The Lessons of the Transition Era, Inequality and the Politics of Universal Health Care:  Re-visiting the Proposals of the Macro-Economic Research Group (MERG) and the Reconstruction and Development Programme by Robert Van Niekerk

The paper offers a reflection on the macro-economic policy debates as it related to social policy in the transition era of the 1990’s, focused on the case of health care. It offers an explanation for the displacement of the political agenda for the universalisation of health care which was a core demand emerging from the anti-apartheid civil society and the progressive trade-union movement.  In the case of health the agenda was the creation of a de-commodified, people centred National Health Service free at the point of delivery.  The displacement of the universalisation of social policy in the adoption of GEAR in 1996 resulted in continued commodification of public goods such as health care informed by the market principle and the entrenchment of residualism in social policy provision (health care being the most stark illustration, with 50 percent of health care resources consumed by a 16 percent of the mainly middle-class minority). The paper re-interrogates MERG and RDP as alternative policy frameworks  to GEAR and which represented an agenda of universalisation of social policy and establishing a universal,  de-commodified National Health Service. The continued relevance of these displaced MERG and RDP  proposals for establishing a universal National Health Service is discussed in the papers conclusion, relative to the current policy debate on the National Health Insurance (NHI), drawing out some the implications in particular for the progressive workers movement in the current era.