In the United States, women diagnosed with breast cancer can select different types of surgery to remove the tumour. While factors such as recovery time, potential complications and cosmetic outcome may influence their decision, a new study has reported another important factor: cost. For many women, the cost was higher than anticipated and the unexpected financial burden complicated their subsequent treatment. Doctors should therefore be encouraged to address the financial implications of cancer treatment with their patients so they can make informed decisions. Under the Affordable Care Act, American women still have access to high quality health care.

In South Africa, this is sadly not the case for all our women. Only 20% have health insurance – and can afford the high cost of breast cancer treatment – while 80% are uninsured and dependent on a public health care system that is struggling to provide the most basic services. In 1996, South Africa adopted a new Constitution and Section 27 states that “Everyone has the right to have access to health care services” and enjoins the State “to take reasonable legislative and other measures, within its available resources to achieve the progressive realisation of the right.”

In seeking to fulfil its obligations, the government has tabled legislation known as the National Health Insurance (NHI) Bill, a financing system designed to ensure that all citizens of South Africa are provided with essential health care, regardless of their employment status or ability to make a direct monetary contribution to the NHI Fund. In this era of State Capture – involving corrupt government officials – there is widespread skepticism that NHI can be successfully implemented.

Perhaps the most thoughtful commentary comes from David Drew, described as “a humble, rational engineer,” who has just published an article entitled “NHI not a moral debate – it’s a maths problem.” Using conservative estimates on NHI funding requirements, he calculated that the government would need R550 billion ($38 billion) annually to provide health care to those citizens who are currently uninsured. That’s more than 40% of the total tax collected annually by the revenue service, and to meet this requirement, corporate taxes would have to double, while individual taxpayers (less than 4% of the population) would each have to pay an extra R13,600 (almost $1,000) per month.

Drew commented: “I’m beginning to think that NHI is an idea being proposed by those who can’t do maths.” Unfortunately, we simply do not have the necessary tax base in this country to provide high quality health care for all our citizens. And that’s a sobering thought.