Achievements of life!

I walked out of the airport and there was somebody carrying a board which read "Samuel Gnanadurai". I called him and off we went to the guest house which was booked for me!

Sounds very fancy, isn' it? Well if you are one of those who was fascinated by these like I was as a kid growing up, it does sound fancy. 

I thought those are the happy people. People, who has achieved so much in life that there is a car to pick them up. It has not stuck me this hard until yesterday when it happened for me twice in two days. I mean, I'm on a big travelling spree and out of the four boring flights, two had people waiting to pick me up. It stuck me hard that it does not mean that you are an over achiever and it means that somebody is gracious enough to pick you up. 

This actually got me thinking! What actually is an achievement then? If you are achieving something which had been a childhood dream, is it not achievement enough? Then most of the petty day to day things will have to be called achievements. 

In one of those travels I stayed with the most brilliant boyfriend I have! He went on to do study engineering in a famous IIT and then went on to design aircrafts. How cool is that? When we started talking and when the talk veered off to our lives, I could read from his mind that he is fighting off the same question. Is that all there is to life? That you settle down in your own two bedroom apartment among the glittery high rises of Bengaluru? Wasn't that an achievement as well, I asked! Yes it is; To buy a flat was a dream! Any day; But is that all? The question never really went away.

How do we define achievements of life? Does the very definition of achievements of one's life keep changing?Is it that important that we keep achieving something? Do we achieve anything in life? Can they be qualitative? I mean, like I'm happy, and so have I achieved? 

Oh! The question marks of life. How often do we answer such philosophical questions. What do you think folks? 

National Health Insurance Scheme - Entering Dangerous Territory!

‘Modicare’, as is now beginning to be called, after the budget presented is not new territory for Indians. But one has to be careful in treading this dangerous path, for pitfalls along this road are sometimes steep.

So, for a start there are many different systems of health care.

1) Health care is provided and financed by the government, just like the Police force. Government run the hospitals and the health care shelters, where people are to be taken care of. The govt fund this from the tax structures. Minimal charges are levied on some functionalities but they are bare minimum

2) Then there is the insurance model. Insurance actually means, that some money is collected by the people who are part of the scheme at constant intervals, which will be put together to finance the cost of the health care. The health care will be provided by private players.

a) insurance schemes where it is compulsory for everybody to be part of it and the insurance money is deducted at source.

b) Insurance scheme where there is a single insurer (usually a government company) and anybody can voluntarily join the company. This helps to keep the cost less since the intention of the insurance company is not profit and also easy to administer. Also government usually fills in for the deficit.

c) Private insurance companies pay for those who have been part of their insurance scheme. The market mechanism of the capitalistic world forces its private players to have competitive pricing. The government can fill in for the deficit here also.

3) Out of pocket expenditure, where the patients pay from their own pocket to the private health providers.

Traditionally we had always followed the first model where the government pays for the health care of all its citizens, but slowly with more and more private players playing bigger roles in health care we have entered the second and the third model. In fact india has among highest out of pocket expenditure in the world and is among the major reason for poverty in the country.

Now, Modi government has come up with this humongous experiment of insurance scheme for nearly 10 crore Indians (5 times more the population as covered by Obamacare).

So what are the pitfalls?

The major pitfall according to me, is the government losing track of the infrastructure development for health care in the primary care level. India right now spends approximately 1.85% to 2% of its GDP on health care. The draft national health policy bill recommends India spend 2.5% of GDP on health. But the modicare alone costs around 5% of the GDP! How viable is a universal health insurance scheme of this magnitude only time will tell. So instead of concentrating on health insurance at the secondary and tertiary hospital level, developing infrastructure and human resource at the primary care would solve a lot more problems.

The other major danger I see is empowering private insurance firms and very soon the insurance firms will be deciding on the course of treatment and diagnosis rather than the hospitals. If there are not enough checks and balances, the fall in this pit is a deep one.

So I’m entering stigmatised territory now. Let us face it! The health care sector in the country is among the most corrupt. We keep denying the inevitable, but the stark reality is to trust a doctor in this country is difficult.Any doctor! I administer courses for doctors across the country and everybody privately agrees that the rot is deep. And to empower private practitioners through the modicare may end up digging up an infected would.

The other major mishap we have faced in the last fifty years is the turn the health sector had taken towards specialist based care. We have always followed the American west, and even in this we have done the same. But the UK based model of having family physicians as the first point of contact is a better model especially for a country as populous as we are and as poor as we are.

Imagine I have a headache, I have to visit a neurologist, an ophthalmologist, an internal medicine expert and then to realize it was stress. May be even a psychiatrist sometimes. But is it not better to go to that one doctor who treated our whole families, and who can then refer in case he thinks he cannot handle on a case by case basis? By this model we can empower the MBBS graduates who are now left lurching around looking for PG seats without knowing their own values. And modicare will greatly profit the specialists and specialist based care.

I know it is a long and a difficult road, the road of affordable and quality universal health care for every Indian. The road ahead is not only long and difficult, but also full of pitfalls. Modi and the team should take slow and careful steps, lest the fall is deep and there are bottomless pits as well.