Sicko – Are we going the American way?

“Do we have our insurance cards with us? Which is the in-network hospital closest to our home? Do we even know what plan we are on? What do we do if there’s an emergency?”, I nagged the husband in full panic mode last night. We had just finished watching ‘Sicko‘, a critique on the American health care system and I was terrified of falling sick while in the US, as a result.

‘Sicko’ is a hard-hitting documentary from Michael Moore of ‘Fahrenheit 9/11‘ fame. Here’s how IMDB’s synopsis describes it – ‘Writer/producer Michael Moore interviews Americans who have been denied treatment by our health care insurance companies — companies who sacrifice essential health services in order to maximize profits. The consequences for the individual subscribers range from bankruptcy to the unnecessary deaths of loved ones.’

Sounds chilling, doesn’t it? I am not sure whether to take the entire narrative at face value but surely the tragic first-person accounts must be real? Sample this. A cancer patient allegedly died because his bone marrow treatment (for which a donor had already been found) was deemed ‘experimental’ and hence not approved by his insurance company, a drug costing 120 dollars in the United States was being sold for just 3 cents in neighboring Cuba, medical practitioners employed by health care companies claimed they were paid bonuses for denying medical expense claims and ‘saving’ their employers money… and all this supposedly happened in America, thought of as utopia back home in India and most other parts of the world.

My first impression was of shock, horror and disbelief. Then there was some guilt – I once worked on a project for one of the insurance companies named in the documentary – was even a tiny part of my salary made through such means? And finally there was relief – I know we always have the option of traveling back to India if ever (God forbid) one of us needs expensive medical treatment while we are here.

Once the personal thoughts were dealt with, I started to think of the larger picture Moore has tried to present – should something as basic as health care be entrusted to a profit-making industry? I am a great proponent of wealth-creation in general, but what sort of people see profit in life and death situations? And is it right for a government to allow such an opportunity in the first place?

“Most of the world’s research is funded by American pharmaceutical companies. They need lots of money for research, don’t you want to see a cure for cancer?”, a friend reminded me. Fair enough. But are we naive enough to believe funding research is the sole motive for profit-making here?

As is my wont, my thoughts raced from America to India as I tried to relate the documentary to the situation in my own country. Health care is still thought of as both competent and affordable back home in India, but I wonder how long it can remain that way. Will it not soon become big business in India too?

And from whose point of view exactly is it affordable even now? From a well-off middle class family’s point of view? How about a poor peasant or factory worker then? Government hospitals are free, I have heard, but are they well-managed, clean and hygienic? Are the doctors qualified and committed or overburdened and underpaid? Are there long queues to get in? And are sophisticated medical treatments ever performed in such hospitals?

From a middle class family’s point of view too, I see things changing around me. My uncle, a doctor, is associated with a charitable hospital in India, a hospital founded long ago with the sole aim of providing affordable health care to all. A few years back, a business conglomerate took over the hospital trust. There is new machinery with the latest technology now and the hospital’s peeling paint and broken flooring has made way for a color-coordinated new look, my uncle tells me, but the locals are not very impressed. The charitable hospital is not so charitable anymore, they say.

Then there is a sad incident that happened in our family last year. Another uncle, retiring from a comfortable job in Mumbai, wished to live close to his only daughter in Bangalore after retirement. Bangalore home prices are sky-high these days, but my uncle and aunt invested all their savings to buy a beautiful new house near their daughter’s. Everyone was happy, until last year, when the uncle suffered a heart attack. A critical heart surgery and a long hospital stay followed. My uncle is fine now but the couple lives in a rental apartment these days. Their home was sold to pay the medical bills.

Several of our friends and relatives rushed to get private health insurance after my uncle’s experience. Many large Indian companies, (especially software firms, from my own experience) provide health care insurance to their employees as part of their pay packages. From all accounts, the Indian health care insurance industry seems to be a growth story. But do we really need an American-style profit-motivated system in India? As medical costs increase, we might not have much of an option.

Yes, our saving mindset makes us somewhat better prepared to handle a medical emergency. While Americans go around spending most of what they make (and a lot of what they expect to make) on new homes and fancy cars, most Indians I know still believe in saving as much as possible for a rainy day ahead. Sadly, with the advent of consumerism and the credit culture, that seems to be changing too. And even for a frugal family, how far can our savings go? What if we are looking at not one, but multiple medical emergencies in the future?

If change is inevitable, universal health care as practiced in the U.K. or Canada seems more humane to me, but given our population and poverty, is it something we can even dream of for our country? Tax payers, a small fraction of our population, are already overburdened in India. Would it be fair to burden them even more? I think not. Not to mention the corruption that would inevitably enter such a system.

What is the solution then? Are we going down the rocky American path after all? Is there a better choice? Does our government have a policy in place?

I apologize for the rambling post friends, my mind is full of questions today! Any answers?

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10 responses to “Sicko – Are we going the American way?

  1. I think you’ve answered your own questions to an extent. It’s true that Indians save up for emergencies – medical or otherwise. And while health insurance is highly recommended even in India now, people still don’t bank on it to save their lives. That’s because despite the private sector initiatives that are supposed to be more efficient and simpler, the truth is that claiming insurance continues to be a cumbersome job in this country and Indians like me would not rely on it.

    Also, the health care industry is already BIG business in India and there are five-star hospitals that have come up all over the country.But govt health care systems in India remain far from adequate. And it’s not so much owing to a cash crunch as the sarkari inefficiency, misuse of funds and the vested interests of the political parties in power.

  2. Thought provoking post.

    I have never believed the rationale that high R&D expenses in the US means they should charge high prices. Granted they did the research,but if you look at their financial statements, you’ll find that marketing expenses are as high, if not higher than their R&D expenses 😦 All those TV ads are expensive.

    I agree that privatized health insurance is not a great option, and really, when you think of it, government healthcare like Canada or UK would be a great idea if only the government had the infrastructure 😦

  3. Tell me about it, lady!
    I was scared to death after I read about Sicko and saw Oprah’s show that had Michael Moore as the guest. The show actually had some folks from insurance companies too and what shocked me even more was the casual attitude with which they answered some of Moore’s questions! It was as though they were not ‘people’ and they themselves would not fall ill anyday !
    After I saw that show, I first called up parents and ILs to check about their coverage etc! It really freaked me out!
    Your post is in itself an eye-opener πŸ™‚ Thanks for this πŸ™‚

  4. You have voiced what I have been witnessing over the years in America and Canada (yes, even Canada). Deteriorating standards, refusal of medical aid and delays in specialists’ appointments-all find their own place in this sorry state of affairs that you have highlighted in this post.

    Seems the ideal is not the ideal after all…

  5. So D, if health care IS already big business in India, and you still don’t trust insurance companies, how does an average family pay for multiple medical emergencies? I am ruling out free government hospitals for obvious reasons here…

    And thanks for the award D,its very sweet of you.

    I completely agree Lekhni. So it looks like we’ll soon be going down the American way after all!

    Oh, I did exactly the same M! πŸ™‚

    Yeah Manpreet, it is very sad! But don’t you see a way out?

  6. A thought-provoking post! Both private and public systems have their own set of unique problems. I like the idea of having a combination of private and public, like in India, but that system can only work if public healthcare is at least reasonably good. Sadly in India, while public hospitals are free and anyone can walk into them for treatment, the quality of the treatment is probably not up to the mark.
    Michael Moore praises the public care systems of Canada and the U.K. but talk to people in those countries and you will know that those systems are beseiged with problems as well. Many people from Canda and the U.K. go to third world countries nowadays for expensive operations because the wait is too long in their own country. But at the same time, the private healthcare racket like in the US is also not the ideal solution. I think it has monetized an industry that should not be about money.
    OK, to stop rambling and get to the point, I have seen some really efficient healthcare systems in Europe (Belgium and Germany come to mind) and these are all those combination systems. People pay very high taxes and in return get great government health care. However, the downside to that system is that there aren’t too many incentives for pharma companies to spend money on new cures as they know prices will be regulated by the government. Most of the breakthrough medicines come from the U.S. If the pharma companies could still be allowed to make ‘sufficient’ profit in a pulic healthcare system, i think then the structure could work well.
    Sorry for hogging the comment box! Not sure if i am even making any sense! πŸ™‚ Michael Moore, in my opinion, exaggerates a lot, but he at least makes us think.

  7. Hi,
    Have been rading ur posts for sometime, but today couldn’t resist leaving a comment. A thought provoking post.
    Healthcare in India is already on the US way. Very sad. Even middle class families opt for more than one insurance plan to help them over emergencies. How about the poor? If only our public health system is cleaned up – It will solve half the problems.
    One of my cousins had a bad experience in UK. He suffered from Kidney stones & had to be hospitalised suddenly. He was kept on just IV fluids & pain killers without any treatment for a week, for he had to wait ‘in line’. He had to fly to India with the help of painkillers and get himself treated. If you don’t get healthcare, when you need it, whats the point even if it is free?!?

  8. Exactly my thoughts Chakli. (The difference is mine were just based on instict, without all the background info you’ve just given me – and thanks for that!) And you made a lot of sense, it is a difficult question to answer really.

    Hi Akhila, I am glad I ‘provoked’ you enough to make you comment this time! πŸ™‚ I must try it more often…

    I had no idea about the UK/Canada horror stories Chakli and you talked about. Yes – I agree, there’s no point if healthcare is not available when you need it, free or not!

    Glad to see you here and please do say hi from time to time!

  9. Pingback: Recent Links Tagged With "sicko" - JabberTags

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