NHI resistance driven by anti-working class agendas

President Cyril Ramaphosa has signed into law the National Health Insurance (NHI) Bill which directs the transformation of the South Africa’s health care system to achieve universal healthcare coverage for all. Many employed South Africans contribute towards medical aid subscriptions for years. However, when they become unemployed, they no longer can afford the medical aid subscriptions and must use the public healthcare, the writer says. – Picture: Kopano Tlape GCIS

President Cyril Ramaphosa has signed into law the National Health Insurance (NHI) Bill which directs the transformation of the South Africa’s health care system to achieve universal healthcare coverage for all. Many employed South Africans contribute towards medical aid subscriptions for years. However, when they become unemployed, they no longer can afford the medical aid subscriptions and must use the public healthcare, the writer says. – Picture: Kopano Tlape GCIS

Published May 20, 2024

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Dr Alex Mashilo

Between the economy as the base and the state, including the government, as the superstructure, much focus in the text that dominates economic policy debates is on the superstructure.

While this observation does not imply that the state plays no role in the casting economic reality, the dominant focus on the superstructure, most of all the government, has failed to go the root of the principal economic problems our society finds itself in.

We are told that the state should refrain from involvement or at least minimise intervention in the economy. We are also told that the state should actively intervene in the economy, provided its intervention promotes the expansion and consolidation of private enterprise dominance.

We are further told the primary role of the state in the economy is to serve private enterprise, which in South Africa is racialised and gendered as part of the lasting legacy of the oppressive colonial-apartheid era.

The interests of the working class, encompassing employed, unemployed and self-employed people, are marginalised. If the working class is considered at all, the workers and poor come second, after private enterprise, and are told that they will benefit from a trickle-down effect emanating from the dominant profit-driven interests.

The prevailing capitalist mode of production, which is old as a world system, dating from the 16th century, has overwhelmingly proven the neo-liberal conception as misleading. Globally, there are countless impoverished people, with many succumbing to preventable diseases. Despite this, neo-liberals prescribe more neo-liberalism and are against legislative interventions aimed at addressing such issues, as seen in the opposition to the progressive initiatives like the National Health Insurance (NHI) in South Africa.

The global south is varyingly the worst affected by capitalist system effects. This is part of the lasting legacy of global unequal relations, which were shaped by global north powers. Others colonised and oppressed global south nations. Almost all benefited from mercilessly exploiting Global South labour and plundering Global South resources. The acquired Global North dominance is not maintained through neo-colonial and imperialist relations.

In South Africa, opposition to the national minimum wage, sectoral collective bargaining and labour law provisions adopted to protect workers against unfair labour practices and dismissals aims to deepen the marginalisation of the working class. Right-wing parties advocating against labour interests and hard-won achievements do so to appease their capitalist funders – who expect reciprocation. The funds are a portion of the value created in production – production income, with labour’s contribution, by far, surpassing the wages paid by capitalist bosses to workers.

Karl Marx, the greatest 19th century social scientist who had profound mathematical prowess, called that labour exploitation by capital – personified by the capitalists. Capitalists view wages as a component of production costs, which constantly seek to diminish through work restructuring and retrenchments to maximise their accumulation, via profits, of the surplus value that remains after the costs of production have been catered for.

The workers do not receive either a cent or dividends from the profits. This is among the key conditions, results and levers for the accumulation of society’s wealth on a capitalistic basis. The final shape of the wealth takes the form of capital. This is the primary reason why workers endure wealth poverty. It is the root cause of the racialised and gendered class inequalities that prevail in our society as a legacy of the racial capitalism forged through colonialism and apartheid.

The opposition narrative that the systemic inequalities were created by the ANC-led government is not only ahistorical but also nonsensical. It is to follow the same pattern to attribute to the ANC-led government the accompanying racialised and gendered mass poverty, which coexists with and is a result of the concentration of society’s wealth in the hands of a tiny minority of capitalists.

In his book, “Capital: A Critique of Political Economy”, Marx uses scientifically verifiable data to show that at a certain stage of its development the capitalist mode of production generates unemployment through restructuring.

He categorises unemployment into three forms – latent, stagnant and floating unemployment. Floating unemployment includes irregular employment – the various forms of precarious employment with which the capitalist bosses have replaced the relatively secure permanent employment relationship. Workers under precarious employment, paradoxically categorised as “flexible employment”, which encompasses temporary, casual and other insecure forms of employment relationships, receive meagre wages and do not have benefits.

In my own post-graduate and post-doctoral research, all the frank chief representatives of capital make it clear that they aim to produce more output with fewer workers. When this succeeds, including through new productive technology, the capitalists forthrightly call the affected workers “redundancies” and then retrench them to capture productivity gains as part of profit making. This has become a significant contributor to unemployment, a situation that opposition parties, including the DA, which governs in the Western Cape, deceptively attribute to the ANC-led government.

The ANC-led government’s progressive policies succeeded to increase employment, from below nine million in 1994 to 16 745 million in the first quarter of 2024, which is 22 000 more employed people than in the fourth quarter of 2023. Through progressive policies, the government has also moderated the poverty rate, from 71.1% in 1993 to 60.9% in 2010 and then 55.5% in 2020. The stubborn problem is that the increase in employment and reduction in poverty were not sufficient to eliminate the two systemic problems – which varyingly characterise societies in which capitalism prevails.

In its manifesto for the May 29, 2024 elections, the ANC puts forward refined and new commitments to make greater progress in addressing unemployment and poverty, as well as inequality and the rising cost of living. Industrialisation, under an enabling, developmental, macro-economic policy, and the expansion of public employment programmes, are among the strategies.

However, learning from the past 30 years, the working class needs to build wider unity to ensure implementation of the progressive thrust of the manifesto and, above that, fight for equitable distribution of production income based on one’s contribution to value creation. To achieve this, the working class needs to confront neo-liberalism more resolutely, fight the policies and practices that badly impacted state-owned entities like SAA, SA Post Office, Denel, Transnet and others, and advance the struggle for a new economy and thriving public economy.

**Dr. Alex Mashilo is the SACP spokesperson.

** The views expressed do not necessarily reflect the views of IOL or Independent Media

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