The NHI will not achieve universal healthcare despite its strong moral foundation. In its current iteration, it is about finances rather than health services. And for all the talk about health being a public good, the NHI will essentially be a transactional system with buyers and sellers of health services.

In another world, the National Health Insurance (NHI), recently adopted by Parliament, will achieve universal healthcare for all South African citizens. It will ensure equitable access to healthcare regardless of the demographic profile, social status or geographic location of the patient.

Sadly, in this world and with the NHI in its current form, this will remain elusive, despite the moral posturing captured in the preamble to the bill.

The moral imperative for the NHI is compelling and it will be hard to find any sane person in opposition to it. While the objective is unchallenged, the same cannot be said about the tools that the NHI intends to use to achieve this.

Blinded by the overwhelming moral case for the intervention, the drafters neglected to properly account for the accompanying practical and complex implementation implications. The result is a grand scheme full of promise that leaves unanswered questions lingering decades after its initial conceptualisation.

The fact that the NHI has been in the making for this long is a red flag in itself. It speaks to the drafters grappling with the historical rationale for the project.

In a sense, history has overtaken the original intent of the NHI, and the...