Manali Shah (name changed on request), a 33-year-old software engineer working in the private sector, lost her savings of eight years in a day when her father, 65, underwent a liver transplant in a private hospital. “Not only did my savings go, I also had to borrow money from the family to foot the bill. The procedure and hospitalisation cost almost Rs 30 lakh, and we have to continue spending Rs 10,000 each month for medicines, follow-up consultations and diagnostics,” she says
Each round of chemotherapy and radiation costs her almost Rs 1 lakh, but she didn’t consider AIIMS because the radiotherapy machine there is booked for the next seven months. [The cost of one round of chemotherapy in AIIMS was just Rs 750/- at that time, hence the overbooking]. From a report in Hindustan Times, 20 October 2013
Doctor, heal thyself, was my initial reaction when I read the front page report in The Hindu that ‘Docs’ were opposing ‘negative’ portrayal by NCERT. The objection raised by them is that the class VII textbook, Social and Political Life II, contained “objectionable description ” of the medical profession. Or so you believe till you realize, by the time you are into the third paragraph of the report, that the issue is not at all about the negative portrayal of the medical profession as such but of its elite practitioners who are making a killing in elite private medical institutions and hospitals at the expense of the ordinary people.
So it is not doctors in general – those who work in trying conditions in government hospitals – who are raising the objection but the Indian Medical Association that professes to be “the only representative, national voluntary organisation of Doctors of Modern Scientific System of Medicine, which looks after the interest of doctors as well as the well being of the community at large”. The IMA says the news report, has written to the President Pranab Mukherjee and Prime Minister Narendra Modi “demanding immediate remedial action”. IMA’s objection is to the following passage in Chapter 2, on the ‘Role of government in health’, under the sub-heading: ‘Private health facilities’:
“In order to earn more money, these private services encourage practices that are incorrect. At times, cheaper methods, though available, are not used. For example, it is common to find doctors prescribing unnecessary medicines, injections or saline bottles when tablets or simple medicines can suffice.”
And what precisely is the objection? Here it is in the words of IMA’s own office-bearers and spokespersons:
“This is a wrong depiction. They have shown that the cost of treating the same illness is Rs.3,500 in private sector and Rs.150 in government sector,” said Dr. K.K. Aggarwal, honorary secretary general, IMA.
IMA national president Dr. A. Marthanda Pillai said: “The message which will go to the students is that private sector fleeces money.”
Honourable Drs KK Aggarwal and Marthanda Pillai may believe that the ordinary person is waiting for the NCERT textbook to disclose to her the true state of what the private sector in health care means, but for millions of people in India today, this is already a known fact. I have cited a case from a Hindustan Times report at the beginning of this post, Dr Pillai, that shows precisely that one round of chemotherapy in AIIMS costs a mere Rs 750/- as opposed to Rs 1 lakh in the private hospital where Manali Shah got her father treated. And the same report also tells us something revealing- that almost 40 percent of the people getting treated for cancer in AIIMS cannot even afford this Rs 750/-. The difference between the private hospital and AIIMS is 133 times, a way above the 23. 33 times difference suggested in Aggarwal’s fictional example. And yet Drs Pillai and Aggarwal want us to believe in the fairy tales they tell about privatization. True, there is a lot that is wrong with government hospitals and things need to be urgently rectified there, especially working conditions of doctors. Many of the ills of government hospitals have to do with overcrowding simply because costs elsewhere are just beyond their wildest imagination for most of the people. Conditions have only worsened with cuts in government spending on the health sector.
I recently lost a cousin who had been suffering from multiple ailments and at one critical moment a few months ago, had to be admitted to a private hospital in South Delhi. In a matter of two hours, his family was handed over a bill of close to Rs 25, 000. This was just for tests. His wife then decided to move him from there in that critical condition, to AIIMS. He survived for a few months after his treatment but the point here is simply that even for a family like ours which is not poor by any standards, it was impossible to meet the projected expenses of the private hospital. So if ordinary people believe, Dr Pillai, that the “private sector fleeces money”, they do not have to read the class VII textbook. Your ilk has drummed home this message to us poor and middle class alike.
In fact, we can go a step further and say that there is something really mala fide in the statement made by the IMA that purports to be an organization representing doctors’ interests as well as those of “the community at large” and yet, makes here a clear pitch for privatization/ corporatization of the health sector. Doctors in the private sector, many of whom have been trained with government (and therefore tax-payers’ money) in government hospitals who have been ‘bought over’ by the private sector, are the ones whose interests are perhaps at stake here. It needs little imagination to see how diametrically opposed the interests of “the community at large” are to those of corporate sharks that seek profit from people’s misery.
Dr Pillai actually goes much further and argues that
When calculating the cost of government hospital treatment, it [the textbook] does not take into account the cost of infrastructure, medical equipment, staff salary, doctors’ salary, cost of attached medical colleges etc…
“There is no way the cost of health care in government sector can be compared to the cost in private sector without taking into consideration the above factors.”
Is that what students and teachers – and tax payers at large – should be concerned about? About how corporations and elite doctors can make their money from ordinary patients and find alibis for high costs of private health care? Or should they be taught how health care can be made available at reasonable cost to all people – irrespective of whether they are in government hands or not? It does not take a visionary to see which side IMA stand on here.
The Hindu’s report then goes on to say that
Doctors have found the sentence “in order to earn more money, these private services encourage practices that are incorrect” as judgmental. Doctors said content like this in NCERT textbooks will brainwash the students and ruin their faith in private health care services.
Thus, says the IMA in its letter, “The matter should be taken seriously and the NCERT should be directed to delete or re-write this chapter it.”
This is, as it were, the most intriguing and pernicious part of the letter. There is no question of a public debate on the ethics of private health care, there is no question of any debate or contestation and the right of defense allowed to NCERT or those who have written the textbook. The IMA demands that “NCERT should be directed” – clearly by the PM and/ or President, that is, by administrative fiat, to simply delete and re-write the chapter. That is why they did not go to the court, where they would have to argue and defend their own bogus case.
For our part, we see this as an opportunity to initiate afresh a full-scale public debate on the ethics of the corporatized health system. Let us be clear here that the point here is not simply about government versus private health care – an easy opposition which requires no thinking, for in that universe there is always only one answer to everything thing: privatize, privatize, privatize. But behind this slogan stand corporate armies of plunderers and I can already see neoliberal ideology warriors jump on to their horses, rattling their sabres, ready to charge forth.
No, the question here is far more complex. It is not against private health care but against corporate takeover of health care – and this includes the predatory insurance corporations as much as it does, corporate hospitals.
To conclude then, let me cite the following extract from a piece penned by two doctors, Amit Sengupta and Samiran Nundy:
Until about 20 years ago the private sector comprised solo practitioners and small hospitals and nursing homes. Many of the services provided were of exemplary quality, especially those hospitals run by charitable trusts and religious foundations. As the practice of medicine has become more driven by technology, however, smaller organisations have become less able to compete in the private healthcare business. Large corporations, such as drug and information technology companies, and wealthy individuals—often from the Indian diaspora (commonly called non-resident Indians)—have started providing health care to make money. They now dominate the upper end of the market, with five star hospitals manned by foreign trained doctors who provide services at prices that only foreigners and the richest Indians can afford. These hospitals are largely unregulated, with no standardisation of quality or costs. Their success may be gauged by their large profits and ability to raise funds through foreign investments.
This puts things in perspective by bringing into the picture the vast range of non-governmental players in the health sector. Religious institutions have played a significant part here and continue to do so. So have what Sengupta and Nundy call solo practitioners and small hospitals. Even today, outside the network of government institutions, they are the ones who most ordinary people have to fall back upon.
IMA has thrown us a challenge that cannot be allowed to go uncontested. This challenge can only be met by bringing the entire ethics and practices of the corporate medical sector into the centre of debate.