Should India Nationalize Healthcare?

Drawing from an online session Roli Books organised with healthcare experts, we examine the pros and cons of nationalized healthcare. This article is a part of IPC’s series on the public health debate. 

The Covid 19 pandemic in India brought massive changes across all areas of both the public and private sectors. Arguably, the most directly affected sector has been healthcare. Having to treat a  virus with no known cure has put a severe strain on healthcare systems across the world, and India is no exception. Weaknesses in Indian healthcare infrastructure have been revealed, and vastly overcrowded hospitals, skyrocketing costs to patients, and a lack of protective gear for medical personnel have exposed how utterly broken India’s healthcare system was well before the pandemic hit.

On the 29th of June, Roli Books organised an online session with Indian healthcare experts Aruna Roy (Socio-Political Activist), Vidya Krishnan (Independent Journalist) and Dr. Ashok Bhatkhande (Independent Healthcare Professional) to discuss the necessity and feasibility of nationalizing India’s healthcare system. Below are the key arguments, insights and proposed changes regarding nationalized Indian healthcare in light of the Covid pandemic.  What is Nationalization of Healthcare? Nationalization of healthcare would involve the purchase and running of medical infrastructure and assets by the public sector. In its current form, healthcare in India involves the simultaneous operation of both public and private healthcare. However, it is commonly believed (except in a few states and districts, such as much of Kerala) that private healthcare is vastly superior. This has led to a situation where public healthcare is seen as accessible and affordable but of poor quality, while private healthcare is expensive and exclusive. Nationalization of healthcare aims to provide affordable, quality healthcare in the public domain, while the private sector would exist primarily for the rich and highly specialized forms of healthcare. Arguments For Nationalized Healthcare - There is no better way to ensure both affordable and quality healthcare reaches a majority of India’s citizens. Private hospitals have demonstrated over the last forty years that, by chasing a profit motive, they are unable to provide widely accessible healthcare. The free market has failed in regulating healthcare costs, possibly because there is a large gap of information between the person supplying the treatment and the one purchasing it. This has been the case in other nations as well. For instance, England would be in much worse shape regarding the health of its population without the work of the National Health Service (NHS) system.

- Private hospitals have received industry level subsidies, have not had to pay for basic utilities at market price and have received a variety of other concessions all paid for through taxpayer money. Despite this, they have not readily opened their doors to the public for fears of losing money. A national healthcare system would ensure that public resources would better benefit the public at large. 

- Regulations that would ensure a uniform system of pricing and universal standard of care, have been kept at bay by private healthcare lobbies in most states despite the passing of the Clinical Establishments Act of 2010. A shift to nationalised healthcare would ensure that optimal standards of care are enacted throughout India and would reduce instances of medical malpractice and corruption. If leveraged properly, it could also help educate the average citizen on the kind of treatment they should expect, thereby lowering the information gap between doctor and patient. Arguments Against Nationalized Healthcare - The government has not shown adequate proof that it is able to create a large scale, nationwide service that all its citizens can be proud of. Expecting a quality service as complicated and important as healthcare may be overly risky. They must set up some examples by which they can be judged competent enough to institute such measures.

- The public healthcare system that currently exists is simply not utilized to its full extent. Citizens still end up paying ‘out of pocket’ for services they shouldn’t, and the current public healthcare system does not deliver on what it promises. Full utilization of this system must first be achieved before nationalization should be considered.

- In order to nationalize, the government would have to buy out most private healthcare resources, something that may not be possible without putting an undue burden on taxpayers. Other Insights - Both proponents and opponents of nationalized healthcare agree that the fundamental Right to Health must be respected throughout the country. Recognised by the Supreme Court as flowing from Article 21 of the Indian Constitution, the government must undertake programs to educate people on this right, increase public health infrastructure, and work on new regulations regarding the pricing and base quality of both public and private healthcare is a must.

- With regards to rural India especially, more education regarding the functioning and components of allopathic medicine is needed, such as an explanation of the way drugs work, the problem with overdosing and the dangers of self medicating with these drugs.

- That public health has not become a topic of significant public debate is worrying. Regardless of one’s stance on nationalized healthcare, the pandemic has proven that the sector at large needs reforms in order to effectively respond to such circumstances. You can watch a video of the session here:

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