by Jurgen Brauer, November 2003
Copyright: J. Brauer. No reproduction without permission.

Recently I spent nearly four weeks in South Africa, traveling from university to university to speak about one of my recent books. As fate would have it, I fell ill and ended up in various hospital emergency rooms three times within the span of seven days. As a compassionate colleague pushed me in my wheel chair from ER to specialist to laboratory to pharmacy, I still had sufficient presence of mind to marvel at the power of my credit card. Out it goes, and the bill is payed.

As a compassionate colleague pushed my wheel around the hospital, I still had sufficient presence of mind to marvel at the power of my credit card.

What is so remarkable about that? It is remarkable because by far the majority of South Africans would have been utterly unable to afford the cost of pain relief and ultimate treatment. On the last ER stop, in Durban, the ER service cost R300, the specialist about R450, the lab work about R400, and the medication R250. That's R1,400 or, given the exchange rate at the time, about $175. Little enough for me but for the average black South African perhaps a month's worth of income. To put this in perspective, if your annual income is $60,000, how would you feel paying a $5,000 ER bill? Not unlikely, you'd stay home, suffer through the pain, and hope for the best.

As a compassionate colleague pushed me in my wheel chair from ER to specialist to laboratory to pharmacy, I still had sufficient presence of mind to marvel at the power of my credit card. Medicine is powerful, and so the money to afford it. Availability of medicine is not enough; people must be able to afford it. Much the same has been said regarding the terrible famines India used to suffer. The problem rarely was lack of food; the problem was the means to purchase the food that was in fact available. The theme of availability and the means to purchase can be extended to other areas. Basic health care, food, water, clothing, shelter, and education are not problems on the supply side. They are problems on the demand side: lack of income to make the purchase.

The day after my ER visit in Durban, which was on a Friday morning, my colleague, some friends, and I drove off for a weekend retreat in the mountains. By Saturday afternoon I could hobble along, by Sunday I could go on a hike, albeit slowly. Without medicine I might have been incapacitated for days on end, lost the enjoyment of healthy and productive days, and would have needed to rely on others' help who would then also lose productive days. Here is a powerful rationale for government provision for basic income or basic service support for the poor. Helping people get back on their feet – in my case, literally – "reimburses" government expense accounts through taxes on earned income. Especially in poor countries, building and maintaining the economic capacities of people should be the primary duty of government. This is good economics, good policy, good politics, and is also the humane thing to do.