The latest row about the use of state hospital beds by private medical schemes has raised again a contradiction between expressed constitutional aims on the one hand and government policy and practice on the other.
One of the founding principles of the constitution is that all citizens should enjoy equal rights, benefits and privileges.
The rights to healthcare, food, water and social security are contained in clause 27 of the Bill of Rights. This clause obliges the state to take reasonable legislative and other measures within its available resources to achieve the progressive realisation of these rights.
In essence, this means every effort should be made to ensure that all South Africans have equal access to quality healthcare. If nothing else, this is a prohibition against the establishment of a two-tier health system where the deciding factor in terms of treatment becomes a diagnosis of each individual patient's bank balance.
Yet that is exactly what we already have and are in the process of entrenching, says an official of the Cosatu-aligned National Education, Health and Allied Workers Union. His view is widely shared throughout the trade union movement.
Growing unemployment and medical aid costs, which have risen well above the rate of inflation, have meant that fewer South Africans can now afford private medical cover. But such cover is now the only guarantee of prompt and efficient healthcare - and it is becoming increasingly expensive.
As healthcare brokers are discovering, beneficiaries increasingly see medical insurance as a grudge payment. So, despite the natural rise in population, the number of people covered has remained fairly constant at seven million, or no more than 16% of the population.
Several trade unionists point out that this is almost the same proportion as between beneficiaries and victims under the former apartheid system.
Since 1994 we have de-racialised the social system to a degree, but the ratio of haves to have-nots has remained roughly the same, says a senior Cosatu official.
Cosatu has, in fact, calculated that any individual earning less than R7 500 a month cannot afford adequate healthcare when all other costs are taken into account. Measured against the costs of full healthcare cover, anyone earning less than that is in the low-income category, says Cosatu spokesperson Vukani Mde.
The union federation is concerned about the way healthcare in the country is developing. However, as an organisation, Cosatu remains optimistic that the situation could change. The ANC and the alliance remain committed to the establishment of a comprehensive social security and healthcare system, says Mde. Delegates to the recent ANC national conference in Stellenbosch had rededicated themselves to this goal.
This does not preclude private healthcare. Those who wish to pay for such a service, over and above paying for a national health system, should be free to do so, Mde says.
But the position of Cosatu is that the rich should pay. Tax rates should include a proportionate payment towards a national health service. The Federation of Unions of SA (Fedusa) takes a more cautious approach, but is also not opposed in principle to the establishment of a public health system.
However, the country's second largest trade union federation proposes a gradual upgrading of state facilities.
Both federations have called on medical aid schemes to see beyond the bottom line.
Fedusa this week claimed that the decision by medical aid schemes to force patients with cheaper packages into cheaper treatment at state hospitals was a purely profit-driven exercise.
Workers contributing to a medical aid have the right to choose whether they wish to be treated at a government or private facility, says Fedusa spokesperson Kim Mapley. However, the medical aid schemes and the industry's registration body, the Council for Medical Schemes, argue that the move to use state hospitals is one way to reduce the cost to medical aid patients.
It is also, they claim, a means by which state hospitals can gain revenue. The trade unions remain sceptical. Medical aid schemes exist to make profits, says Mde.
Their priority is not the provision of the best possible healthcare. It is the provision of as much healthcare as does not interfere with their profits.
The greater use of state facilities is therefore seen as a ploy to maintain and increase the burgeoning profits of the major players in the medical aid industry. Fedusa pointed out this week that most state hospital facilities were in a situation of neglect.
To cream off resources to satisfy the needs of medical aid companies could compromise the already generally poor healthcare available for the majority of the population. In the view of many within the labour movement, this would qualify as a serious crime. (Source:
Business Report, 31 January 2003)