The SA National Health Insurance (NHI) plan is fast becoming the stuff of legend and folklore. Like the overused notions of transformation, equity, triple challenges, national democratic revolution, reconciliation, Rainbow Nation, national imperatives and ubuntu, the NHI has become part of meaningless government-speak.

Samuel Beckett might as well have been talking about South Africa and the NHI when Pozzo in the play Waiting for Godot says: “They give birth astride of a grave, the light gleams an instant, then it’s night once more.” The gleaming NHI light, too, might have disappeared in an instant!

In his 2015-16 budget speech on Tuesday, Minister of Health Aaron Motsoaledi was brief and muted in his reportage of progress with the NHI. Gone are the threats about the imminence of the NHI, which we have come to associate with him over the past five years. Admittedly, in his speech he included the successful implementation of the NHI as one of three priorities, which will determine whether the health goals of the National Development Plan are achieved or not. He also mentioned the MomConnect Project and the Operation Phakisa pilot initiative. We note five years and several thousand words later, the NHI remains as hazy and as mythical an idea as ever.

I fear the NHI plan might be bound for the ever-increasing graveyard of ideas useful to keep the masses hopeful, which, unfortunately, our leadership doesn’t have the courage to implement.

Ask any healthworker about the prospects of the NHI and expect a cynical laugh in response. As procrastination eats away slowly at the idea of a universal health-care system, the implementation of the plan becomes less likely.

Nevertheless, we won’t and should not let go of the concept. Such is the importance of it, the government must not be allowed to backtrack.

We must demand the government stops telling us why they can’t implement it but rather when they will do so and how. We must use the next two elections as ultimatums for the implementation of the scheme. The powerful stakeholders that might hound the government into retreat or hold it ransom must not be allowed to derail it.

With no disrespect to Judge Sandile Ngcobo and his panel investigating the high cost of private health care, the NHI is about more than the split between the public and private health sectors and their malcontents.

Despite the government’s considerable investment of nearly 10 percent of its annual budget in the health sector, the rich 16 percent of the population consume at least 50 percent of that annual health budget.

Our problem is not only the rising costs of private health care but also that the public health-care sector may in fact be disproportionately subsidising the private health sector in more ways than the purely financial.

While the inefficient and monopolistic, non-competitive and costly nature of the private health care has been noted frequently, what has often been overlooked is the extent and nature of poor service delivered.

Perhaps a recent personal experience may help illustrate.

On March 3, I underwent an operation at Kloof Mediclinic in Pretoria. I could have died the next morning from complications caused by poor medical aftercare, appalling bedside manners and an approach that seems to valorise profit ahead of the wellbeing of patients. It would not have been much consolation but had I died, I would have died in a hospital belonging to a JSE-listed company, which is apparently one of the country’s top 10 brands.

The morning after the op, I was frogmarched to my third ward in 24 hours. This despite a requirement that since my operation led to a loss of balance, I should be kept in a horizontal position.

The official explanation from the hospital was they had a “shortage of beds” – probably a euphemism for profit-driven overbooking aimed at keeping bed occupancy rates on a constant high.

The business model implied in a Mediclinic advert on TV appears to confirm my suspicions. Central to it is a voiceover saying: “We synchronise every clock in pursuit of precision. We save precious time with radio translucent operating tables that allow patients to be X-rayed in theatre. We obsess over every corridor width, every door handle height. Mediclinic. Expertise you can trust.”

In the advert, the patient seems to have been forgotten. For all their impressive buildings, toys and gimmicks, some private facilities are a perfect hiding place for some of the most expensive but dismal health care.

The time for piloting is over. It is time for the phased implementation of the NHI, which is why we need the White Paper to complete the legislative processes now.

* Maluleke is a professor at the University of Pretoria. He writes in his personal capacity. Twitter @ProfTinyiko

** The views expressed here are not necessarily those of Independent Media.

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