Further Reflections on Healthcare
Posted April 9, 2010on:
We are so grateful for the comments and numerous letters expressing concern over my wife’s medical condition. Karin’s surgery was successful and she is recovering well at home under my expert nursing care. The wonderful news is that she does not need chemotherapy. We seem to have caught the cancer early, before it spread into her lymph nodes.
The topic of healthcare elicited more comments on my Blog than any other, including war and terrorism. This is obviously a topic that affects all of us directly, and it seems that the healthier we are the more obsessed we are with health issues. This is why health-care provision is a bottomless pit and generates such fervent political passions. But, as I tried to point out in my last post, it is dangerous and misleading to separate healthcare from debates about education, income poverty and the mass media. Healthcare budgets, in both rich and poor nations, can be greatly reduced by a multi-pronged approach to health. Bans on public smoking, stricter pub licensing laws, ethical codes on food advertisements, anti-pollution campaigns, safer work environments, shorter working hours and less stressful work conditions, inducements to families and local communities to care for their elderly and mentally handicapped… all these measures can significantly reduce what governments have to spend on a public health service.
This is why I am not impressed either by the oft-heard complaint that public medicine is too costly or by the charge that the system creates many “free riders”. Every system is liable to abuse, and ultimately if the moral ethos of a culture is disposed towards chronic dishonesty and corruption, obviously no economic system can work. But accusations of abuse are curiously selective. The indignation of the rich at the abuses of the poor are wondrous to behold. Who complains about the continued existence of offshore tax havens and anonymous bank accounts, by which the super-rich use public facilities without paying for them? Who protests at the “creative accounting” of multinational companies that enables them to hide their profits while enjoying lavish tax benefits? Before 2008, who complained when corporations were bailed out by public funds? There are plenty of other anomalies that never get into the media. In Britain, for instance, elite private schools such as Eton and Harrow are registered as public charities. Donations to such schools can be exempt from personal income tax. What this amounts to is the diversion of taxes to subsidize privileged, private schools. Why is there so little hue and cry over these abuses compared to the rage over “welfare cheats”?
My recent experience with Karin’s surgery confirmed what others have told me about private hospitals in poor countries like Sri Lanka. Apart from speed, comfort and relative cleanliness (because far less crowded) private hospitals do not generally offer a better quality of medical and nursing care than government hospitals. We were also shocked at the doctors’ fees which seem totally arbitrary. Given a relatively small pool of specialists and the fact that it is the relatively well-off who use private hospitals, private medicine is enormously lucrative for the few. Surely, private hospitals can become fairer and more transparent institutions if the law insisted that the Board of Management had to include all stakeholders, including patient representatives and nurses (who are paid a pittance compared to the doctors).
I agree with those comments on my last post which called for more middle-class people to use government hospitals and other public services as the best way of improving them. Medical students in countries like Sri Lanka are trained only in public hospitals where the vast majority of patients they meet are poor. Thus they rarely learn to talk with their patients and to respect the latter’s rights. Little wonder that patients and even nurses in poor countries regard medical students and their professors as demigods. If more of us middle-class folk would use these hospitals and talk to the students and professors as our equals (which they are), perhaps that would help to improve the training of doctors as well as the efficiency of public health services. Or is this being naive?