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.



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