Healthcare and livelihood are connected. When a government has to look at healthcare, it is bound to look at effects on livelihoods. In India where most people fend for themselves when it comes to healthcare, the causality between health expenses and livelihoods is most obvious to the patients and their families. The country does not have a great national healthcare system to guarantee the citizens at least basic care when in distress. This is more acute in the rural hinterlands of India, in fact most of India functions as it always had when it comes to issues of health and sanitation. A degree of inevitability and fate has built up in the minds of the population which combines with a sense of karma which is the anesthesia for all the nation's troubles. Hence the calls for improvement in healthcare is the last issue on anyone's agenda. This is evident when the budgetary allocation for healthcare is a meager 1.3%. It is easier for all to overlook the deficits in healthcare as matters that are political in nature.
With all the troubles in healthcare in India, the question of livelihood are not comprehended or at best ignored. For the vast majority for whom survival is subsistence, any damage to health will lead to loss of income which combines with the absence of savings lead to consequences which go beyond mere healthcare. In fact this inability to sustain through treatment or even the mere knowledge of this possible plight changes the psyche and therefore the behavior of a large parts of the population.
Right vs Responsibility
In the recent US elections the two presidential candidates were asked to state there view of how healthcare should function. Barack Obama said Healthcare is the Right of every citizen while John McCain saw it as the responsibility of every citizen. The Right vs Responsibility debate is at the crux of healthcare. The big pieces such as Government, Drug Companies, Medical Fraternity, Health Insurance providers etc can only fit into place when the choice or balance between Right vs Responsibility is understood.
First, if we look at the 'Right' side of the debate. Healthcare as a basic right of the citizens is a position that can only be possible when there is a government in place to ensure and carry out the right. In fact all the rights written into constitutions need guardians to enforce them, without these guardians these rights become hollow promises. Hence the role of the government increases when healthcare is seen as a right. When the mantle of healthcare then falls on the government, the complications might be many but what is for sure is that in the eyes of the law, every citizen is entitled to healthcare.
With India being a country of limited resources, its not a surprise that health has been a subject of the government. And just as other resource allocation schemes undertaken by the government such as Public Distribution Schemes (PDS), healthcare has also been on a path that leads to nowhere. This is understandable since it is unfair to expect one sector, even if it is as critical as health to be treated different from any other by the government, be it in efficiency or effectiveness. Therefore as a right, healthcare will only improve along with the performance of the government if it is left alone as a right.
But when healthcare is looked at as a responsibility of the citizen, then there is a huge difference in the outlook. With the responsibility shifted to the beneficiary of healthcare, so does the burden of the means to provide the service. As healthcare becomes a service commodity with the laws of supply and demand being applicable, the role of the government becomes that of a watchdog while the role of the Drug Companies, Hospitals, Insurance providers increases. But the biggest change in role is that of the beneficiary of healthcare as he ceases to be a beneficiary and becomes a consumer of health services. And if we are of the inclination that market economy will find its way, then eventually people will start to work towards providing for their health costs just as they provide for their other expenses.
Here again the scenario in India is such that for a section of the population healthcare from birth to death is a responsibility because of the inadequate heath facilities that they can access through their rights. This a sign of the stratification of the society in terms of education and wealth. The government too welcomes any move away from the 'right' notion as that removes the direct burden on it. But the fact remains that when a section of the nation cannot afford to carry their own cost of treatment and if healthcare is continued to be seen as a responsibility then the government will have to share their burden. Thus subsidizing healthcare for some, but not lowering the quality.
Thus, India presents a case where healthcare both as a right or a responsibility will work.By not choosing either one of the means of focusing on the problem there is a risk that there is a lack of the sense of direction to the efforts and hence the risk of ultimately wasting resources and lives because of a lack of unified perspective on the problem. But as the target is to first get everyone under either one of these umbrellas before shuffling around or opting for one, a change of course will itself bring huge costs.
