Death of NHI Offers GNU a Path to Universal Basic Healthcare

The news, broken by this newspaper yesterday, that the Government of National Unity (GNU) is stepping back from the National Health Insurance plan to nationalise South Africa’s private healthcare industry is the most promising policy turn in years.

Scrapping a scheme that would have wrecked South Africa’s world-class private healthcare system lifts a cloud over investment, skilled professionals, and growth. Yet a pause is not enough. It should clear the way for a pragmatic new plan that secures cover for every South African while keeping the competitive private engine that holds costs down and standards high.

The first step in that new plan should be compulsory low-fee medical insurance for every formally employed person. Employers would pay the premiums for low-wage workers and claim the cost back through matching tax credits. The state should finance the same cover for the unemployed. With those two measures, the country would ensure world-class basic medical care to all of its people. The state would underwrite major incident cover for people on this basic plan.

People earning above a certain threshold would be required to fund their own healthcare coverage.

This is a proposal that activists, unions, and ordinary people can rally behind. The support of organised business is the last step that must fall into place.

The gains for South Africa would be immense. Early diagnosis and sound management of common conditions will cut the need for expensive late-stage medical interventions. A healthier population keeps breadwinners at work, supports classroom attendance, and lifts productivity. Hospital budgets would ease, meaning that more resources would be available to upgrade healthcare facilities and serve the poor even as the overall costs of healthcare provision in South Africa decline.

Politically, the prize is just as large, especially for the African National Congress, whose voters are disproportionately exposed to the horrific and corrupt failing public healthcare system. Many poorer households already pay out of pocket for private care. Extending dependable primary coverage to every family would resonate deeply in poor communities.

South Africa already offers some of the best value-for-money healthcare in the world. By pairing that strength with universal insurance and a focused public safety net, the GNU can turn securing universal basic coverage into one of its flagship reforms. Investors will welcome this, citizens will gain real protection, and the country will take a decisive step towards a healthier and more prosperous future.