“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?