Socialised healthcare, the US and India

Only dedicated campaigners for socialised medicine will remember the promise made to the country on the eve of independence that no man should have to go without healthcare because he cannot afford it. The report that recommended such universal care was written by Sir Joseph Bhore, a year before freedom, but today, it cannot be located even on the website of our Ministry of Health and Family Welfare!

The promise has been belied over six decades and today India’s public health system is being systematically torn down by a cartel of corporate hospitals and health insurers; they are not deterred even by the presence of a Left-backed government. In fact, the UPA seems to tacitly aid its destruction.

Given that background, it is of great significance that the run-up to the US Presidential election is witnessing an intense debate on what kind of healthcare Americans should get. The ‘special interests’ in medicine in the US, just as in India are unlikely to warm up to the idea of expanded state-supported healthcare. Quite unsurprisingly, these forces are receiving the earnest backing of the Presidential hopefuls of the Republican party, which has just successfully thwarted improvements to children’s health insurance in America. The most recent and arguably interesting evidence comes from the “zero tolerance” former New York Mayor, Rudy Giuliani, a presidential hopeful. His arguments on medicine and healthcare are decidedly shaky, as Paul Krugman points out in his column in today’s New York Times.

The debate on US healthcare reform, which was waiting to achieve criticality in 2008 and was kicked off in good measure by Michael Moore’s film “Sicko,” is bound to expand and pose more uncomfortable questions to Right wing politicians. These members think nothing of the nearly 50 million Americans without health insurance. Watching the debate nervously will be the financial backers of the Right in the pharmaceutical, corporate hospital and health insurance companies.

The debate is of immense importance to India, where the same set of forces has been straining to skim off profits — currently picking the low hanging fruit, aided by  middle class insecurity about healthcare. The nationalised insurance companies are also part of the deception in India. They all offer policies protecting against catastrophic health expenditure for prospectively acquired illnesses at high premiums, in high cost corporate hospitals, but ignoring the need for sustained access to healthcare through the general medical practitioner and prescription drugs that are being financed out-of-pocket. These insurers are biased against the elderly, against women, and chronically ill people (remember that in the US, the elderly are fully insured by the Government). Their policies would make any sane person ask, if only healthy persons with no condition whatsoever are to be given health insurance cover, what is the risk that they are actually covering?

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