Opposition to NHI driven by a neo-liberal agenda fixated on profit accumulation

SACP national spokesman Alex Mashilo. File photo: Independent Newspapers

SACP national spokesman Alex Mashilo. File photo: Independent Newspapers

Published May 22, 2024


In the early 1990s, the SACP General Secretary Chris Hani led a campaign called the HHH Campaign.

One of the three “Hs” refers to quality Healthcare for all. This became a campaign on its own, culminating in the struggle for the National Health Insurance (NHI).

In one of his interviews, Hani offered a brief review of how newborns faced limited chances of survival in oppressed black majority communities, including where he was born, in Sabalele, Cofimvaba.

The solution, as the Freedom Charter declared, was “A preventive health scheme”, which “shall be run by the state; Free medical care and hospitalisation”, which “shall be provided for all, with special care for mothers and young children”.

Adopted in 1955, the Freedom Charter is by far older than the United Nations General Assembly resolution, adopted on 2012, December 12, urging countries to accelerate progress towards universal health coverage.

Through the HHH Campaign, Hani, the leadership “H” of the campaign, if you like, was taking forward the struggle to achieve the demands of the people of South Africa who faced colonisation, apartheid and related oppression between 1652 and 1994.

The beneficiaries of the racist and sexist colonial and apartheid oppression had access to, while the oppressed black majority were deprived of quality healthcare.

Those who were unrepentant, including Chris Hani’s assassins, opposed the transition to democracy. After they lost in April 1994, they re-grouped under the banner of different right-wing political parties and non-governmental organisations to defend their gains and inheritance – which dates back to the colonial and apartheid era of white privilege and oppression of the black majority.

Their politics revolved and still revolve around seeking to maintain their inherited monopoly and privileges in the control of our society’s wealth and access to quality services, such as quality healthcare.

This is where their political and economic opposition to the Freedom Charter, including the introduction of the NHI, has its roots.

The adoption and articulation of neo-liberal politics anchored in the legacy of racism in South Africa serves a conservative purpose, among others.

By demanding that the state must neither take part nor intervene in the economy and that its role must be limited and delimited, these neo-liberals are pushing societal control by the largely untransformed private enterprise sector.

White domination in terms of ownership, management control and high incomes prevails in the private enterprise sector. This is a legacy of colonial and apartheid oppression and the long history of what the scholar, Stephen Gelb, called “racial capitalism” in his book, South Africa's Economic Crisis.

It was published by David Philip in 1991. Neo-liberal conservatism brings together those advancing it and outright conservatives of old order, racially acquired or inherited advantages.

Hence, the connection between the two groups, including with regard to their shared opposition to the need for a transition to the NHI.

At present, the healthcare sector in South Africa is fragmented along the line of two tiers. The private healthcare sector, which, in terms of hospitals, is dominated by three oligopolies – Netcare, Life and Mediclinic, represents one of the two tiers.

Those who command control in the private healthcare sector make profit from healthcare – converted into a commodity only provided to those who have the money to buy it.

As a result, the private healthcare sector caters for a minority of the rich, the well-off and those who are lucky to have income levels from which they can sacrifice a portion to subscribe to exorbitant medical aid schemes.

However, these medical aid schemes have little, if any at all, attention to primary healthcare in their benefits structure or have increasingly cut day-to-day benefits.

This has led to too many people, among our society’s minority who have a medical aid cover, facing the prevailing situation where their day-to-day medical aid cover is exhausted by around mid-year annually.

From the moment this happens, the victims are as good as having no day-to-day medical aid cover at all. Many are forced to make out-of-pocket payments for medical services, including medicine.

New financial sector accumulators have insinuated themselves into the situation, taking advantage through what they call “a gap cover” for the victims to pay more over and above their annually increasing primary medical aid scheme monthly premiums.

In other situations, there are patients who have had their medical aid benefits exhausted while admitted in private hospitals – which evicted them afterwards.

There are patients who died after this experience. These are among the untold stories which those opposed to NHI introduction towards quality healthcare for all conceal.

As if that were not enough, one reason those accumulating wealth through private hospitals are rich is that a significant portion paid by patients in their hospitals does not go towards and has nothing to do with healthcare.

It has everything to do with and goes towards profits, a key factor that underpins exorbitant pricing, which was once investigated in what was called the “Healthcare Market Inquiry”.

Under the private hospital accumulation regime, well-trained and experienced healthcare professionals and specialists – who are largely the products of public universities and hospitals – have been converted into exploited modern serfs, to whom owners are akin to modern, rentier feudal lords.

The advance towards the NHI must expand to include an emancipatory struggle to free the exploited healthcare professionals and specialists. This can be achieved by moving towards making more publicly owned healthcare infrastructure available for them free from the exploitation they now endure.

The NHI Fund, which is a critical pillar of the NHI, will make a meaningful contribution in addressing inequalities in healthcare provision. Under the NHI, everyone will be entitled to healthcare services through the NHI Fund, regardless of whether they do not have money to pay.

The fund must be governed, managed and administered competently. A reasonable person cannot be opposed to this direction towards equality in healthcare.

While a lion’s share of healthcare spending in the oligopolies-dominated private healthcare sector is heaped up as profits, the public healthcare sector, which caters for the overwhelming majority, needs increased funding, resources and more healthcare facilities.

These include more healthcare professionals and specialists, a stronger focus on primary healthcare and clinics, as well as day and 24-hour comprehensive and specialising clinics and hospitals.

This must be addressed through equitable distribution of healthcare resources, underpinned by the principles of solidarity and justice. To this end, President Cyril Ramaphosa’s signing of the NHI Bill into law on 2024, May 15, represents a historical victory for the majority of our people.

The working class needs to unite to defend the advance to the NHI both from those opposed to this progressive legislative intervention towards universal healthcare and from corrupt forces.

*Dr. Alex Mashilo is the national spokesperson of the SA Communist Party.

** The views expressed do not necessarily reflect the views of IOL or Independent Media.

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