I admire you for a few things. You have proved yourself a pioneer in an industry infested with copycats. You started the trend of sports based films with “Lagaan”, promptly imitated by Shahrukh Khan in “Chak De India”. You started films based on diseases/disorders with “Taare Zameen Par”, and again imitated in “Paa”.
You have pioneered now with “Satyameva Jayate”. And you will no doubt be imitated. As they say, imitation is the best form of flattery. You are no doubt doing a service to the community by raising awareness about social evils like female infanticide, Child Sex Abuse and dowry harassment. But, I have a few reservations with the costly *prescriptions* you have offered for “healing the healthcare” in the latest episode of *your* show. This is the article you wrote on the subject in “The Hindu”. I feel the prescriptions offered here stem out of ignorance of basic human nature and thus how the bureaucracy works, and a lack of understanding of Economics. I list below some points in the article which caught my attention and caused alarm.
A number of us pay our taxes. Some of us don’t. And most of us don’t earn enough to be required to pay direct taxes. A host of indirect taxes are also collected by each State. Each time we buy something, big or even small, we pay some or the other tax. So it turns out that the poor are also paying for public health care.
The poor are definitely paying tax, in the form of VAT, every time they buy something. This VAT collected from the poor is but a percentage of total tax collected by the govt. The total tax collected is utilized for many other things like infrastructure, education, food subsidies etc. So, they might be paying a very minute percentage of the total amount spent on healthcare. So, the above argument by you is very frivolous. You are effectively saying that a poor person can say “I have given 10 paise tax to govt, so I am paying for public healthcare. So, govt has to pay 10 lakh for my healthcare” .
Experts who work in this space say that it should be at least six per cent for a very basic level of public health facilities. I am neither an economist nor a doctor, but I would prefer to err on the safer side and say eight to 10 per cent is what it should be.
Even though the experts are saying 6% is required you prefer the govt to err on the *safer* side and spend 10%. How generous? Do you realize that GDP is *not* the total amount of revenue received by the govt? So, we don’t have 100% of GDP to spend. Our tax revenues are around 10.6% of GDP and if you add a rough approximate of 1.4% of non-tax revenue, you the govt can spend a total of 12% of GDP(Reference for the figures). You tell the gullible viewer/article-reader that you want to give 10 of the 12%(2% left) to healthcare and you become the messiah.
The rational minds who say that you can’t do that become heartless souls who want children of poor people to die. If you also cared to tell the audience that if you wanted 10% GDP spent on healthcare they would need to pay twice or thrice the current tax they are paying, maybe they would have shed a tear less. Or if you just wanted to cut expenditure from elsewhere and had you told that there would be potholed roads and 5 hour power cuts as a result of a cut in expenditure in transport and energy sectors(Reference), they would have stayed home in their AC’s and watched some other show.
Private hospitals are most welcome, but let’s concentrate on our public health-care system and make it so strong that private hospitals have to work harder to compete, and therefore, we as a society get better services.
Please name one sector where private sector is allowed and where the public sector is giving serious competition to the private sector. See the pathetic state of BSNL and Air India. There are already so many govt hospitals. Do you think the poor go there? My mother used to work in a post office in the campus of a govt hospital. She says that the going rate for giving an injection to a patient is one butter dosa for the nurse. So it’s no wonder that people go to the private hospitals and pay from their pockets. Their logic: at least they get cured. Suppose your kid gets injured in an accident and is in need of an orthopedic surgery.
Where would you take him? Would you take him to the friendly neighborhood govt hospital? No, you would you take him to Lilavati hospital or some big shot hospital like that. Why?. Because you know that there would be a big waiting list to even get an appointment with the surgeon. Plus, you would need to run around getting all sorts of documents, get them franked, then attested and what not.
In case the bureaucrats are happy that all documents are in order, you might get the surgery date fixed. Then, the odds are that surgeon in the govt hospital is a mediocre one because all the good ones are in pvt hospitals as they pay much more than the govt. Also with the reservation policy, the govt feels that the surgeon who has to do the surgery on your kid has to be one whose grandfather/great-grandfather was discriminated against by yours. And if the surgeon screws up the surgery , he would not get fired.
But, if a surgeon in a pvt hospital screws up, of course the first time in most hospitals, no action will be taken. But, if that continues for some time, he will be asked to leave in order to maintain the reputation of the hospital. Of course, you know this is what happens in a pvt hospital, so you know that by a process of filtering, the best doctors would be present in the pvt hospitals and you go there. So, why do you not want the same privilege for the poor?
In the rest of the article, you talk about the malpractices indulged in by the doctors. They overcharge, they give costly prescriptions(like your prescription for healing healthcare) and what not because even though the patients know that doctors do that,they have no choice to go back to them, because there are only so many doctors. If they boycott such doctors, there will be no one left.
So, the solution to this problem is simple. Increase the number of medical seats. So, if there are doctors who indulge in such malpractices, one can always give them the middle finger. Of course the politicians want to maintain the shortage of medical to earn windfall profits through capitation fee. That’s why they are not doing anything. Instead of presenting this solution of increasing competition among doctors by increasing number of medical seats, you would rather make the doctors the villains and patients the wrongfully wronged. Of course, otherwise the Gross Tear Production would not be that high. The doctors are merely making an economic decision.
I will charge this guy thrice the amount for consultation, and prescribe costly medicines. But, these will cure them and there are not many doctors around. So, he will come back to me. Why the heck do you think you can charge so much per episode and get away with it? Because there are very few as good as you. Likewise, are the doctors. Remove that shortage, and they can’t get away with it.
You are a person who attracts millions to your show. This blog will be read by a maximum of a 100(I am being optimistic). You have power. So, please don’t give wrong information to your viewers that higher spending is the way to go. They might elect UPA again. We can’t afford another UPA term even though you might indirectly say so. Like you did when you said, after voting in 2009, “Some people have problem with Manmohan Singh as PM. But, I feel he is a good PM “. I am paraphrasing because I couldn’t find the video of that interview on the internet.
A honest Tax payer
(Rakesh Babu is a friend of CRI)