Combinations of poverty, racial and social inequalityand a history of neoliberal policy decisions have contributed to the poor state of the health system in South Africa. For a country that boasts the highest GDP on the continent, we have very poor health indicators and face massive inequalities in access to health care. The HIV/AIDS & TB epidemics, a growing burden of non-communicable diseases, and high rates of injuries and fatalities, mean that South Africa faces a quadruple burden of disease and our health system is in a state of crisis. Close to half of government funding is spent on 16% of the population in the private sector (facilitated through tax credits), whilst the other half of funding is directed towards the remaining 84% of the population in an overburdened public sector.

South Africa has formally opened discussion and debate on the proposed National Health Insurance (NHI) plan, the primary goal of which is to “ensure that everyone has access to a defined comprehensive package of healthcare services.”(2) This plan is one step towards achieving universal health coverage in post-apartheid South Africa where the majority of South Africans do not have access to the available, expensive health care. Universal coverage means that all citizens would enjoy financial protection from the costly burden of ill health. The idea of the NHI has been present in the public sphere for decades and the release of the Green Paper by the Deparment of Health on 12 August 2011 signaled the beginning of the policy debate in official government capacity.

OPINION:Misinformed scaremongering seems to have been the order of the day since the release of the National Health Insurance (NHI) Green Paper. South Africans have been subjected to a barrage of reports about how the proposed NHI is unaffordable, how it will increase the cost of labour and will push the economy into recession. by Di McIntyre.

We need to consider some facts. What is the NHI all about? What are its likely costs?

The proposed NHI is about achieving a universal health system. That means two things: everyone enjoys financial protection from high health care costs; and everyone is able to access good health services when they really need them. South Africa is very far from this ideal; at the moment, the reality for millions of South Africans is that they simply don’t get health care when they are ill. The NHI is intended to address this reality. It includes building new facilities, upgrading existing ones, introducing community-based teams of health workers to take services to people’s homes, taking steps to improve the quality of care in public facilities, drawing on health professionals in the public and private sectors to provide improved health care for all. The most under-served areas will be focused on first.

The recent release of the Green Paper on National Health Insurance (NHI) has rekindled the heated debate around reforming South Africa’s health system. After the abhorrence of over a decade of denialism and neglect in the public health sector, it is evident that health is in a state of crisis and that urgent, real change is necessary. The critical state of healthcare is not accidental, nor just the result of a massive burden of disease. Policy decisions taken by government over the last fifteen years, including the introduction of GEAR, fiscal discipline, privatisation, retrenchment of health workers and deliberate strengthening of the private sector, have contributed to bringing us to where we are today. Newspapers are filled with statistics about the inequality between the public and private sector in South Africa, and some numbers are so startling that they bear repeating. South Africa spends 8.3% of its GDP on healthcare. Half of that is spent on the 16% of the population covered by the private sector with a per capita expenditure of R11.150.

‘It’s a much straighter shot from section 27 to the NHI than it is from the commerce clause to Obamacare’

THE US recently made an attempt at nationalised health insurance. It had an amazing opportunity — but it missed the chance. The relevant bill, which came to be known as Obamacare, didn’t even include a public health insurance option when it was finally passed. The "compromise" it does include is simply a requirement that all people buy health insurance.