Do we have a robust healthcare system that is universally accessible at minimum cost, one that will provide us with a reasonable level of care in our hours of physiological breakdown?

It would be wrong to deny that we have a functional healthcare system, even if that is a bare-bone one with no bells and whistles. It may be unsatisfactory, but it’s better than not having any. So let’s give credit to where it is due. However, the important issue is ascertaining who gets what kind of care at what cost from where? Does our system leave out the most vulnerable to their own devices—and fate?

On the face of it, the cost of getting a decent healthcare is soaring by the day and the access to health service is increasingly becoming inequitable. We have reached a point where the haves and the have-nots have access to two sets of healthcare support: one is the private, personalized and quality care and the other a basic, almost apathetic, service rationed by the government hospitals.

Our public funded health infrastructure is crumbling out of neglect, mismanagement and disregard of the Hippocrates’ Oath by the physicians themselves. To cite just one instance, many doctors in the payroll of government are illegally opening private clinics and joining the for-profit hospitals at the expense of patients under their care at the government hospitals. The government doesn’t mount a crackdown on such malpractices because they are apparently in a bind. Their healthcare service is simply inadequate to tackle the surging ranks of sick citizens in need of treatment. So they wink at the mushrooming clinics staffed and owned by those doctors who should be looking after their patients in decrepit public hospitals.

The problem of doctor’s absenteeism is even more pronounced in the rural and hilly areas. There are reports of primary health centres run entirely by nurses and sweepers because the doctor doesn’t care to show up because he is busy making money in Imphal. As long as the complications of the patients are routine and minor, these rag-tag staff can handle them, but when patients with serious life threatening cases come to them, there is only so much that they can do.

Most countries have a two-tier system of healthcare delivery, which means both public hospitals and private care-givers exist to complement each other. We too have this system but the balance is now heavily tilted in favour of the private enterprises. There are those who say privatization will bring down the cost of healthcare due to competition, boost innovation and solve the problem of accessibility. The flaw in this argument is that it doesn’t take into account the cartelization tendencies of the healthcare czars in the absence of an effective regulatory mechanism. Health industry sharks may emerge, set arbitrary fees that only the rich can afford and deepen the doctors-labs-pharmas nexus.

So what’s the way out? We are left with two options. We can either embrace universal free healthcare system or what many call ‘socialized medicine’ in which the state pays for the healthcare needs of the people funded by additional taxation. Here, all infrastructure is owned by the government and all healthcare professionals get a salary from the state. This system exists in Canada, France, Cuba and other developed countries.

Then there is the second option of privatized healthcare industry but the state insures the citizens for all treatments subject to a cap, beyond which extra billing kicks in.

The first option is a costly venture and will demand extraordinary political will and resources. Given the inept political leadership, it’s almost impractical. The second option is implementable but will need a major mental revolution on the part of the people to be responsible for their own physical well-being, meaning they should be willing to pay for the insurance. The advantage of such a system is that the government or citizens’ advisory boards/charters can negotiate and fix quality standards and better rates for healthcare. This will also ensure a shift from curative treatment to prevention.

The current practice among the Manipuris is that they will postpone going to a doctor until a very serious complication arises that can’t be taken care of by the over-the-counter drugs. This may help in suppressing and alleviating the temporary inconvenience temporarily but in the long run this sets you up for a time-bomb like health eventuality that is both costly and risky. And throw in the usual arrogance of the doctors and the huge sum (and debts) that you incur for treatment, then you have a cocktail of explosive situation that leads to doctor-patient conflicts like the ones we see quite often nowadays.

For reasons that I mentioned earlier, at present we can’t simply leave our healthcare to free market. Healthcare is not a commodity to be traded rupee for rupee for maximum profits like potatoes. It is a matter of life and death and denying it those who need them the most just because they can’t afford it will be gross violation of human rights.

Unfortunately, our current system of healthcare delivery is highly imperfect. Neither the state nor the private players are able to provide affordable and satisfactory service to the lower strata of the society which is most vulnerable to health problems. To tweak Dr. Palin’s analogy a bit, the common man has become just like “a cow tied in the middle of the road,” clueless about what direction to take.

And yes, we should encourage entrepreneurs like Dr. Palin and give them the right regulatory impetus to expand and flourish. Dr. Palin’s Vision 2010 is commendable with its ambitious roadmap of upgrading Shija Hospital into a leading brand in healthcare industry and a destination for medical tourism in the Southeast Asia.

Predictably, skeptics are already out with knives describing his vision as a tall order for a small 100-bed clinic that aims to transform itself into a 5000-bed multi-disciplinary medical facility within so short timeframe.

This seeming haste should not detract from the nobility of his project. We should respect his dream, for many great realities are once the orphans of such dreams. But the real challenge is greater than that.

One of the most memorable lines from Spiderman movie that I recall is when Uncle Ben tells Peter Parker: With great power comes great responsibility. I think the skills and opportunity to heal people’s sufferings is nothing less than a great power. Dr. Palin has a great responsibility to translate his business success into humanitarian success. I hope to see the day when Shija Hospital becomes an international gold-standard for quality, with its super-speciality wards buzzing with patients coming from all over the world and its cash register jingling with foreign currencies. I also envision that a portion of those revenues will go to subsidize another section of the hospital that provides free treatment for the downtrodden sons-of-the-soil, who have never seen a dollar in their life.

Call it humane approach, philanthropy or corporate social responsibility, whatever—can we count on that future, Dr Palin? Or is it asking for too much?