NHI: infected with doubt

Health systems news and health systems financing news, in particular, seldom get the nation talking. But the announcement of the imminent arrival of National Health Insurance (NHI) on our shores, and the subsequent release of the policy paper on the NHI, certainly did. And rightly so! For a country that spends a respectable percentage of GDP on health care but yet does poorer on health indicators than most of its economic counterparts, it was a long overdue topic of discussion.

So as I tried to keep up with the back and forth of “it won’t work” vs. “it will work”, and googled my way through the abnormal economics of health economics and battled to make sense of the graphs and diagrams that had our country’s economists furiously drawing, I wondered what all the fuss was about. Isn’t it obvious? A no-brainer? Of course NHI! Yes NHI! Now NHI! Viva NHI! South Africa’s health care system as it now stands is highly inequitable. Haven’t the researchers shown time and time again that the privileged few access health care to values almost five times higher than the poor and vulnerable majority? Hasn’t it been demonstrated again and again that our health care resources are distributed along deeply inequitable lines? Don’t we know that most of our country’s doctors are in the private sector serving a small fraction of the population while the public sector crumbles under the weight of the masses?
Why are we wasting time? Why are we not rolling up our sleeves and getting to work at making it work?

It made me angry when people said it was infeasible. How easy it must be to call it infeasible when one speaks from the comfort of hospital cover and accident cover and dental cover and travel cover and hail stone cover. The way the word infeasible was being tossed around from article to article made me wonder about what our values are as a country. This commodity that we call health isn’t just a bag of potatoes or a ton of coal, it’s who we are, it’s the thing we live in, it’s our essence. And even if there is no altruism in us, the wise economists from all over the world have shown that healthier nations are wealthier nations. So why is doing the right thing for the health of our country’s people like taking blood from a stone?

I was convinced that there was no nobler goal. I was sure, 100%. Not just sure: certain. Excited. Amped. This must work. This will work. And was quick to remind people that there were reams of examples of things in history that were said to be infeasible, and later surprised the world.

But as I sat getting ready for school yesterday morning, and listened on the radio to the scary financial mess our provincial governments have gotten themselves into, incapable of paying the laboratories that our hospitals simply cannot function without, I could no longer deny that, although still hopeful, I too was now infected with doubt.