People from Koodam asked for opinion on the PIL in Supreme Court regarding fees in private hospitals (and clinical establishments act). They shared a folder collating views of various individuals, including this excellent working paper which I refer to in the text below as Oxfam publication.
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Hi Gayatri, I went through the whole folder. All I wanted to know was
what Koodam was. But, lol. Anyhow. What I’m going to write is obviously
my personal understanding of the transformative nature of law (and the
limits of it). It is going to be biased by my worldview. I’m going to
label them explicitly as much as possible.
Regarding the nature
of documents in the folder. The compilation, over all, is very nice.
That’s mostly because of the excellent documents prepared by JSA. Minus
that, the arguments and the scholarship is rather weak. Koodam which
explicitly says “diverse views” has the least diverse of views. The
Oxfam publication by Abhay Shukla, et al is perhaps all that one needs
to read.
Regarding non-additive nature of law, and the paradox of
how parts are worse than the whole. I am not sure how well I can
articulate this. But basically, for law to act in transformative way, a
series of measures that are all reinforcing each other need to be
enacted together. This is hinted to in the JSA/Oxfam publication. If
there’s unbalanced law that’s enacted, it creates all kinds of
unpredictable troubles. In law, 1 + 1 + 1 is not the same as 3. The
order of laws, the simultaneousness of it, everything matters.
If
there’s unbalanced push for price regulation, without other mechanisms
that lead to a holistic transformative change (eg: competition
introduced by well functioning public healthcare, financial support from
government, in-sourcing of private healthcare providers, control on
corruption, etc), then there’ll be more failures than success. Examples
of this generated by AI: https://www.perplexity.ai/
Private
sector is not a homogenous villain: Various documents here takes a
black-and-white opposition to “private”. This is wrong in two ways –
politically and conceptually.
Politically, if one were to really
get this going against the “medical industrial complex” and IMA and so
on, one has to cleave the opposition (divide and rule). And the easiest
(?) way to do that is to turn small clinics against big hospitals.
Putting all private providers in one bucket only helps solidifying them
as one bloc
Conceptually, all the accusations against medical
industrial complex applies only to big hospitals. But the “dominant”
private healthcare system is not big hospitals, it is the clinics and
the single practitioners. If the argument is that these are all corrupt,
it is an unwinnable argument. Firstly, a lot of these clinics and
single practitioners are not corrupt. They’re just people like you and
me going about their daily lives, with as much influence of capitalism
as every other profession has. Secondly, one just can’t call an entire
class of profession corrupt unless one is also going to radically
restructure the world and actually thinking of revolution.
On the
specifics of fixing price: Fixing price is a thoroughly impractical,
de-contextualized solution. Chinu’s very brief response is very
important. Fixing price might actually cause increase in price. I have
written about consultation fees in general practice https://mbbshacker.blogspot.
– the biggest challenge for me as a practitioner is that I’ve to make
it sustainable while at the same time charging a bit fairly. Fixed price
almost never works for me. If I’m forced to, I’ll choose a higher
price. And there’s nothing in the CEA that prevents me from choosing a
higher price. So, in turn, there’s not much that transparency achieves
(is this the point that Amar is making? I read it too fast)
On
market: My father had a sagittal sinus thrombosis a few years back. I
am thankful that there was an Aster MIMS in Kannur. I didn’t care about
the money at all. There’s an upper class in India (like my family) that
prefers to not worry about cost, but only worry about health. This
market exists.
I hate capitalism. But one thing I know about the
world is that when there is a market for something, there’s no
regulation which can stop that from being capitalized. By hook, or by
crook, things will happen. This is true for banning alcohol, weed,
drugs, and so on. This is true for organ trade, human trafficking, and
so on. This is true for almost everything. We really can’t fight the
market.
On the political climate: There’s a section on political
economy in the Oxfam publication. But what about the political climate?
What political will is there in the present political scenarios to look
at deep societal transformation in the areas of health. This is a high
risk gamble with low rewards for politicians.
Am I being too
pessimistic?: No, I’m really surprised why the Koodam didn’t take up the
issue of “right to healthcare” which is much easier to understand, has a
momentum going for it, and can be used to focus both on public
healthcare and private healthcare. Taking CEA from a decade ago seems
ill-timed. Unless of course, this is placed in the larger context of
right to healthcare and the focus is shifted to the patient rights
charter. We really need to build an alliance with small private clinics
and practitioners. Something like patient rights charter is such an easy
first step