Why the private health industry is bad for your health

We have many things of which to be proud in this country. The way we treat sick people is not one of them.

Recent reports have focused attention again on the awfulness that faces the poor and weak when they try to access public healthcare — child deaths at Frere Hospital and babies kept in cardboard boxes at Chris Hani Baragwanath are two examples. Every now and then, the chronic ill treatment of patients at our public hospitals makes it into the media. But, if the reports are occasional, the problem is perpetual.

The causes are also fairly clear. Public hospitals don’t have the resources they need to retain the best staff or to provide the service that a caring society ought to offer everyone who needs medical help.

But, while the medical care available to the poor is horrendous, it would be a mistake to imagine that, if you are middle class in this country, the system works for you.

Treatment Action Campaign chairperson Zackie Achmat has suggested that the time might be right for a campaign for change in the healthcare system because middle-class people are also losing out. He may be right: our health system does not treat middle-class people well. If it works for anyone at all, it is only the very affluent who benefit.

Unlike the poor, middle-class people can rely on private hospitals. Obviously the medical care they offer is superior because the better doctors and nurses work for them. But they often treat their patients with as much contempt as the public hospitals do. And in their case, there is no excuse: they have the money to treat people properly. But they choose not to — in the hope of making more money.

To illustrate: a hospital in Johannesburg, run by the same private company that is so keen to protect the health minister’s medical records, decided a while back that it will have only one lift in service for six months. If that sounds trivial, imagine a situation in which, for months and by design, seriously ill people and those with injuries and disabilities must make use of only one lift. And why? Because the company is engaged in an upgrade programme — no doubt to enhance its bottom line.

This is only an extreme case of a much wider problem: if private hospitals have to choose between making more bucks and treating their patients with care, the patients come second every time.

Private hospitals are, however, patient-friendly compared with the biggest blight on the life of the middle-class with health needs — the medical-aid industry.

Once upon a time, medical aids were meant to be voluntary societies in which people got together to pool their medical risks. Today, they are large companies making millions at the expense of those who rely on them for help.

Space does not allow a full discussion of the many ways in which medical aids maximise their profits by ignoring patients’ needs. Suffice it to say that the range of medicines that they cover always seems to shrink as the schemes’ profits rise.

One way in which medical aids manage to look after themselves rather than their patients is to devise immensely complicated rules. The only people who can explain them are the companies themselves and their consultants, who usually work for the companies rather than the patients and who tend to back the companies even when they work for themselves. Clearly, the company and its consultants are not going to explain the rules to you in a way that allows you to challenge their decisions. And so they can get away with just about anything because only they know the rules.

If you challenge the medical aids, they will tell you they can only survive if they cut down on “unnecessary” costs. The government, they complain, has now forced them to take all sorts of people they didn’t have to take in the past (poorer people!) and they can only cut costs by focusing on essentials.

If you want to know why this is nonsense, look at the profits which our major medical aid companies are making — they brag about them to the financial media. They could offer their members much more than they do without even remotely endangering their survival. They won’t because they care about their shareholders, not sick people.

So why do middle-class people allow themselves to be treated like this? After all, unlike the poor, we have ways of making ourselves heard — essentially, because we have no option.

If we want medical care, we have to have medical aid — the private hospitals have made sure that no one without it could possibly afford treatment. You can perhaps get a slightly better deal from some medical aids rather than others, but the difference is fairly marginal.

The solution, therefore, does not lie in us being smarter consumers — it lies in us realising that the reasons for the poor being maltreated at Frere and Baragwanath and the middle class losing out (even while it gets much better care) are the same: that we allow the private healthcare industry far too much latitude.

Poor people don’t get decent care because their hospitals get the crumbs. Middle-class people don’t because they are at the mercy of private providers. And the answer in both cases is to roll back the private medical industry and extend the public health system.

Before that raises visions of the horrors of socialised medicine, all North American and Western European democracies except one have far more generous public health systems than ours. The one exception is the United States — where the costs of not having adequate public health provision have become so high that even conservative companies are getting together with unions to fight for better public provision.

While many public health systems are under pressure, this is not because they have failed but because they are too successful — people are living far longer and so they face new demands to which health systems are battling to adjust. We have more than enough health problems to make a public system sustainable for decades.

Obviously, we can’t afford to alienate the skilled doctors and nurses who continue to provide for the health needs of those who can afford them. But there are ways of mixing far more public provision and retaining skilled medical professionals. This society will not work for all its people until we begin discussing how we can do that.