SONGSOPTOK: Do you consider primary healthcare to be a fundamental right? Is it deemed as such in the society you live in? Please explain your answer with a few examples if possible.

ASIM RANJAN PATI: Yes, I believe primary health care should be a fundamental right. Unfortunately many in USA (where I live) believe this should not be a right but rather a service that people should buy just like other services, for example from a lawyer or financial adviser. Health care for all is expensive, a financial burden to the society and may increase taxation on taxpayers - not everyone would like to share the responsibility of others less fortunate. More compassionate citizens however will disagree and believe healthcare should be accessible to all.

SONGSOPTOK: What is the system of healthcare in the country and the society you live in? Is it a just and equitable system in the sense that all citizens enjoy the same benefits across economic and social classes?

ASIM RANJAN PATI: Even though emergency care in this country (USA) is available to all, routine care is not. So it is an unjust system. Citizens from lower economic and social class do not enjoy the same benefits as those from higher economic and social class.

SONGSOPTOK: Do you think that free healthcare cannot be a right, but it can be a privilege and a shared burden of sacrifice for the sake of the social contract?

ASIM RANJAN PATI: Free health care should be a universal right, not a privilege. Thus it should not be a burden of sacrifice but rather a moral and ethical duty of the society to provide for all irrespective of ability to pay.

SONGSOPTOK: What, in your opinion, should be the role of the government for ensuring equal healthcare to all citizens? What role is played by the government of the country you live in?

ASIM RANJAN PATI:   After all, citizens elect the Government especially in the democratic countries.  So when the majority believes in equal healthcare for all citizens, the government elected by the people has to make sure the infrastructure and the resources are in place to provide the care. However, a compassionate Government may sometimes pass laws that may not be supported by majority but may benefit all citizens. Hopefully they will persuade citizens to see the benefit to the society and come on board. On the other hand, a conservative right wing Government may do exactly opposite and create limited access for health care for the lower socioeconomic class. Unfortunately in the USA still there is lack of access to health care for many millions of people from lower socioeconomic class. The Government sponsored Medicare program benefit the older citizens while the Medicaid program helps the young unemployed or poor patients. But there are many millions of underemployed or poor people who are not covered and lack access to health care. In countries that are not democratic, presumably the Government has much more power and influence to create equal healthcare for all its citizens provided they have the will and determination to ensure utilization of resources to make this happen.

SONGSOPTOK: According to the data published by World Health Organization (WHO), nearly 16 000 children under the age of 5 die every day in the world (5.9 million in 2015) from infectious, neonatal or nutritional conditions. Is this a reality in the country you live in? If so, what would your suggestions of improvement be?

ASIM RANJAN PATI:  In the USA, early childhood mortality has declined overall. In the longer term however disparities persist with increased mortality among black children as well as those in poorer socioeconomic class. While every country has their unique problem in this field, in the USA, the leading causes are injuries, birth defects, homicide, heart disease and cancer (ref: Singh GK US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau).
Improvement in access to healthcare for less fortunate citizens, education and

SONGSOPTOK: “Free access to healthcare is a fundamental human right. Access to free healthcare is not” – do you agree with this statement? Please explain your choice.

ASIM RANJAN PATI:  I do not agree with this statement. Unless healthcare is free for all citizens, the lower socioeconomic class will never have free access to health care. When someone has to choose between food, shelter or healthcare, healthcare can no longer be regarded as freely accessible.

SONGSOPTOK: How important is the role of the private sector for providing healthcare and related facilities in your country? What it is your opinion about it?

ASIM RANJAN PATI:  In the USA, private sector provide the health care of the employed citizens and their families - the wealthy citizens can of course pay their health care insurance premiums. Since in this country health care system is not universal, the private sector has an important role to cover health care in this population. I believe universal health care coverage like in several countries in Europe would be a better system to ensure coverage for all citizens.

SONGSOPTOK: Are charitable and Non-Governmental Organizations (NGO) active in the domain of public health? If yes, then in what spheres? Do you think that the civil society, either independently or through these organizations, should become the prime actor for ensuring healthcare for all?

ASIM RANJAN PATI:  Yes. Throughout the world many charitable and NGO's are active in providing health care specially for the underprivileged. Starting from basic health care, they are active in providing health care in many other specialized fields like cataract surgery to name one. While these organizations provide a great service, I believe the society should ensure healthcare for all. The civil society can create the right environment by voting for a Government with vision to enact legislation and taxation to ensure healthcare for all citizens.

SONGSOPTOK: Do you think that multinational pharmaceutical and healthcare companies are responsible, to a certain extent, for the widely variable quality of healthcare in different countries? Can you please illustrate your reply with some examples?

ASIM RANJAN PATI:   The pharmaceutical companies are very important in drug development and research and contributing to overall improvement in health care. They also sponsor teaching and research programs and play a significant role in education. However, they have also been criticized for their aggressive marketing and influencing physicians and the physician community should be aware of their vulnerability. Since they are private profit motivated businesses, they cannot be entirely blamed for variable health care in different countries. I believe a strong Government should be able to handle a rogue drug company by creating proper legislation and oversight

SONGSOPTOK: Do you think that adopting the Social Security model implemented in a lot of countries in Europe which ensures primary health coverage to all citizens and is financed by the totality of the working population can be relevant and efficient in all countries?

ASIM RANJAN PATI: I think this is a good starting point. I have personal experience of working in such a system as I also worked as a health care provider in United Kingdom for a decade.  For the most part it  is an efficient system specially for primary health care coverage. However, there will always be room for improvement and justified criticism for inefficiencies and long delays for patients in need of non urgent care like hip replacements and routine surgeries among others. What is possible for Europe however may not apply for poorer countries in the world where many other demands on the society and the Government make provision of a reasonable health care for all a real challenge.


We sincerely thank you for your time and hope we shall have your continued support.
Aparajita Sen

(Editor: Songsoptok)


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