Protect the poor but don’t meddle with those who can pay: Debating solidarity in the context of the NHI

This paper examines ideas about solidarity that have been generated by the South African government’s proposals to create a National Health Insurance (NHI) Fund. Historically the liberation movement has viewed the creation of a unified health system as central to building a society that “belongs to all who live in it”. Over the past decade, the government has focused on promoting this objective through a proposed NHI Fund. The NHI proposal has been very divisive. n this paper I focus on two types of critiques. The first defines South African society as comprised of two distinct communities, i.e. the rich and the poor. While the constitution obliges the government to take care of the poor, this argument goes, it should avoid meddling with the rich, who can afford to purchase private health care and should not be coerced into using public facilities. A second line of argument argues for inverting the terms of incorporation set out in the NHI Bills: instead of getting the rich to use public health facilities, this argument proposes that the NHI should institutionalise a payment scheme that channels larger numbers of poor people to private facilities. What do these debates reveal about how solidarity is understood in postapartheid South Africa? I argue that they reveal the contradictions of trying to foster social solidarity in the context of the “death of the social” (Rose), which in South Africa is expressed as a preoccupation with representing the “rich” and ”poor” as “two nations”, rather than elements of one single process and constitutive of a single society with a shared fate.