A SMAC in the Face #68: The NHS is in ICU

The ANC inherited a morally and ideologically compromised state, but one which was the envy of Africa in many ways.  It was far and away the most advanced educationally, industrially, technologically and had a first world level banking system.  The provincial hospital system provided a fantastically affordable and top notch service albeit with disparities across racial lines.  With South Africa the darling of the world, the first 15 years were plain sailing and the economy grew significantly.  This allowed the medical system to be equalised across racial lines.  However, the consequences of badly thought through policies, corruption, state capture, the burgeoning of indolent and incompetent supernumeraries in the state sector and the defunct SOEs put increasing pressure over the next 15 years on all state activities.  Eventually the medical system copped it and it flatlined in 2023.

If South Africa’s medical service featured as a patient in some American TV medical series, the PA system would be squawking CODE BLUE with multiple lights flashing – medical emergency, patient requires resuscitation. 

South Africa has always had a universal medical service available at various cost recovery regimes depending on income.  For Europeans, this was historically a fantastic service, equal to the best.  For non-Europeans the service was at a lower level, but if you presented with severe trauma, you would get some of the best ER treatment in the world.  It was well known that doctors who interned at (Chris Hani) Baragwanath Hospital, the third largest hospital in the world, were some of the best trauma doctors to be found. 

After the dawn of the new improved South Africa, the same service levels were rolled out to all races.  This obviously required large budget increases which were relatively easily met by a GDP growth rate that exceeded the population growth rate and fewer White people using the service.  The wheels started falling off during the perfect storm of the global financial crisis of 2008, the Zuma presidency in 2009 and the onset of serious loadshedding which combined with the bloating and loss of skills in the state and quasi state sectors. The result was that the GDP has underperformed the population growth – a harbinger of the present malaise.

In a final spasm of his presidency, Zuma pushed through an ill-thought through tertiary education grant system which was to cost the fiscus an unbudgeted R50bn per year initially and, together with the state capture Zunami years, required the VAT rate to be increased in 2018 as personal and company tax rates were considered to be at their competitive limit.

The final nail in the coffin of the fiscus was the Corona virus and the OTT reaction to it by the glum grinch, Nkosazana Dlamini-Zuma.  The unique banning of cigarettes and alcohol blew a hole of another approximately R50bn in the fiscus and the Social Relief of Distress grant required many more billions to fund as well.  The underperforming GDP meant that our debt to GDP ratio steadily increased into the unsustainable red zone and has reached 75% from a fantastic low of 25% in 2008.  So for the last 15 years the ANC has been borrowing to keep up the pretence to the proletariat that things are getting better but actually, they were just mortgaging the future.

The hadedas finally came home to roost in 2023 when the budgets for all state departments were reduced including for health.  Cynically, the only area where a budget increased was for VIP protection.  The state of the hospitals is appalling with many critical machines broken down and, if your problem is not life threatening, then join a long queue.

The final embarrassment came in 2023.  There has been a constant refrain that our universities could not produce enough doctors which was just an excuse to send people to Cuba for study as pay back by helping their fiscus and showing some young Saffers what a socialist utopia can be like.  Hmmm.  Ironically, last year we suddenly found out that we could not employ about 800 freshly minted doctors because there was no money in the budget. 

With nowhere to turn tax wise, the ANC is now going to rape the coffers of the private medical insurance schemes and table the long threatened NHI Bill this year – and what a bill it’ll turn out to be.

No matter how the ANC wishes to spin it, the NHI Bill is a disguised tax grab.

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