It is difficult to argue against the principles underpinning the National Health Insurance Bill, approved by lawmakers late last year. As with all legislative interventions, however, the devil is truly in the detail. On this score, the Bill fails to offer assurances in the areas of affordability, fundability and, crucially, effectiveness. Given the collapse of the monopoly State enterprises that have hitherto been responsible for electricity and freight logistics, South Africans have every right to be concerned.