Speaking freely about our private health system
To the Editor: I would like to comment on a recent editorial.1 Freedom of speech is greatly appreciated, especially by the previously under-privileged. Since we are going through a transformation, I would like to see an accurate, informative and constructive approach to restructuring and progress. As Editor, you have the right and duty to express your general opinion, including on issues related to the South African Medical Association and its members.
My family was decimated by World War II. My father is a labour camp survivor (Mauthausen), the sole survivor of a family cremated in Auschwitz. He joined the communist party and the struggle. I was part of the youth league, received military training and graduated as an officer in the popular liberation army. When I defected to the West in 1980, he was disgracefully fired from the Party and forced to retire from work and politics. I graduated in Romania and did 2 years’ community service, internship in Israel and South Africa, and specialist training locally. I believe that I am truly part of the previously disadvantaged, and never compensated. I believe we both have the right and the duty to critically appraise and criticise.
My son emigrated to the USA. He has a Master’s in aerospace engineering and works for Space X, with a good medical aid. He needed a root canal treatment. After the initial $400 visit and X-rays (R3 500), 80% of which was covered by the insurance, he was quoted $2 500 (R20 000) for the treatment in the rooms, i.e. $800 (R6 400) was not covered as the cap was considered a cosmetic procedure. My private dentist quoted R2 000 per root (R8 000 inclusive of the cap!). I told my son to book a flight, a dental visit and provisional filling and one week in a lodge at the Kruger National Park, with a final filling and cap before leaving – I would pay the difference in price. I hope this puts your costing to rest. A decent medical aid system has been derailed after 1994. We eagerly adapted plans and schemes from the free world. The national schemes in Western Europe, the UK, Spain, France, Ireland and Portugal, which worked well 20 years ago, are now defunct or in a deep coma. We have a National Health Insurance, we pay taxes and have inherited a healthy (I would like to rephrase, living) public health system. It is crumbling and needs funds, nurses, doctors, technicians, equipment and medicines, and not management, economic directors, 5-year plans, and cost-containment and job-cutting ‘efficiency’.
Transport, education and healthcare are the duty of a social democratic state and are not cost-effective or private obligations. That is why we pay taxes, which we do not mind provided they do not only pay for fighter jets and politicians’ salaries. The tax system, VAT, the petrol levy and the toll system should be improved to equalise taxation and benefits for all. There is public transport (not taxis and private cars), public education and grants for the needy in primary and secondary schools, and in tertiary, technical and vocational institutions (not private schools, private universities and private colleges), and finally a healthy, strong public health system, well run at primary, secondary and tertiary care levels (not the private insurance, RAMS and private medical aids). In democratic societies, the state should care for all, and the privileged (the American dream) can contribute towards their own better transport, education and healthcare. Only oppressive, unjust, dictatorial systems, such as the communist system I defected from 32 years ago, deny people the right to better themselves. Communism, with its beautiful and idealistic ideas, died because of its inhuman exploitation, terror and dictatorship and lack of competition, initiative, motivation and incentives.
Criticising, finding fault and leading towards destroying a system ‘well regarded for its quality of care’, to quote you, not wondering why medical aid contributions have increased and benefits decreased, seems short-sighted. Calling private healthcare self-destructive is an outrage. What guidance is it when leaders like yourself say that we are outrageously expensive and look at ownership instead of quality, despite your saying that the public health system is crumbling? You criticise monopolies, pharmaceuticals and fee for service, see medical aids as scapegoats and private doctors as over-servicing. This kind of thinking forced me to resign from SAMA. How can we negotiate with the powers to be with this kind of thinking from within?
1. Ncayiyana DJ. The self-destructing private sector is no less a blot on our health system than the crumbling public health system. S Afr Med J 2012;102(10):772. [http://dx.doi.org/10.7196/SAMJ.6442]
S Afr Med J 2012;102(12):897-898. DOI:10.7196/SAMJ.6322
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