HEALTH CARE – A
RIGHT OR A PRIVILEGE?
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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