The Election Crisis (II): Over the Top.

July 11, 2013

Suppose, for the moment, that in the middle of 2014 the leadership of the ANC is looking at a strikingly poor showing in the late election. They have won, let us say, 57% nationally. In Gauteng they get, let us say, 55%. In the Northern Cape, 52%, alerting even the DA to the possibility that they might win if they put some effort into it. The mood in the National Executive Committee is glum. Even if outwardly optimistic, they know that unless they do something they will quite conceivably lose the next election and have to go into a coalition.

So what, if anything at all, will they do?

Even at this stage, the ANC does not really face disaster. An identical decline in the party’s fortunes in 2019 would force the party into coalition at national level and in several provinces, but the coalition could easily be with parties which were small enough to be easily controlled. More to the point, coalition with other parties would not mean coalition with parties of different ideological persuasions, since no such parties exist in Parliament at the moment. Therefore, danger is not immediate.

Zuma could not become President again in 2019 in any case without violating the Constitution, and while he might not shrink from that he would probably be prepared to retire – he will, after all, be very old and arguably no longer capable of serving his foreign corporate masters. The real issue, however, would be 2017. Would he want to keep control of the National Executive Committee by running for President of the ANC again, and thus – possibly – hold onto indirect control of the government? Above all else, Zuma needs to ensure that he does not face charges for his crimes; whatever he does in the intervening period to protect himself against such charges can always be undone by an unsympathetic government, as Silvio Berlusconi has discovered in Italy.

The trouble is that Cyril Ramaphosa is Deputy President of the ANC. It is possible that he would want to become President, simply because it is quite clear that the President of the party has more power than the President of the country. It is also likely that many of the big businesspeople who installed Ramaphosa at the Mangaung conference would prefer to see Ramaphosa in full control of the party. Of course, some of these big businesspeople would actually view Ramaphosa as a problem, because he is seen (in the business community, if nowhere else) as a competent person, and therefore one who would improve the image of the ANC – whereas of course they would ultimately like their party, the DA, to take power eventually. As a result, the Ramaphosa factor, which supposedly was going to protect Zuma against the perils of Kgalema Motlanthe, may place Zuma in danger in any case.

Another trouble is that once it becomes clear that Zuma’s regime is in any kind of trouble, all the forces of destabilization which Zuma employed against his former opponents are liable to be unleashed against him. For instance, Zuma will have no more guarantees of patronage once he ceases to be President of the country. As a result, it is possible that competing candidates for the party and for the nation will be able to argue that they should be supported because they can give people jobs whereas he cannot. This was a major factor weakening Mbeki’s control. Meanwhile, there will be people who will want to see Zuma fall merely because of what happened to Mbeki – and they may be stronger than Zuma realizes, if only because his inclination is to avoid things which he does not wish to think about.

Hence, there will be a terrifyingly wide variety of dangers for Zuma to face, which cannot be evaded or resolved by telling lies or bribing or bullying people. So what can be done?

One alternative would be to try to appeal directly to the people, to win public support for Zuma and try to use this against his gathering enemies. This would be an almost ideal answer, but it’s hard to believe that Zuma or his allies could do this. In order to appeal to the people, Zuma would have to establish public trust by taking action which would actually serve their interests – and that would mean that the people whom he currently serves would become distrustful of him. In other words, for Zuma or his allies to try to establish themselves with the people they would first have to endanger their current position. Which could not be tolerated by their supporters – it would be an invitation to massive conflict within the ANC.

A simpler alternative would be to carry on as before. Zuma’s recent decision to purge some potential opponents, such as Baloyi and Sexwale, and replace them with compliant stooges, shows the kind of behaviour which could be expected – reshuffles of people whose disappearance would not antagonize wealthy white people or foreigners, their replacement with nonentities increasingly dependent on Zuma or his allies. That might seem to be the royal road to peaceful dominance. The trouble is, however, that the people whom Zuma has purged over the past two or three years have all been people who seemed submissive nonentities or reliable stooges. After all, Mbeki once considered Zuma a submissive nonentity and a reliable stooge – whereas he eventually turned out to be a rebellious nonentity who wished to be a reliable stooge for someone else, a fact which Mbeki only recognized much too late. Therefore, carrying on as before will probably not prevent catastrophe. After all, the more purges you conduct, the more enemies you create and the more allies you make nervous.

But if Zuma actually cannot reform and cannot carry on as before, then there is very little for him to do. Perhaps he can strive to transform the system into one more controllable – but in a sense he has already done that in a way which only works provided that the majority are prepared to accept the system. If the majority rise up and defy Zuma, he will be in very serious trouble indeed, especially because the more he dominates the ANC’s political system, the more he discredits it and the more likely mass demonstrations against it are likely to win support from disgruntled, disenfranchised members, branches and regions – a problem which pervades the system at the moment.

The most likely response is a weak combination of all these things – unsuccessful attempts to win public support, unsuccessful attempts to bribe or bully allies into subservience, unsuccessful attempts to change the system into one less subject to control by others. The fact that all these attempts are likely to fail does not mean that Zuma will be defeated, but it does mean that any counter-attack against an almost inevitable challenge to Zuma’s authority (in the almost certain event of a substantial decline in ANC support) would have far less weight than the Polokwane stitch-up or the September 2008 purge of Mbeki’s supporters.

It would, however, have weight. One possibility might be that the first challenge to Zuma would fail – that it would fail to gain traction within the spineless National Executive Committee, or would fail to get any support from the provinces and the metropoles, so that even if the NEC were against Zuma, Zuma could appeal to a real or purported mass support base and attempt to overawe them. In which case, Zuma would be in a position to launch yet another purge, which he would be forced to go ahead with – but this would simply place him further out on a limb, with many of his supporters now facing the axe. Also, his supporters in the media and the big business community would undoubtedly begin to wobble, wondering if they were backing the right horse. Ultimately, the danger might then be that Zuma would be a weakened leader, one who was forced to pretend that he was strong, and to throw weight around which he actually did not possess.

However, if Zuma’s opponents succeed, what then? Then, presumably, there would be a lot of unhappy Zuma supporters around. Zuma would want to take revenge if he could, and equally presumably, forcing Zuma out would so disrupt the ANC as to make it difficult for members of the ANC to prevent him from doing them immense damage, either indirectly through Zuma supporters or directly through the immense amount of damaging information which Zuma possesses and can use against his opponents. After all, Zuma’s defeat would also mean the defeat of the security services who desperately want to retain their power and job security. There would be a lot of powerful people desiring either to see Zuma back in power, or else to see Zuma’s successors weakened.

Meanwhile, the people who had removed Zuma would not have done this because they particularly wanted to pursue a specific ideology which challenged his. Mostly, they would have removed him out of greed, desire for revenge, or fear that he and his allies might threaten them in some way. This is not a stable basis for building a coalition. There is actually no firm alternative to Zuma in the way that Zuma provided a spurious firm alternative to Mbeki. Hence, any post-Zuma administration within the ANC and within government would be extremely vulnerable – and would be conscious of this fact, meaning that it would be continually paranoid and self-justifying, and therefore eager to conceal its existing flaws as well as any new flaws which developed.

Thus, given the probability that the ANC will trip over its untied shoelaces in 2014, the likely consequence of this happening will be an intensification of the present problems of the ANC – weak and unpopular governance and a lack of coherent goals. This is rather unfortunate, because about that time (looking at watch) South Africa should be facing some really serious economic – and therefore, social – problems.


Disaster I: All Charged Up.

November 29, 2010

Let us for a moment consider the problem of South Africa’s electrical requirements and the South African government’s proposal to resolve this problem.
Abundant electrical power would be central to the construction of a “developmental state”. If we want industrial development, we need electricity. If we need a reliable inter-city and municipal public transport network, we need electricity. (Dependence on trucks, buses and taxis is what causes our horrendous road-death rate and also boosts our trade deficit because of the need to import oil.) If we want to improve household conditions, we need electricity. Everything desirable in the future evolution of South Africa goes back to the need for the level of abundance of electricity which we possessed from the 1970s, when the state overestimated South African economic growth and budgeted for a gigantic electricity demand which did not arrive until thirty years later.
Self-evidently, we need more electrical generating capacity than we now have. Even if the power outages of 2007-9 were largely driven by corporate and political corruption, they reflected the fact that power demand growth was reaching a point at which power outages were at least credible threats. At the moment, the electricity company is proposing to spend nearly 500 billion rand on developing less than ten billion watts of power, a rate of far more than R50 a watt. Obviously, somebody is pocketing a large fraction of this, and equally obviously, somebody ought to be looking into this, and equally obviously, nobody wishes to look into this because they are being paid off by whoever is doing the pocketing. We don’t need to be Marxist geniuses to recognise this. Government, electricity company and business (especially their propagandists) are in cahoots to rip off the public.
Recently, the government unveiled its strategy to sort out all our electricity problems by 2030. Of course, this strategy did not say what would be done with the electricity — that would have been too much to ask for. But it did make some proposals about where the electricity should come from.
How did they do this? We have a Ministry of Minerals and Energy. This Ministry is supposed to regulate the activities of the private mining companies and energy companies, and of the parastatal (but really, apparently, all but privatised) energy company. Therefore it is supposed to contain people who know what they are doing. But they did not know this well enough to be able to develop a strategy to sort out our electricity problems, even though this could have been done by one of the Creator’s cats in its spare time from warming its tummy in the sun.
Instead, they outsourced the development of the plan to ESCOM, the corrupt ur-privatised parastatal responsible for the waste of money and the fraudulent power-outages. This was remarkably similar in behaviour to that of George W Bush when he handed authority for energy supply over to his Vice-President, the construction and defense industry magnate Dick Cheney, who in turn handed authority for planning development over to ENRON, the corrupt power company which speedily collapsed owing to incompetence and criminality. There was quite a lot of outrage over this behaviour by Bush and Cheney in the United States. There was no outrage in South Africa over this behaviour by Zuma and company in South Africa. So utterly have we abandoned any desire to rule ourselves effectively, that we are even beneath that hapless kakocracy which decays between Tijuana and Niagara.
So the fox was put in charge of the henhouse, and unsurprisingly, presented a plan for the most effective slaughtering and dividing-up of its contents. This plan was apparently predicated on the absurd lies told by Jacob Zuma at Copenhagen about how South Africa would somehow reduce its carbon dioxide emissions immensely by 2014, which was not going to happen. At any rate, the end product was a plan which (according to Kevin Davie, the Mail and Guardian’s corporate cheerleader) shifts us from 88% coal, 6,5% nuclear and 5,5% other (mainly gas turbines and hydroelectric) to 48% coal, 14% nuclear, 16% “renewables” and 22% “other” by 2030.
Let’s ponder this a bit. Nuclear in South Africa is Koeberg, which is 1,8 gigawatts (thousand million watts, or GW). If that’s 6,5% of the total, then our total is about 28GW. Of which coal makes up 24.64 GW. The new coal power plants, which are costing all that money, will push that up to about 30GW at least. So assuming that in 2010 coal is 30GW, and this is 48% of the total, that means that the total will be 63GW. The proposal is, therefore, to increase our power output in twenty years by 125%.
That’s impressive, considering that it costs R450 billion to generate 10GW by coal plants — the cheapest available, supposedly — and therefore the plan to create 35 extra GW will cost R1,575 trillion. Well, at least Jacob and company, and that company in this case is ESCOM, aren’t thinking small.
But hold. We aren’t talking about more coal plants. We are talking about 8.8GW in nuclear (7 additional nuclear GW even if we weren’t decommissioning Koeberg, which would be 46 by 2030 and thus a decade past its design limit). We are talking 10 GW of “renewables”, meaning direct solar or wind, all of which will have to be built in the next 20 years because these “renewables” are currently insignificant. We are talking 13.8GW of “other”. At the moment, this “other” is only 1.5GW, virtually all hydropower. So in 20 years, we have to build 29GW of power plants which are immensely more expensive than coal-powered; of this, the nuclear plants are probably the cheapest, costing only half as much again as a coal plant (although they have the problem that we would have to import the fuel, whereas the coal plants are fuelled from domestic sources) as opposed to much more costly wind and solar, which (if gold-plated, which appears to be the current plan — all those carbon-fibre-blade windmills one sees here and there bought from Europe) costs considerably over double what a coal plant costs.
Are we, then, going to be able to do this? Well, for a start, we don’t have the infrastructure to produce enough concrete for the dams we will need. We cannot manufacture most of the machinery for the other power plants, whether nuclear or coal or renewable. We will probably not even be able to produce all the material to house and found all these plants. Therefore, in order to do all this in twenty years, we have to either develop a great industrial base, or we have to import almost everything which we will need to get this done. In other words, substantially more than two trillion rands’ worth of goods, something like a whole year of gross domestic product, will have to be imported over a twenty year period. A hundred billion a year of imports. Two arms deals a year for the duration of twenty years, to put it another way.
The Creator doesn’t think it can be done. It seems quite likely that our ports and our rail network wouldn’t be able to handle the extra traffic. So, firstly, we almost certainly don’t have the money, and secondly, we only doubtfully possess the capacity to get the work done if we find the money. (Do we even have the engineers and other qualified personnel to undertake this gigantic project? Or are we going to hire the personnel, too, from elsewhere?)
Of course, all this can be done. We can start a massive investment now. But unfortunately we are already investing extensively in important stuff for the Medupi plant. And we have a couple of other projects on the go, too. So, basically, if we are to accomplish this transformation of our entire electricity generating capacity, we have to start immediately at the project of trying to fund it, trying to avoid having to devote too much of our resources to imports so that we can no longer afford to import the other things which we need at the same time, trying to get enough of our people working on the project so that the expense of this whole affair, an eighth of our entire national budget, is not to drain away money which could be used on creating jobs. But also, of course, getting the general public on board. And making sure in all this tremendous project that only a small fraction of the money is drained away on corruption or mismanagement, because if only one percent goes on corruption, that would be twenty billion rand.
There is no sign that any of this is happening. Indeed, there is no sign of plans to increase taxation or float bonds or do any of the things which will be necessary in order to accomplish the funding for this gigantic project. Needless to say, there is no sign of any attempt to direct public or private investment towards laying the basis for accomplishing any aspect of this gigantic project. What is being done, apparently, is what was being done before — namely, continuing to build the one big coal-powered project, trying to decide whether or not to build another big coal-powered project called Kusile, trying to decide whether or not to start considering whether or not to build a big nuclear-powered project, and pretending to care about whether or not to build some large renewable projects.
The renewable plan is supposedly to have 10 000GWh a year by 2014, which is impossible as even the renewable enthusiasts. There are vast imaginary plans in places like Upington, but these are certainly pipe-dreams even though someone is making a little money out of doing the environmental impact assessments for these projects which are not going to be built. But none of this is going to happen. All that it is doing is enabling a handful of people who pretend to be green to acquire consultancies where they can pretend to work. These people appear to be trying very hard to sustain the propaganda of the fossil-fuel industry and of famous dead idiots like Michael Crichton, that all conservationists are corrupt and greedy imbeciles. (Something of this also turns up in Julian Barnes’ Solar; perhaps he has met a few of this kind of person.)
But the grimmest fact of all is that most of this is just a cloak for increased private involvement, via such things as the mad plan to get large numbers of people to install solar water-heaters, supposedly subsidised, but without any guarantee that the subsidy will be paid (the money for the subsidy often seems to be filched, or diverted to other projects, even before the plan is implemented). Meanwhile, these heaters are counted as if they were solar power plants, which they aren’t. It is easy for a corrupt government to pretend that it is doing something when it isn’t, and to fool a public which is often underinformed. And as if that weren’t enough, it is particularly easy for a corrupt government to abrogate its responsibilities and suggest that business can take up the slack. Then, when business fails to do so, the government can tell its supporters that this was business’s fault, while business, which controls the press, can tell its supporters and anyone else who will listen that it is the government’s fault. And if the lights go out, at least we have someone to blame, and meanwhile someone has made a pile of money.
Which appears to be all that the Zuma administration cares about any more.

For Now Is The Time For Your Tears.

November 12, 2010

A couple of decades ago, the American cartoonist Dan Piraro drew something which seemed funneh at the time. It showed a little knot of men in suits wearing construction hard-hats and carrying clipboards squinting at a patch of land while their leader gestures. The joke lay in the caption, which was to the effect of “OK, what we do now is put a fence around this field and dig a big hole, then some people will come and put a building in it and some flowerbeds at the front — all we need now is money”. Back in the 1990s this was a joke; nobody believed that people really behaved like that.
But this is exactly how the National Health Insurance has been treated!
The call for National Health Insurance was raised at Polokwane. Like most of what was raised at Polokwane (apart from doling out jobs for Zuma cronies) it was vague and questionable. What would National Health Insurance entail? (That is, if we dig a hole, what kind of building are they going to put in it?) What effect would National Health Insurance have on the national healthcare crisis? (Unanswerable while the first question went unanswered.)
The answer to these questions seems to be that nobody went to Polokwane with any intention of answering such questions. The idea of National Health Insurance was taken directly from the platform of the American Democratic Party — in other words, it had no connection with anything South African at all. It was presented in an effort to show that the Zuma faction had ideas for solving the South African mess, and that was all. Once it had been safely presented, the idea went back to the bottom of the bottom-drawer of the filing-cabinet in the spare room, along with the used condoms and empty booze bottles, where it belonged.
But then, unfortunately, COSATU began flexing its little muscles. Its leaders began denouncing everybody again, because its membership were not getting any return on all their rhetorical efforts to create a make-believe left-wing policy. Rather than confront this titanic toddler, the ANC and SACP decided instead to distract it by offering it some pabulum. (Note that this did not happen under the relatively sane and coherent leadership of Kgalema Motlanthe, but only burst into prominence like a titanic pustule after the Zuma regime, that empty khanga held up with a strap-on dildo, came into being.) So the National Health Insurance was launched as a solid policy, albeit with no idea what that policy meant. Someone, in the fullness of time, would come and put a building in it.
The person in charge of this is Olive Shisana. Olive was, no doubt, once a worthy person. However she is a darling of the white liberal community, which is always a fatal sign. She earned her stripes by nebulous denunciations of Thabo Mbeki, which ensured that she would be supported under the Zuma administration. Meanwhile, she turned the Human Sciences Research Council into a corporate propaganda organ (admittedly many people working for the HSRC were useless, lazy frauds, but although she fired some of these she imported many, many more and turned the whole institution into a consultancy mill). This rather indicates her favoured path of operations, and indeed it has been so. We do not know what kind of building they will put in the hole, but it will, whatever form it takes, be a “public-private partnership”, meaning a structure devoted to stealing taxpayer’s money and shovelling it into the pocket of businesspeople — like the HSRC itself these days.
“All we need now is money” — yes, indeed, and this is essentially the only thing which Shisana and her hand-picked corporate hand-job team have come up with. They have decided what they intend spending on the thing whose nature and structure is yet to be determined. When you come across any business plan with a series of headings all bearing under them the legend “TO BE DETERMINED” and then you find that there is a very specific number under the “Budget” heading, you should immediately put both hands in your pockets and walk away very fast. Unfortunately, because this process is not under our control, we can’t do that; Zuma’s hands are both in our pockets and our ankles are chained to an immense iron ball with the logos of all of South Africa’s Medical Aid Schemes embossed on it in platinum letters.
The amount of money required by Shisana & Cie Plc Gmbh dot-com is a fairly large sum. In 2012 it is supposed to be of the order of R120bn. By 2020 it is expected to rise to R250bn. That is, presumably, annual sums. The former figure is approximately 5% of gross domestic product. The latter figure is approximately 10% of gross domestic product. At present, the government’s Health budget is 3,4% of gross domestic product. Therefore, National Health Insurance will raise the cost of state-sponsored healthcare by 47% over two years, and by no less than 194% over ten years.
That’s a lot of moolah. It is, proportionately, a greater spending commitment, by 2020, than the U.S. military budget at the height of the Cold War in the early 1960s. It is much more than the military budget of the apartheid state at the height of apartheid’s dirty wars. Supposedly, we are going to finance this through increased taxation, and one of the original suggestions raised has been that the poor can be made to pay for it by increasing VAT.
Before we say that this is unaffordable, we must notice that it is perfectly affordable provided that it offers enough benefit to the state system. What the system will do, for instance, is to include the entire current medical-aid system, which entails a large part of South African healthcare for the affluent, into one national system into which all private medical aids will feed. The difference is that everybody will be paying for this, not just the affluent. Particularly, middle-class people will be subsidising the healthcare of the rich as well as of the poor, unless the poor are compelled to subsidise healthcare through VAT, in which case the poor will be subsidising middle-class healthcare as well as healthcare for the rich.
Put that way it doesn’t sound like a very good idea.
There are at present three healthcares in South Africa. There is the extremely expensive, extremely well-funded private healthcare. There is the rather expensive, decidedly ill-funded public healthcare provided in cities and towns. And there is the extremely cheap, desperately underfunded public healthcare provided in villages. The idea of the National Health Insurance is that these three completely different systems, with completely different purposes and different histories, should all be folded into one system funded from one source. This is not exactly like the unification of the different education departments of apartheid South Africa, because they all derived from the same origins and had really been funded from the same source even though their mission statements and structural systems pretended otherwise. What Shisana’s gang are proposing to do is much more like the reunification of East and West Germany. We all remember how quickly that was completed, how cheap the process was to pursue, and what a triumphant success it ended up being.
How is all this going to be done? It appears that the start of the process, which seems sensible enough, would be to revitalise rural primary healthcare. One feels nostalgia for this, because it was what was attempted by Nkosazana Dlamini-Zuma during her five-year term as Minister of Health. However, the whole plan was destabilised firstly by GEAR, which forced cutbacks in new infrastructure and new staff hires, and then by the campaign against Dlamini-Zuma which led to her replacement by Tshabalala-Msimang — a much less dynamic figure — and then by the need to divert funds into the gigantic AIDS treatment programme. After all this there was nothing left for rural primary healthcare. So, it seems like a welcome and sensible manoeuvre to plough funding into rural primary healthcare.
But that’s not going to be sorted out by 2012, which is when the system is supposed to come into operation, when the South African government will assume responsibility for all funding of all healthcare activities, both public and private, in the whole of South Africa. And when there will undoubtedly be a critical financial shortfall, because there always are in these projects — because the initial funding proposals are always underestimates so as to lure people into committing themselves. But, incidentally, it is quite likely that 2012 will be a recession year which follows four years of increasing budget deficits, so that suddenly National Health Insurance will feel like a drain on the fiscus equivalent to the bottom falling out of the money bucket. How is this to be met?
At that stage, the biggest single budget item will be the health budget and the biggest portion of it will be National Health Insurance which will constitute virtually the whole of the health budget. There would be screams if education, policing or social services were significantly cut. Cutting any of these would entail cutting existing, well-established programmes with powerful backers in politics and the trade unions. In that case, would it be possible to cut back cautiously on the health budget itself?
Obviously, not on the section of the health budget funding the big rich urban medi-clinics. Those are the hospitals to which the political and commercial elite go. What about the section of the health budget funding the big impoverished urban public hospitals? But those are the hospitals where NEHAWU and MASA members work. Furthermore, those are the hospitals to which members of active ANC branches with contacts in the Zuma administration are likely to go if they can’t afford the big rich urban medi-clinics. Those are also the hospitals at which the media and the DA point the figure when they fail, and it would be extraordinarily bad politics to slash their funding for they would then have cast-iron excuses for their failure.
So, in that case, it would be logical to put the recapitalisation and expansion of rural primary healthcare on ice, to save a few billion a year by not finishing the new clinics, not providing the additional staff, and not supplying the public transport which people in rural areas need to get to clinics which may be 20 or 30 kilometres from where they live. Rural people are not going to vote DA, and rural clinic staff, even if they belong to NEHAWU or DENOSA, are in no position to toyi-toyi where the TV cameras are watching, nor do any journalists venture so far away from the tarred road.
It is thus a 10-1 bet that National Health Insurance will not serve the interests of the rural poor, and will thus not actually improve access to healthcare.
Of course, it may improve access to healthcare in urban areas. The very poor living in the cities will all have their National Health Insurance cards with which they will be able to travel to the underfunded urban public hospitals. (It is virtually certain that they will be referred to these rather than to the well-funded urban private hospitals.) That could be an improvement — although, of course, those are the hospitals to which they try to go anyway, pleading desperate poverty, and this is why those hospitals are so understaffed, underequipped and underperforming. But now they will do it with National Health funding, which will presumably be directed to the hospitals through the National Health Insurance system.
How will that funding be directed? You arrive at Castro Hlongwane General, with, let’s say, a simple broken arm. A broken arm requires X-rays, setting, a day or so’s observation and medication, and then release with a later appointment for examination and removal of any cast, stitches, etc. You can work out how much that costs and set a flat fee for a simple broken arm which is paid to any hospital wherever it is. But in that case, with a flat fee, any hospital can gain extra money by just doing as little as possible. Why have more than one X-ray? Why provide unnecessary medication? Why not just wrap the arm in bandages to immobilise it? (That was how the Creator’s paternal ancestor on Earth lost his leg through gangrene.) Then the doctor in charge can afford a Porsche instead of a Mazda.
Alternatively, the NHI can make allowances for probably lousier care at Castro Hlongwane General as opposed to the Mamphele Ramphela Medi-Clinic, and therefore provide lower subsidies to the former than to the latter for the same treatment. But in that case, Castro Hlongwane will continue to be subsidised at a lower rate than Mamphele Ramphela, and in consequence the township-dwellers will continue to get the shitty end of the stick as compared to the gleaming cleanliness of the suburbanites.
The whole thing will be controlled by the National Health Insurance system, with the Ministry of Health reduced to a body transferring the funds provided by the Treasury to the NHI, which will be essentially an organisation of administrators, bureaucrats and accountants. Therefore, this body will stand between any healthcare programme desired by the government, and the situation on the ground. This body will also consist almost entirely of people who go to suburban private hospitals. It isn’t hard to guess what their funding priorities would be, and it isn’t hard to see how difficult it would be for the Ministry of Health to order them to do anything else, even if it wanted to. Or, as Steve Earle put it, “accountants wielding scalpels and counting out the pills”. An enormous bureaucracy whose purpose is to ensure that someone else’s money is sent to the places where the bureaucracy wants that money sent, with no reference to public need, since the bureaucrats are neither elected nor responsible in any other way.
The place to have started would have been to try to get the actual health service right, of course. But that wouldn’t have made money for the system. The pretense is that the NHI is modelled on the British National Health Service. Actually, the NHI is modelled on what New Labour has tried to turn the NHS into. It looks like being a cracking success for the accountants.