Latest news with #universalhealthcare
News24
4 days ago
- Health
- News24
What is National Health Insurance?
The NHI is a policy aimed at providing universal healthcare access for all South Africans, funded through taxes. It establishes a single-funder system to deliver equitable, need-based healthcare, though concerns about affordability and implementation persist. National Health Insurance (NHI) is a health policy aimed at improving universal health coverage and ensuring that everyone in the country has access to quality healthcare in line with their needs and not their ability to pay for health care. What is NHI? The aim of introducing NHI is to ensure every South African has access to quality health care in line with their healthcare needs. The NHI service will be pre-funded by all taxpayers, so that no one pays the costs of what they need when they go to hospital, see a doctor, get medicine, have a diagnostic test or access any other healthcare service. There are many different models of NHI around the world, but generally it is defined as health insurance provided by a government entity and funded by taxes. Public and private sector providers are typically contracted to provide the services that the government entity funds. Healthcare policy since democracy NHI was initially the targeted health policy of the democratic government elected in 1994. It chose to pursue this policy by initially implementing social health insurance. Social health insurance means those who could afford to pay for private healthcare would do so through medical schemes, while those who could not afford it would access state healthcare facilities and only pay according to their means. Regulation of medical schemes was revised to prohibit discrimination on health status and ensure minimum benefits were provided to all members. In order to strengthen cross subsidisation, civil servants were obligated to belong to a scheme, the amalgamation of schemes was encouraged and plans were made to equalise the cost of providing benefits to all members through risk equalisation. It was envisaged that over time, NHI would be introduced with multiple funders, but a single risk equalisation fund. State healthcare facilities, however, remained overburdened and private healthcare became increasingly expensive. South Africa's healthcare spend, relative to other countries, does not match healthcare outcomes, as measured by life expectancy, burden of disease and other leading indicators, that other countries achieve. Renewed focus on NHI The ANC-led government revised its plans for implementing NHI in 2007. A green paper (draft policy) was produced in 2011 and a white paper (NHI policy) in 2015. In 2018 the first draft of the NHI Bill was published and it was tabled in parliament in 2019. The NHI bill was passed by parliament in late 2023 and President Cyril Ramaphosa signed the Act into law in May 2024 without specifying an implementation date. The Act has since then been challenged in at least six court cases, two of which were combined for hearing and resulted in a High Court ruling in May 2025, compelling the president to release the full record of how he decided to sign the Act into law despite numerous objections to it. This case is now being appealed. Why the single-funder NHI model? The argument for choosing a single funder NHI system is that the government will become a powerful single purchaser able to bulk purchase healthcare services, drive prices down and ultimately pay for more benefits. There are, however, counter arguments that when there are multiple purchasers of healthcare services, as is the case when there are many medical schemes, there is more competition and innovation by providers. This aspect of the NHI Act is being challenged in court. Some of the legal challenges also point out that even with these efficiencies, NHI may be unaffordable in South Africa given the small tax base and recent lack of economic growth. How will NHI work in South Africa? The NHI Act provides for an NHI Fund to be established to pay for healthcare services for all South Africans and certain foreign nationals. The fund will be governed by a board which reports to parliament. The NHI Fund and the board account to the Minister of Health, who is also required to approve many aspects of the fund's work, including the approval of the benefit design. The fund will co-ordinate the work of a number of committees and units, including: A Benefits Advisory Committee to decide which healthcare services the fund will pay for including the setting in which services are provided and the treatment protocols for those services. A benefits pricing committee that will decide how and what to pay for those services each year. Alternative payment mechanisms will be negotiated, for example, an amount per person for a general practitioner to provide primary healthcare services to a certain number of people who sign up with that doctor. A unit that will accredit providers who can provide healthcare services and a contracting unit that will facilitate contracting with these accredited providers in both the public and private sectors. The performance of providers will also be monitored so that they can be paid in line with their performance in providing healthcare. A procurement unit that will decide what medical devices and other medical supplies to buy and from whom. A central registry of health records for all NHI users. The fund will also report on how NHI is impacting the health of the country. How will NHI be funded? The NHI Act states that the NHI Fund will obtain funding from a number of sources including: General tax revenue, including the amounts government already allocates to healthcare spending for the different provinces; The removal of medical scheme fees tax credits; A payroll tax (a percentage of an employer's wages and salaries) that employers and employees will pay, similar to the way that employees contribute to the Unemployment Insurance Fund; and An additional charge on individual taxpayer's personal income tax. The Act also provides for funding of medical expenses paid out by the Road Accident Fund, Compensation Fund for Occupational Diseases and Injury and the fund managed by the Compensation Commissioner for Occupational Diseases in Mines and Works to be redirected to the NHI fund. The removal of subsidies paid to government medical schemes (Goverment Employees Medical Scheme (GEMS), Polmed, Parmed, and so on) has also been included in the NHI White Paper, but is not explicitly mentioned in the NHI Act. What will NHI cost? Estimates on the cost of NHI were produced with the Green Paper in 2011, adjusted in the White Paper in 2015 and have not been updated since. The estimate in the White paper was that NHI would require an additional R256 billion for the healthcare budget by 2025. This was based on an economic growth rate of four percent which has not been achieved. The estimate apparently also does not take into account any deterioration in public health facilities since 2010, the failure to implement aspects of the National Health Act and the reforms that started with GEMS and the Medical Schemes Act in 1998. The cost estimate was done without any decisions on the benefits for which the fund would pay and this could have a material impact on the cost. The Act states that the NHI Board must advise the Minister of Health on the NHI fund's budget. The amount of revenue required will be determined based on the size of the population and the extent and cost of the health benefits to be provided. In order to direct funding to the NHI fund, parliament needs to pass what is known as a money bill. How will the NHI Fund be governed? The fund will be governed by a board and a chief executive officer who will be appointed by the Minister of Health in consultation with the Cabinet. The board will be made up of up to 11 publicly nominated people with relevant expertise and recommended by an advisory committee. They will serve a five-year term. The NHI Act gives the Minister of Health the power to make regulations, to issue directives and make technical decisions relating to the operation of the NHI Fund. The fund must be run in accordance with the Public Finance Management Act and the expenditure and reporting of the fund will be audited by the Auditor General. When will NHI be implemented? The President signed the NHI Act in 2024 without specifying when it would be implemented. The government and the healthcare industry have indicated that realistically it will take 10 to 15 years from signing, without considering any legal challenges. A set of draft regulations that have been published are expected to bring at least 20 of the NHI Act's 58 sections into effect, setting up the NHI Fund's Board and Committees, and appointing the chief executive officer. The Act provides for its implementation in two phases. In phase one, for a period of four years from 2023 to 2026, the fund must: Continue to strengthen the health system by aligning human resources that may be required by NHI users; Develop the National Health Insurance legislation and amendments to other legislation; Undertake initiatives aimed at establishing institutions required for the fund; Purchase health care services for vulnerable groups such as children, women, people with disabilities and the elderly; and Prepare for the establishment of the fund, including developing and implementing administrative and personnel related arrangements. In phase two, between 2026 and 2028: Strengthening of the healthcare system will continue. Additional resources will be mobilised. The fund will start contracting selectively with providers. The fund has begun contracting with providers in some pilot studies but is only set to start purchasing services for vulnerable groups such as children, women, people with disabilities and the elderly in 2028. This article was first published on an initiative by the Association for Savings and Investment South Africa (ASISA). News24 encourages freedom of speech and the expression of diverse views. The views of columnists published on News24 are therefore their own and do not necessarily represent the views of News24. News24 cannot be held liable for any investment decisions made based on the advice given by independent financial service providers. Under the ECT Act and to the fullest extent possible under the applicable law, News24 disclaims all responsibility or liability for any damages whatsoever resulting from the use of this site in any manner.
CBC
6 days ago
- Health
- CBC
Kinew wants to improve universal health care, Smith says major projects needed to fund it
Manitoba Premier Wab Kinew said that having a universal health-care system is a fundamental Canadian value that sets the country apart from the U.S. Alberta Premier Danielle Smith responded that Canada has to 'make money before we spend it.'
Globe and Mail
11-06-2025
- Health
- Globe and Mail
Letters to the editor, June 11: ‘The obsession with NATO's 2-per-cent defence spending target ignores another global responsibility'
Re ''Nation-building' projects should also reflect Canadian values' (June 10): As a registered nurse who has practiced in both the United States and Canada, I would never trade our imperfect but equitable universal health care for the ragged patchwork quilt of American health care that leaves many with no coverage whatsoever. We should act to strengthen the health care system that sustains us all. As a health care worker with a deep concern for planetary health, I also echo the concern that nation-building must be undertaken by investing in programs that make people healthier. Building more pipelines would add to our carbon emissions and worsen climate change, darkening our chances for overall well-being and a healthy future. Agnes Black RN; New Westminster, B.C. Canada accounts for less than 2 per cent of global greenhouse gas emissions. While we should do our part to reduce emissions, I do not believe halting pipeline projects will prevent wildfires or significantly change global outcomes, especially while countries such as China and India continue expanding coal use. Pipelines are the safest and most efficient way to transport the oil and gas our society still depends on. Until a reliable, affordable, large-scale alternative to fossil fuels exists – and we are nowhere close – oil and gas will remain essential. Cutting off pipeline infrastructure wouldn't stop demand, just shift transportation to rail or truck, which are riskier and more carbon-intensive. Wildfires are caused by a combination of factors: lightning, human carelessness, forest mismanagement and climate trends. Suggesting that pipelines 'bring fires' seems to ignore the complexity of the issue and undermines serious conversations about adaptation, fire prevention and energy transition. Kevin Kobes Lloydminster, Alta. Columnist André Picard advocates selection of nation-building projects to strengthen medicare and extinguish HIV-AIDS, in accordance with the Canadian values described in Mark Carney's 2021 book Value(s). I agree, but first we should have major projects that contribute to national prosperity and economic resiliency, while respecting Indigenous reconciliation and climate change. Bottom line: There is a price attached to solidarity, fairness, responsibility, resilience, sustainability, dynamism, humility and even compassion. Virtue-signalling is morally vacuous and valueless until we enable ourselves to put our money where our mouth is. As Mr. Carney also says, we can't redistribute what we don't have. Ellen Anderson Summerside, PEI Re 'Carney lays out defence boost, says era of U.S. dominance over' (June 10): The obsession with NATO's 2-per-cent defence spending target ignores another global responsibility: foreign aid as a share of national income. If we want to build a safer, more stable world, we should prioritize lifting people out of poverty, not just boosting defence budgets. Countries such as Sweden, Luxembourg and Norway routinely exceed the United Nations' target of 0.7 per cent of gross national income for aid. Canada, though still falling short at between 0.34 and 0.38 per cent, gives a much higher share than the United States, which contributes less than 0.24 per cent, and that number is set to fall even further under the Trump administration. If NATO members matched defence rhetoric with real investment in global development, they would be far more effective in addressing and reducing the root causes of conflict and creating lasting security. I thought that was the end goal anyway. Am I wrong? Timothy Kwiatkowski London, Ont. Re 'Carney should know it's way too soon to invite Modi to Canada' (June 7): I thought Mark Carney was a Blue Liberal in the tradition of Paul Martin, but he is doing what Stephen Harper recommended recently regarding India. Narendra Modi's attitude toward Sikhs is part of his vision of Hindu chauvinism, which targets minorities. His repression in Muslim-majority Kashmir flows from the same vision. Mr. Modi must be mighty pleased that Canada seems to be disregarding not just his interference in Canada, but also his repressive policies and actions, including toward the press. Masud Sheikh Oakville, Ont. Canada's G7 invitation to Narendra Modi has understandably generated debate, given the allegations linking Indian agents to violence on Canadian soil. These accusations must be taken seriously, but it is important to remember the facts have yet to be determined in court. As host, Canada faces the challenge of balancing bilateral concerns with India and broader international responsibilities. The G7 is a forum for the world's largest economies and leading democracies to address global issues. India, as the world's largest democracy and fifth-largest economy, is an important partner in this context. By inviting Mr. Modi, I believe Canada is not ignoring unresolved bilateral issues, but rather recognizing they should not overshadow the G7's multilateral purpose. Canada is a strong supporter of multilateral dialogue and a rules-based international order. Engaging India at the G7 is consistent with these values and ensures the summit remains relevant and effective in today's interconnected world. Stewart Beck Former Canadian high commissioner to India; North Vancouver Re 'Industry Minister Joly signals action on steel dumping into Canada coming' (Report on Business, June 7): Please forgive my failing memory, but aren't these now foreign-owned steel companies – presently criticizing the government over the lack of tariffs on steel dumping to support the floor on domestic prices – the same group that, a few decades ago, admonished the government of the day for interfering with the global market by restricting foreign ownership of critical infrastructure industries? Stephen Halman Toronto Re 'Some university professors say AI is here to stay, so students should learn how to use it'(June 4): I thought the point of going to school and receiving an education was so students would be able to understand complex language, by looking up the meaning of words so they can converse in the terminology of their chosen discipline of study. In the future, are people going to walk around asking artificial intelligence to translate everything for them, because they are too lazy to learn the meaning of words, concepts and issues? Kim Patrick O'Leary Vancouver Re 'For Trump, the L.A. protests are an opportunity to wield power and spread fear' (June 10): It was 55 years ago when the Ohio National Guard was called to Kent State University where, on a U.S. campus peacefully protesting the war in Vietnam, four young people were shot dead by guardsmen. Soon after, Neil Young wrote: 'Tin soldiers and Nixon coming / We're finally on our own / This summer I hear the drumming; Four dead in Ohio.' Will the lyrics need to be altered? 'Tin soldiers and Trump coming / How many dead in greater L.A.?' Heather MacAndrew Victoria Letters to the Editor should be exclusive to The Globe and Mail. Include your name, address and daytime phone number. Keep letters to 150 words or fewer. Letters may be edited for length and clarity. To submit a letter by e-mail, click here: letters@
Forbes
06-06-2025
- Business
- Forbes
Majority Of Millionaires Supports Wealth Tax
NEW YORK, NEW YORK - APRIL 15: People protest on tax day calling for billionaires to pay more tax on ... More April 15, 2025 in New York City. Activists suggested a 90% wealth tax to guarantee universal healthcare, free college education and to eliminate hunger and homelessness. (Photo by) A recent survey by Patriotic Millionaires UK shows that a majority of millionaires in G20 countries supports a 2% tax on wealth. When asked if any millionaires with a wealth of more than $10 million should pay the tax, 58% of the more than 2,000 millionaire survey participants said yes. As part of the same survey, 75% agreed that billionaires should pay the tax. Between 66% and 69% said that those with a household wealth of more than $50 million and more than $100 million, respectively, should pay up. On the other hand, there is still a considerable share of respondents with household investable assets of more than $1 million who think otherwise. Almost a third opposed or was torn about the tax concerning those with a wealth of $50 million or more, while this number was 40% concerning those with assets of $10 million or more. Only 11% of surveyed millionaires definitely opposed a tax on billionaires, however. This chart shows the share of surveyed G20 millionaires who said they supported additional wealth ... More taxes (in percent). Patriotic Millionaires UK is an organization of more than 60 British billionaires that advocate for the higher taxation of wealth and its fairer distribution. The first advocacy group by the name was founded in 2010 in the United States to lobby for the expiration of Bush-era tax cuts, which were extended under President Barack Obama, however. At the World Economic Forum in Davos in 2024, 250 millionaires and billionaires actually demanded that global leaders take action to tax very rich individuals but change has not come. According to a 2023 report by Oxfam, only 4 cents of every tax dollar raised globally came from wealth taxes, while half the world's billionaires lived in countries with no inheretance tax. Meanwhile, support among the public for wealth taxes mirrors that of the millionaire survey. According to Ipsos, Global Commons Alliance and Earth4All, 68% to 70% percent in G20 countries said they were in support of a tax on wealth, on high incomes and on large business profits. Many polls across time and different countries have shown the same results. The report by Patriotic Millionaires UK refutes the often-made claim that wealth taxes would led to capital flight and in turn, economic decline. It claims that many rich individuals would not change their residence and in fact welcome the change that they think strengthens democracy, fights global issues like climate change and not least prevents an eventual outbreak of violence over the unequal distribution of wealth. Three quarters of surveyed millionaires said that they thought well-funded public services and a functioning infrastructure were vital for entrepreneurs and a strong economy. 54 percent said that extreme wealth was a threat to democracy while 72 percent agreed that wealthy individuals were paying for their political influence. According to the latest figures by the World Inequality Database, the top 10% of the wealthiest individuals in the United States held more than 70% of the country's wealth in 2023, surpassed only by several African, Latin American and Arabian Gulf countries. In the United Kingdom, this figure stood at 57% most recently, comparable to the European Union level of 59%. Few countries achieved better result, with the most equal distributions found outside the EU in Norway at a still-high 52.6% and in Iceland at 56.7%. Within the EU, the lowest figures were 45.4% in the Netherlands and 49.4% in Slovakia. Charted by Statista
CBS News
13-05-2025
- Health
- CBS News
After promising universal health care, California Gov. Gavin Newsom must reconsider immigrant coverage
SACRAMENTO — Gov. Gavin Newsom didn't expect to be reckoning with another health care crisis. In March, as President Trump and congressional Republicans escalated a nationwide debate over whether to slash health care for poor and disabled Americans, the Democratic governor had to tell state lawmakers that California's health care costs had spiraled out of control due to major Medicaid initiatives he backed — including the nation's largest expansion of taxpayer-financed health care for immigrants living in the U.S. illegally. His top officials at the state Department of Finance quietly disclosed to California lawmakers in a letter that the state had borrowed $3.4 billion to pay health insurers, doctors, and hospitals caring for patients enrolled in California's Medicaid program, known as Medi-Cal. Facing rising health care costs amid a deepening state budget crisis, Newsom now must contemplate rolling back coverage and benefits. The second-term governor faces a tough political decision: renege on his promise to achieve universal health care and strip coverage from millions of immigrants who lack legal status or look elsewhere for budget cuts. With nearly 15 million low-income or disabled residents enrolled in Medi-Cal, California has more to lose on health care than any other state. Yet even as Newsom has condemned Mr. Trump's approach to tariffs and environmental policies, he has been tight-lipped on health policy. Complicating his political tightrope: Polling shows that providing health care coverage for immigrants without legal status has tepid support. And any resulting budget trouble could harm his political legacy should he run for president in 2028. "We all know that the cuts are definitely coming," said Carlos Alarcon, a health and public benefits analyst with the California Immigrant Policy Center, which has helped spearhead a decadelong campaign in California to expand Medicaid to eligible immigrants without legal status. "The governor should keep his commitment — we'll be very disappointed if we see cuts and rollbacks. When times get hard, it's always our marginalized and underserved communities that lose out." California allows any low-income adults to enroll in Medi-Cal if they earn 138% of the federal poverty level, or $21,597 a year or less, regardless of immigration status. But the costs have been dramatically higher than expected. Democratic Gov. Jerry Brown first expanded Medi-Cal to people age 19 and younger without legal status, but he expressed reluctance to go further because of potential costs. Newsom signed bills into law adding people age 20 and older. An estimated 1.6 million immigrants without legal status are now covered, and costs have soared to $9.5 billion per year, up from $6.4 billion estimated in November. The federal government chips in roughly $1.1 billion of that total for pregnancy and emergency care. "We can expand out of the graciousness of our heart to everywhere and anywhere, but the moment these resources run out, now everybody loses. We're hitting that breaking point," said California Assembly member David Tangipa (R-Fresno). "Either we get fiscally responsible, or there's not going to be services for anybody — and that includes the Californian and the undocumented immigrant." Democratic leaders responsible for approving the state budget declined interviews. In a statement, state Sen. María Elena Durazo (D-Los Angeles), who championed the expansion in the legislature, said, "Rolling back this progress would be a harmful and shortsighted decision." Lawmakers are considering freezing enrollment for immigrants without legal status, imposing cost-sharing measures such as drug copays or premiums, or restricting benefits, according to people familiar with the matter, who asked not to be identified to protect relationships at the state Capitol. However, it's unlikely Newsom will slash funding in his budget revision set for release on May 14. Instead, cuts would follow if congressional Republicans approve a budget deal with major reductions in federal spending on Medicaid. "This is going to be very problematic for the governor. Budget cuts will disrupt the lives of millions of immigrants who just got health care, but the governor has got to do something, because this is not sustainable," said Mark Peterson, an expert on health care and national politics at UCLA. "The prospect of cutting other places in order to support immigrants living in the country illegally would be a hard political sale; I don't see that happening." Should Newsom, along with the Democratic-controlled legislature, be forced to make cuts, he could argue he had no choice. Mr. Trump and congressional Republicans have threatened states like California with the latest U.S. House proposal cutting Medicaid funding by 10 percentage points for states that provide coverage for immigrants without legal status. For Newsom, political analysts say, Mr. Trump could make an easy scapegoat. "He can blame Trump — there's only so much money to go around," said Mike Madrid, an anti-Trump Republican political analyst in California who specializes in Latino issues. "It's making people look at the health care that they can't afford and ask, 'Why the hell are we giving it for free to people who are here illegally?'" The exorbitant cost has come as somewhat of a surprise. In Newsom's first budget proposal as governor — in which he called for expanding Medi-Cal to young adults without legal status — his administration estimated it would cost roughly $2.4 billion annually to extend benefits to all eligible people regardless of status. But the latest figure reported to legislators was nearly four times as much. Newsom declined to respond to questions from KFF Health News, instead referencing previous comments that leave the door open to scaling back Medi-Cal. The governor noted "sober" discussions with lawmakers and said cutting Medi-Cal is "an open-ended question" that the president will heavily influence. "What's the impact of Donald Trump on a lot of these things? What's the impact of federal vandalism to a lot of these programs?" Newsom asked rhetorically in December, suggesting it's unclear whether he'll be able to sustain the expansion to immigrants without legal status in future years. Newsom expanded Medi-Cal in three phases, starting with immigrants ages 19 to 25, who became eligible in 2020, resisting pressure from health care advocates for one big, costly expansion. He argued doing it incrementally would ultimately save California money. "It is the right thing morally and ethically," Newsom said in 2020. "It is also the financially responsible thing to do." Record budget surpluses in recent years allowed Democrats to continue. Older adults ages 50 to 64 became eligible in 2022, and Newsom closed the gap the following year, approving coverage starting in 2024 for the biggest group, those ages 26 to 49. But the costs have grown tremendously while the budget picture has soured, according to a KFF analysis of the most recent 2023 records available from the state Department of Health Care Services, which administers Medi-Cal. Aside from children, it was more expensive to provide Medicaid coverage to immigrants without legal status than to legal residents. For instance, Medi-Cal paid L.A. Care, a major health insurer in Los Angeles, an average of $495.32 monthly to provide care for a childless adult without legal status and $266.77 for a legal resident without kids. Not only were immigrants without legal status more expensive, California footed most of the cost. The state paid roughly between 60% and 70% of health care costs for a childless adult immigrant covered by L.A. Care, and about 10% for a legal resident without kids. Those costs don't encapsulate the entire cost of providing care, which can vary depending on where Medi-Cal patients live, and grow higher when filling prescriptions, going to the dentist, or seeking mental health care. These payments also differ by insurer, but the trend holds across the state's Medi-Cal health insurance plans. Patients in most of the state can choose from more than one health plan. Children without legal status in many cases were cheaper to cover than children who were legal residents. Generally, kids are healthier and require less care. Mike Genest, who served as finance director under former Republican Gov. Arnold Schwarzenegger, argued that the state should have planned for the immense price tag. "The idea that we'd be able to afford in the long run paying for health care for all these undocumented people — it's beyond unsustainable," Genest said. While costs are high now, the expansion of Medi-Cal will result in long-term savings to taxpayers and the health care system, said Anthony Wright, who previously lobbied for the expansion as the head of the nonprofit Health Access and is now fighting Medicaid cuts as the executive director of Families USA, based in Washington, D.C. "They're going to be showing up in our health care system regardless," Wright said. "Leaving them without health insurance is just going to end in more crowded emergency rooms, and it's going to cost even more. It doesn't make any sense economically for them to be uninsured; that takes critical revenue from clinics and hospitals, just causing more problems." This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. KFF Health News is the publisher of California Healthline, an editorially independent service of the California Health Care Foundation.
