A legitimate concern about the proposed National Health Insurance is the almost complete lack of trust in the state-government-elite axis to manage effectively anything more than rinsing a tumbler. The rest is simply ideological and disingenuous.

Taking legislative steps to establish a National Health Insurance (NHI) scheme is a principled, progressive and necessary move if South Africa is to continue working towards a more just, equitable, prosperous and healthy society. The most successful social democracies in the world established national/public health systems, and their societies have benefited enormously.

In the case of South Africa, today, the effort to establish a publicly funded national health system is a necessary step, but it is insufficient. The next, more difficult step is to expand the middle class - often ill-defined - who are the most important part of the revenue base. An even more difficult step will be to build trust in the state, the government and the ruling elite - the axis that has brought the country to where it is.

Before we even get to that, we need to have a serious look at the ideological opposition to an NHI, an opposition that is driven by a seriously flawed set of ideas, beliefs and values imported from the US.

The monetarist, decidedly conservative politics and policies that took shape in the early 1980s and gained traction among free marketers and market fundamentalists began to erode belief in...