When understanding fails

So Aaron Motsoaledi “has reiterated his position that private healthcare is exorbitantly priced, supporting recent findings by the World Health Organisation (WHO).”

He goes on to state “Those that are here not only attacked the facts but also the methodology of the report. As for me, I will challenge anyone who says that there is no inequality.”

This comes after the HMI held a workshop yesterday where a number of parties pointed out flaws in the offending paper.

Minister Motsoaledi’s position is ridiculous, and I’ll tell you why.

How does one support research?  Pay for it.  Give access to data and other resources.  Educate and train researchers.  The way the honourable  Minister “supports” the OECD paper is the same way someone would support a sports team.  I suspect that he likes it because it makes a conclusion that fits his world view, and because it recommends price control as a way to make private hospital care more affordable.

Beware the law of unintended consequences.

This is not the way to set policy.  We need to understand what is really going on with the cost of private hospitalisation.  Then consider a number of alternative policy interventions, weigh the pros and cons of each and choose the best solution.

As the minister should know one must aim to treat the underlying condition, not only the symptoms.



Mini throw up


The C4MS decided that a good use of its time and resources was to renew its Vision and Mission.  They felt so proud of it they wrote an actual circular about it.  When I read it I had a mini throw up made of muesli and yoghurt mixed with black coffee.

I hate these things on principle because, ultimately, they mean nothing and only serve to give people who have no useful skills a warm and fuzzy feeling after a day of workshopping and brainstorming instead of doing real work.

Look at this:

From 1 April 2016 the CMS’ new Vision is to promote vibrant and affordable healthcare cover for all.

From 1 April 2016?  Does that mean that on 31 March the vision was something completely different?  The opposite?  Are we going to see the CMS behaving in a completely different way from now on?  I think not.

Also, what the actual fuck is “vibrant healthcare cover”?!  I ask this because I actually bothered to look up vibrant in a dictionary and this is what I got:

vibrant adjective

› energetic, exciting, and full of enthusiasm:
a vibrant young performer
a vibrant personality
a vibrant city
The hope is that this area will develop into a vibrant commercial centre.
› Vibrant colour or light is bright and strong:
He always uses vibrant colours in his paintings.

Are medical schemes going to be required to use lots of primary colours on their websites?  Should they use more bouncing animations?  Will all calls now be answered using a Barney the dinosaur voice?

Of course everybody would like to see more affordable healthcare, Captain Obvious.  How about actually getting on with figuring out how?

And don’t get me started on the Mission.  They could have written “Our mission is to do our jobs.”  But of course coming up with that wouldn’t get you out of work for a few hours.

Many of us think these things are a load of crap but, as the picture below shows,  there is a good chance that you disagree with me.  This only proves that about half of us are idiots.   Or at least bigger idiots than the other half.


Frakking bullshit…images

Hi!  I’m Bursar and I’m an unreformed cynic.

Finally…we get the booby prize


Finally, after many years of unfulfilled promises we get the NHI white paper!  I actually believe that even Motsoaledi was taken by surprise.  He certainly wasn’t well prepared for his briefing this morning.

You can grab a copy here on the government website.  Uncle Aaron was quite proud that it is 97 pages and has “over 400 paragraphs.”

I have to admit I have only done some speed reading but I already have some impressions.

The ideological case for universal coverage has been beefed up.  They have also expanded on all the things that NHI must do.  But there is a lot of appeal to emotion and your sense of fairness with very little apparent research backing anything up.  I’m sure it will be very popular with the electorate.  Essentially it reads like a wish-list with no implementation details.  It is a bit absurd: “we still don’t know what we are going to do but we will have it done in exactly 5 years.”

the-homer-inline4This actually put me in mind of the Simpsons episode “Oh Brother, Where Art Thou?” (S02E15).   Homer gets tasked with designing his dream car with no design parameters being imposed on him.  The resulting monstrosity puts the company out of business.

It will be powered by fusion reactors that produce chocolate as waste product.  There will be lasers! Robots!  Ponies!

There are absolutely no details on HOW the NHI will achieve all these wonderful things.  Funding model?  Here are some things we are thinking about.  What benefits will NHI deliver?  To be determined.

In business terms this is a functional specification (defining the user experience) rather than a technical specification (how it will work).  This also makes it difficult to provide concrete feedback during the public consultation.  It will do all these wonderful things!  How can anyone possibly object?

In terms of substance there is little more information compared to the 2011 green paper.  When that came out I wondered how it could have taken them so long to come up with essentially the same content as its predecessor.  I am wondering the same thing now.  Is this a delaying tactic?  Kicking for touch while still seeming to deliver on election promises?

The dogma that a single funder/purchaser will necessarily be able to generate large efficiencies remains intact.  This together with the discussion of governance models confirms that this government is a huge fan of monolithic centralised control of all aspects of South Africa, in the Soviet tradition.  When asked about the potential for abuse he told us that it won’t.  Because we should trust government with a fuckload of money, given its good intentions.  He even managed to say that with a straight face in this of all weeks (#ZumaMustFall).

You have to wonder if NHI is maybe a fifth possible reason for Nene getting sacked.

Oh! I’m sorry!  You wanted policy certainty?  Our white paper only says that medical scheme legislation and regulation will be changed in around 9 to 10 years (and their role will be significantly reduced).  In the meantime any problems you have are your own.

Minister Motsoaledi has repeatedly stated that it is not his intention to kill the medical schemes industry.  Based on everything else he says and does (or fails to do) it appears that, if he saw it was  drowning he wouldn’t try to save it.  In fact I’m sure that, when he visits the industry in the emergency room he is not above standing on its air pipe and failing to press the emergency call button when the time comes.  Any of you who still believe that it will simply take time for the government to come around and realise that it should reform the medical schemes industry sooner, rather than later, are idiots.

edited 2015/12/14 10:49: fixed some more typos.


What’s going on?


Kudos to Bronwyn Nortje for asking some very relevant questions about the sudden retraction of the Low Cost Benefit Option framework.  I agree that the timing of the retraction seems a bit suspicious.  On the other hand I also believe that the retracted framework had some deep flaws and that the process was more than just a little broken.

It would be great if the Department of Health could get involved now since it is actually its job to make policy, not the Council for Medical Schemes’.  I have previously explained how I feel about management by exception.  The C4MS was trying to make LCBOs happen by using the exemption powers given to them in the Medical Schemes Act to an extent that (probably) goes far beyond the intention of that act.

Hopefully this will be taken as an opportunity to do a proper job of Low Cost Benefit Options as opposed to the usual way of doing things, which is to let such endeavours die a slow death by means of malignant neglect.



The C4MS’s Circular 62 of 2015 informs us that “following various submissions relating to the proposed package” received by the C4MS as well as the DoH, it is retracting the Low Cost Benefits Package as set out in Circular 54. Presumably this means that any medical schemes who were planning to introduce LCBO products in 2016 have to put them on ice until the regulator can get its act together.

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We no likey


‘The South African Communist Party objects to the C4MS’s framework for Low Cost Benefit Options and lays out its argument in this declaration from the SACP Gauteng Lekgotla Declaration (the link for the same document on the SACP’s own website is completely empty for some reason)

The financialisation of the health sector continues to be pursued by monopoly capital through private medical schemes that are linked to the major financial institutions listed on the JSE as demonstrated by the recent approval of an exemption framework to the Medical Schemes Act to create the legal space for the establishment of low income medical schemes. These low cost benefit options are targeted at bringing an additional 15 million people from the working class communities and low income earners into a financialised health sector controlled by private monopoly capital. These low income medical schemes offer a minimum and inadequate package of benefits and will be introduced in January 2016 to bolster a devouring financial black hole of the greedy private medical schemes industry. National Health Insurance (NHI) is the only viable policy instrument that will ensure that the working class is protected from a financialised health sector and will afford the working class financial risk protection. The Medical schemes have used sophisticated instruments to effect corporate capture of the Regulatory System and to gate-keep in preventing the speedy implementation of NHI. The SACP calls for the speedy implementation of the NHI and will urge the working class to reject the low cost benefit options.

Such paranoia!

Those “sophisticated instruments” do sound very cool.  Does the industry use hypnosis? Doppelgangers that have infiltrated the Regulatory System?  Is the industry going to lure LCBO members to clinics where mind control devices will be implanted in their brains?

How exactly can LCBOs be used for gate-keeping that will prevent the speedy implementation of NHI?  Surely the NHI will be a matter of law.  The ANC either is in control of the country or it is not.  Am I missing something?

Maybe they should forget about private monopoly capital and rather worry about the Reptilian Elite who are really the ones controlling the world.

Cutting through the BS


Imagine that.  Some people actually went and read the proposed Regulation 8 amendment to figure out what the implications are.

I was pleasantly surprised by the C4MS’s press release which dealt with the matter in an emotionally detached and logical manner.

Who are you and what did you do with the real C4MS?

Then there was this piece published by the Helen Suzman Foundation which challenges some of the bullshit statements certain parties have been making.  While there is some misunderstanding about the implications of the amendment due to some people reading what they want or what they fear (or not reading it at all – what’s their excuse?) I can’t help wondering if the wording shouldn’t be redrafted to make it clearer.

The emerging consensus seems to be this:  It will be in the interests of medical schemes and healthcare providers (and by implication medical scheme members) to start contracting with each other as soon as possible.  Some people find that prospect less appealing than others.

Dear Doctors


Dear doctors

Look, I understand that you are angry about the proposed changes to Regulation 8 of the Medical Schemes Act.  If I was in your position I would also be angry at what I perceive as a threat to my business (and my lifestyle).


While I support your assertion that healthcare practitioners should be compensated fairly, your strategy of attacking the RPL as not having a scientific basis exposes you to charges of hypocrisy.  How does “whatever the doctor chooses to charge” have a scientific basis?  The fact that analyses of claims show how differently various specialist practices charge for the exact same thing (see some BHF conference presentations from previous years) proves that you have no real idea of the true costs either.  How about an acknowledgement that the status quo is problematic?

Secondly you should probably shut up a bit and listen to your legal council.  Don’t assume that because you are a doctor you know everything.  Go look things up so you won’t make a fool of yourself in public.  Accusing the Minister of Health of price fixing is stretching things a teensy bit.  Medicine prices are regulated through the Single Exit Price mechanism.  Is that price-fixing as well?  Governments can regulate prices.  Live with it.

Under the proposed Regulation you can still charge whatever you like, but now you will have to consider the consequences for yourself and your patient.  If you want to argue on such points you may rather want to join Genesis in its court case where it challenges the Minister’s right to make such regulation in the first place.  How ironic would that be?

This is a proposed change to regulations.

So how about everybody just calm the hell down and stop saying stupid idiotic things in the media.  Do you really think that sowing fear and confusion amongst the general public is going to help anything?  Exercise your right to submit comments on the proposed changes.  Do your homework and provide evidence to support your (rather dramatic and alarmist) assertions.

sisters-screaming-at-each-oMy biggest problem with the “debate” thus far is that the various stakeholders (and my friend Alex van den Heever) are basing all of their arguments on the rather strong assumption that the “opposing” stakeholders won’t budge from their position.  Commentators allege that medical schemes only want to pay the minimum that they are liable for and are happy to leave their members in the lurch.  Really?  How do you think that will work out for them?  Are we abandoning options that pay at more than 100% of scheme rate? Others allege that providers will not adjust their pricing at any cost, that “do no harm”  doesn’t apply to any aspects other than the clinical.   Everyone seems to be assuming that the Minister and DoH is married to this proposal and will not be willing to consider alternative proposals.

What nonsense!  Industries change (or get disrupted).  The players adapt.  Life goes on.

I expect better from all of you.  What I want to see is everybody (medical schemes, healthcare providers, patients, regulators and government) sitting down and finding a workable solution that is based on science and reason rather than armchair philosophy.

Remember that a compromise is a solution that satisfied no-one.

Ignition in 3, 2, 1…


Oh goody!  It’s opening night and the show is about to start.

In case you haven’t heard, The DoH has gone ahead and announced proposed changes to the Regulations to the Medical Schemes Act.  By far the most controversial aspect is the proposed changes to Regulation 8…

As I have said previously, this is going to create a lot of source material for this blog.  Keep an eye on the Sunday papers for what will no doubt be a parade of soundbites from extremely indignant healthcare providers who are “concerned about their patients.”

If you have the opportunity also try this: ask a representative from the C4MS what their view is on this and watch them squirm as they weasel out of a straight answer.

314b5afe6737a2194cab330f141e67d4I don’t think that the interpretation of “payment at cost” currently being enforced is right.  On the other hand changing Regulation 8 without mending the other issues that have created this situation (lack of reference prices, ethical charging guidelines and collective price determination) or the structural issues (open enrolment without mandatory cover and community rating without risk equalisation) is akin to mending a broken deck chair on a sinking passenger liner while Celine Dion sings that bloody song.

<p”>Now shhhhhh!  The show is about to start…

(Honey?!  Where did we pack the popcorn machine?)

{Edited 10:18 to fix font issues}

Spin to win


No person in the history of the world has ever been able to provide a satisfying definition for that unique combination of words “public relations”. The inability to provide a clear definition has much to do with the fact that there is no single activity associated with the job of public relations officer, which is true of all but the most menial of job descriptions. What most people do know is that writing press releases comes with the territory.

It was the CXMS’s Press Release 6 of 2015 that got me thinking about the business of managing your relationship with the public. You really should go read it. Now.  It will be entertaining.  Promise.

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