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Last week, this newspaper reported that, having lost in the Constitutional Court over the certificate-of-need system, the Department of Health is reportedly looking for another route to the same destination. Instead of controlling where doctors may practise directly, the state may now seek to control the facilities through which they practise.

This is not reform. It is nationalisation by obstruction – revealing the same contempt for the idea of private healthcare that was central to the minister’s scathing comments that the constitutional judges were biased in safeguarding their own private healthcare interests.

If the minister succeeds, he will do immense damage to South Africa. Retaining a middle class depends on retaining a functioning private healthcare sector. In South Africa’s case, that sector is among the best in the world. It has demonstrated world-beating innovation funded through its cost-effective insurance model. Millions more people access it via out-of-pocket expenditure.

So, what should be done about that?

The hard reality of it is that, with an unemployment rate of over 30% (which is six times higher than the global average) and a rapaciously corrupt state (the R2 billion looting spree at just one small Gauteng regional hospital is said to be commonplace across the public healthcare sector), the room to find workable options appears limited – but not entirely so.

What the government should do is this.

Pursue a policy to introduce low-fee medical schemes. Research seen by The Common Sense shows that expanding access to low-cost medical scheme products allows millions more people access to basic healthcare professionals, meaning that personal healthcare problems could be caught early, before they reach the stage requiringcomplicated and expensive treatment. As a consequence, such a broad insurance footprint would bring down the per-capita cost of health insurance funding in the country, while ensuring a healthier society and a more productive workforce and economy.

These funds may be made compulsory for all employed people, paid by their employers, with the costs offset by tax rebates. There would be nothing to prevent the state itself setting up a fund to provide that cover, and doing so for free in the case of indigent people, and thereby competing with private providers. If the minister is correct that private funds are slothful, his will be a roaring success.

If the African National Congress (ANC) won’t do this, the Democratic Alliance (DA) should use the leverage it now holds over the ANC (via a potential motion of no confidence in President Cyril Ramaphosa) to champion the idea itself and force the government into doing it on pain of the blue party otherwise moving closer to forcing Ramaphosa’s termination. For that, the DA will have massive public support and a deepening of the substantive support it already commands among the middle classes – its core constituency (and in politics, you must always preach to the choir).

Healthcare is also an aspirational issue, and the massive aspirant middle class will be drawn closer to the DA if it champions a viable route out of the horrors of public healthcare. The ANC still commands a majority of the aspirant middle-class vote, but this one issue could shift that to a great degree if the DA explains how easy it would be to expand private healthcare access via low-fee funds.

On these political points, in 2024, the Social Research Foundation ran a tracking poll in the final month of the election race. At one stage, the ANC was holding at levels near 45% and might even have hit 47% or 48% on election day if it had played its cards right. It didn’t, and, in a typically foolish manner, doubled down on a radical drive behind nationalising healthcare in the hope that this might be such a strong statement of revolutionary intent that it would win the elections. It didn’t, and instead contributed to cutting around five points off its final vote tally. That is the one big lesson the ANC seems completely unable to learn: that “the people” are chiefly sensible and want sensible policies.

Lastly, their collective vote may not add up to many votes, but it is an open secret that the DA would also enjoy the support of the ANC’s Cabinet ministers, the bulk of whom, like the Constitutional Court judges, have the good sense to wish to continue to access private healthcare and who therefore believe the health minister is a zealot and a lunatic and hope that someone will have the courage to stop him.