Ramaphosa’s betrayal: Wealth, hypocrisy and the NHI Bill

In a scathing critique, President Cyril Ramaphosa faces accusations of hypocrisy as he champions the National Health Insurance Bill while condemning affluent dissenters. With a personal fortune exceeding billions, largely amassed through strategic business ventures, his lavish lifestyle starkly contrasts the struggles of ordinary South Africans within a decaying public healthcare system. Critics decry the government’s obstruction of affordable private healthcare options, foreseeing dire consequences of a centralized healthcare monopoly. Ramaphosa’s rhetoric falls hollow, betraying the very people he claims to champion.

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By Sara Gon*

President Cyril Ramaphosa, you have slammed “well-to-do and rich people” for criticising your signing the National Health Insurance Bill (NHI) into law.

But you, Mr President, should remember that when you point one finger, there are three fingers pointing back to you.

You are, after all, the epitome of “well-to-do” rich people in the worst possible sense. You are worth R8,262,261,000.00 − that’s over eight billion rand.

The same BBC article from which this figure comes says: “As white businessmen tried to accommodate him, Mr Ramaphosa acquired a stake in nearly every key sector − from telecoms and the media to beverages and fast food (he owned the South African franchise of the US chain, McDonalds) to mining”.

This wealth wasn’t the result of the hard slog starting with nothing. You, Mr President, “stepped away” from politics when former president Thabo Mbeki became Nelson Mandela’s deputy president.

“Ramaphosa’s excellent connections and strong deal-making skills helped Shanduka build a diverse portfolio with shareholding in businesses in the resources, food and beverage, telecoms, financial, and property industries”, according to MyBroadband.

Your role came to be one of raising money for the ANC (and for you) to offer big corporations access to the new government and Mandela.

Boards

You were given positions on the boards of these companies and attended board meetings in exchange for your influence with the ANC government. By the accounts of some who sat on these same boards, you frequently arrived late, hadn’t even opened let alone read your board pack, said nothing, and always voted with the majority.

You sat on the boards of, among others, Standard Bank, SAB Miller, MTN, Macsteel, Mondi, Lonmin, Johnnic Holdings, Bidvest, and Alexander Forbes.

You founded Shanduka Group in 2001 and held the position of chairman. The Shanduka Group was a South African investment holding company that had interests in “extractive resources, telecommunications, food and beverage, property, financial services, energy, and industrial sectors”. In 2015 it was sold to the Phembani Group. At the time, according to Phembani’s website, the entity had “approximately 28 investments and R8bn in assets in the combined portfolio”.

You are an obscenely rich man, Mr President.

You say: “We cannot, and must not, go on with the new South Africa when we still have inequality in some areas of life − and healthcare, which is the most important area of life for anyone, is one area where we need equality. And, believe you me, we are going to have equality, whether people like it or not”.

Shibboleth

But even you cannot believe that achieving equal outcomes is anything but a shibboleth in a country where your party, the ANC, over 30 years in power, has turned what universal health care we have into a shell. This is a consequence of the ANC’s policies you support, the mismanagement of public health facilities, particularly hospitals, the appointment of hospital CEOs who are incompetent and out of their depth, not to mention corruption and venality on a scale that plumbs the depths of depravity.

Yet, at a gathering of “professionals, local and international business leaders, the clergy, and civil society − mainly from the Muslim community” – hosted by, believe it or not, the ANC Progressive Business Forum – you said of resistance to NHI:

“The opposition is coming from well-to-do, rich people. This is what often happens. The haves don’t want the have-nots to benefit from what they have been having. We are saying, through NHI, all of our people must have equality, there must be equality.”

You found it possible to go as far as saying that the NHI was “driving fear into the hearts of some white people” who felt that they would “lose privileges”.

Such racism is breathtaking. The extraordinarily wide opposition to NHI is multiracial. You are accusing people who increasingly spend more than they should on medical aids and health care because getting reasonable health care becomes an increasing priority as people age.

If you’re living with chronic conditions or being faced with potentially fatal diseases or injuries, you will do what you can to deal with it without recourse to the public health system that you, Mr President, have allowed your party to devastate.

Tiny tax base

You can abuse the tiny tax base that supports the ANC’s necrotic (pun intended) utopian economic policies that are designed to obtain poor results, and that inevitably have led to the venality we have seen.

The fact is that you (and your health minister and your Deputy DG of Health) refuse to understand that the taxpayers that you so deride have purchased private health care after paying the taxes they’re obliged to pay for the public health care system. This is an indictment of ANC governance.

Do you even know that an attempt that an attempt to relieve the burden on the overwhelmed and poorly performing public health care sector has been stymied by the government?

It is a cruel and unfounded accusation to say that “The haves don’t want the have-nots to benefit from what they have been having”. Why would that possibly be true? Who are those people who don’t believe that the healthier the country is, the greater the benefits in every way?

The IRR said it exactly in its press release of 14 May 2024: “South Africans have seen what happens when the ANC controls critical institutions. They anticipate that health care will collapse, just as has happened with the supply of water and electricity, education, law enforcement and municipal services, to name some examples.

“While middle-class citizens have been able to protect themselves from many of the worst consequences of ANC misgovernance by paying for functioning private services, they will not easily be able to avoid the harm a wholly state-controlled health system does to them and their families.”

Economic recklessness

John Endres, chief executive of the IRR said: “The decision speaks to economic recklessness and a lack of foresight that will impose a high cost on South Africa”.

Ivo Vegter wrote in an article in the Daily Friend in August 2023 about the refusal to allow medical aids to offer benefits that fall below the legislated minimum.

As of 2022, there were 9,699,000 members of medical aids – 16% of the population – and by all accounts that number is dropping because of the state of the economy. Between 10% – 15% pay for private medical care from their own resources.

Vegter noted the refusal to acknowledge that the reason private medical schemes did not cater for the less affluent was that the government was preventing them from doing so. This is the work of the government’s Council for Medical Schemes (CMS) which “regulates the medical schemes industry in a fair and transparent manner…”

Vegter continues: “The statutory regulator of health insurance companies, the Council for Medical Schemes (CMS), would like everyone to think that it is working hard to introduce what it calls ‘Low-Cost Benefit Options’ (LCBOs)”.

So why has it taken 22 years not to achieve this noble goal?

Vegter quotes Christoff Raath, joint CEO of Insight Actuaries, as having told the Board of Healthcare Funders (BHF) that the “prevarication and stalling” on the part of the CMS had deprived up to 20 million low-income South Africans of basic private healthcare.

Vegter asked the former CEO of the Free Market Foundation, Leon Louw, why the CMS was so reluctant to finalise the process. “Is it incompetent? Is it simply bureaucratic sclerosis? Or does it have a more pernicious motive?”.

Louw’s answer? “All of the above. Yes, yes, and yes. The CMS through its demarcation regulations [which prescribe minimum benefits] has been trying desperately to prevent innovation and prevent low-cost healthcare for the poor.”

Pernicious

Louw added: “The more pernicious motive is to pave the way for the NHI. As long as the poor are prohibited from buying low-cost medical cover, the case for an NHI, however vaguely formulated, is stronger.

Everybody already has universal healthcare. The only thing NHI does is ban private healthcare and ban private health insurance. It has no other purpose. So the two are linked.”

Louw concluded that it seemed that the CMS was simply treading water until then.

So, there you have it, Mr President. Few have any doubt that the eye-watering sums of money that the government intends administering on behalf of the welfare of the people will be the source of heretofore unthinkable corruption.

You have touched loyal, hard-working, long-suffering South Africans on their ability to manage their health at no cost to the state. Shame on you, Mr President.