Democratic Alliance (DA) leader Geordin Hill-Lewis argued on Wednesday that South Africa cannot build a sustainable healthcare system by centralising "enormous power, money, and decision-making" in a State that has repeatedly failed its current mandates.

Hill-Lewis’ remarks come as the Western Cape government takes its fight against the National Health Insurance (NHI) to the Constitutional Court.

The provincial government is seeking to defend the principle that superior healthcare is a product of good governance rather than centralised control, arguing that major reforms like the NHI cannot be pushed through Parliament as a "box-ticking exercise”.

The Constitutional Court is hearing two major challenges to the NHI Act between Tuesday and Thursday, focusing on an allegedly flawed parliamentary public participation process.

In February, President Cyril Ramaphosa confirmed that he would not promulgate any provisions of the NHI Act prior to the Constitutional Court handing down judgment on these public participation challenges, and that he would not enforce any part of the Act until he was requested to do so by the Minister of Health.

Hill-Lewis highlighted that State capture had shown, through failing hospitals, broken procurement systems and collapsing public services, that concentration of power without competence does not produce better health outcomes.

“It simply produces failure at a larger scale. In the DA-governed Western Cape life expectancy is 67.6 years for men and 72.2 years for women, above the national figures of 64.0 and 69.6 respectively.

“In the Free State, life expectancy falls to 57.3 years for men and 64.2 years for women. A ten-year life expectancy gap is the clearest possible proof that healthcare is ultimately a governance and accountability issue,” he stated.

He defended the good government argument against the NHI, stating that government needed to prove that it could manage the public health system it already controlled, before spending on a new healthcare fund.

“… that means running hospitals properly, keeping clinics stocked with medicine, appointing competent managers, paying suppliers on time, preventing corruption, and treating patients with dignity,” he said.

He claimed the NHI Act was threatening the security of millions of working and middle-class South Africans.

“These are not wealthy elites. They are teachers, nurses, police officers, small business owners, young professionals, pensioners and working parents who already pay tax, VAT, school fees, security costs and, in many cases, private healthcare because the State has failed to provide reliable services,” he said.

Hill-Lewis said government could not make promises that healthcare would improve if it had failed to fix current public healthcare.

“South Africans deserve healthcare reform that is practical, lawful, affordable and grounded in good governance. Healthcare is too important to be built on wishful thinking,” he said.