Don't Jump On Private Healthcare

People from Koodam asked for opinion on the PIL in Supreme Court regarding fees in private hospitals (and clinical establishments act). They shared a folder collating views of various individuals, including this excellent working paper which I refer to in the text below as Oxfam publication.

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 Hi Gayatri, I went through the whole folder. All I wanted to know was what Koodam was. But, lol. Anyhow. What I'm going to write is obviously my personal understanding of the transformative nature of law (and the limits of it). It is going to be biased by my worldview. I'm going to label them explicitly as much as possible.

Regarding the nature of documents in the folder. The compilation, over all, is very nice. That's mostly because of the excellent documents prepared by JSA. Minus that, the arguments and the scholarship is rather weak. Koodam which explicitly says "diverse views" has the least diverse of views. The Oxfam publication by Abhay Shukla, et al is perhaps all that one needs to read.

Regarding non-additive nature of law, and the paradox of how parts are worse than the whole. I am not sure how well I can articulate this. But basically, for law to act in transformative way, a series of measures that are all reinforcing each other need to be enacted together. This is hinted to in the JSA/Oxfam publication. If there's unbalanced law that's enacted, it creates all kinds of unpredictable troubles. In law, 1 + 1 + 1 is not the same as 3. The order of laws, the simultaneousness of it, everything matters.

If there's unbalanced push for price regulation, without other mechanisms that lead to a holistic transformative change (eg: competition introduced by well functioning public healthcare, financial support from government, in-sourcing of private healthcare providers, control on corruption, etc), then there'll be more failures than success. Examples of this generated by AI: https://www.perplexity.ai/search/Give-me-examples-k9aCXE9ERCyq9LnFzWDvZA

Private sector is not a homogenous villain: Various documents here takes a black-and-white opposition to "private". This is wrong in two ways - politically and conceptually.

Politically, if one were to really get this going against the "medical industrial complex" and IMA and so on, one has to cleave the opposition (divide and rule). And the easiest (?) way to do that is to turn small clinics against big hospitals. Putting all private providers in one bucket only helps solidifying them as one bloc

Conceptually, all the accusations against medical industrial complex applies only to big hospitals. But the "dominant" private healthcare system is not big hospitals, it is the clinics and the single practitioners. If the argument is that these are all corrupt, it is an unwinnable argument. Firstly, a lot of these clinics and single practitioners are not corrupt. They're just people like you and me going about their daily lives, with as much influence of capitalism as every other profession has. Secondly, one just can't call an entire class of profession corrupt unless one is also going to radically restructure the world and actually thinking of revolution.

On the specifics of fixing price: Fixing price is a thoroughly impractical, de-contextualized solution. Chinu's very brief response is very important. Fixing price might actually cause increase in price. I have written about consultation fees in general practice https://mbbshacker.blogspot.com/2019/09/the-curious-case-of-consultation-fees.html - the biggest challenge for me as a practitioner is that I've to make it sustainable while at the same time charging a bit fairly. Fixed price almost never works for me. If I'm forced to, I'll choose a higher price. And there's nothing in the CEA that prevents me from choosing a higher price. So, in turn, there's not much that transparency achieves (is this the point that Amar  is making? I read it too fast)

On market: My father had a sagittal sinus thrombosis a few years back. I am thankful that there was an Aster MIMS in Kannur. I didn't care about the money at all. There's an upper class in India (like my family) that prefers to not worry about cost, but only worry about health. This market exists.
I hate capitalism. But one thing I know about the world is that when there is a market for something, there's no regulation which can stop that from being capitalized. By hook, or by crook, things will happen. This is true for banning alcohol, weed, drugs, and so on. This is true for organ trade, human trafficking, and so on. This is true for almost everything. We really can't fight the market.

On the political climate: There's a section on political economy in the Oxfam publication. But what about the political climate? What political will is there in the present political scenarios to look at deep societal transformation in the areas of health. This is a high risk gamble with low rewards for politicians.

Am I being too pessimistic?: No, I'm really surprised why the Koodam didn't take up the issue of "right to healthcare" which is much easier to understand, has a momentum going for it, and can be used to focus both on public healthcare and private healthcare. Taking CEA from a decade ago seems ill-timed. Unless of course, this is placed in the larger context of right to healthcare and the focus is shifted to the patient rights charter. We really need to build an alliance with small private clinics and practitioners. Something like patient rights charter is such an easy first step