Populists gather support for unjust proposals by maintaining that everyone has a ‘right’ to benefits such as housing, food, water, clothing, education, social security, and medical treatment. But nothing is free. Every so-called ’right‘ carries a cost or burden that ‘someone’ has to bear.
People who believe in freedom are of the view that helping the less fortunate is a voluntary matter: something you do out of the goodness of your heart. Populists, though, hate philanthropy. They don’t want the wealthy and generous to get the credit for good deeds. What they want to do is, at the point of a gun, prise money out of the wealthy and not-so-wealthy and then say to the beneficiaries, “See what we’ve done for you!” If you think, in the final analysis, that the money isn’t taken at the point of a gun, try not paying your income tax. Resist with all your might any attempt they make to get the money out of you. At the end of the process, you’ll find that people with guns will come to fetch you and take your money.
Unfortunately high taxes have steadily eroded people’s generosity. Governments tell you, the voters, that they need money to provide police to protect you from criminals, courts to punish criminals and settle disputes between individuals, and an army to protect the country’s borders. Who can argue with that? Why then does every government, when it gets elected, dream up some extra service ‘it’, in its generosity, wants to provide? The only money a government has is the taxes it takes from its citizens. So you don’t get to use your money to do good deeds. Instead your government takes it to provide what it calls ‘human rights’ and then takes all the credit. Government’s good and not-so-good deeds and its need of your taxes ratchet steadily upwards, you are left with less and less money for charitable endeavours, and your generous spirit shrivels and dies.
Government’s ability to tax tends to hit a ceiling when high-earning citizens start working less because the after-tax return on extra effort just doesn’t make it worth it, or they escape to some place where they hope to get better treatment. South Africans are in the unfortunate position that when the government has finished fleecing them, the criminals come for their share, a situation that has driven many good people out of the country.
Fortunately, we South Africans are a hardy breed, toughened by hardships and deprivations that would have defeated lesser mortals. We need to be because now the populists, in the name of granting a right, are intent on depriving us of one that is highly valued: the right to use our hard-earned money to choose and buy high-quality health care for us and our families. Paying contributions to medical schemes is not easy but most families are prepared to make whatever sacrifices are necessary to try and keep them free of disease or save their lives in times of crisis.
What the populists are saying to public health care patients is: “We understand that you are unhappy with us for allowing public health care to fall into decay while private health care providers continue to maintain and provide high standards of care. But don’t blame government for the difference in quality of care; rather blame all those people with medical schemes who spend obscene amounts of their own money to pay for their own and their families’ care. It’s their money that enables private health care providers to supply such good quality medical care. Our solution is simple: we are going to take everyone’s ‘health care spend’ away from them and spread it out evenly among all of us.”
But don’t members of medical schemes largely also pay the taxes that provide the money spent on public health? In other words, don’t those people whose ‘health care spend’ the populists want to confiscate already pay for close to 100% of all health care provided in the country?
Are the populists also going to one day decide to take your ‘housing spend’, ‘food spend’ and ‘clothing spend’ to share out equally? Aren’t housing, food, and clothing, most of the time, more important for survival than health care?
Are they going to demonstrate their approach to human rights by sharing their homes with the homeless, sharing their food and clothing, and personally paying the medical expenses of the destitute? Will they suggest to President Zuma that he should set an example: give up his official residences to accommodate the homeless and stop state banquets so that the money can be used to feed the hungry? If this sounds ridiculous, why is it not equally ridiculous to suggest that people should be prevented by force from ensuring that they and their families have good health care?
Apart from the illogic of the National Health Insurance proposals there are serious practical considerations.
|The loss of quality health care by current medical scheme members will not automatically translate into ‘quality health care for all’. The resources are inadequate. And when this fact eventually sinks in, will the populists then insist that costs must be cut, staff salaries reduced even further, and that everyone will just have to settle for all-round lower quality and diminished access to health care? The result is entirely predictable: specialists, doctors, nurses, pharmacists and other professionals will leave the country. They will go to one of the many countries where their services are in demand and better appreciated. If the quality and availability of private health care also declines drastically, SA will experience the worst brain drain ever, not only in the health care field, but also in all other sectors of the economy.|
The burning question I want to ask the populists who recommend the NHI: Why do you want to do this? Why interfere in such a destructive manner in the lives of peaceful and productive citizens when there are much better ways of dealing with the issue. First, don’t do a static analysis – assume that SA will become a high-income country – assume that all citizens want access to high quality health care if they can find the money to pay for it. Second, make all public hospitals, clinics and other facilities fully functional by transferring ownership to the people who work in them. Give them full management responsibility. Let the money follow the patient, and create competition for the business of taxpayer-funded patients. Efficiency and quality of care will attract customers and health care will improve. Third, remove all shackles from the competitive private health sector and allow it to grow rapidly, steadily increase the quality and reduce the cost of the health care it delivers, and grow the percentage of the population it serves.
Above all, give young South Africans a target: encourage them to strive for high skills, high incomes and independence. And for pity’s sake give them the knowledge that part of the package they gain will be high quality health care for themselves and their families.
Author: Eustace Davie is a director of the Free Market Foundation and of its Health Policy Unit division. This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author's and are not necessarily shared by the members of the Foundation.HPU Feature Article / 29 June 2009