Brace yourselves for the economic Ebola that is NHI
No number of Cuban doctors will help us once this virulent legislative virus claims all of ours
Between 1347 and 1351, a medical catastrophe called the Plague wiped out half of Europe. Between 1918 and 1920, a medical catastrophe called Spanish flu killed up to 100 million people. And in 2018, a medical catastrophe called National Health Insurance is set to complete the circle by setting South Africa back centuries.
Outbreaks and plagues trigger panic and invite hyperbole, but I don’t think it is too great a stretch to suggest that the NHI, as outlined by Health Minister Aaron Motsoaledi, is a virulent legislative virus ready to unleash a form of economic Ebola on us from which we will never recover.
Universal free healthcare, is, of course, a magnificent ideal and something to which every country should aspire. This particular country, however, is also the one in which a highly urbanised province killed 143 patients and the Health minister didn’t resign in disgrace and nobody went to jail. Instead, the MEC on whose watch the Life Esidimeni scandal happened was photographed with the president on one of his morning walks in March. Then again, I shouldn’t be surprised: shit does tend to float.When Aaron Motsoaledi told us in April that healthcare in South Africa was not collapsing, he was telling the truth. In many parts of South Africa healthcare is not collapsing. Because it has already finished collapsing. It’s done. It’s over. Any set-up where you wait for a year for radiation therapy, as is the case in some hospitals in KwaZulu-Natal, is not a system. It is a ruin.
And now a government that can’t maintain a 1987 Ford Escort wants to introduce a new tax so it can buy a space shuttle it doesn’t know how to fly.
So far, the NHI’s critics are presenting it as a looming medical crisis. But the NHI is just Patient Zero, the poor sap carrying the plague. The real horror starts later.
It will begin, however, as many outbreaks do: quietly, with nothing more than a slightly elevated pulse and a light sweat. The dozens of medical specialists sitting in the departures lounge at OR Tambo International on the morning NHI is announced will be polite and soft-spoken, catching their breath and mopping their foreheads after their frantic rush to the airport.To be clear: they won’t be leaving us because they are nasty or selfish. They will leave us because they are human beings. If your considerable earning potential is being capped by a system that is also eventually going to compromise the quality of healthcare available to your family, you go where you will be paid and your children can get the best care you can afford.
Which is why the plague will soon claim our doctors in ever greater numbers. Hundreds, and then thousands, will shuffle through emigration and disappear, some weeping, some stoic, as we press poultices to our noses and keep fires burning in every room.
The government will insist that this inevitable exodus will be offset by the arrival of skilled foreign doctors eager to work in this country, plus all the extra specialists our universities are going to start pumping out any day now. Because obviously red tape isn’t a thing, and academic hospitals are totally going to keep getting funded by big business once NHI kicks in, and Nehawu will welcome foreign workers with all the traditional hospitality we show people from other countries, and all the wards will be staffed by unicorns and there will be ice cream for everyone.
And this is where things get very dangerous for the country. Because this is the part where the plague spreads beyond the medical world and enters the population at large.
You might have heard it, at some point: “It’s so tricky. I would probably leave but private healthcare in South Africa is still so good compared to the NHS or other places, so we’ll probably stay for now.”
The mobile rich have stayed in South Africa for two reasons: sunshine and high-quality private healthcare. Compromise the latter, even by a small margin, and they will go where they and their money feel safer in their old age.
But it’s not just the rich who will vote against NHI with their feet.For large swathes of the middle class, access to good private healthcare is not just a lifestyle choice or the difference between staying in Sandton and nipping off to Kensington. It is an essential service, like the private security and private schooling they pay for, going into debt to fund those essentials their taxes are failing to provide.
If middle-class people feel they can no longer buy themselves or their families the medical care they expect, they will leave this county if they can. And if they can’t, there will be tax revolts.
Either way, if NHI is implemented, the money will leave, en masse, on a scale and at a pace perhaps unprecedented in this country’s history.
And all the Cuban doctors in the world won’t be able to put us back together again.