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Even many NHI advocates admit that an NHI is unlikely to work unless public hospitals can be brought up to private hospital standard — but research shows that this would take at least 15 years with regular real increases in their budgets. They would also need an extra 170,000 nurses — who do not exist. Thereafter the problems only grow. Already the early propaganda about an NHI has driven yet more doctors to emigrate. Apparently the proponents of NHI believe that the huge extra tax levies needed to make their plan a reality will come by way of a payroll tax, but quite apart from the craziness of taxing employment in a society with 40 per cent unemployment, the overall tax burden could be so heavy as to cause more middle-class emigration, further shrinking the tax base. There are also those within the ANC who speak of setting up a national retirement fund — again to be financed by an extra payroll tax. A vast new bureaucracy would be required to administer the NHI, staffed with the same undereducated ANC cronies who have wrecked the public-health sector.

The SACP has a clearly defined strategy in all this. It is deeply suspicious of the Treasury technocrats who tend to knock holes in such millenarian plans, so it has kept all policy-making within the ANC party structure and then itself packed the key committees — not difficult when one realises that the ANC secretary — general, Gwede Mantashe, is also the chairman of the SACP. In effect a three-line whip was operated within the NHI committee so that the original draft was never amended. Such secrecy was exercised that all documentation had to be handed back to the chairperson at the end of each committee meeting, and there was no consultation with any of the professional interests concerned, let alone the public. Then, having rammed through a proposal which could wreck the budget, the SACP and Cosatu are now trying to impose the NHI by lobbying and mass rallies.

The more vocal communists clearly want to abolish private health altogether and would legislate to compel doctors and nurses to join the NHI, however unconstitutional that may be. The basic assumptions are that the white minority must be made to pay, by wholesale expropriation if need be, and that white capacity to pay is bottomless. In fact, whites now constitute only 9.6 per cent of the population, a proportion which continues to shrink, and they are already quite heavily taxed. But anyone who shows that no amount of redistribution from the top 10 per cent can make the bottom 90 per cent much better off is immediately dismissed as a counter-revolutionary.

The NHI now has to face examination by the government technocrats and the various pressure groups involved. This is already generating a bad press for the NHI but the communists will be even more furious if their plan were to be watered down. Yet the alternative — that they manage to ram the NHI all the way through — beggars the imagination. Not only would this cause further large-scale medical emigration but many of the 8 million who currently enjoy private health would be likely to emigrate too. The tax base on which this whole superstructure of Scandinavian welfare rests would crumble, along with the public health sector and what was left of the private sector after its forced merger. The resultant shambles would make the term "train smash" seem very mild indeed

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