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Friday, June 16, 2017

Hospitals and banks: the way things work

With all the hullabaloo in the media over remedies for the shoddy treatment and overbilling that have become the hallmark of private hospitals in our state, several very pertinent points are being systematically overlooked, or deliberately ignored.  First I want to put on record that I have been personally a beneficiary (besides having had the good fortune to talk to some people who have been the same) of the state run public hospital system, and I am grateful.  They serve you at rock bottom prices, with a lot of facilities absolutely free, and incredible as it sounds, there are still doctors and nurses and ward boys who give sterling service, despite all the pressure they work under, and all the amenities that are in short supply or non-existent. If the government were sincere about improving the health sector, they should greatly boost the system a) by encouraging in every possible way those who do so much good work while sternly punishing the other kind, regardless of party politics, b) by spending much more on health care, and monitoring the spending to cut down on waste, inefficiency and plain theft, c) by training far more doctors and nurses for next to free provided they are willing to give an undertaking to serve in the public sector for most of their working lives, d) by significantly raising prices, at least for non-BPL patients, so that a large part of the costs can be recovered – people don’t value things enough when they get things for free. The prices could still be kept much lower than what private hospitals typically charge, yet the burden on the public exchequer would decrease considerably. It would also help greatly if the entire non-BPL population were ordered by law to take out medical insurance. I wonder why that hasn’t been done yet, when everybody who buys a car or bike also has to buy insurance before he can even take the vehicle out of the showroom. Talk of the stupid governing the stupid, the blind leading the blind…

Not only the best doctors but also often the best equipment are in our public hospitals. The real problem is that the system is unspeakably overloaded, so most people who are not desperately poor want to bypass it for one that works faster – and that is the felt need which the private/corporate sector took advantage of to spread like mushrooms in wet weather. And now that they have been found wanting in a double sense, a lot of indignant voices have been raised, a lot of demands are being made to rein them in, to make them accountable by fiat, to force them to render better service at ‘reasonable’ prices. Sensing strong electoral payoffs, the government has responded by suggesting various remedial means, including fixing upper limits on prices for various tests and treatments. Predictably, doctors and hospitals have reacted with dire warnings, the gist of which is that setting such caps might strongly discourage them from offering their patients the ‘latest and best’ procedures. Some doctors have gone so far as to threaten moving out of the state. Everybody is trying to justify skyrocketing costs by arguing how wonderful and useful the latest gadgets, drugs and treatments are (which claim is often actually little more than empty publicity), and how expensive it is to invent/develop them  and recoup costs. The devil, of course, lies in the details. On the one hand, doctors have confided in me that ‘costs’ go so high because the directors of the pharma companies and equipment manufacturing companies ‘need’ to live seven-star lifestyles; or else it is the hospitals which are greedy, and pad expenses shamelessly. Both true, of course, but what is too rarely mentioned is how greedy a certain section of doctors have become: they measure success, nay, their very sense of self-worth, by how big and fancy the car and penthouse and luxury vacation they can buy, and how often, the Hippocratic Oath be damned. I have benefitted greatly all my life by following my own maxim, namely to find out what sort of person the doctor is, not just what fancy degrees he has, before I go to him if I can help it. And now that parents are paying ‘donations’ of upto a crore to admit their children in private medical colleges, children whose first prirority in life will be to recoup the expense and reap a handsome profit, God help the next generation of patients.  Or maybe beating up doctors and burning hospitals will become so much a mundane fact of daily life that no one will raise an eyebrow in the days to come, and that is how a certain barbaric balance will be struck between public service and private greed…

[P.S.: My newspaper on June 17 carried this article. It's a pent-up sigh about what doctors used to be like, and a few still are, though they are a fast dying breed in this 'advancing world']

On the other hand, there are the Augean stables of the public sector banks to be cleaned up, and they are making a sorry mess of it. At one time they were grossly overmanned; now they are so terribly shortstaffed that everything moves at a snail’s pace, despite the advent of computers and the internet (sometimes, it seems to me, because of them!). There is an infinity of niggling rules for them to keep their money safe (so, as I found out yesterday morning, it takes ages merely to close down an old, idle account, which I have done elsewhere in a jiffy, without even presenting myself in person); alas, it seems, that such rules exist only to harass the ordinary small customer, while tycoons run away with vast loans they never intend to repay, so that bad debts, now going under the fancy name of Non Performing Assets, have grown into a mountain big enough to threaten the stability of the whole economy. Their websites shrilly advertise how they are dying to serve us, while when we do visit them, we have to deal with the laziest, surliest, most unhelpful and/or incompetent people in creation. The only reason I have not yet moved all my accounts to private banks is the old, perhaps silly but very widespread fear that they, unlike the PSUs, can simply down shutters one fine morning and run away with your lifetime savings. But I have been closing accounts in public sector banks right and left, and maybe the day is not far when I will take the plunge. Unless a genuine revolution comes about, as I hope it would, and soon. For starters, why can’t banks run round the clock, seven days a week, if the railways and power plants and police stations and hospitals can?

1 comment:

Nishant said...

Dear Sir,

Discussions on health insurance is something I have been reading a lot about given that the US is probably the only developed nation that still doesn't have universal healthcare. I completely agree with having laws regarding compulsory insurance, and the younger and those with more money supporting the older and those with less money. And, like you mentioned, a single-payer system (government, in this case) might be a good model too except there will be a lot of money being siphoned into the pockets which, I think is inevitable. But if, in spite of that, we can ensure free and decent minimum healthcare coverage for all, I wouldn't mind the corrupt pocketing a small fraction.

The kind of system they have in countries in western Europe seems to be doing well. There is a certain minimum that one has to pay if he can (and it covers certain minimum conditions), and then one can buy more coverage from private insurers. In most cases, no one can be denied coverage because of pre-existing conditions. They joked about the recent draft of the new healthcare bill in the US which, in essence, makes being female a pre-existing condition! But I don't know if I should make fun of others when things are so dire in our country. I wish we had universal healthcare and free education, at least K-12.