When at the last moment Wednesday's National Council of Provinces vote on the controversial National Health Insurance Bill was delayed for a week, the door for further engagements opened. It's understood some background discussions are already under way.

That something was up became clear when the National Council of Provinces (NCOP) was running 10 minutes late on Wednesday. It takes a little bit of time to prep the deferment motion that was announced in the chamber.

The vote on the National Health Insurance (NHI) Bill that seeks to introduce universal public healthcare in SA is now scheduled to be held on 6 December. And that vote must happen, regardless of the political twists and turns that were on display on Wednesday afternoon.

At this stage of the legislative process, few options exist.

One would be to withdraw the NHI Bill entirely -- a political impossibility ahead of the 2024 elections when the governing ANC alliance partners are actively demanding the NHI.

Or the Bill may be rejected in the NCOP -- again a political pickle, and difficult unless the ANC changes its stance, given that eight provinces declared their support for the Bill on 21 November. If that happens the Bill will be sent to the mediation committee to potentially linger for years, like the 2018 National Gambling Amendment Bill -- again, politically unpalatable in the run-up to next year's elections.

If the Bill is approved in the...