Almost two decades into the 21st century, in a world driven by impressive technological progress in almost all fields of human activity, healthcare has become a burning issue in a lot of countries in the world. The raging debate about healthcare in the United States have made headlines in international news for quite some time now, though health care policy and system may be considered as an universal problem. While the countries in Western Europe functioning under a well regulated social security system reel under colossal deficits, thereby jeopardizing the quality and efficiency of professional healthcare, many other countries like India are trying to figure out how best to deal with the problem. There are several dimensions to the word ‘healthcare’ and the understanding and appreciation of the term varies widely. The World Health Organization (WHO) considers healthcare as a fundamental human right - the right to health includes access to timely, acceptable, and affordable health care of appropriate quality. While there seems to be a consensus that this ‘primary healthcare’ is indeed indispensable for the well-being of humans, there is no consensus as to who actually is responsible for providing this to all sections of the population. Different models, more or less perfect exist in different countries resulting in a wide diversity in the nature and quality of healthcare.

Primary healthcare can be provided either by the governments or public sector organizations through different structures (dispensaries, family and child welfare centers, hospitals and specialized clinics providing a certain number of specific amenities or services). This model, widely followed in Europe, is largely financed by the Central and Regional governments and by private citizens through a well-defined security system. Each working person contributes a fixed percentage of her income to the social security fund. There is a certain redistributive justice in such a system though at the level of the individual the benefits may not be commensurate with the contribution. Several countries in Europe – France, Germany, Belgium, United Kingdom and the Scandinavian countries are considered as exemplary for ensuring primary healthcare to all citizens. However, the financing of the social security regimes are becoming increasingly difficult because of demographic trends, stagnant economic growth and growing popularity of neo-liberal ideology.

According to a report published by the WHO, about 100 million people globally are pushed below the poverty line as a result of health care expenditure ever year. It also specifies that the vulnerable and marginalized groups in societies tend to bear an undue proportion of health problems since they can’t afford to pay for healthcare. This is because in the majority of countries across the globe, health care is not a free commodity and like any other consumption good, directly related to the purchasing power of the individual. In countries like India, families going bankrupt to pay the medical bills are all too common. The general hospitals run by the government or the public sectors are under equipped, understaffed and overcrowded – patients lying in hospital corridors are a common sight not only in India but a host of other countries in South Asia and Africa. However, healthcare industry anywhere is highly lucrative being totally income-inelastic, and hence a favorite target for multinational companies. The private hospitals and clinics provide quality care at astronomical prices, and since there is no alternative available to average citizens, they are obliged to beg or borrow to pay the medical bills. The scenario is bleak in USA as well where the health care facilities are largely owned and operated by private sector companies. There is no nationwide system of government-owned medical facilities open to the general public. 60–65% of healthcare provision and spending comes from programs such as Medicare, Medicaid, the Children's Health Insurance Program, and the Veterans Health Administration. Almost 12% of the adult population in the US was uninsured in 2015 as revealed by Gallup. Of the 17 high-income countries studied by the National Institutes of Health in 2013, the United States was at or near the top in infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and rates of disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. The Affordable Care Act (ACA) or, colloquially, Obamacare signed by President Barack Obama on March 23, 2010 aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and the government.

Should primary health care be a fundamental human right as decreed by Article 25 of the Universal Declaration of Human Rights and not be considered as a consumer good? Should the governments and the public sector take the responsibility for ensuring easy access to healthcare at affordable prices? Ensure free care to those below poverty line? Should pro bono services be made compulsory for all health professionals? Should healthcare become the collective responsibility of all citizens irrespective of cast, creed or social class?

I personally think that like all other public goods, health care should be a State responsibility – all elected governments should ensure equal access to basic healthcare facilities to all citizens. After all, modern day governments pay a substantial percentage of their GDP for buying arms and weapons to prevent an eventual act of war. It may not be totally unjustified to demand a reallocation of government spending to invest in healthcare infrastructure and subsidize cost of treatment for the economically weaker sections of the population. It is possible to imagine different economic models that take into account the ability to pay of each patient and ensures redistributive justice.

The Millennium Development Goals drawn up by the United Nations were accepted by all nations who committed to achieve the targets and indicators set by the UN. The United Nations Millennium Declaration asserted that ‘every individual has dignity; and hence, the right to freedom, equality, a basic standard of living that includes freedom from hunger and violence and encourages tolerance and solidarity’. The MDGs emphasized three areas: human capital, infrastructure and human rights (social, economic and political), with the intent of increasing living standards. Some progress has undeniably been made all over the world to improve the overall quality of living, but still a very large percentage of the world population does not have access to basic amenities, including primary healthcare. Very little progress can be made without the collective will of the civil society and political will of those who govern.

Aparajita Sen


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