The NHI According To Dr Crisp  – The Next Economic Fantasy in a Crumbling World

Last Updated: 28 June 2023By

Business Tech published an article by its Staff Reporter on the opinion of Deputy Director General of National Health Insurance, Dr Nicholas Crisp that the NHI could become the next SARS or ACSA rather than the next Eskom or SAA. Thus, he touts that the NHI could be a roaring success rather than a dismal failure.

The good Dr Crisp asks a poignant question, “Can we fix what is wrong?” He then answers his question in true ‘Barak Obama’ fashion with a resounding “Yes We Can!” He enthusiastically posits, “We have done it before. We have good organisations in this country,” and then holds up SARS and ACSA as the finest examples.

So let us examine Dr Crisp’s prognosis of the NHI and put its future impact under a microscope of logical reality before moving on to his comparison.

Dr Crisp rightly points out the inequality between public and private healthcare. He considers it a problem from the public perspective for the following reasons:

Firstly, the public sector is unable to retain skilled doctors and nurses as they drift to the ‘lucrative private sector’. Somehow, he fantasises, that the NHI will solve that problem. He seems oblivious to the prognosis that the NHI will be unable to retain skilled doctors and nurses for the very same reason, as doctors and nurses flock to more lucrative positions in other countries, leaving the NHI bereft of doctors and nurses and thus destroying healthcare in this country for everyone rather than fixing it.

Secondly, he complains that private healthcare is largely unregulated, particularly in its pricing structure and serves a small portion of the population. Perhaps he should get some of the vaunted economists in the country to talk him through economies of private healthcare. Private healthcare is regulated by market forces and those who benefit from it pay very high premiums for the benefits they receive.

He later reiterates, with the absurd notion, that the private healthcare sector has become a “FREE FOR ALL”, with hundreds of packages and schemes that only a few benefits from. There is nothing ‘FREE’ about these very ‘EXPENSIVE’ packages and they certainly are not for all, only those who can ‘AFFORD’ them. 

He then goes on to catalogue the woes of public healthcare, the complexities and inefficiencies at a structural level along with a briefly mentioned fact that corruption has become rife. He pronounces that because of these reasons, the public health sector has “become inefficient, delivers no value for money and provides poor quality of care”.

What the good doctor cannot see is that the NHI will extend this poor state of public healthcare to all healthcare. What he and those who promote the NHI as the solution to SA healthcare needs is that you cannot amalgamate a failing monolithic public healthcare structure with a smaller successful private one and expect the successful model to overtake the failing one. It never works that way in reality, the failure will merely spread, overwhelming the successful and bringing down the whole structure to mediocracy and increasing breakdown.

Not only will the NHI decimate effective medical care for all, but it will also infect the country with a deadly disease of economic failure. It will be the straw that breaks the camel’s back of an already dismal economic outlook.

So let us turn our attention to the comparisons that Dr Crisp has made that the NHI could be the next SARS or ACSA and will not necessarily end up like Eskom or SAA, and also examine its future economic impact on the country.

Trying to compare the NHI to SARS is a bit like comparing fruitcakes with financial assets. There can be no comparison and yet there are some common effects that the effective SARS and the proposed NHI have in common regarding the future of South Africa’s economy.

SARS is working well, and some would say that it is working too well. SARS or its increasingly aggressive business of tax collection is among the top reason that wealthy taxpayers are fleeing our shores. Those fleeing are using ACSA as an exit point. Unfortunately, they are not flying away on SAA. The less said about Eskom in this article the better.

SARS has no products, it does not sell anything, it is merely the collector of taxes that are handed over to the government. Its clients have no choice of tax products and failure to do business with it results in penalties and prosecutions. SARS is doing well, because all it needs to do well, is to streamline and enforce its collection methods.

Backing SARS are the tax laws, probably the only laws that are rigorously implemented in South Africa, but only rigorously implemented at what the commissioner labels “low hanging fruit”, whilst fruit that is higher up the branch, particularly fruit that is connected to the core of the vine, not so much!

South Africa is way up there among the most taxed countries in the world, simply because the actual tax base is a small percentage of the working population, which in itself is a small percentage of the total population.

Thus wealthy and upper-middle-class taxpayers have had enough and the trickle out of South Africa is turning into a flood.

Now, whilst SARS, as Dr Crisp pointed out is “doing fine”, the recipient of all its fine work, the state, is not doing too well. The ill effects of corruption and wastefulness have accumulated into a disease that the NHI will not remedy. The moral compact between the taxpayer and the tax receiver, the government of the day, is suffering an increasing mental breakdown, simply because the government does not care how it spends the money, nor prosecute those who steal it.

Also, the state is essentially broke. Its legitimate expenses as well as theft, wastage, vainglorious projects, state-owned enterprise bailouts etc… far exceed the income it can squeeze out of an already squashed population, a fading business environment and the growing cancer of unemployment.

Whilst South Africans are generally optimistic and hopeful people, ignoring reality will eventually lead to a schizophrenic society, unable to see the wood for the trees of its demise. Economists and financial gurus love to tell us that things always return to normal and in a normal world they generally do. However, the world is no longer normal in the normal sense of the word. On every front, human society is teetering on collapse. The way humans have governed the world over the last century, politically, financially and socially, collapse was always a very real possibility that is quickly becoming a sure thing.