State Health care: A Personal Journey

Laid low by the worst cold I've ever had, I finally ventured out of the house in order to visit an Indian doctor. It was my first time. When I asked for the address, my cousin told me the clinic was "under the flyover." This should have warned me. After all, in the United States, anything listed as "under the bridge" is likely a fly by night operation.

These days everyone talks about medical tourism, wherein rich Americans and Europeans fly into India for designer surgeries that cost a tenth of what these procedures would cost in the United States. Most of the big private hospitals offer special deals for these consumers, with mixed results (I recently read about a cosmetic surgery clinic that bundled in free Botox with lipo in an attempt to attract foreign patients)

I also remember one of my cousins in Mumbai cheerfully telling me that in her opinion the hospitals in India still weren't up to American standards. She was right. I visited a couple of Mumbai's top private hospitals, and not a one of them is what we in the US would consider "clean" (although the cleanliness of a hospital is always a dubious affair, after all, even the cleanest hospital is a hotbed of disease-resistant microbes)

At any rate, the doctor I went to operates a family clinic, and according to my cousin, this doctor is practically a social worker. He performs most services for free, which is why, when I arrived, his waiting room was packed with a real assortment of people. Inside, beyond a frayed curtain, he'd set up two metal beds. The sheets on both were grayish and stained. I sat down. He hasn't killed anyone in my family yet, I thought. He asked for my symptoms and then popped a thermometer out of his bag and into my mouth. "Are you going to put a little plastic cover on that thermometer first?" I wanted to ask him. I bit my tongue.

From there we went over to the lab, where a very beautiful, very young-looking nurse in a blue salwar kameez took my blood. Haunted by the memory of an experience six years ago, when a well-meaning Indian doctor attempted to give me a tetanus injection with a reusable needle, I asked my cousin if this nurse used disposable stickers.

"Of course," he and the nurse answered me at the same time. I felt like a doofus for asking. The blood-drawing was painless. Afterwards the nurse gave me a little alcohol-soaked cottonball to put over the injection site. No Bandaid.

On the way to the pharmacy, my cousin told me the unencouraging story of how, during the height of the great Mumbai flood a year ago, educated but equipment-strapped doctors started sharing needs between patients. Talk about a Devil's bargain. I can't imagine the choice those doctors faced.

I had three prescriptions to fill, and then I got the bill. My medications, bloodwork and doctor's visit cost me Rs. 500, or about ~$10. I could try and claim that from my American health insurance, of course, but their system might break.

Later, talking with a friend who works in the pharmaceutical industry, I learned one of the reasons why the costs are so low. The state controls the sale price of hundreds of common medications, about 40% of the drugs on sale in the market. Indian pharma moans about these restrictions, which (among other factors) discourage Indian companies from developing new and innovative molecules. (Most Indian drug manufacturers make their money on generics)

I appreciate the government's predicament, also. In India, you can't generalize about economic status. Phrases like "average per capita income" are patently absurd, from a policy point of view. Just look at the patrons in the clinic under the bridge. Most of them were local workers, auto drivers and their wives. Then there was my cousin. Then there was me, not even an Indian citizen. You could create a pricing policy based on the "average per capita income" of all of us, but the policy would serve no one.

Recent reports predict that the Indian drug market is poised for fast growth, and that a newly affluent segment of the population, flush with MNC cash, will be willing to drop big bucks on branded and patented drugs. That's great news for pharma, I guess, but it still dosen't mean much to the people under the bridge. This, unfortunately, is still the "India story" so beloved of Time, Newsweek and other well-meaning but clueless publications. On the one hand, Infosys. On the other, Slumdog Millionaire. In between, a corrupt and outdated federal bureaucracy that faces what are arguably some of the world's most urgent policy challenges.

Then again, the problems of "health care" are not the problems of India. They are the problems of the new millennium and the entire world. As drug resistance rises, as blockbuster drugs go off patent at record rates, as an ever shrinking number of new drugs get approved, and as regulatory agencies get stricter thanks to rising healthcare costs, we will all have to come up with some kind of pricing policy. People are justifiably hesitant to trust the private sector with their lives, after all, have we learned nothing from Pfizer's many scandals over the years? Conversely, we can't really trust the government either, as the US battle over the health care bill demonstrates.