Your reps say there should not be medical schemes for the rich and others for the poor. They say they will minimise complexity and the expense of admin. That’ll be easy; just don’t record anything, especially items you don’t want others to know about. Oh! And your reps have friends who want your medical scheme banned. 

Where are these ideas coming from? SA is taking its lead from Canada, a country with an estimated PPP (purchasing power parity) GDP per capita in 2008 almost four times greater than ours (US$39,300 compared to SA’s US$10,000). According to the World Health Organisation, Canada’s single-payer government health system, funded by taxpayers, cost US$2,754 per capita in 2006 compared to SA’s public health care, which cost US$191(that’s14.4 times greater than ours). In Canada, private spending on health care was US$1,158 per capita compared to SA’s US$ 265, that’s 4.4 times our private spending and 6 times our government spending. Sorry about all the numbers, but you’re scarcely going to believe the next part of the story.

Waiting Your Turn: Hospital Waiting Lists in Canada 2008 Report, published by the Fraser Institute, tells us that ‘Total waiting time between referral from a general practitioner and treatment, averaged across 12 specialities and 10 provinces surveyed, fell from 18.3 weeks in 2007 to 17.3 weeks in 2008.’ The longest average wait for treatment in 2008 was in the province of Saskatchewan, a total of 28.8 weeks; 12.7 weeks to get to see a specialist and 16.1 weeks to get treatment. For crying out aloud, a 3 month wait to see a specialist and then another 4 to get treatment. And that’s after you’ve seen a GP, and many people even have a battle to get onto a GP list. Do the poorest South Africans currently face such an appalling prospect? It’s enough to frighten us to death. Now there’s an unfortunate way to solve the problem! 

Before you decide that you’re OK with waiting 7 months for treatment, think about it a bit more. If those are the waiting times for Canadians in their single-payer system, what will they be in ours? Based on our respective per capita GDP’s, will our waiting times average four times that of Canada’s, that is 69.2 weeks (1 year and 4 months)? Maybe not quite that long, but all governments, be they in the UK or Canada or any other country, that offer ‘free health care for all’ use the same method to not provide what they promise, they make the patients wait. 

Why is so-called ‘free’ health care such a mess? Simple: when health care services are ‘free’, won’t you be tempted to use them more than when you or your medical aid has to pay for them? That’s right, there’s an exponential increase in demand. What better way to create a nation of hypochondriacs? Also: people are living longer and the cost of health care for the aged is rising, also exponentially. And where’s the money to come from? From YOU - especially if you’re fit and young and earning big bucks. 

Which is more important – health care or food? What if government decides that no one must go hungry and that food must be provided to all on the same basis as health-care? Will you be happy to give up more of your income to pay for ‘free’ food for the hungry? And what about clothing for all so no one has to dress in rags? Are all the poor, aged and sick your dependents or will you be able to make your own choices and support the deserving where you can out of the generosity of your heart? 

Wake up young South Africans! Defend your rights, and those of your children and their children – to choose your own health care and how you want to spend your hard-earned money. It’s your choice. Don’t let a smothering bureaucracy take over and decide for you. Make your voice heard!

By Eustace Davie

Director of the Free Market Foundation and the Health Policy Unit.