This is a topic that is currently bugging the middle classes in India. Unlike life insurance which has long term implications and hence not considered a suitable topic for discussion in everyday parlance, medical insurance has the potential for discussions and occupying time which otherwise may be passed in slumber.
The concept of medical insurance is a part of the welfare state concept. Like so many modern concepts, it is also a product of the western way of life, suiting their unique needs and mental satisfaction of the capitalists who rule the roost, as a salve to their collective conscience. It is the natural outcome of the dominance of the industrial way of life in western societies. Having blocked the government from interfering in industrial activities, the industry owners had to find some way of keeping governments occupied, so that future interferences are avoided.
The leader of the western society, the USA government, chose two fields of activities to maintain its relevance – creating a welfare state and politicking in the international arena where their acceptability is easy to obtain, given the wealth and dominance created by the industrialists. This way there is a legitimate role, acceptable to both the indigenous and outside world. The outside world really has no say in the matter, have you ever heard of a lessee permanently outing the landlord?
One field which western governments fully and continuously arrogate to their active role playing is medicine. The wellbeing of a subject is a matter close to the hearts and minds of the ruled and nary will raise a negative peep. People are often happy that Big Brother is caring for them and will foot the bill. Duh!
Footing the bill is where the nexus between the industry and government strengthens. The bill is prepared by the industry (pharma and chemical industry largely, in this case) and is paid by the government, without questions. With no oversight of the insurance process – simply because, NONE of the stakeholders has any interest in doing so, on the contrary, each of the stakeholders wants to maximise his benefits – it is a situation designed for complete disaster in the long run. Cultural and monetary. Milking the milch cow scenario. But, even Kamadhenu can get tired in kaliyuga.
When the going is good, why complain? But when the going gets tough, the government and industry get going leaving the hapless insured in limbo. The government, because it has no funds to continue the largesse and the industry because it has no interest in any activity that does not earn a daily profit.
Medical insurance is a total misconception. A better concept, which has been found acceptable and working successfully in the Indian medical field, is “borrowing from Peter to pay Paul.” In other words, institutions like the Aravind Hospitals have found an essentially socially acceptable, sustainable, equitable model which enables them to charge those who can afford to pay a little more, and use the excess funds to subsidise the cost for those who cannot afford. The good thing about this methodology is that it leaves huge scope for changes that happen in society. As the middle class keeps increasing the overcharging per customer can come down, while, simultaneously, those needing subsidies will also go down as the general economic conditions improve. What can be a better, market regulated, free market phenomenon? But then, we will always like to be led by western practices without a thought to the applicability, the ease of designing and implementing an alternative – and in this case, a better solution – in preference to blindly following.
Where does this leave the common citizen and the Indian government? The common citizen is often compelled to become a part of the insurance policy funded medical expenses framework while the government is compelled to find alternative ways to introduce insurance policies for the poor, like the Rs 11 premium per month. Such efforts will continue, for after all, who can forget the comment by Rahul Gandhi: this is a government of suits and boots ( suit-boot ki sarkar). I find that the Modi Sarkar has completely changed its vocabulary to sing praises of the poor man and farmer and denigrating the rich and wealthy. This is unfortunate and not helping anyone.
I think in the long run it may be better to let the market do the arbitraging, if at all. With increasing wealth, and a good supply of doctors, the cost of medicines should not increase sharply in India, as there is still a large percentage of the population which has not entered the medicine purchasing market. The government should intervene from time to time to set limits on the prices, which overall is a simpler, less bureaucratic and least expensive process for all concerned. It enables the country to get some medicines at low costs (hopefully these are the ones which are commonly demanded) and the others at higher costs, which is a burden which one needs to bear once or twice in a lifetime.