Healthcare Policy – Myth and Reality

Good health is central to human happiness.  A Human may be a happy human without much wealth but he cannot be a happy without good health.  There is the old saying - where there is health there is hope. Because of this, Health care must remain a central subject of healthcare policy of governments. Recently, this author has contributed many of his thoughts on the topic to leadership of US and India on twitter where this policy is under active debate and transformation. However, twitter, because of its brevity and informality cannot explain points fully. This note shall attempt to do that. A blog note also has a wider and more durable presence for the world at large and all do need to devote their attention to this topic some of the time, so central it is to life.

Ranking Countries by Healthcare Outcomes

Several different ways and methods exist to rank countries of the world on healthcare but the simplest is infant under five mortality rates in a country. It is a reflection of a lot else within a country on the health front. It is not a perfect criterion but it is also least amenable to manipulations and bias and a fairly good one for a quick check. Such rates can be found in lists on Wikipedia and elsewhere easily. Some countries fare well with infant mortality rate under five deaths per thousand live births. The worst touch near hundred.

Three factors influence health and infant mortality rates most, first is the life style and environment of people that includes the air, water and food they consume: second the general level of prosperity in a country and lastly public spending on health by governments for public and not private healthcare.

Thus Monaco a small city state seems to have the healthiest population in world, scoring high on all three fronts.  Japan and Scandinavian countries score very high because of high second and third factors. Cuba a small country has lower infant mortality rate than USA because of public healthcare even though the latter is much richer that depends on private for profit care and insurance. Ikaria an island in Greece has perhaps the healthiest population on the planet for lifestyle reasons.

Private for profit versus non-profit charitable or public healthcare

An unfortunate reality of human life is that humans are driven by greed. Only a few saintly persons among them escape its grip. Perhaps humans are much too recent in evolution on a planetary timescale to have reached a higher level of existence yet.  Human traits regarded as bad in general play a role for good in special cases for humans too, not just animals. It is for this reason Nature has created such traits. Fear helps a human to learn and protect, anger has helped humans to overcome injustice, lust is essential for procreation and so it is with greed too, it has a role to play in human welfare.

While humans have been wise to exploit greed for some of its needs through capitalistic mechanisms with careful control in many areas to create prosperity and provide services, the profit motive fares badly in some areas. One area where profit motive does badly is care of infants. Rich persons have tried to provide care for their children through hired nannies but only in rare cases is such care better than that by love of a mother. In many it is disastrous. Secret cameras installed by mothers have revealed some of the most horrific of treatments of babies by nannies in some cases. Seems a nanny in a British royal family would pinch a royal baby’s bottom every time she handed it to the mother so that it would begin to cry and she could secure her job. A second area where ‘for profit activity’ has failed in human experience or at least fared very badly is healthcare.  It can lead the’ for profit healthcare’ industry consciously and subconsciously to make people sick rather than healthier while giving an impression of caring for them. The daily deaths by the opioid crisis in America are a proof of this as is widespread prevalence of prostrate and other cancers in richest countries of the world. For profit healthcare tends to create unnecessary fears and procedures for profit. A human can choose if to buy a facial cream or car but he has no choice when fears of death or severe pain are raised. In India, patients are routinely pushed into ICU for high profits by some hospitals and then kept there even after near dead on artificial support to prolong the profit.

Wise nations such as Iceland and Japan have banned for profit private hospitals realising this truth about human nature and healthcare and ended up with some of the best healthcare in the world. If policy makers of some countries offer arguments to the contrary, it is because of three reasons: First because of ignorance or brain washing by peers, second because of trying to hide a government’s shortcoming in providing public healthcare to people and lastly because of the loot and exploitation of public for profit. The entire for- profit chain of the for-profit healthcare industry shares the loot and this includes some lawmakers too.

It goes without saying that when healthcare is publically funded healthcare, the health insurance industry has no role to play. It only has a role in the for-profit healthcare system.

Private Practice by Medical Practitioners

While inadequacy of for-profit hospitals has been made amply clear in the last section, there is a useful role for the family or neighbourhood doctor or dentist on payment basis in society to meet lesser healthcare needs of society that do not need care of a larger facility or hospital. An individual doctor may not design organised practices of loot as a larger business organisation may and can provide convenient help. Such a practice may be carried out from homes or an office in a commercial area. However, to ensure that private practice by medical practitioners does not morph into private hospital care some regulations are necessary. An example of such regulations is

1 A doctor on salary in a public or charitable hospital may not carry out private practice because it will compromise the former.

2 Private practices by a doctor must employ no more than two full time employees and two part time employees and shall be carried out in an establishment of no more than five hundred square feet in carpet area.

Minimum and Maximum Charges

Around two decades ago in a note comparing the good and bad of communism and capitalism this author had published an online note that suggested that while government funded healthcare is a good idea it is also a good idea to charge a small fraction of costs from patients. This realisation of the author had emerged from his experience in a fully paid healthcare system in Canada. A small charge say around 10% of costs with caps prevents misuse and increases public participation in improving quality of healthcare in a country. It also improves the efficiency of public hospitals. This author is glad to note that this practice exists in places like Iceland, Norway and Japan with some of the best healthcare systems in the world. However more thought is needed on the minimum and maximum charges

Minimum Charge:

The famous doctor A J Cronin had described how a practitioner with private practice could make good money by pampering hypochondriacally or leisurely rich old ladies by pampering them with placebos. While this is fine on high street it compromises public hospitals. A minimum charge of around a few dollars for visiting hospitals prevents misuse by public. Many a person would then just take a day of bed rest with a common cold rather than knock on the door of a hospital. A percentage of total treatment cost is also a good idea for minimising unnecessary hospitalizations and treatment. The minimum charge could be simply charged by issuing a ticket at the gate of the hospital to all who enter, not just one in need of consultation but also others. It would help to keep a hospital less crowded and serene as needed in a place of care. So open have some hospitals in India become that some recent reports have shown even dogs and cows roaming not just in its grounds but also the corridors.

Maximum Charge:

While charging a minimum as a percentage has been explained it is also necessary for fixing a maximum to prevent citizens from getting Bankrupt in case of serious needs. Norway has fixed a cap of three hundred dollars a year. An even better idea is to make this cap equal to the income tax paid by a citizen in the preceding year.

This note ends with a wish that may God grant humans wisdom to lead healthy and happy lives as long as they live.