In April this year the national health insurance Act 2018 was enacted “to provide for sound financing for the national health system; provide for a universal access to quality insured health care services; establish the National Health Insurance Management Authority and provide for its functions and powers; establish the National Health Insurance Scheme and provide for its systems, procedures and operation; establish the National Health Insurance Fund and provide for contributions to and payments from the Fund; provide for accreditation criteria and conditions in respect of insured health care services; provide for complaints and appeals processes; provide for the progressive establishment of provincial and district health offices of the Authority; and provide for matters connected with, or incidental to, the foregoing”.
The Universal Declaration of Human Rights, article 25, at page 5 states, inter alia, that everyone has the right to a standard of living adequate for the health and wellbeing of oneself and of one’s family.
This implies that everyone has the right to medical care when sick. This obliges the government to create conditions in which every person has access to medical services and attention in the event of sickness. This right obliges the government to provide enough funds for preventive health care and basic health care assistance. This right extends to the preventive aspects of health care. This includes improved nutrition, sanitation, immunisation, education on health, improvement of all aspects of environmental and industrial hygiene. This right obliges the government to pay a special attention to epidemic, endemic and occupational diseases. This right also obliges the government to pay a special attention to the improvement of healthy conditions of the children. The right to health is also connected with the rights of the persons with disabilities and the rights of the persons with HIV/AIDS.
The right to a decent standard of living also obliges governments even those, like ours, which are poor to use the maximum resources available to realise this right.
The enjoyment of the right to adequate standard of living entails adequate and equal access to health services for all. This requires an acknowledgement of the problems that beset health services and the willingness to tackle them.
Equality among citizens and the demands of justice call for policies which aim to provide adequate health care for all without distinction. Human beings can never be reduced to status objects. Every person is of equal dignity. The value of life is not to be measured by one’s possessions or position in society. Every person, whether rich or poor, has the right to receive health care.
One cannot claim to uphold the principle of the sanctity of life if provision has not been made for even minimal health care for every person.
In order to rethink fundamentally the issues surrounding this Act, we need to first understand what exactly health insurance is and what it insures. With external objects, such as a house, or a car, we know exactly what a policy insures: a house, a car, respectively. We insure for the recovery, whether by repair or replacement, of the products that we buy in case of damage or loss.
With health insurance we are able to secure funding for the necessary cost of recovering our health from a disease. In this sense, there seems to be no difference between a car policy, for example, and a health policy. However, this does seem quite right.
In the case of a car, we understand without a doubt that it is an external object that is physically separate from us. The same with houses and other things. Unlike these objects, however, our health is not external. It is what makes us function, what enables us to lead productive, meaningful lives. It allows us to be who we are. It is inconceivable to even imagine that our health is somehow external to us. So then can we talk about the health insurance industry in the same ways as we talk about the property insurance industry?
How then is health insurance even possible?
In order to understand this problem, we turn to Karl Marx’s concept of “alienation”. Marx uses this concept to understand the relationship of labour to its product. This concept is useful in helping us understand how our health undergoes the same process of “alienation” from ourselves in a dialectic process that makes health both ours, but at the same time not ours. Let me explain.
Let me begin by stating that to work is human nature. As humans we are defined by the work we do. In fact, we are our work, and our names often reveal that – Manjimela, Milimo, Ndui, Kapokola, Mulonda, Fisher, Smith, Mason, Cooper, Shoemaker, Miller and so on and so forth.
However, as soon as these products enter the cycle of being bought and sold for profit, the relationship we have with these products undergoes a fundamental change. They become something alien to us and take on a life of their own, complete separate from us. So as they accrue value, the workers who produced them see their ownership in them diminish while at the same time seeing their own value in proportion to the value of their products diminish. According to Marx, “[t]he greater his [worker’s] activity, therefore, the less he possesses. What is embodied in the product of his labour is no longer his own. The greater this product is, therefore, the more he is diminished.”
This is precisely how the process of “alienation” starts. The worker starts to be “related to the product of his labour as to an alien object.” The “alienation” of the worker in his product means not only that “his labour becomes an object, assumes an external existence, but that it exists independently, outside himself, and alien to him, and that it stands opposed to him as an autonomous power.”
So as the worker works, the more he produces through his work, the more alienated his activity becomes from himself. It becomes a “commodity as it enters a fundamentally different relationship, “a commercial relationship, a relationship of exchange, of buying and selling”. Thus, our work, that which defines us, that which is our nature, becomes the source of profit, not for us, but for those who control it.
Our health has become a commodity for an entire insurance industry.
This process of “alienation of labour” helps us understand just how the health insurance industry works today. Our health, that which enables us to work, becomes alienated from us. We insure our health as if it were an external object just like a car, or a house.
The way the health insurance industry is set up, the industry insures our health only as long as it is productive. Our health is wrested from us, made into an external object, with which to draw enormous profit, not for us, but for those who control the industry. It is literally alienated from us having undergone the transformation from something intrinsic to us to an external product. The health that is insured , however, is not the whole of our health, from good to bad, but only that part that is productive. Only that part that makes profit. Only that part that generates profit.
The word “industry” itself is apt in describing our insurance system. Under “industry” we assume that there is a concrete, external object produced through human labour that is insurable. The word itself propagates the idea that our health is capital, curiously not our own, but rather the capital with which the industry itself becomes wealthier and wealthier.
Somehow, we feel deep down that this is not right. That our health is not a commodity.
Hence, the problem with this health insurance is that our health maybe insured, but we are not. As soon as we are not able to produce that desirable external object, our health, we are no longer insurable. And why not? Because we are no longer the owner of our health. The insurance companies are. Those that profit from owning our health are. Hence, the healthier we are, the less ownership we have of our health.
Can you really be alienated from your health?
In our opinion, it is absurd to think that our health is something that can be alienated from us, commodified by a whole industry for its profit. Commodities exist solely for the profit of the owners. However, insuring our health is not like insuring a car, or a home. There is no pretence about these objects being external. If we lose them, we do not die. On the other hand, if we lose our health and our insurance because we are no longer healthy, we die for the simple fact that we cannot afford the care necessary.
We can’t play casino games with our health in this way.
It is time to fundamentally rethink this health care insurance. First of all, we need to move away from the notion that our health is something to be insured by an “industry”. The notion that it is any part of an industry is a fundamentally wrong. Health is not a commodity. It cannot and ought not to be commodified. Our health should not be used for profit.
We need to take back the ownership of our health.
Let’s bring the care into “health care” instead of giving it to an “industry.” Our lives depend on it.
Our viewpoint, as socialists, questions whether major improvements in our health system can occur without fundamental changes in the broad social order. One thrust of the field — an assumption also accepted by many non- socialists — is that the problems of the health system reflect the problems of our larger society and cannot be separated from those problems. Today our whole country has been turned into a casino where everything is being gambled – land, water, forests, food, education, health, political power and so on and so forth. All have been turned into commodities to be acquired by the highest bidder – they are up for speculation!