As US president, Barack Obama, the 44th and only Black in the Oval Office, drew more attention in one issue more than any other; that was his healthcare insurance programme for all Americans, that came to be known as, Obamacare.
He had campaigned on that issue and wanted the poorest of the Americans, who are mostly, Black, Hispanics and Latinos to be as equitable as their White counterparts in the provision of healthcare.
Eventually, with a good amount of resistance from Congress, Obamacare was passed in his second administration.
Virtually all working Americans are in formal employment, even the five percent who are occupied with agriculture as commercial farmers. It therefore made sense to bring everybody into the bracket and charged as such.
In the recent past years, Obamacare has been the one health insurance that has drawn, and even in the Donald Trump era, continues to draw global press. That is because the wealthy bracket of the Americans, are to contribute more to it, than the poorer sections of society.
It may not be an ideal model, but health insurance should be crafted to benefit all society. So, the recent proposal by the NRM regime to tax the formal workers of Uganda an additional percentage from their National Social Security Fund (NSSF) scheme, to fund a healthcare insurance project, has left loopholes in its plan.
The four percent tax will be on the lower “middle class”, who constitute a very minor percentage of the population. In any case, the largest number of people are in peasant agriculture, that make up anywhere from 65% to 85% of Ugandans. This is the category whose present health service is wanting. The contribution of the formal employees, will most unlikely address the glaring inadequacies of the present health sector.
Also this insurance would cater for the “upper class”, which are already rich, and would be predatory on the working class. In most cases, they do not even attend to the moribund healthcare services offered, preferring to go abroad for their treatment.
This would mean that actually there would be money enough from the health insurance to improve the health of all the people.
But what has been happening now where, the Government and donors are contributing to the health services? There is a conspicuous insufficiency in the health system. For instance; perhaps all the Health Centers Two, a great number of Health Centers Three and a good number of Health Centers Four, are dysfunctional, for a variety of reasons.
The former Director of Health, Dr. Anthony Mbonye, has sounded an accurate warning, which is a sad observation: the failure of the health system so far must be laid at the feet of theft. And he does not see how the healthcare insurance money will escape the pervasive dragnet of corruption that is engulfing all the sectors of the economy.
The National Organization of Trade Unions (NOTU), is therefore, hesitant about the project. Moreover, it comes at the time when the unions are tied up with the Government on the issue of increasing the workers’ wages. So, to remove this percentage from the workers’ pay in addition to the failure to increase their pay is merely an added suffering to this class. And, to boot, where they are not likely see any benefit of the subtracted money accruing to them.
If this is for the workers, what about the peasants who have no say at all, and whose medical situation has not improved at all in the intervening years? Furthermore, what is evident is that the upper crust of society has not been included in contributing to this tax. And it is in this bracket, mostly composed of the “investors” and their accomplices, that there are tax wavers.
NOTU officials are saying that, it should actually be into this bracket, there should be a big taxation to create the proposed healthcare insurance, if at all the scheme is to go forward. Needless to say, one can assume that there will be a big resistance from this group since they form part of the ruling elite and they are their bed-fellows.
If these are some of the obvious objections to the introduction of the healthcare tax, why did the authorities go ahead with the suggestion? It would appear that there was no wide consultation, and therefore, consensus on the issue. It means that the idea was hatched, more probably, in line with what Dr. Mbonye fears is likely to happen. He should know, since he is a health expert.