Obamacare is one of the most progressive, pro-people legislations in recent time. The manner in which the White House pushed it shows the power of political will, which is a lesson for New Delhi. But India must look inward to find its own healthcare solution
The US Supreme Court’s endorsement of the Patient Protection and Affordable Care Act last Thursday is undoubtedly a defining moment in the Obama Administration’s efforts to provide healthcare coverage to all Americans. Popularly known as Obamacare, the legislation was the US President’s most important electoral promise back in 2008. It was signed into law in 2010 and aims to insure millions of Americans who live dangerous lives without any medical coverage.
In short, Obamacare makes it compulsory for almost all Americans to buy health insurance. If one can’t afford health insurance, the state shall provide for it. But anyone without insurance will have to pay a penalty. Termed ‘Individual Mandate’, this second clause was hotly contested and there were legitimate concerns if it would stand judicial scrutiny. The Supreme Court put those fears to rest last week when it ruled that the penalty was indeed a form of tax, and that the Government had the right to impose.
That apart, another salient feature of Obamacare is the manner in which it aims to rein in private health insurance providers. For instance, private insurers routinely refuse patients with prior health conditions. By making insurance mandatory for all, Obamacare has in effect blocked that loophole. Similarly, by extending the coverage available to the elderly under Medicare — which along with Medicaid forms the two main state-sponsored insurance schemes — it has also plugged the notorious ‘doughnut hole’ that compelled senior citizens to pay for their expensive medication.
But none of this comes for free. In fact, Obamacare lays the ground for enormous Government spending. Not only will the exchequer have to pay for the insurance of those who can’t afford it, it will also have to foot the bill for an extended Medicare and Medicaid coverage. Washington, DC hopes to pressure the States to eventually chip in but even that will not be before 2020, if at all.
Nevertheless, there is no denying that Obamacare is perhaps the most progressive, pro-people legislation that has been formulated in recent times. Yes, it will cost the federal Government an obscene amount of money and yes, it will drastically change things within the healthcare industry. But more importantly, Obamacare sends out the message that it is wholly unbecoming of a civilised country to not make basic healthcare available to all its citizens.
Expectedly, this is a message that has found resonance in India where political apathy, crumbling infrastructure and rising costs have deprived thousands of the healthcare they rightly deserve. One can only hope that the raucous over Obamacare will also generate debate on India’s healthcare systems and eventually push the topic of public health into the national mainstream.
Some have pointed to the Planning Commission’s stated goal of achieving Universal Health Care in the country by end of the 12th Plan period in 2017 as a positive step in that direction. Indeed, towards that end, an expert panel has even recommended a ‘National Health Plan’ which will, by law, make every citizen entitled to a basic healthcare package.
Unfortunately, this is where the comparisons with Obamacare become problematic. Not only is such a project far more ambitious than Obamacare, given its proposed scale and density but it is also a pointless exercise that will serve as a topic for academic discussion at best and an excuse for colossal money laundering at worst. An Obamacare-like plan will have little positive impact in India because it is not designed to address India’s problems. Instead, Obamacare is a tailor-made response to the American problem of sky-rocketing medical expenses wherein healthcare is so ridiculously expensive that insurance is an absolute necessity.
In India, however, medical services are relatively cheap and affordable. Government hospitals and healthcare centres across the country provide medical services at highly subsidised rates and often even free of cost to marginalised communities. The problem here is not so much the cost of the treatment but the quality of it. Abysmal infrastructure at many Government-run hospitals and healthcare centres means that even the best of doctors cannot effectively tend to all their patients.
If the Government is indeed considering pumping money into India’s healthcare system, it is in this aspect of improving infrastructure that the money should be invested. Or else, a hair-brained health plan that is really a cross between the wasteful populism of the Mahatma Gandhi National Rural Employment Guarantee Act and the wall flower-like idealism of the Right to Education Act will come to naught.
Ultimately, if the Government is really serious about achieving its UHC goal by 2017, it must leverage the country’s inherent potential to build a workable model that provides quality yet affordable healthcare to all.
Take for instance, the Aravind Eye Hospital network that is headquartered in Madurai and provides high level ophthalmic care to poor patients across south India. Here, cataract cases form the bulk of the patient body — only 30 per cent of which comprises paying patients who shell out anything between Rs 12,000 and Rs 15,000 for one surgery. But the revenue this section generates is enough to fund the treatment of the remaining 70 per cent of patients.
This financially self-sustaining model is based on the unique Indian innovation of the Small Incision Cataract Surgery. Instead of using modern phacoemulsification machines that are expensive, have high disposable costs and are not well-suited to cut out advanced and mature cataracts that are typical of developing world populations, doctors at Aravind perform a manual, sutureless, small incision extracapsular procedure with indigenously produced equipment on poor patients. The procedure is quick, cheap and safe and the results comparable to surgeries done on paying patients using the phacoemulsification machine.
There are several such examples wherein Indian doctors have come up with low cost but high efficiency technology that has revolutionised the way medicine is practised in this country —keeping it away from the debt trap of the West’s bloated healthcare system.
And if Aravind in south India has used technology as a game changer, across the country in the small towns and mofussils of Bengal, Disha Eye Hospital (another regional chain) has capitalised on India’s burgeoning population to build a financially sustainable model that provides world-class health facilities. Its hospital in Barrackpore alone caters to approximately 1,200 to 1,500 patients daily. Out-patient fee is a nominal Rs 60 but the tremendous bulk of the patient body renders this a profit-making institution that is able to provide quality medical services. Hospital chief Debasish Bhattacharya has his fingers on the pulse of his patient body when he says, “Whenever we think of eye care, we either picture a state-of-the-art hospital or a charitable organisation for the poor. The common man with his handful of money and heart full of pride fit nowhere.”
If only the Government would care to listen.
(This article was published in the op-ed section of The Pioneer on July 5)
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