There is no question that South Africa’s current health system is failing to meet the needs of its citizens, especially those who do not have the means to access private healthcare. There is also little question that the drafters of the National Health Insurance Bill have the best of intentions. Given the wretched position of many of this country’s State-owned firms and public institutions, however, it is going to be extremely difficult to inspire confidence in what will be a massive (larger than Eskom) centralised fund. This fund will act as the single buyer of pharmaceuticals, healthcare and other medical products and services and will have the power to cap the prices paid to doctors. What could go wrong?