Saturday, December 9, 2023

Government Control Of Health Sector: To Be Or Not To Be

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The allegations of loot by private hospitals in India are getting louder and louder. Even those in favour of free market economy suggest that some government regulations of private hospitals and private schools is a must.

Firstly about the government regulator. There are two complaints against private hospitals: They do unnecessary surgeries, and they charge huge amounts. So, how will the undersecretary of the Ministry of Justice, Truth, and Fairness know whether the surgery was required or not? How? How exactly? Will he hire another doctor to do the check? Why will the first corrupt doctor not bribe the second doctor doing the check? Why? I hope you do not believe in the joke that the doctor appointed by the undersecretary of the Ministry of Justice, Truth, and Fairness will be honest. Doctors come from the same society, study in the same colleges, and where they practice makes no difference to their integrity. So you will end up paying the salaries and bribes of undersecretary of the Ministry of Justice, Truth, and Fairness and his doctor, in addition to the fees of the corrupt doctor you are paying now.

About the second allegation, high charges. What are the reasonable charges? Which you can pay? Which the rich can pay? Which the upper middle class can pay? Which the middle class can pay? Which the landless labourer in the village can pay? What exactly are the reasonable charges. If you want that the undersecretary of the Ministry of Justice, Truth, Fairness, and Reasonable Charges should fix the fees of the private hospitals, remember that he reports to politicians and is answerable to Courts. Just one round of elections and three PILs in the Supreme Court, and charges will come to rupee ten for the registration and rupees hundred for the knee replacement. Everybody will become eligible for Medanta, there will be a ten year long waiting list, and you will die waiting for the rupees hundred knee replacement surgery.

Ridiculous, facetious, you say? In the UK and most OECD countries the medical services are totally free. But then the catch kicks in. In the UK, you may have to wait upto three weeks to see the General Practitioner (GP), the non-specialist who decides where you go next. And after that, the government target for a cancer patient, that is the patient who is suspected to have cancer by the GP, to see the specialist is 62 days. 62 days. In 62 days he should be able to see the cancer specialist after being suspected of having cancer and start his treatment. And even this target is not being met. For non-urgent but essential surgeries, the target is 18 weeks, and last year there was 40 lakh patient long waiting list waiting for surgeries. इतने दिन में तो AIIMS में ही नम्बर आ जाएगा आपका। क्यूँ हल्ला मचा रहे हो? AIIMS में नाम नोट कराओ और प्रतीक्षा करो। जिसको निजी अस्पताल में जाकर “लुटना” है उसके options की क्यूँ वाट लगा रहे हो?

Next consequence will be that the private hospitals will die. Capital goes where it sees profit. Both, the money Capital and human Capital goes where it sees highest returns. That is why choices for various Engineering branches is always changing, and the choice of Services in UPSC exams is always changing. Once people realise that private hospitals are making losses, they will not set up new hospitals, and existing ones will shut down. Young people will stop studying medicine. And your waiting list at the AIIMS will stretch to ten years in no time.

A country that was under socialist boot for 40 years should have known that government controls do not work. Government controls only make things costlier, more scarce, and eventually create black market. Black market attracts criminals. Once criminals enter the market, the country dies. No exceptions to the rule are found.

Some friends say that government control must not be there in any thing, but in medicine and in education it is a must. If government control is bad for everything else, how it can be good in medicine and education? Why can’t you think?

Now the solution. Solution is simple. Completely dismantle government control, regulation (regulation as in process regulation, not legal rules), permit, license, clearance, and NOC raj. Government control makes people corrupt. And if people are corrupt, doctors will not be honest either. With government control gone, you will have job explosion and huge growth in incomes, and your hospital charges will become a simple fraction of your income. No? You say no? Mumbai Delhi airfare was 25% more than my salary when I joined service. Today it is 7% of the salary of the new entrant in the same service. It happened not because of government regulation. But because government regulators were sent home. Retired. Sent off with their विदाई वाला नारीयल एंड माला। Exactly same will happen with hospital charges and school fees once all regulations of every sector of economy are removed: they will become absurdly small fractions of your salary.

Still you are not ready to agree? बहुत सताते हो यार। In India, home loan interest rates are 10% per annum and above. So, with a 10% interest rate and 20 year tenure if you take a 30 lakh home loan, you will pay 40 lakh interest in addition to the 30 lakh principal. In the US, the home loan rates are 4% and below. So if you obtain the same loan in the US, you will pay only about 11 lakh in interest, in addition to the principal. Lo, and voila, you save about 28 lakhs in interest and that will take care of all your medical expenses for the entire life. That is the magic of free market your Leftist doesn’t want you to know. And you will similarly save in every other expense. So, do not demand regulation. You demand regulation of hospitals, because you think you are the only pressure group. But pressure group are numerous, and once the principle is accepted that government knows the fair charges of a commodity/service, pressure groups force it to regulate everything. And economy dies. You job disappears. Your salary becomes a pittance. And all you are left with are the waiting lists, for everything.

And now the cruel and heartless part. If you think carefully, you will realise that we rarely fall sick before 60 years of age. May be some fevers. Very rare and unfortunate cases require hospitalisation and surgeries before the age of 60. And they are clean cases. Ailment is definitive, and treatments are straight forward. Allegations of overcharging mostly come in case of patients above 60 years of age, and become very common in the patients of above 70 years of age. Because doctors are also helpless in such cases. Senescence is something we do not talk about, but it is a reality. So doctor operates on such patients, and discovers something else also has gone non-responsive, some other organ is threatening to fail as a result of the surgery, and he is forced to operate, and relatives start crying “Loot, where is the government?” Fact is, avoid hospital if you are above 60 if the procedure is not going to add at least ten years to your life. And if you are above 70, do not go to hospital for surgeries. You will only end up bankrupting your family, and get between two to four years of life. Those too mostly of very poor quality of life. Children can not take such decisions for the elders. So, in the west government takes such decisions, indirectly. By putting them on waiting list.They depart the world, waiting for the surgery. In the US, even the closest relatives are not allowed to donate liver to the patient who requires liver transplant. They say they will not mutilate the healthy for the sake of the sick. So the patient waits for the liver in the cadaver programme, and if he survives the wait, he gets the liver. If government regulations come in India also, such patients will not start getting surgery on demand. They will only get waiting lists, but at least the children will not feel guilty. But children will also not get the healthcare they need even at young age.

We are genetically programmed to live the years assigned to us. Our lifestyle can shorten them, not increase. But even for a healthy life style but genetically programmed to depart at 70/80 years of age, medicine can add two to four years at the most, but will bankrupt the family in doing so. Maharana Pratap, Guru Govind Singh ji Maharaj, Chhatrapati Shivaji Maharaj, all departed around the age of 50. We still remember them. They lived a full life. If you have lived 70/80, you are lucky. But nothing spectacular is going to happen now. When the call from the maker comes, go gracefully, without bankrupting your family. And without destroying economy of the country by forcing government regulations.

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