Talking Shop: Prognosis. Antipathy. Callousness.

“Two things cause people to

be (totally) destroyed: the

fear of poverty and seeking

superiority through pride.”

― Ali ibn Abi Talib

Hubris is temporary and greed long-lasting. What I am writing may be poignant, even tragic, in different ways. Our smartest-thinkers showered rose petals on medical practitioners during the COVID-19 crisis, deserved and certainly well-earned. Over 140 crore Indians, including me, my missus and you, cowered inside our homes, while our medical warriors risked life and families to protect us from physical and mental haemorrhage. Then came the histrionics, loud-spoken and advertised showering of petals, and pre-ordained media coverage.

Sometime later came horrific images of decaying dead bodies queuing up at cremation and burial grounds, wrapped in Hazmat plastic suits and waiting to be disposed of, so that the still-living could get back to cowering. To cut a sordid story short, many ‘warriors’ were not paid salaries for months. Many of them died...terrible it was. Mind you, this column is not at all a reflection on all our doctors, only those who claim to know something even when they don’t, or perhaps do really know but don’t share, just to make money. I am sad to write this piece and I shall take no names, yet the behaviour of some is preposterous and disgusting.

Before I get personal, let me tell you where this comes from. I took a loved one to the most prestigious hospital in our National Capital and she was diagnosed with a minor ailment that would take two or three sittings to cure. How much? Rs 1 lakh, the honourable doctor said. This was too much, she felt, and the doc offered to treat it elsewhere for Rs 80,000. Grumpy, she went to the same big hospital’s other branch. Rs 5 lakh, she was told there over 10-12 sittings.

I just don’t get it

In good faith, we went to another reputed hospital in the Capital—doctors here said she had no problem and this was all a misdiagnosis, that she could have died on the operating table had the procedure been carried out. This begs the question—what does the average Joe or Jane do when some doctors are stooping to such tainted practices?

Sure, medicine is big business, as are education, domestic hospitality and telecommunications. However, today, I find India floundering as a medical and educational destination, losing credibility both nationally and internationally as our own flee our borders for greener pastures. India, till recently a refuge and Mecca of medical treatment, is fast losing its gloss in this field, especially as certain greedy medical practitioners forget the Hippocratic Oath and milk the cow that leaves behind bags of money tough to carry. Where did it all go so wrong? In one simple word, greed!

Industry-watchers aver that the grip of financial interest in the healthcare sector is becoming a disease in itself, with dangerous and insidious consequences. No branch of medicine is immune from the pursuit of profit, be it pharmaceutical companies, health insurance firms, hospitals, investors or physicians themselves.

Rapidly rising pharmaceutical costs are now a familiar trend. Pharma companies have used monopoly ownership of medications to raise prices to stratospheric levels, and not just for new drugs. Patent laws have loopholes that are being exploited by drug companies to gain control of some simple and long-known medications and raise prices without restraint or conscience. Dizzying prices for new, essential, enabled by the failure of any serious pricing regulation, have yielded enormous profits even though a large chunk of the research funding comes from governmental sources.

Not restricted to India

This is not a trend that is restricted to India alone. The United States, for instance, has been all but buckling down under profiteering by insurance companies. Originally intended to give beneficiaries access to well-managed care at lower cost, the country’s Medicare Advantage program has mushroomed into a massive exercise, covering over half of all beneficiaries and costing more per beneficiary than traditional medical care ever did.

Recently, JAMA Network opined that US hospitals are claiming large operating losses, especially in the COVID-19 period, even though in reality, large organizations are sitting on balance sheets with tens of billions of dollars in black ink. Prices for the top infused drugs averaged 86.2 per cent higher per unit than in physician offices. And get a load of this—a patient in Chicago was billed $73,800 for two injections of Lupron, a treatment for prostate cancer, a drug available in the United Kingdom for as little as $260 a dose.

To drive up revenues, hospitals in nearly all countries are taking advantage of Governmental subsidies originally intended to reduce drug costs for people with low income. The erosion of the medical profession’s position of respect is ultra-evident and further attrition will only aggravate the problems and blur the moral status of the profession. Certainly, doctors should earn good incomes which reflect the training, time and effort they have put in, but it would be a pity if soaring medical costs diminish the stature of a vast majority of doctors. All said and done, there has to be a line that stops shameless exploitation of those who fall sick.

What is the solution?

Well, perhaps the model followed in the UK could be a good starting point. Unlike the practice followed in India, the US and scores of other countries, the UK’s National Health System controls costs and reimbursements, keeping a strict check on medical expenses. The US and India, to the contrary, have an ‘open healthcare market’, with private hospitals and doctors charging fees as they deem to be ‘reasonable’. In simpler terms, this translates into all that a patient can afford before wilting and buckling under the expense mountain. Giving a flexible leash to medical practitioners opens up the opportunity for them to keep jacking up treatment rates as per their whims, fancies and greed.

Michael Dirda once said: “What matters are those ordinary acts of kindness and of love, not vaulting ambition with its attendant hubris and smugness.” Absolutely correct, and the problem we are facing today is this vaulting ambition and need for wealth. For instance, in most private hospitals in India itself, even patients coming in for the treatment of minor ailments are advised to undergo extensive pathology tests, MRIs and CT scans—all of which cost a bomb. Ironically, in most cases, when the report comes in as ‘normal’, those same patients heave a sigh of relief, thank the Lord, count their stars and go home relieved. This is a trend that needs to be curbed before it gets worse. Else, a once revered profession will fall further in stature and we will dread hospital visits even more than we do today.

The writer is a veteran journalist and communications specialist. He can be reached on narayanrajeev2006@gmail.com. Views expressed are personal