JOINT SUBMISSION BY COSATU AND NEHAWU TO THE PUBLIC HEARINGS ON THE REPORT OF THE COMMITTEE OF ENQUIRY INTO COMPREHENSIVE SOCIAL SECURITY SYSTEM
Type of spending |
Estimated cost (constant Rbns) |
% of total social protection spending |
||
2001 |
2015 |
2001 |
2015 |
|
Voluntary private schemes |
152.4 |
175 |
56% |
41% |
Universal grants |
58 |
154.8 |
21% |
36% |
Means tested grants |
54.8 |
6.2 |
20% |
1% |
Mandatory private schemes |
5.5 |
91.2 |
2% |
21% |
Total |
270.7 |
427.2 |
100% |
100% |
Source:
Calculated from Report, page 148, Figure 23
Group (assuming full take up) |
Reduction of Poverty gap before BIG |
Reduction of Poverty gap after BIG |
Overall population |
37% |
74% |
Pensioners only |
100% |
|
Skip generation |
80% |
95% |
Three generation |
60% |
85% |
No pensioners (children + adults) |
22% |
67% |
Adults only |
8% |
56% |
The universality of the BIG is a critical factor. It removes the stigma associated with receiving grants as well as any possible disincentive to work. It also vastly reduces administrative costs, makes it easier to reach the rural poor, and encourages self-reliance. In addition, as a grant per person, it favours larger households (which tend to be poorer) and empowers women and children. Richer people will pay back the Grant through the tax system. It would therefore effectively target the poor, without the inefficiencies and unnecessary restrictions associated with a means test.
We welcome these proposals, and urge their immediate adoption. In addition, we propose the following to strengthen the impact of the new grant system:
Government should urgently develop measures to accelerate the issuing of identification to children and to extend grants to orphans. There is considerable evidence that delays in providing identification for minor’s forms a major obstacle to access to the child grant.
The NEDLAC constituencies should be requested formally to develop campaigns and programmes to accelerate extension of the child grant, collapsing the current incremental approach to 14 years and setting a target for its extension to 18 years in the shortest time possible.
Every effort should be made to introduce the BIG, as proposed by the Committee, without a means test.
The report floats as one option, without discussing it, the idea of using an increase in the VAT to fund the new system. This proposal is entirely unacceptable, and we rather support the other option raised by the Committee, namely to recoup the BIG through income tax, supplemented by the fiscus. The VAT is highly regressive, as the Treasury itself admits. If it is increased, it would reduce the benefits to the very poor from the BIG – a counterproductive effect. We would, in contrast, support the introduction of a variable rate for the VAT, with a higher rate for designated luxury goods.
5. National Health Insurance (Chapter 8)
This is possibly the weakest part of the whole report. The proposal in the Taylor Committee report is misleading. What is actually being proposed is a Social Health Insurance (SHI) system not a National Health Insurance (NHI) system. This very important distinction has been acknowledged by the Department of Health. This has led over the years since the concept was first mooted in 1995, to the terms being used interchangeably. This is a very disturbing feature since any planning that must be done based on the recommendations of Taylor Committee will be substantially different depending on the model to be chosen.
In fact there are five (5) different variants of SHI that can be proposed, and the Taylor report does not pick these up.
It is our strong submission that our country needs a strong efficient and expanding Public Sector Health system and that this be funded through a NHI.
The terms of reference of Taylor Committee under health funding and insurance stipulate that the public and private sector environment must be examined with a view toward ensuring universal access to basic healthcare.
It is our submission that the report fails in this regard. Firstly no analysis is given as to the reasons for the problems that face the public health sector and using that analysis what conclusions should be drawn, upon which recommendations can be made.
When examining the findings its is clear that the report seeks to make a case for the retention of the private health service in its current form but within an increased regulatory environment.
It is our submission that the co-existence of private and public health in its current form is a vital factor behind the inefficiency of health spending in our country. R8 billion in the form of tax subsidy is given on an annual basis to the private health care sector.
This sector serves less that 20% of the population yet absorbs two-thirds of total health funding. In contrast the public health sector serves the majority but remains under-resourced resulting in poor service delivery. Only 7 million South Africans, of whom only 9% are African, are covered by private medical schemes.
The annual revenue of the private medical schemes comes to more than R29 billion per year, roughly the same as the total health budget.
The two-tier system promotes a mal-distribution of resources and wastage, inflates health costs and defeats the commitment to health care for all. The private health care system actively weakens the public health system by shifting the cost of caring for patients with serious illnesses onto the public sector, and by setting up a parallel system of expensive private hospitals that diverts potential paying patients from public hospitals.
We propose the NHI to end the two-tier system by incorporating all health resources into the public sector. A new NHI Authority would allocate the health budget to hospitals and practitioners. It would be funded by the existing budget plus a progressive dedicated levy equal to existing private health costs.
The levy would be on high incomes, both salaries and other, and would effectively replace the current cost of health insurance and medical schemes. Because it would replace the employee-employer insurance premiums and out of pocket expenditures, it should not increase the cost of health care to anyone currently accessing medical aid, or to society as a whole. In the long term, by reducing administration and procurement expenses, the cost of health care will ultimately fall.
NHI would not increase the burden of health costs on society in the short run, and will reduce the burden per person in the long run. This has great importance for controlling the costs of living and of production.
Initial cost estimates to run a NHI would be in the region of R19 billion per year.
The above proposal will of course lead to a major reduction in private health institutions since many are kept alive through government subsidisation. However the above proposal does not necessarily mean that there would be no private health institutions. These would be there but would no longer depend on the state for subsidisation, and if anyone wished to use such a system they would have to bear the costs of a strictly private health system which will be substantial.
Key in the recommendations of Taylor is to change the current environment of a general tax funded public sector and a private contributory environment to a broader contributory environment, replacing taxes as a source of revenue. We believe that this model, which can be found in certain European countries, is unrealistic. The levels of poverty in our country, which are borne out the Taylor report, do not allow even in the long term, a contributory environment.
This also raised the question, do we want the state to relinquish funding in the long run, and what are the political consequences for this to happen. It is our belief that a universal contributory system is not the appropriate model for our country.
In phase 4 of the Taylor recommendations on the implementation of a NHI, it states that medical scheme contributions would not be replaced but rather the contributory environment would fund the subsidy provided to medical schemes.
The proposals are not only complex, but place an onus upon working people to carry the costs of the proposals. The reality of our country is that not only do we have a massive unemployment but we also have a poverty of the employed, workers unable survive from month to month.
Means testing is introduced in the proposals in respect of entitlement to a subsidy equivalent to the risk-adjusted per capita average of all contributions, and revenue received into a Central Equity Fund.
The complexities of the system as proposed by the Taylor Committee, means that costs of purely administering their option will be high. These costs will be borne by a contributory environment. The Taylor report admits that the proposal is complex and multi-dimensional. There is an attempt to explain this away by stating that it is inherent in health systems’ reform.
It is our submission that the more complex the system, the more discriminatory it becomes, the more means testing will be required. Our submission on a NHI has the major advantage of its simplicity and long term cost saving.
The consequences for workers of the Taylor recommendations are huge, and we submit such proposals would need to go to NEDLAC to be discussed.
The proposal to restructure tax relief on employee contributions to medical schemes, while requiring all employees of larger companies and the public service to join medical schemes is a problem, and these proposals will lead to substantially higher costs for low-income workers.
As presented in the Committee’s Report, these proposals risk:
Increasing the cost of medical care for the working poor.
Major disruptions of wage negotiations if the changes in the tax subsidy on medical aids lead to higher health costs for large numbers of workers.
A major problem is that the Committee’s proposals do not specify critical parameters for the proposed contributory system.
The risk is that it ends up effectively improving funding for health by making the working poor pay more, rather than the rich. In particular,
The proposals emphasise both mandatory contributions and membership in medical schemes for workers in "large employers" and the public service. Many of these workers are not well paid at all. Some 20 per cent of public servants earn R2500 a month, while many miners earn even less. This approach contrasts with the comment to progressive mandatory contributions, so that "middle and high" income people paying the most.
The proposed changes to the medical-scheme subsidy are not well defined. Making the schemes take on greater risks will raise their costs, so even with the same subsidy members could end up paying more. The transition is even more worrying. The document does not say how government will ensure that the subsidy is passed on to members, rather than being absorbed by medical scheme managers.
In addition, the report does not deal with important issues beyond the financial framework. These include:
Access to and staffing for clinics
Labour relations issues and the brain drain, both from the public to the private sector and overseas
The structure of tertiary care and how that affects equitable access.
Finally, the Committee expects to maintain a strong private sector in health. It seems too optimistic about the ability of the state to regulate it in ways that will ensure efficiency and cost containment. The risk is that, if this project fails, we will see continued soaring health costs and a drain of personnel from the public sector. In addition, the agreement to establish privileged facilities for private users in the public sector could lead to a two-tier public health system. Like the two-tier fee-based system in education, this would prevent more equitable solutions.
We support of the Committee’s measures to enhance equity and control medical costs. The main proposals to achieve this end are:
Regulations to control costs and improve consumer protection in the medical schemes
Increased funding for public health through an increase in effective income taxes and/or the deficit, and through increased contributions by the rich
The definition of minimum standards of care for both the public and private sector, including treatment for AIDS, in order to improve equity
The restructuring of tax relief for medical schemes to reduce the benefits to the rich.
We cannot, however, accept proposals that would increase health costs for those low wage earners or impose excessive cost increases on middle income earners
Because of the likely impact on lower-income workers, we reject:
Mandatory membership in medical schemes for any group, including workers for large employers and the public service
Changes in the subsidy on medical schemes unless they are designed to ensure a substantial improvement in funding for public health, and that the new subsidy does not cause higher medical-scheme costs for ordinary workers.
Any reform scheme that does not substantially improve the public health budget.
"Contributions" for healthcare that are based on employment status rather than income.
If these concerns are not addressed, the proposals could severely disrupt labour relations, as workers will recoup increased medical costs through wage negotiations.
6. Labour market issues (Chapters 6, 9 and 12)
6.1 The Unemployment Insurance Fund
The Committee argues that:
Because the majority of UIF claimants were poorly paid when they were employed, replacement income levels are correspondingly low. Even the progressive scale of benefits in the new Act will not solve the problem of benefit exhaustion.
The scheme is vulnerable to fluctuations in the level of economic activity to a point where it is non-viable. State support may be required to keep the scheme afloat.
Maternity benefits proposed in the new Act are inadequate.
The Committee concludes that comprehensive insurance against unemployment is impossible in the current circumstances of mass unemployment. It nonetheless recommends:
The level of contributions should be increased.
Maternity benefits: income replacement rate should be raised on the income replacement schedule. Mothers should become eligible for full benefit packages (17 weeks paid maternity leave) after 13 weeks contributions. Possibility of introducing maternity type benefits for those in casual, seasonal or insecure employment should be investigated,
Domestic workers should be included, with a modest tax rebate to their employers.
Public servants should be allowed to decide whether or not to join.
Government must underwrite the UIF in the final instance.
By and large, these proposals align with our positions. However we propose the following be amended: -
The proposal to let public servants themselves decide whether to join will undermine cross-subsidisation – a critical element in the financial stability of the UIF. The system must be compulsory.
The report fails to make specific proposals on benefits levels and periods of eligibility, despite its own argument that current amounts are inadequate.
In respect of the latest developments in the labour market, we need more time to assess the likely impact of the proposed tax relief on UIF contributions for employers of domestic workers.
In the course of the implementation of the Act, workers have raised several concerns that must be taken into consideration when considering the recommendation of the report: -
that workers will benefit once in a four-year cycle is seen as punitive and regressive, in that the old act allowed workers to benefit several times for a period of six months.
that workers would not benefit if they resign. While the underlying objective to discourage resignations is noted, there is a concern however, that workers, who are forced to resign for legitimate reasons would not benefit under the act.
If an employee resigns because of sexual harassment by an employer this will definitely be deemed a ‘constructive dismissal’, and a worker may then benefit from the UIF after a ruling that effect has been made. However, if a worker resigns because of being sexually harassed by a co-worker or the workplace has become intolerable, this will not be covered under constructive dismissals and as such the worker will not benefit from UIF. In this respect, the Act may have to be relaxed to permit workers under prescribed circumstance, to benefit from the Fund, in the event that they resign.
In the Nedlac negotiations on the UIF Bill, and the final Act, it was agreed that there would be a comprehensive review process after two years, which would finalise a range of questions, including level of contributions, level and period of benefits, state funding etc. It is important that detailed terms of reference are finalised for this Review and that the process is expedited.
6.2 Active labour market policies and job creation initiatives
The Committee proposes the establishment of an inter-departmental body to co-ordinate active labour market policies and job creation initiatives. In effect, this body would co-ordinate important elements of economic and social policy. We support this proposal, which should be complemented by a regular assessment of all government programmes in terms of their direct and indirect impact on employment.
To create jobs, the Committee proposes:
Support for current Department of Labour initiatives to create several hundred thousand learnerships in the public sector, and
Up to 2,6 million public works jobs, continued for a sustained period
While these proposals are critically important, the institutional mechanisms for implementing such huge programmes remain vague. We would like to see concrete implementation plans, which should be tabled at NEDLAC to ensure broad support from civil society.
The implementation plans should include Youth Brigades, which could perform community service as well as engaging on public works. Tens of thousands of positions could be created through programmes such as home-care for people with AIDS, ABET and childcare. Youth Brigades could, in this way, contribute substantially to alleviating suffering and building social integration, as well as creating employment for young people – the most affected by rising unemployment.
6.3 Occupational Injuries and Diseases (Chapter 12)
The Committee’s key findings are:
The current system excludes large numbers of people (domestic workers, and those in non-standard forms of work and independent contractors);
COIDA does not encourage labour market reintegration through for example rehabilitation and retraining. Prevention is also not accorded priority in the health and safety arena.
There is duplication with other forms of social insurance.
The legislative framework is still fragmented.
While the report acknowledges exclusion of domestic and other workers, it does not propose strong solutions. It is our submission that compensation must be available to all employees.
Further, when the COIDA amendment Bill was processed in parliament in 1997, the portfolio committee on labour referred a number of issues to the Department of Labour for further study. We expect the Department of Labour to act urgently on the proposal for an in-depth review of the main aspects of the compensation system.
7. Retirement funds (Chapter 9)
7.1 Coverage and benefits
The Committee recommends a compulsory minimum contribution for retirement for all formal employees, including casual and part-time workers, except where their incomes are very low. It also supports a national savings scheme for other workers.
Whilst we support a compulsory contribution system in principle, we recognise that poverty may make it unrealistic. We therefore request a more detailed assessment of the likely impact of this proposal on workers in different income categories.
The report notes that there is a proliferation of small funds, which is inefficient and costly. It suggests that provincial governments, together with unions and local business organisations and retirement funds administrators, should investigate the establishment of regional funds, which could be more efficient and democratic.
This proposal has two shortcomings.
It does not provide any compulsion to small funds to join in.
It excludes the Registrar, while including administrators. Administrators should only administer the funds, not get involved in this type of policy decision. It makes more sense to say that labour, business and the Registrar involved in such a process should be empowered to call on expert advice when the need arises.
Instead of regional funds, we would like to see more support for sectoral retirement funds. These can provide many of the benefits of transferability and wider coverage sought by the Committee. Moreover, they have an institutional base in existing bargaining councils and sectoral forums. The Department of Social Development should encourage relevant structures, including bargaining councils and sector job summits, to start putting mechanisms in place for engagement to establish sectoral retirement funds.
We support the proposals on transferability and on improved benefits for retired people, disabilities, and other groups. In addition, in light of the impact of the AIDS pandemic, retirement funds should review coverage for orphans.
7.2 Administration
We support the report’s argument in favour of empowering trustees and improving fiduciary responsibility, as well as the proposal for investigation of a single, specialised, well-funded Pension Complaints Tribunal.
7.3 Investment
The report proposes that funds:
Be required to invest certain portion of their assets in defined socially desirable investments, with a return equivalent to marketable assets, and
No further increases on offshore investments be permitted until better assessment of the risks are possible.
We strongly support these proposals. We have made specific proposals in this connection at the negotiations at NEDLAC in the run up to the financial sector summit. We hope that the Committee’s recommendations will inform government positions in that engagement.
7.4 Taxation of Retirement Funds
The Committee report deals with taxation of retirement funds at section 9.2.4. What has to be taken into consideration when looking at the proposals is that the impact of the tax regime on low income-earners can have a very negative effect. After government decided to tax retirement funds COSATU entered into negotiations with the then Deputy Minister of Finance, Honourable Alec Erwin, and secured an agreement that implementation of the tax would be subject to the ‘top-up’ arrangement recommended by the Smith Commission, which would compensate low income earners for the effect of the tax. This issue requires further examination and discussion and we should not move on any option until this is done.
8. Conclusion
We thank the Portfolio Committee on Social Development for the opportunity to present our proposals and comments on the Committee’s Report. We commend the Committee for a robust and thorough report as well as a participatory process. We trust that the report from these public hearings will find its way to the July cabinet Lekhotla and that the product of these public hearings will receive the timely and due consideration of cabinet.
There are areas that need far more consultation and we believe that this should be one of the recommendations of the Public Hearings.
We are willing to meet with the Department of Social Development and any other relevant department to discuss issues canvassed in our submission.