For the privileged South Africans who have private health insurance, the National Health Insurance Bill is a profound shock. The need for a better healthcare system for all South Africans is nowhere in dispute, but the idea that members of the private system will have no choice but to be served by the dysfunctional public system is, well, heartstopping. But is that what the new system will require? If so, could the Constitution come to their aid? Lawyers are already debating both those points.
Leaving aside the issue of the effectiveness of SA's existing public healthcare, the debate about a single national health insurance system rests on two contradictory arguments.
On the one side, government and some healthcare professionals argue that SA's current total healthcare expenditure is massively skewed, which of course nobody disputes.
In SA, the private sector system spends about R20,000 a year per person on healthcare, which serves 15% of the population, while the public system is funded out of the Budget and comes to about R4,000 a year per person for the remaining 85% of the population.
For proponents of National Health Insurance, the solution is easy: merge the two systems and distribute the money evenly....