After the Bell: The great financial squeeze — a new movie coming to your medical aid scheme

I’m sure that, like me, as you wander and wonder through life, buffeted by the trials and tribulations of Grade 11 Maths and Grade 8 socialising (apparently Y is still equal to MX+C) you come across moments and dilemmas that are tailor-made to be filmed.I’m not talking about the headline-grabbing Steinhoff scandal or something completely insane like your average day in the Trump Administration.I’m talking about the little incidents of ordinary life that make it both tough and interesting. Those moments that you possibly cuss and mutter about at the time, but give your life grit and make up your real-life story.Many of these little incidents are about choices that are almost eternal – how much would you do for your children? Almost anything short of murder (and sometimes that…). How much would you do for your parents? (A huge amount, including having them live with you.)About once a year there is a Netflix-worthy story involving a South African medical aid scheme.Life-saving and fund-breakingIt is usually about a particular course of treatment that is, in every sense of the word, life-saving, while also being, in every sense of the phrase, fund-breaking.This morning Moneyweb published the details of a story guaranteed to have you in tears about three-and-a-half minutes after pressing the “skip intro” button on your streaming service.It concerns a 15-year-old with a rare blood disorder who can live a normal life with the right treatment. Which just happens to cost more than R6-million a year.As it happens, this would appear to fall under the “prescribed minimum benefits” that the medical aid scheme has to pay.If blood flows through your veins you’re obviously with the child. And their family. All of our instincts, whether you are their parent, a parent, or a human being, wants this poor child to have a normal life.And, such is the way of things, what costs R6-million a year now will probably cost about R3-million a year in five years time and much less than that in a decade. By which stage we will all have given up on the El Niño-ravaged physical world and uploaded ourselves into the Great Augmentation anyway.But I think you are allowed to feel more than a pang of something for the medical aid administrators.This is not a Discovery that could easily swallow that cost. All of our other medical aid schemes are much smaller than they are.Imagine for a moment being in your later years, belonging to a relatively small fund, and wondering if it will be able to pay for the procedure you’ve been waiting for to really improve your quality of life.Heart of the problemThis really gets to the heart of our medical funding problem.The pool of people who can afford to stay in a good-quality medical aid is getting smaller, and younger people are making a financial bet that they are going to be better off without joining the fund their parents were forced to join at work.They’re rational to do that, financially they might even be right.But if the pool of money gets too small then what can really be paid out will have to get smaller too.It is an inconvenient fact to those who oppose National Health Insurance (NHI) that the best possible pool of funds is one that includes all of us.In cases like this there are all sorts of procedures to determine if the medical aid scheme will have to pay for the treatment.Much of the argument in these procedures will be technical and legalistic. What does the law say? What are the terms and conditions of the scheme?But what would happen if, somehow, there were one hundred children on that scheme needing the same treatment?Could the scheme survive? If it did, how much money would be left for all of its other members?No choiceAnd those members might decide they have no choice but to try to join another scheme, even though the late-joining fees would probably cripple them, and perhaps their middle-aged children, financially.There are reasons why this movie is now being repeated so often.Rare and difficult diseases are much more likely to be diagnosed than in the past, and for a 15-year-old, huge advances in medical treatment now give them hope when before there was none.This means this kind of financial squeeze is going to happen more and more often.For a while the people running these medical aid schemes will probably be able to manage things. Some funds will find ways to avoid paying for such treatments, others might even merge to broaden their pools of members and funds.But unless the national pool of people able to pay for private medical care and thus medical aids starts to grow, this kind of squeeze is going to happen more and more often.And more and more 15-year-olds will be forced to look a financial administrator in the eye and beg for their life. DM