Health Minister Aaron Motsoaledi and his department are on a collision course with Cosatu over the National Health Insurance (NHI), ahead of the governing ANC's critical national policy conference in July.
While the department sees a role for the private sector in the implementation of the NHI, which aims to introduce a single fund that purchases healthcare services for all South Africans that are free at the point of delivery, Cosatu is adamant the private sector should be excluded.
Cosatu, with 1.8m members, is SA's biggest labour group and a member of the governing alliance. It recently used its political muscle to force the government into delaying its plans for provident fund reforms and won concessions on the national minimum wage.
The public sector lacked the infrastructure, technical capacity and administrative flexibility to implement the NHI in one fell swoop, health director-general Precious Matsoso said.
Cosatu is pushing for a big bang approach to implementing a single NHI fund, in which there is no space for other funding mechanisms, such as medical schemes.
"The 'single payer, single fund' may be the ideal, but the conversation is what will happen tomorrow". You don't wake up one day and have a fund," Matsoso said.
"It would be sad in this country if we just look at unorthodox options and pursue those, and that ends up undermining the very basis of achieving universal health coverage.
"I can assure you, we will end up with unintended consequences," she said.
Matsoso has held a series of meetings with various stakeholders including doctors, pharmacists, medical schemes, private hospitals groups and medical scheme administrators to discuss what role they may play in implementing the NHI.
She declined to comment on the details of the revised white paper, expected to be presented by the minister to the Cabinet in coming weeks.
Cosatu spokesman Sizwe Pamla said the minister and his department were going rogue on the ANC's policy on the NHI, watering it down to enable the continuation of the two-tier system, in which poor people relied on the inadequate state sector and wealthier people retained access to better care in the private sector. The government was betraying voters who were promised a single payer NHIin the ANC's 2014 election manifesto, he said.
"What we are starting to see worries us " government is changing its tune. If the [ANC policy] conference thinks the health department is on the right path, there [will be] a clear break for us," Pamla said.
The issue would be discussed at Cosatu's central committee meeting, from May 29 to June 1. Cosatu was opposed to public-private partnerships for the delivery of health services, as the private sector's profit motives would always be placed above patients' needs, he said.