India Wants to Give Half a Billion People Free Health Care
nytimes.com
nytimes.com
That said, I think Aarogyasri was overall a huge success in my state and has saved millions of lives and I'm excited to see it being adopted at a national level.
I wonder what will happen to this Free Health insurance program when central government changes next time.
The previous government even though was corrupt at least did something for the poor. I personally witnessed AROGYASHRI being used by the poor and the amount of stability it bought to their daily lives.
I also agree that there was lot of corruption in the program. If the choice is between saving the lives of the poor with corruption vs letting them die without I would choose the former any day. After all, the healthcare system in the US is filled with corrupt participants.
Let’s us not make the perfect the enemy of the good.
P.S:- I am not a citizen of India or don’t have any Indian roots but I lived there for a few years doing volunteer social work to help the poor.
This is very important. We need to finally realize that corruption is endemic to the system, and when corruption is raised as an issue it is generally to disadvantage the poor (last time I looked Wall Street is still doing fine even under the highest levels of corruption one can imagine).
Corruption inherently makes the system insolvent, and in the worst-case, will result in a major debt if not addressed early on.
False. Profitable private companies have to deal with loss all the time. It's called shrinkage. It can be mitigated, but like everything the costs of mitigation must be weighed against the benefits.
http://fortune.com/2015/06/05/walmart-theft/
Keep in mind, right-wing governments actively exploit this "corruption exists, therefore the entire social program is worthless" bug in our national consciousness. It's an effective political tool to transfer wealth away from the poor.
I agree with parent:
> Let’s us not make the perfect the enemy of the good.
I bet they'll try to undermine it at every stage well before they ever get power. That will make it easy to kill or fix it when they do get power back.
I think it depends on how much corruption is tolerable when trying to achieve such an important goal.
I wonder if there’s a consulting/contracting opportunity for them here.
+1 that many people benefited who were unable to afford decent healthcare
The card was given to white ration card holders(BPL). But many undeserving people also hold the white ration card.
They could also put those funds in developing govt health care centers, which are spread across the state and are in very abysmal state.
Eventually the numbers will be clear.
Brazil has 100% of its population (210M people) covered by free, single-payer, universal healthcare, resulting in a life expectancy of 75 years (US is 79, Japan and Switzerland with 83 IIRC).
But your experience can vary dramatically. It all depends on how much money is actually being put on it (in healthcare-costs-PPP-adjusted $/capita).
Norway is on the far extreme with it's strict restrictions on private healthcare. Almost every other country has private healthcare insurance as at least an option.
The question tends to be how much you end up contributing towards public healthcare if you take out a private option - ranging from no difference (you pay the same taxes no matter what), to only healthcare for poor/unemployed coming out of general taxation.
There is even a portal where you can search for your ailment and choose hospital (private or public) based on their waiting lists.
https://helsenorge.no/velg-behandlingssted
The government also buys up a lot of the private spots to reduce public waiting lists. Last time I was in due to sinus infection, I went to a private and a public clinic both paid for in full by the government.
And nothing wrong with that, I actually support that model, just like in Switzerland, where healthcare is private, but mandated by the government and heavily regulated (with less-regulated private complimentary insurance options).
It allows for innovation and competition between providers, without the harm to users due to the asymmetry of power.
Oh, and births are free.
Also: are there any places that charge for births???? That sounds ridiculous and insane to me.
Then the entire US healthcare system will sound ridiculous and insane to you :)
And, to be honest, it is. I have American friends who had accidents while in developing countries (broke an arm in Costa Rica) and were puzzled that they were treated and didn't have to pay anything, or very little (broke feet in Croatia).
In the U.S., if you have decent insurance, you'll still end up paying a couple thousand or more after insurance payouts. And that's just for the birth and short (1-2 days) hospital stay. Any complications and you're potentially paying much, much more. Especially NICU, it's not unusual to pay hundreds of dollars per day of NICU care after insurance, and non-insured costs can easily end up in the tens or hundreds of thousands, and in rare situations in the millions.
The restrictions in Norway are on which services private providers are licensed to provide.
It's not that many years ago that private providers were unable to offer surgeries that were covered by public healthcare at all. E.g. most private providers in Norway once they started getting licensed at all only offered things like cosmetic surgery. The first private hospital in Norway wasn't started until 1985 (Ring Medisinske Senter, now Volvat) and I remember the controversy it caused, even though it's services originally were very restricted (they were "famous" early on for being the first place in Norway you could get breast enlargements, as they were not covered by public healthcare)
It's been softened up gradually, but you'll note i you click around on the linked provided earlier that for many types of operations the only providers are either non-profits like LHL or government run hospitals - for some this is simply because no private providers have wanted to enter that space yet, but for others it's down to concerns about availability/training making the government hesitant to allow more providers, as described elsewhere.
As I pointed out in my other reply, I'm not criticizing it (at least not as long as it is regularly evaluated for whether or not it continues to offer the best treatment options, as it seems to have been).
The argument for this has traditionally been that there is a unique scalability problem in medicine: You can't e.g. just educate twice as many heart surgeons, because they need a sufficient number of operations that they can assist in etc. to gain proficiency with real patients, and that pool of patients is limited.
This creates a problem where not restricting which services can be offered has the potential to lower quality of service for all. Something that's a particular concern in countries with smaller populations.
The services that are not restricted are in general areas where there's either a higher volume of patients, or where it requires less training. A sinus infection is a good example of both.
Note that I'm not arguing that this is worse in any way, but used it to delineate one of the most restrictive alternatives when it comes to the availability of private services.
And Chile is always a special case, the combination of natural resources, small population and good public systems does wonder for the country. Despite the extreme differences, I tend to compare Chile to the Nordic countries more than with LatAm.
Not sure if that's scalable to larger countries, which is always the big question.
You are flat out wrong with this comparison. Chile has one of the lowest tax burdens in the world. It can be accurately compared to either Hong Kong or Singapore.
Average tax burden by country: https://files.taxfoundation.org/legacy/docs/OECD_Tax_Wedge_C...
Scandinavian countries have 4x higher taxes than Chile. They are polar opposites.
If Chile can have government programs with comparable return or results to the Scandinavian countries at a fraction of the cost then they're a hell of a lot more interesting from a policy perspectives.
Comparing governments based on taxes they levy is like comparing modes of transportation based on the amount of fuel they consume.
I don't think this is a very good analogy. We compare modes of transportation based on the amount of fuel they consume all the time. Unless I'm missing your point? And not everyone likes the Scandinavian countries. They are blessed by very homogeneous populations, in a region unscathed by war the past 70 years, with abundant natural resources, and stable governments. I wouldn't exactly consider them a good model for the rest of the world and I'm not sure what there is to like about them beyond these natural advantages and the fact that most of their people are very nice... Lucky would be more like it.
For example, Norway, the richest per capita of them derives "Export revenues from oil and gas have risen to almost 50% of total exports and constitute more than 20% of the GDP."[0] not exactly something the rest of the world can model.
Also, don't confuse low population density with high natural resources. The US for example get's for more wealth from oil than Norway. Norway just has a tiny population (5.2M).
Further, the US has a much wider range of natural resources including vast coal deposits, gold, diamonds, etc.
Do you really think that I am comparing tax burdens?
Sorry, but you're flat wrong with your understanding of what I'm comparing, which I listed in case it wasn't obvious enough.
But apparently writing down what I was comparing wasn't obvious enough for you.
Other hand a lot of public health stuff is really cheap as long as everyone gets it and it's timely. AKA people go to the hospital and get IV fluids and sent home vs going in two days later and spending a week in the ICU (or up and dying).
Expectancies for a 40y man, and for 20y at both ages are somewhat lower in Brazil. This is easy to explain due to deaths by violence and traffic accidents.
Funny to see that despite being chronically underfunded AND spending way less per capita than the US, the end results are similar.
"The health care plan ... would offer 100 million families up ... $7,860, of coverage each year. That sum, while small by Western standards, would be enough to cover the equivalent of five heart surgeries in India."
It's much easier to provide universal healthcare, when medical costs are low. Finding ways to bring down costs in the US, would go a long way towards improving the healthcare situation here.
I seriously doubt if this will actually be implemented ever. This is the magic of India, They won't deny insurance, but when the people will go to create insurance, there will be some or the other issue with the system and they won't be able to apply for it.
Also the media is a sycophant of the govt so nobody will question it and on the exterior, it'll be shown that they did provide insurance although nobody got anything.
a. Food Security which provides food to nearly 2/3rd of the population or 820 million people.
b. Minimum Support prices for grains which was hiked in this budget. Farmers also get loan waivers.
c. National Rural Employment Guarantee which provides employment to over 100 million people
Agricultural supports also can be looked at with a political filter, but the US provides government back agricultural insurance as a positive economic measure. Otherwise there may be a dwindling population of farmers and farming companies and increased food instability. One could argue about private vs publically funding these stabilization and boosting measures but it's much simpler/stabler to provide some forms long term guarantees via gov't policy than hoping a private market does it and does it correctly (without wiping out or consuming their customers). Are all these measures the same? No, but you have to look deeper than populist bad, private markets good.
Let's say Obamacare covered only a specific section of US what would have happened then?
To clarify my stand here, I am in favor of Universal Healthcare but not this.
Edit: I saw your edit on agriculture later. So, let me count that out too. We should do everything to support agriculture but the whole policy is skewed towards grains and every bump happens helps to ingrain the fact that grains good but vegetables bad. Do we really want that? So, I am in favor of a policy which works for all and not for specific sections which at least Indian laws tend to do.
Food Security bill provided coverage to 2/3rd of population which was estimated to be 850 million people.
This bill says it will cover up to 500 million people.
So there are 320 million people who are poor that they can't eat but not poor for health care. That is the question on inclusive-ness.
Though we have to see the full bill to actually find out what exactly is going on.
https://www.kff.org/uninsured/fact-sheet/key-facts-about-the...
I don't know the right answer on specifics of agricultural policy. I wish grains were less emphasized in US agricultural supports - but I also acknowledge that there is a built up knowledge base, and capital momentum around grains and the efficiency of food systems (as a total system around citizen health), isn't trivial. You have to trade off energy->food, caloric efficiency, and total health just to name a few factors.
You are using a bait-and-switch debate tactic. Nothing that you said disproves that claim that "Universal healthcare is a 'populist' measure"
Also, there's enough money for all these schemes while still maintaining a decent fiscal deficit. What has to be worked on is the delivery of these. For better or worse linking Aadhar to bank accounts and delivering the benefits directly into the bank accounts helped to certain extent.
I am wary of applauding before seeing how well this is implemented. India is known to come up with lot of big programs that make good rhetoric, but not all of them are implemented with equal amount of vigor or commitment.
I am sure part of the motivation may be to help next election cycle which is coming soon.
[1] thread about this https://twitter.com/Memeghnad/status/959026718722768896
Thats roughly $800B dollars, or over 30% of India's GDP. What am I missing? Most people won't participate?
EDIT: according to the article, the Finance Ministry has allocated $314 million (or 4 hundredths of a percent of the theoretical max total benefit). As in, the funding they acknowledge is non-existent.
As part of the budget proposal, Mr. Jaitley said the government would levy a surtax that would raise about $1.7 billion a year specifically for health care programs.
https://en.wikipedia.org/wiki/2018_elections_in_India
NYT article to be read in tandem with this one
https://www.reuters.com/article/us-india-budget/with-electio...
The reason I'm skeptical about this step is because there are simply no specific blueprint whatsoever. And with recent government implementations, their biggest failure turns out to be ambiguity. Good example is GST. After it's launch several month's ago, almost every big/small industry is finding it hard to get the specific details.
I highly doubt about government's ability to implement it. This insurance should have been given on basis of economical standing. Choosing a random 500M number is good for making headlines but again it is not clear on who will gain this insurance benefits?, what will be covered?, how to claim it? I foresee, "divide and rule" :p
On another note, please have a look at Sensex. It's near all time high. The reason behind such rally is not FII but DII. Infact, FII has actively removed over $20Bn since 2015. There was slight influx of FII money post two months of demonetisation but again outflow increased in following months. But still Sensex didn't crashed because of the counter balance from DII or read it as mostly mutual fund companies. Also, I had noticed an increased expenditure in mutual fund investment ads on TV and almost all types of media. And these ads were sponsored mostly by govt bodies and associations. There is nothing wrong to invest in mutual funds. But when I heard about long term and short term capital gains tax today, things got much clearer for me as to why DII raised some much cash in very short period of time. To check the validity of above numbers, you can refer to sensex related stats on moneycontrol.com and check out the YoY sensex FII/DII activity. It has a very well explanatory chart about it.
I don't get what problems does industry have with regards to GST apart from simpler return filing and changes in rates. The implementation was itself smoother than expected. Just compare with other countries that implemented GST and you'll realise that it took almost 2 years for things to stabilize. Comparatively, the implementation and addressal of most issues took only few months! Today, Hasmukh Adhia also hinted at automatic preparation of GST returns and simplification of invoice entry by directly entering details into the system which is pretty amazing if you ask me. I'm actually quite happy with how GST has shaped. Especially when compared to other governmental bodies which have error prone systems. I have faced no issues filing GSTR-3B returns and with simplification of GSTR-1 and GSTR-2 I guess all worries are taken care of.
CMS.gov: “U.S. health care spending grew 4.3 percent in 2016, reaching $3.3 trillion or $10,348 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.9 percent.”
World Bank puts total health care expenditure at 17.1% for the US in 2014 and 4.6% for India...
They must mean just US government spending, not counting private expenditure.
https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014...
EDIT: Ah, my post crossed your edit, which recognizes the issue, but:
> They must mean just US government spending, not counting private expenditure.
The part you quote from TFA explicitly says it is comparing government expenditures.
[0] from the same CMS page you seem to be using: https://www.cms.gov/research-statistics-data-and-systems/sta...
One believes that preventative care will increase health, limiting the need for procedures and pills. The other believes that one can pay a lower premium (possibly through the state), betting on getting sick. These are opposite of each other.
I'm not saying this is bad - just that people have to know what is being discussed, or inevitably people will be disappointed.
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If something like this is implemented, I'm curious to see what it does to prices - will a heart surgery continue to cost less than $2,000?
Healthcare seems like a supply problem to me, not a demand one. Where healthcare is affordable, demand should be stable year-to-year. It seems like what's needed is more doctors and devices, not more ways to pay.
In most countries, the cost of such operations are fixed by the state (ex: Canada).
> "Where healthcare is affordable, demand should be stable year-to-year.
What do you mean? There are so many factors that could explain higher healthcare costs, including an aging population, or better health coverage.
I'm also not sure what it means for healthcare to be affordable. In most countries, the cost seems proportional to the general wealth. The US might be the exception, since it's one of the few countries with great wealth disparity and with a non-universal system (more bureaucratic overhead/costs).
Yeah I think ₹5 lakh is excessive. I have a ₹2 lakh cover for me and my wife and unless we both are diagnosed with bone cancer simultaneously we are in no danger of maxing it out.
The point is having a doctor available for everybody, not just the people who can afford it. Yes, those of us who make more money pay more for it, in the form of taxes.
Ultimately, you'll need to decide if you want to care only about your wellbeing, or about society's wellbeing.
Not necessarily in a timely manner, which is important for things like Autism (and because of the belief in the system, can actually harm the person). Even if you can afford it, you don't necessarily get to see a doctor, even with years long wait times. And even if you see a doctor, the actual service they provide might be worthless (e.g. suggesting you put your child in an institution and forget about it).
This is just my experience dealing with the Canadian healthcare system in Montreal. Moving to the US provided cheaper, faster, and superior results in every metric.
On a related note, since you mention autism: for all the faults of the healthcare system in the US, it's far and away the best at treating chronic mental health conditions. For various reasons, most European countries have a pretty bad approach at providing access to mental health care. This isn't just for specific conditions, but for a wide range of the most common mental health ailments (depression, anxiety, ADHD, ASD, etc.)
Just getting diagnosed is incredibly difficult, but even for people who've been disagnosed, getting approved for treatment is such a long and painful process that many people give up[0]. I know people who have literally turned down jobs that would require them to live in Europe for extended periods of time because they couldn't afford (in the metaphorical sense, not financial) to go without treatment for months before getting approved.
Mental health care in the US has a lot of problems, and I hope we fix them, but there's no comparison if you're looking at other countries.
[0] Don't forget that many of these conditions also affect a person's ability to make it through the months-long process in the first place, so telling them "you'll have to jump through a series of hoops for a year before you can get treated" is basically equivalent to refusing to treat them.
I went to a just a few private doctors too to get a second opinion, and because they had a reputation as some of the best in the field, and they were cheap as well. My guess is because they have to compete with the national healthcare system.
Most doctors in France are private practitioners. They may or may not draw some (or all) of their revenue from insurance, which is partly funded by the government, but not fully (only a little more than 70% of health costs, in the aggregate).
Journalists should really start using "public healthcare" or "public health insurance", otherwise they are making their agenda quite clear. And I say that in support of gov subsidized health insurance.
Virtually everyone who has even a minor understanding of how society works intuitively understands that "free healthcare" is paid for with public money, just like "free libraries" are paid for with public money.
In fact, calling it "public health insurance" makes it actually more ambiguous and confusing. It sounds like access to it is open to anyone, like how access to a bookstore is open to anyone. "Free" is less ambiguous as to how much it costs to the person receiving the service.
There is a running joke in India that "You can only go to a govt hospital" implication being that you'd not return alive.
I suspect this is another scheme concocted to gobble up public money via corruption. A gift that would keep giving for decades to come. For politicians to promise jobs in bureaucracy to their caste members.
Ofcourse, Nytimes piece mentions none of this in its effort to push "See even India has 'free' healthcare" ideology.
Quoting from the article:
If passed by the Indian Parliament and properly funded, the new program would be a vast expansion of health coverage, allowing people to visit the country’s many private hospitals for needs as varied as cancer treatment and knee replacements. Although government-run hospitals are theoretically free for everyone, the waits are long, quality is poor and corruption is endemic.
I have never heard this joke atleast in Mumbai or Pune.