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Health mustn’t hinge on wealth

When the “buy one, take one free” sales pitch hits the market for healthcare, it is time to sit up. “Buy a heart bypass and t...

Written by K. Sujatha Rao |
December 24, 2003

When the “buy one, take one free” sales pitch hits the market for healthcare, it is time to sit up. “Buy a heart bypass and take a week’s holiday in Goa” or “Get the second bypass at 50% discount” is no longer a joke. It is on offer today. The question is that while most of us would be lured into buying that extra pair of shoes we do not need, how many of us are willing to have our teeth extracted or heart cut up only because there is a discount? Is it not reasonable to assume that those in dire need of such services would not only respond, but the need for survival being so great, would do so at any future cost to themselves or their family?

This then brings in the question of individual vulnerability which an Ambani and the rickshaw puller have in common, giving rise to the most fundamental principle — is profiteering on the sickness of other humans ethical? Can companies be lauded and individuals be rewarded the best entrepreneurial award for increasing profits on the ill health and vulnerability of people who are struck with the misfortune of falling sick? These are important issues, ones that were hotly debated in UK during the 40’s, in Canada and most of Europe in the 60’s and 70’s, as also in Singapore, Australia during the 80’s, resulting in all these countries opting for a strong interventionist role by the state. And this is the issue that troubles the conscience of most Americans, too, as evidenced by their constant yearning for the Canadian model of health care.

Compared to the US, Canada provides universal health care of the same level of quality at one third the cost. Besides, despite being the world’s highest spender on health, with 40 per cent from the government, US has nearly a third of its people denied access to basic care and a longevity of life among its black populations at about 58! The sharp differences between the US and Canada are largely on account of the values enshrined in their respective constitutions. For the Canadian psyche, it is social solidarity, order, peace and good governance, while for the US it is personal freedom, pursuit of happiness and liberty. And while in both countries provisioning of healthcare services is by private providers, Canada insures all its citizens — rich and poor — inpatient care and physician services, while in the US, public finance is only for specific target groups, namely the poor and the elderly. Given the widespread poverty, our intellectual traditions and constitutional pronouncements of equality, it is inexplicable as to why public discourse on health systems has not followed UK or Canada and why we are creating a system resembling the US.

As in the US, we too do not seem to be troubled by accepting a two-tier system, where the rich can access world class health care as per their ability to pay while the poor must rest content with the public health system. This is worrying, because unlike Singapore, which also has a two tier system with the public hospitals providing the benchmark in quality of care, public health care in India is considered substandard as a result of it being underfunded,understaffed and overstretched. Is this gradual veering towards the US model a reflection of our Hinduism which is intensely atomistic and where each lives and suffers in accordance with his own karma?

Is it really true that concepts of equality and social solidarity are indeed foreign and borrowed and therefore not relevant to India as seems to have been pointed out by the then prime minister to a group of agitated women activists in response to his stand on the famous Shah Bano case? Clearly, there is an immense amount of conceptual clutter and lack of direction in our discourse on health. In jumping to ideological positions of public is bad, private is good and governments are bad and markets are good, our intellectuals have trivialised serious debate. The devastation markets have caused, in terms of human suffering and public spending in the US, have not even been studied. Instead, intellectuals have allowed themselves to fall prey to facile arguments for privatisation such as, for example, that in providing choice of private hospitals, the rich will opt out of the public hospitals providing space for the poor!

It is not widely understood that profits by private hospitals are made in two ways — one, volume; and two, during the first two or three days, when patients are normally required to undergo extensive diagnostics and invasive procedures. The incentives implicit in profit making is what forces private for profit hospitals to reduce the length of stay or make the prices so unaffordable that the patient opts to leave. This explains why a large number of the “rich” continue to frequent the public hospitals and why US subsidises the care of all its senior citizens, who largely suffer from chronic diseases, under its medicare programme.

The hijacking of the health sector by the market fundamentalists arguing for more subsidies for the private sector, starving public hospitals of resources, has been possible because of the absence of a national consensus on the values that we need to adopt for ourselves. To start with, as pointed out by former US president, Bill Clinton, in Hyderabad to a gathering of top industrialists, do we believe that there is a higher purpose in life to merely making profits? If yes, can we then agree that those who cannot afford healthcare should be denied it and allowed to suffer and die? Do we believe that all humans are not equal?

As all philosophical principles remind us, can there be true happiness and, more importantly, social stability in a society where a large number of its members suffer want and disease? Is it then not necessary for turning the debate around and placing the principles of social solidarity and public accountability in health getting precedence over privatisation and a further commercialisation of health? A national consensus on some of these issues is important for clarity in public policy and for instilling values of compassion and concern in our society at large and among our health professionals in particular.

The author is with the Indian Administrative Service. The views expressed here are her own.

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