The NHI is far worse than Zuma’s craziest idea

August 26, 2019

The looming spectre of Medi-Eskom, optimistically named National Health Insurance (NHI), is a relief in one respect: as the first major piece of legislation put together by Cyril Ramaphosa’s government, and potentially the last, it has allowed us finally to dispense with the childish but persistent belief that Ramaphosa has a plan.

We all understand the algebra of dysfunction in the ANC; that there are a great many things Ramaphosa can’t do for fear of embarrassing the made men eating spaghetti and meatballs around the kitchen table.

His statements about land reform and Eskom have been so densely hedged you could carve them into topiary. When it comes to NHI, however, Ramaphosa has been as vocal a cheerleader as any politician who ever shook a pompom and cried: “Gimme a T! Gimme an A! Gimme an X! Whaddaya get? Nothing!”

Of course, some pundits believe NHI will never arrive, ending its life in legislative limbo or euthanased by the courts. If this is the case, and Ramaphosa knows it, it would make sense for him to trumpet the rhetoric of socialised health care, pocketing some man-of-the-people cred while knowing he will never have to deliver.

This might also explain his enthusiasm: invertebrate politicians are always keen to commit wholeheartedly to things that seem to have no political price tag. Still, by backing NHI Ramaphosa has invoked a comparison that demands to be made loudly and clearly.

Four years ago Jacob Zuma’s government told us that it wanted to spend R1-trillion on nuclear power stations. The response was unanimous horror. Even if all that money wasn’t stolen, and even if the power stations worked, it was patently obvious to anyone who could read that raising R1-trillion in extra taxes would wipe out the struggling middle class, collapse the economy and erase SA from the map.

The proposal went straight to the top of the list entitled “Things Mad Kings Do To End Countries”, and we all rolled our eyes at the nihilistic absurdity of Zuma and his government.

A year ago it would have felt unfair and faintly boorish even to suggest that our current president might contribute to this list. Everywhere we looked, op-ed pieces and hastily published paperbacks were telling us Ramaphosa was not Zuma.

Where Zuma was essentially a rustic patriarch who was ignorant of the basics of finance, Ramaphosa was an urban modern and an astute businessman. Ramaphosa was charming. He jogged. He didn’t sing songs about machine-guns. Best of all, he understood how money worked.

It was a story that rubbed up nicely against our unconscious belief that wealth implies virtue or at least competence. He would never, we assumed, support the idea of spending trillions of rand we didn’t have on systems the ANC could never administer honestly or efficiently. And yet here we are.

Zuma’s plan, which so astounded us with its ignorance of basic reality, was to spend R1-trillion, once, on a system built by engineers.

Ramaphosa’s plan is to spend almost R1-trillion every two to four years, on a system built by the same people who brought you Life Esidimeni, Charlotte Maxeke Hospital, corpses in ceilings and pensioners chained to beds.

Task teams and cautious optimism and jogging be damned: it is a fact of simple arithmetic that Ramaphosa’s NHI hallucination is a far worse idea than anything Zuma ever dreamed up in his most Caligula-esque fantasies.

The thing that depresses me, however, is not the crude idiocy of the ANC’s endless schemes to crush SA’s economy. I’m used to that by now. What gets me is the cynicism — and inevitable success — of low-grade cons like the nuclear build and NHI. Because that’s what they are. Long before they are bricks and mortar, even before they are angry headlines, they are money in the bank for connected cadres. The nuclear build was never going to happen.

The NHI might evaporate, but simply by stating its intention to pursue them the state sprays money at consultants, lawyers, auditors, even catering firms to feed the people roaming around empty veld doing half-arsed feasibility studies.

Ramaphosa doesn’t have to build a single clinic for intergenerational wealth to flood through the patronage system. It’s a perfect bait-and-switch.

While we stare in horror at impossible figures they quietly pocket improbable figures; and when the whole thing goes away, we’re too busy bracing for the next crisis to do the sums. After all, what’s a few hundred million spent to decide that trillions weren’t feasible?

Hell, that sounds like a win for the common people. So on they go; the same players, playing the same game. Some say: “Heh heh heh”. Some say: “Watch this space”. But in the end they’re all saying the same thing: pay up, suckers.

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