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What is this ‘entitlement’ everyone is talking about?

09 October 2009 Gareth Stokes
Gareth Stokes, FAnews Online Editor

Gareth Stokes, FAnews Online Editor

What is entitlement? A quick search on dictionary.com provides a definition suitable for this forum. Entitlement is “the right to guaranteed benefits under a government program [such as] social security or unemployment insurance.” The South African govern

We believe entitlement is something the poor benefit from and expect the rich to pay for. We associate the word “entitled” with laziness and a lack of accountability. But we’re wrong! In much the same way the African National Congress (ANC) and some of its trade union allies are wrong about a selfish upper class. South Africa operates a progressive tax system whereby individual wealth is already ‘de facto’ distributed among all of the country’s citizens. The gaps that exist between rich and the poor are not because the country’s wealthy are uncaring, but rather due to limited resources!

Hiding the truth from the masses

A perfect example of this resource shortfall can be found in South Africa’s healthcare environment. The ANC wants to implement a radical National Health Insurance (NHI) solution that would see a small section of the country’s population subsidise comprehensive healthcare services for all. The ruling party offers a compelling argument against the current system. They say that 16% of the country’s citizens – the wealthy individuals who have access to private medical schemes – are soaking up 45% of the country’s healthcare funding. But their argument is flawed. What they fail to acknowledge is the same 16% of the population contributes 78% of the sum available for healthcare by way of medical schemes premiums and various taxes (including income tax and VAT). To implement their proposal would require a payroll tax in the region of 20% over and above the revenues already collected from individual taxpayers.

Apart from financial constraints the plan faces insurmountable human and infrastructure resource shortfalls. Why are politicians punting a service they cannot provide? For one thing, they have phenomenal support. The arguments for universal coverage are widely accepted by all citizens, rich and poor. Companies – even those that could be destroyed by the current NHI proposals – cannot argue against the plan without coming across as uncaring.

Finding answers to global political riddles

The trick with social welfare is to sell the concept to the public and worry about the realities of implementation at a future date. A similar ‘game’ is playing out in the United States at the moment. The US government has shrugged off the recent financial crisis, forgotten about its promises to exit wars in Iraq and Afghanistan and is now distracting its citizens with a fierce healthcare reform debate. But the debate centres on which healthcare reform process to follow rather than whether the proposal has merit to begin with. In an article titled The Truth behind Healthcare Reform, Tom Cornwell noted the US health reform debate looked suspiciously like a ploy to distract voters from government’s recent failings.

He identified another interesting subterfuge in that citizens weren’t being sold on the contents of a particular healthcare reform, but rather the source of it. The argument centred on whether President Obama’s or Senator Jones’ plan was better! “The version is meaningless as long as it falls into government hands,” wrote Cornwell.

Frightening similarities between US and South Africa

“Americans are being forced to buy the concept of the “need” for healthcare reform,” writes Cornwell. It’s quite an interesting observation. What Cornwell is saying is that everyone who needed healthcare in the US in the past could get it. Even the so-called “undocumented non-citizens” could walk into a public emergency room and get treatment. “No one gets turned away in America – at least not from hospital-provided emergency care,” he writes. The same situation exists in South Africa. If you can find you way to a public clinic, join the queue and get to see a doctor your treatment is pretty much guaranteed.

Cornwell gets to the heart of the matter when he raises the entitlement versus coverage debate. It is quite easy to extend some form of healthcare to the entire population, but not so easy to determine what level of healthcare those people are entitled to. “No one is denying healthcare to those who are not wealthy, he says, “but they cannot expect access to the best surgeon or medical specialist!” When we protest the structure of the NHI we’re actually dashing down the wrong path. We should be questioning the need for an NHI in the first place.

On healthcare and aeroplanes

Another angle – published with minor alterations from Cornwell’s article – is an economy class versus first class debate.

Lots of people fly. Most people fly economy – some fly first class. Suppose someone gains momentum with the argument that all travellers are entitled to first class seating. Well, the first problem is that there is not enough first class seating for everyone. OK, then, let’s re-design the cabin so that it is ALL first class, for the price of economy. The problem you create is there won’t be enough income from ticket sales to fly the plane from point A to point B. This is where politicians jump in: The ANC: We can have the people subsidize air travel to make up for the loss. The SACP: No – let’s re-design the cabin so that it is all economy. And on and on it goes!

“By the time most wake up and catch up to the fact that there is an argument over ‘first class rights’ the real issue is long forgotten and ignored,” wrote Cornwall. South Africa has bought into the concept of universal (and equal) healthcare benefits for all. And the media frenzy has already turned our attention from the real issue. NHI is an inappropriate healthcare solution for South Africa. Government’s best medium term intervention – and that means the next decade – is to plug the gaps in public healthcare. Government must expand public sector infrastructure, repair its appalling public hospital administration record and train doctors and nurses by the thousands.

Editor’s thoughts: We doubt any caring citizen would argue the merits of extending healthcare to all. But we owe it to the country to assess such social intervention on the basis of affordability and practicality. Is it fair for existing private medical scheme beneficiaries to pay more by way of taxes for reduced healthcare benefits? Add your comment below, or send it to gareth@fanews.co.za

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