Is Health a market commodity?

For Eastern Mirror column

Patients are no more treated as patients but as business clients. Pharmaceutical companies intrude into doctors’ medical practices. Insurance companies decide who is sick and who is not. 

When it comes to health care, USA is not a country to look up to. It is a terrible thing to fall sick in the US if you are not insured. And about 16% (49 million) of the population do not have health insurance. 26% of Americans face grave problems paying medical bills, 58% delay treatment due to inability to pay, and medical bills are the number one cause of bankruptcy.  Many people could not avail the benefits of safety nets (e.g. Medicaid and Medicare) because they are not poor enough, not old enough, or they are not dying. The poor, who are not destitute poor, the sick who are not suffering from terminal diseases are therefore caught in the middle, of becoming ineligible for these free services and not rich enough to pay insurance. The idea is to exclude as much as possible those who are unable to pay. The poor and the sick are not good business partners and it is best to try not to insure them. Another flipside of insurance in the US which was reported in the media a couple of days back is that some people refuse to buy health insurance and choose to pay penalty as that is cheaper than paying the insurance premiums.

The US spends more on health as percent of GDP than most of the industrialized nations but has poorer health indicators like Infant Mortality Rate, Maternal Mortality Rate, Life Expectancy, etc. The Obama administration tried to reform the health care delivery system but have faced stiff resistance from these private insurance and pharmaceutical companies.

What has gone wrong in the US? The government has sold out its health to private hands in the spirit of free market capitalism. This has resulted in the rise of star-hotel-like hospitals running on for-profit business models and has moved ahead leaving behind a huge chunk of the middle class, the poor and the vulnerable. 

The general trend of the countries worldwide is that where the government has a bigger hand in health care, there is more inclusive coverage, equitable distribution of resources and better over-all health indicators. Examples are Cuba, Sri Lanka, and Canada. 

India, however, has a mixed story. Though health care is more in the public sector, the private sector has been increasing by leaps and bounds especially in the cities and big towns. Corporate hospitals have sprung up along with private insurance companies and big pharmaceuticals. Medical tourism is a booming industry. But because majority of Indians still live in the villages, public sector institutions cater to the health of the majority of the people. Except for charitable mission hospitals, there is hardly any private hospital or nursing home in rural areas. It is not profitable for the private bodies to set up hospitals in the villages. And the public institutions are in a sorry state due to a host of factors like lack of government commitment in spending on health, manpower crunch, geographical hurdles, poor staff motivation, interference of party politics, etc.

The present central government’s increasing commitment to improving health can be felt.  The UPA’s first term’s flagship program National Rural Health Mission (NRHM), despite all its complexities, has been immensely contributing to improving health. The aim to provide free generic medicines in all public institutions; and to increase government spending in health to 2.5% of GDP (from the current 1.4%, which is among the least in the world)  for realizing universal coverage are welcome moves. 

There has not been a commensurate increase in commitment to health in Nagaland. The state budget on health is still small and stagnant and there is no State Health Policy to tell where we came from, where we stand or where we should go from here. Health is a State subject and the commitment of each State government determines to a large extend the level of health care its peoples receive. The public health institutions are still the hope for most of the Nagas. In Nagaland, majority of the population will depend on public health institutions (Sub Centres, Primary Health Centres, Community Health Centres, District Hospitals) for health care at least for a very long time. Private hospitals are concentrated only in Kohima, Dimapur, Mokokchung, and a handful of private clinics in other district headquarters. Preventive health care is almost exclusively in the domain of the government set ups.

Private sector is heterogeneous and the various forms of private agencies cannot be generalized as purely profit motivated or that the ethical standards are the same everywhere. Private sector do have a place in health care and in certain areas, they can do a better job than the government. In private, profit is a necessity for self sustenance and growth. Some components of the government health programs do run in partnership with private and civil society organizations. But the emphasis here is the responsibility of the government to provide basic health care which should not be allowed to be run over by any other agency. If taxes and other sources of the State’s income are used in return for the welfare of the people, health care should be a priority and not an afterthought.

Is Health a market commodity which can be sold and bought from the market? Unlike other market goods, good health is not something that we may choose to buy or not buy. It is an absolute necessity and not something optional. It is as basic as education, housing, employment; it is a basic human need. And therefore basic health care is recognized internationally as a human right as mentioned in the Universal Declaration of Human Rights:

‘Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care, and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control’.

The preamble of the World Health Organization realizes this:

‘The enjoyment of the highest standards of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, and economic and social condition’.

Such fundamental right should not be made a market commodity; a goods to be sold and bought in the market. Privatization of basic health care will lead to skewed distribution of health services; widen health inequalities by exclusion of people groups; and will be a violation of human rights. The government should not shirk this solemn responsibility of providing accessible and affordable health care to its people.