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Mainstream, VOL LVIII No 22, New Delhi, May 16, 2020

Time To Rethink Universal Health care

Sunday 17 May 2020

by Shubham Kumar

The outbreak of COVID-19 is arguably the biggest threat mankind has faced since World War II. The economic consequences of the pandemic may even outweigh the crises triggered by the Great Depression. It has been projected that Indian economy could contract further by about 20 percent in the first quarter of fiscal year 2021 if lockdown continues till mid-May 2020, which seems inevitable now. Recently, USA after a lot of furor passed Families First Coronavirus Response Act which makes testing free and not the treatment. India, on the other hand, with some initial optimism is struggling with a high mortality due to the novel Corona virus (or COVID-19). Though the ratio is expected to improve still the Ministry of Health and Family Welfare should take the ‘deaths: cured patients’ very seriously, as it suggests that every fourth person tested positive is succumbing to the pandemic which is very alarming especially in state of Maharashtra, Madhya Pradesh and Delhi. In such times, the question looming over the world is whether ‘Universal Health care’ is the need of the hour to tackle the pandemic? Till now what may have been a moral argument is now getting some acceptance in the policy circles across the world, especially in USA.

Universal health care is a services whereby all the citizens are provided quality medical services regardless of their ability to pay in lieu of the income taxes or payroll taxes payed by the citizens. It leads to lower overall health care costs as the government controls and regulates the prices through negotiation and regulation. Also, the hospitals are compelled to provide same standard of services to everyone which leads to a healthier workforce, as preventive care reduces the need for emergency room usage. As per Economic Survey 2020, out of pocket expenditure(OoPE) on health is one of the biggest reason for people falling into poverty in India. Universal health care will help in reducing the OoPE on health thereby reducing poverty induced due to health care costs. Countries struggling with thousands of people being tested positive and many of them dying due to the virus makes the case for universal and accessible health care even more pertinent. However, the debate over universal health care raises few relevant questions. Firstly, whether the government is capable of running a nationwide health care scheme; and secondly, whether such scheme would be too expensive for the government to render any long term benefit?

After the Second World War the world health care saw a massive turn around. It was during this time that major economies were devastated due to the after-effects of the war and health care everywhere was left in tatters. It was during this time that countries regrouped and respective governments decided to provide health care to their citizens. Often during such health crisis, it is only the government which is capable of dealing with precarious situations especially when businesses and economies are in ruin. A pandemic or health crises makes the case for universal health care even more persuasive as for any country the access to treatment, especially during a pandemic, should not be on the basis of affordability.

One major concern towards the universal health care is regarding the government’s ability to fund such a massive service. There are moral and economical arguments to it. The moral argument borrows its potency from Gandhi’s talisman, which says,

"I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test. Recall the face of the poorest and the weakest man [woman] whom you may have seen, and ask yourself, if the step you contemplate is going to be of any use to him [her]. Will he [she] gain anything by it? Will it restore him [her] to a control over his [her] own life and destiny? In other words, will it lead to swaraj [freedom] for the hungry and spiritually starving millions? Then you will find your doubts and yourself melt away."

For any country, ensuring basic health care for all should be the first priority. An unjust, inhuman and exploitative society fails the test of justice, if it fails to guarantee even basic health care to its weakest and needy citizens. This is the reason why ‘ensuring universal health care coverage’ is one of the stated goals in the UN Sustainable Development Goals to be achieved by the member countries by 2030.

In so far, the economics of the universalization is concerned there are various models being followed by governments for funding such services for example through income taxes or payroll taxes as done in many countries.One must note that throughout the history countries have managed to convince people for exuberant spending over wars [or resolving conflicts] and in comparison to that spending over health is negligible or at the max worth a footnote in expenditure budget.

The majority of countries in 21st century have already incorporated some form of universal health care system whereby all the citizens are guaranteed quality medical services regardless of their ability to pay. USA is the only developed country that does not have universal health care but have Medicaid, Medicare and Department of Veterans Affairs providing health care to targeted population groups. USA’s health care system has been subjected to severe criticism due to its high costs making it unaffordable for the majority of the population to even seek general medical advice. Recently, Senator Bernie Sanders’ infused the Americans with the dream of ‘Medicare for all’. Though politically unrewarded, he has still been able to successfully bring some symptomatic changes in the US Presidential elections with his ‘tryst with US Socialism’. As per a poll conducted by Morning Consult between March 12 and 13, 41% of US adults are likely to support a universal health care policy. It must be noted that with Trump administration failing badly in controlling the outbreak of the pandemic and casualties rising exponentially on daily basis the likelihood of more people buying the idea of universal health care may further increase.

India, on the other hand, has a ‘quasi-universal health care’ system at place. In 2018, in furtherance of the commitment to providing equitable and quality health care for all, India launched Ayushman Bharat and through its Pradhan Mantri Jan ArogyaYojna (PMJAY) initiative it aims to provide health insurance cover to 40% of the population. As per PMJAY, a cover of Rs 5 lakhs is provided per family per year for secondary and tertiary care hospitalization across public and private empaneled hospitals in India. Even though PMJAY is world’s largest health insurance scheme fully financed by the government, a majority of the population in India does not have health insurance or free and accessible health care.

The fallibility with public health care in India is that we have few government hospitals to serve a huge population. This fact has been reaffirmed by the sluggish response of government to the pandemic whereby the government hospitals lack enough equipment to protect physicians, nurses & other health workers from becoming infected themselves, or enough beds or ventilators to treat the patients. All these factors increase the possibility of people shifting to private health care but with enormous costs the same may be availed by only few people.

India at the most basic level needs to increase its spending on public health. The total expenditure by the government (Central and State) was 1.29% of GDP or Rs. 2.6 trillion. As per OECD, India’s total health care spending (including out of pocket and public) is 3.6% of the GDP which is abysmally low when compared to other developed or BRICS countries. Increase in budgetary allocation for health can be used to fund a ‘universal PMJAY’ covering a wider group and improving other infrastructural and functional issues associated with public health care like availability of medicines or equipment, improving doctor-population ratio, bed-population ratio, doctor-nurse ratio (often ignored), etc.

The author Shubham Kumar is Ex-Legislative Assistant to Member of Parliament,
BA. LLB (Hons.), Dr. Ram Manohar Lohia National Law University

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