Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.
Associated Press - September 17, 2009
Donna Bryson, Associated Press Writer
Even an insurance executive on Thursday acknowledged at a public forum that the gulf between South Africa's poor majority and the wealthy few must be closed.
"It is not morally OK for some of us to continue with the status quo," said Joe Seoloane, an executive with Pro Sano, a South African medical scheme as insurance companies are known here. "It is just so obvious that something has to change."
Seoloane also recommended that the audience of other executives, doctors and hospital administrators see "Sicko," the documentary in which Michael Moore accuses the U.S. health industry of greed and ignoring patients' needs.
The governing African National Congress party wants to pass universal health insurance before President Jacob Zuma's first term ends in five years.
Questions have been raised about how such a plan could be funded and whether it would fix the troubled health system in South Africa, which has an estimated 5.5 million people living with HIV - the highest total of any country.
Most believe, though, the plan ultimately will pass and South Africa's health care industry wants to influence how that plan turns out rather than antagonize the ANC.
Only about 7 million in South Africa, with its high rates of poverty and unemployment, are insured in a total population of 50 million. By comparison, U.S. President Barack Obama is pushing to cover nearly 50 million uninsured Americans out of a total population of 307 million.
Tebogo Phadu, a top ANC strategist on health, told Thursday's forum the country "desperately needs" national health insurance. He outlined a system under which all South Africans would contribute according to their ability to a pool that would be augmented by taxes.
Payments from the fund would be administered by the government: No one would pay when visiting a clinic or a hospital, whether it is a public or a participating private institution.
But critics question the ANC's numbers, and say a government now watching its hospitals crumble and doctors flee cannot be trusted to administer a new system efficiently.
South Africa is burdened by the legacy of apartheid, which set aside for the white minority the best hospitals - including one in Cape Town where the world's first successful heart transplant was performed in 1967.
At the end of white rule in 1994, most blacks were left without the jobs or skills to afford insurance or anything but public health care. The post-apartheid constitution declared "everyone has the right to have access to health care services," but successive ANC governments have not yet made that a reality.
According to a recent issue of the medical journal The Lancet, South Africa's public system is failing women and children in particular. Those researchers endorsed the proposed national health insurance plan and other reforms promised by Zuma and his new health minister, Dr. Aaron Motsoaledi, who took office in May.
Officials now acknowledge the fight against AIDS in South Africa was hobbled for a decade by former President Thabo Mbeki, who denied the link between HIV and AIDS and whose health minister tried to promote beets and lemon as AIDS remedies.
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