Cape Town - In what has been described as a historic milestone for universal access to health care in South Africa, Parliament approved the National Health Bill (NHI), which has been more than 12 years in the making.
It will now be referred to President Cyril Ramaphosa for approval.
The ANC was able to secure a majority of 205 votes, including the support of its 200 MP’s, two votes from the GOOD party, and one each from the NFP, AIC and PAC.
Opposition parties against the NHI only managed to garner 125 votes, with the DA securing 71 votes, the EFF 30, IFP 12, Freedom Front Plus eight, ACDP three and ATM one.
Speaking during the debate prior to the vote on the bill, Health Minister Joe Phaahla said: “It feels good that today we have reached this historic milestone.
The aspiration to create an equitable and just health system has been part and parcel of our struggle for freedom and democracy.
“The bill we are called to pass today is meant to create the legal framework and foundation for the noble aims embodied in the Freedom Charter and our Constitution. This is one of the most revolutionary pieces of legislation presented to this House since the dawn of democracy.”
The NHI, Phaala said, sought to stop the “two trains”, i.e. Private Health and Public Health travelling on parallel tracks, but “both surely going toward crashing, while if they can be pooled together there is a good chance of complementing each other”.
“The NHI seeks to pool resources of those who can only contribute to the fiscus through indirect means such as VAT and other collections, and those of us who are able and are already making fragmented contributions into 81 different schemes into one pool that can purchase services from both the public health system and private providers from lowest level of care up to the highest.”
He said a major injustice was that almost all health care professionals were trained at the expense of all tax-paying South Africans, including those paying VAT, but also clinical training was done on ordinary South Africans who used public clinics and hospitals.
But once they became specialists and super specialists they were available only to the top payers.
“As the number of people in formal jobs is not rising in line with the investment in private health care and the cost of administering medical aids, the cost of subscription is rising above inflation every year while the benefits are reducing and getting exhausted before the end of every calendar year.
The availability of top health professionals to only those on medical aids and even migration to richer countries is unjust,” the minister said.
He added that while the public health system was under tremendous pressure, private health care was over-servicing its clients, leading to ever-rising costs to the members of medical schemes “while the investors are enjoying huge dividends, including from the JSE”.
DA MP Michele Clarke said the NHI was not the miracle the ANC purported it to be.
“It is smoke and mirrors meant to make voters believe that the grotesque looters standing in front of them have returned to their revolutionary roots that once liberated a nation,” Clarke said.
She said once the NHI was implemented, the 9 million people on medical aid would have to be accommodated in an already overburdened public health system.
“Instead of going directly to their privately paid doctors or hospitals, they will now be competing for treatment in the public health system with its severe staff and resource constraints,” Clarke said.
EFF MP Naledi Chirwa said the NHI would be the ANC’s biggest scam.
“The NHI is far from what it is said to be. It is not the eradication of the two-tier system,” she said.
IFP MP Duduzile Hlengwa said her party supported universal access to health care, but the bill in the current form was not achievable.
She cited affordability and warned about the denying of access to existing health care, rather than promoting it.
“This is not affordable and on its own. It is a cause for the bill to fail,” Hlengwa said.
Freedom Front Plus MP Philip van Staden said the NHI was nothing but a political gimmick that the ANC was using to canvass votes for the 2024 elections.
“It promises everyone everything, but in the end there will be nothing left for anyone,” Van Staden said.
He said what was particularly alarming was that the bill, like the Covid-19 state of disaster, made no provision for any parliamentary oversight to be exercised over the NHI Fund.
GOOD party MP Brett Herron said it was an equally undeniable fact that the structural ills of the past persisted.
He said the concerns over corruption, poor quality public health facilities and inadequate resources, human and financial were legitimate, but weaponising the NHI debate in the run-up to the next election lacked legitimacy.
“South Africa’s NHI aims to address inequality and the scarcity of health care resources, and improve health care services for all. It seeks to eliminate price gouging in the private health sector and improve access and quality of care for those who rely on the public health sector.”