A Different Sort of Health Care System

Jesse Walker | September 4, 2009

Writing in Salon, Aruna Viswanatha describes India's health care system as "an anarchic hodgepodge, with little insurance, little regulation and a range of services offered by hundreds of government-run, trust-run and corporate hospitals." It is by no means a purely free-market approach, but it's much more market-oriented than the American model. Among the results:

Almost 25,000 doctors graduate from India's medical schools every year. Because there is so much competition, doctors and hospitals are forced to keep their prices low to get patients. Residents, who go to medical school straight from high school, only make the equivalent of a few hundred dollars a month. An average surgeon's salary would be around $8,000 per month. The take-home pay to fix a hip fracture, for example, might run between $100 to $300, out of the $1,000 fee to the patient, says orthopedic surgeon M.S. Phaneesha. At his hospital in Bangalore, he says, there are 20 orthopedic surgeons alone on staff. For 1,600 beds, the hospitals employs around 700 doctors full-time; 300 of them are surgeons. In the U.S., by comparison, a first-year resident might take home around $2,500 each month, and the average surgeon more than $20,000 per month. A hip fracture would cost a patient around $30,000, of which the surgeon's charge is $5,000. Even general practitioners in America earn on average more than $100,000 a year.

Another factor in India's costs is the tiered system of beds that most hospitals employ. One night in a general ward at the private Artemis Health Institute in a New Delhi suburb, for example, costs around $20 per night. One night in a single room, or a deluxe, or a suite, though, will cost you between $100 to $200. Services are similarly tiered. A general ward patient at Artemis would only pay $2 for an X-ray, while single-room patients would pay more. There are so many hospitals, says Artemis' chief operating officer Jose Verghese, that rates at the lower end stay low.

In addition, health insurance is uncommon in India, so patients typically pay out of their own pockets for routine care. That too plays a role in keeping costs low.

As a result, medical services in India are faster, cheaper, and far more consumer-friendly than here. Some examples:

It was about 9:30 in the morning. My friend, who works for an outsourcing firm, called a gastroenterologist -- not a general practitioner but a specialist -- and set up an appointment for 10 a.m. We drove to the hospital, a mile away. It looked brand-new; the floors were shiny and everything glistened. The staff was courteous and the whole place was quiet. The doctor called me in at 10:02. He diagnosed the problem as a bacterial one, gave me a list of what to eat and prescribed a course of antibiotics. The pharmacy counter where I could pick up the drugs was just outside his office. The cost to see the doctor? $6. The pharmacy bill was about $1. Total cost, $7, with no insurance company involvement whatsoever.

Before I left New York, I had spent $20 just on a copay to visit a doctor and get a blood test done, another $20 copay to pick up the test results, and a third $20 installment for a tetanus shot. That was $60, plus whatever my insurance company paid, just so I could get a clean bill of health....

Even emergency care in India seems to work along the same lines. The same friend who first called a doctor for me had been in a horrific car accident about eight months before I arrived. He was taking a right turn at 2 in the morning when a truck came from the opposite side, ran into his car and just kept going. His femur was broken like a twig, as were his collarbone and wrist. His lip was split and his nose was hanging off his face. Two months and a few surgeries later, he walked out of the hospital. He walks now without any aid and has had no major complications. The total bill, paid by his Indian insurance company, was less than $10,000. A similar accident in the U.S. would run up a $200,000 bill and bankrupt almost anyone who didn't have health insurance.

Given all that, you'd think the point of the article would be the ways we can learn from India. Instead, Viswanatha notes some similarities between the two nations' systems, then concludes that "it is remarkable that the healthcare system of the world's most powerful country has anything at all in common with the healthcare system of an emerging industrial nation, and so little in common with the systems of the other Western democracies." Apparently, in the mainstream health care debate, the only models you're allowed to cite are countries that are relatively rich and white. Aside from some socialists smitten with Cuba, hardly anyone wants to look to the Third World.

That's a mistake. The Indian system is far from perfect, and Viswanatha lists several problems with it. But from an American perspective, her two chief objections to the Indian approach shouldn't be dealkillers. Taking them one by one:

But this type of care isn't available to all Indians, since the average income in the country is still around $65 per month, and more than 300 million Indians out of a population of 1.2 billion still live on less than $1 per day.

That's a genuine and severe problem, but it's a much bigger one there than here -- America has plenty of poor people, but poverty is far wider and deeper in the subcontinent. It's thus much easier to think about ways to bridge those gaps here in the U.S.

Only a handful [of Indian doctors] are from reputable institutions....Quality of care varies throughout India, and is a big concern in smaller towns, where the more questionable institutes are based. But it is also a concern in the big cities.

I'm not sure if this is a bug or a feature. There is a middle ground between "brilliant surgeon" and "dangerous quack," a zone that includes categories like "perfectly capable of dealing with a fractured tibia but not someone you want poking around your heart." The important question is how powerful and accurate a system ordinary Indians have for gauging different doctors' reputations. Unfortunately, Viswanatha doesn't explore that topic.

At any rate, learning from a country doesn't mean copying it wholesale. It means adapting the things it's doing right to a different social context -- by, say, reducing our reliance on insurance and eliminating our artificial restrictions on the supply of medical providers. There's an unstated assumption that the institutions that have grown up around the American and European medical systems are a cause of our higher standard of living. But what if they're a product of that wealth: vast bureaucracies that no nation needs but only the richest can afford? India is already a destination for medical tourists seeking more affordable care. If we could combine our wealth with Bangalore-style competition, they wouldn't need to travel: Prices would come down and doctors would be much more responsive to consumer demand, this time in a country where far more people can afford to participate in the medical marketplace.

Comments

|9.4.09 @ 4:57PM|#

There's an unstated assumption that the institutions that have grown up around the American and European medical systems are a cause of our higher standard of living. But what if they're a product of that wealth: vast bureaucracies that no nation needs but only the richest can afford?

Thought of the frickin' day.

Elemenope|9.4.09 @ 5:11PM|#

Of course, they're average life expectancy is a full decade and change below ours. So, there's that.

Jesse Walker|9.4.09 @ 5:17PM|#

Of course, they're average life expectancy is a full decade and change below ours. So, there's that.

Poverty and poor sanitation will do that. "Health" and "health care" are separate concepts, just like "health care" and "health insurance."

SpongePaul|9.4.09 @ 5:21PM|#

Dont know how to fix it, wont venture a guess, but when it costs 4,000 for a 30 min er visit to have a joint popped back in place, the system is seriously fucked

alice bowie|9.4.09 @ 5:28PM|#

SpongePaul ,

was that a Shoulder?

MattXIV|9.4.09 @ 5:32PM|#

The difference in physician salaries is significant, even among developed countries - see the table here for GP salaries. The second highest on the list is the UK median, which is 75% of the US average.

Dello|9.4.09 @ 5:33PM|#

I have a friend in Panama, says the same: $20 to see the English speaking doctor IN YOUR HOME, $35 to have a dental filing, everything except opiates can be given out by a pharmacist without seeing a doctor, and an weeks supply of generic Claratin (allergy meds) is $2.

|9.4.09 @ 5:37PM|#

Jesse,

If they were only making the equivalent of a few hundred per month, it would be a typical salary of $8000/year, right?

Sviluppo|9.4.09 @ 5:41PM|#

Is India paying full American prices for all their prescription drugs? Aren't negotiated, just-above-cost prices supposed to kill the pharmaceutical industry? Isn't the specter of any lower costs for treatment supposed to discourage Americans from becoming doctors in the first place?

Is there any US city that has to send dump trucks around every single day to pick up all the dead bodies off the street of the people that didn't get any medical care?

24AheadDotCom|9.4.09 @ 5:41PM|#

Isn't the population of starving people/untouchables in IN about equal to the entire US population? I tuned out about halfway through, but did Gillespie acknowledge that?

P.S. Here's something funny.

mark|9.4.09 @ 5:41PM|#

The cost of having a baby in 1950

|9.4.09 @ 5:43PM|#

You are making sense, Jesse. I can only hope that the push for "Obamacare" fails and that the national dialogue continues for a while longer, so that examples such as the Indian "approach" can be put on the table. It will be interesting to see how liberal supporters of the President, especially those with counter-culture leanings, respond to the Indian example. Usually, we hear from the left that emerging nations and older cultures have much to teach us, and that our arrogant dismissal of their examples is a bad thing. Here is a case where, looked at thoughtfully, India seems to be getting it right. But will they see the state of Indian health care as an example of truth from the emerging nations that we should heed, or evidence of their backwardness that we should not only fail to embrace ourselves, but actively seek to change by whatever aggressive intervention we can pursue in India? I can't wait to learn the answer to that one.

24AheadDotCom|9.4.09 @ 5:44PM|#

If WP can be trusted (it can't, but let's pretend): 456 million Indians (42% of the total Indian population) now live under the global poverty line of $1.25 per day.

|9.4.09 @ 5:46PM|#

LoneTwit, what is your Twitter feed, dude? Provide us with the greatest entertainment in the history of mankind, please. I'll just find it anyway, so give it up.

Jesse Walker|9.4.09 @ 5:50PM|#

Isn't the population of starving people/untouchables in IN about equal to the entire US population? I tuned out about halfway through, but did Gillespie acknowledge that?

You tuned out way before halfway if you think Nick wrote the post.

|9.4.09 @ 5:54PM|#

Well, too late, LoneReject. I found it: @24AheadDotCom.

Everyone follow him! Imagine the constant tweets about IllegalMexicans and WhiskeySoakedDespair! AWESOME

|9.4.09 @ 6:06PM|#

spongebob
Man up for god's sakes; when my shoulder would go out, I would pull mine back in myself.

Flex Nasty B.I.G.|9.4.09 @ 6:09PM|#

Jesse: THANK YOU for offering a positive example of an alternative system, instead of just bitching about Obama's plan like everyone else.

We really need to hold up a plan of our own and say "look, here's the bright future we think is possible, and here's a roadmap for getting there." Real hope, real change, etc.

The Republicans are not doing it. They're just a bunch of crusty old farts who are making complete asses of themselves, and failing to put forth any sort of compelling vision AT ALL.

So, maybe a couple libertarian groups could get together and come up with an alternative plan? Make a nice YouTube video about it - something that could appeal to the center, left, and right?

Elemenope|9.4.09 @ 6:14PM|#

Poverty and poor sanitation will do that. "Health" and "health care" are separate concepts, just like "health care" and "health insurance."

Point partially taken. But poverty here and poverty there are like talking about two different concepts entirely, and those details are salient before even thinking about whether anything in their system, with their conditions, is applicable to ours.

Besides that, while "health" and "health care" may be technically separate, they are certainly *interrelated*. A nation's average life expectancy is at least somewhat correlative to the average citizens' access to medical treatment.

JB|9.4.09 @ 6:16PM|#

The big advantage is 1st party payer.

A person will shop around to get a better deal. That competition reduces price and improves quality.

Hobo Chang Ba|9.4.09 @ 6:24PM|#

The two centerpieces of my own health reform plan would be:

a.) allow insurance companies to cover international medical tourism

b.) allow insurance to be purchased across state lines by individuals or businesses with pre-tax money.

The former would cut down on the costs of catastrophic treatments exponentially; the latter would end the whole problem of pre-existing conditions, as when you move out of the state, you can permanently keep your same insurance without having to reapply (where the pre-existing conditions problems come in to play).

Flex Nasty B.I.G.|9.4.09 @ 6:34PM|#

Quality of care varies throughout India, and is a big concern in smaller towns, where the more questionable institutes are based. But it is also a concern in the big cities.

One thing to keep in mind is that there are wild differences in India's regional economic systems. Some states have embraced markets and have a prospering middle class, while others (mostly the rural ones) remain socialist strongholds mired in poverty.

Kunal|9.4.09 @ 6:41PM|#

The important question is how powerful and accurate a system ordinary Indians have for gauging different doctors' reputations. Unfortunately, Viswanatha doesn't explore that topic.

This is actually a pretty big problem for many Indians. Poorer Indians are separated from their doctors by wealth, class and even language barriers (med school is invariably English-medium) which makes it hard to tell whether you're in front of Dr Hibbert or Dr Nick.

Isn't the population of starving people/untouchables in IN about equal to the entire US population?

But in America you are lynching Negroes persecuting IllegalMexicans!

Doug|9.4.09 @ 6:56PM|#

I used to work with an Indian national here in the states. He used to forgo the U.S. medical system and take care of his doctors visits when he went back to India to visit his parents. Can't say I blame him.

|9.4.09 @ 7:11PM|#

Of course, [their] average life expectancy is a full decade and change below ours. So, there's that.

Yeah, but they're Hindus, so they just start right in on the next life, no biggie.

...but did Gillespie acknowledge that?

You tuned out way before halfway if you think Nick wrote the post.

Oh, I thought he was saying that Nick just acknowledges every piece here, not necessarily that he writes them. He's like, Acknowledger In Chief, looking over your shoulder going "uh huh... uh huh" -- which has got to be tricky 'cause you guys are spread out all over the country, but then that Black Leather Jacket(tm) gives him some kind of super powers, so...

I liked how they do the price discrimination based on room -- if you can pay more for a room, then they figure they can charge more for treatment, not just the room. Price discrimination is a good thing ...to each, according to his ability to pay.

SIV|9.4.09 @ 7:31PM|#

Elemenope | September 4, 2009, 5:11pm | #
Of course, they're average life expectancy is a full decade and change below ours. So, there's that.

Health risks in India we don't have in the USA
Kraits,cobras,Russell's Vipers...

Elemenope|9.4.09 @ 7:38PM|#

The snakes are scary, I'll grant you, but I think even if you were to control for that, there would be a huge gap.

And we have bears. They don't have bears.

|9.4.09 @ 7:45PM|#

Sounds good to me. But, we can't learn from them because India is an inferior nation, of course. Europe and Canada are more culturally developed than we are (not to mention white and liberal) so they must be right. Right?

SIV|9.4.09 @ 7:56PM|#

El,

You're wrong about bears in India

I do regular news searches on bear attacks.India has plenty of them

SIV|9.4.09 @ 7:58PM|#

We don't have that drunken elephant problem either

Flex Nasty B.I.G.|9.4.09 @ 8:10PM|#

I do regular news searches on bear attacks.India has plenty of them

SIV, that's quite a hobby you have there.

Elemenope|9.4.09 @ 8:13PM|#

You're wrong about bears in India

Well, fuck me. You're right. They have bears and snakes. And elephants.

SIV|9.4.09 @ 8:19PM|#

Tigers and leopards too

|9.4.09 @ 8:23PM|#

And... lions in India. How weird is that? Doesn't take much from life expectancy, though.

ed|9.4.09 @ 8:31PM|#

Photo caption: How many Indians does it take to give a flu shot?

|9.4.09 @ 8:43PM|#

Photo caption: The sex change shots begin at the age of 4.

Elemenope|9.4.09 @ 8:48PM|#

Lions, tigers, and bears: Oh my!

alan|9.4.09 @ 9:43PM|#

Just yesterday, I went over to the home of an Indian couple who I have business dealings. Their two year old daughter runs up to greet me, and yells, "I'm Tiger Woods." She makes a swinging motion with an imaginary club.

I smile and tell them, "You make me feel obsolete. I couldn't imagine knowing who Tiger Woods is as a toddler."

alan|9.4.09 @ 9:46PM|#

El,

You're wrong about bears in India

I do regular news searches on bear attacks.India has plenty of them

SIV,

If anyone thinks they have you pegged, they need to carve a few more notches in the board.

cuernimus|9.5.09 @ 4:01AM|#

Lions, tigers, and bears: Oh my!

Don't forget all the bull sharks in the Ganges.

Art-P.O.G.|9.5.09 @ 4:31AM|#

Don't forget all the bull sharks in the Ganges.

And don't forget about the Dhalsim attacks.

|9.5.09 @ 9:26AM|#

I agree, afterall, why waste your time on a book when you can watch the movie instead? LOL

RT
www.privacy-web.pl.tc

M o n k e e |9.5.09 @ 9:53AM|#

Without knowing alot on the subject

when you study engineering you do a degree in a field of engineering say civil, mechanical, materials etc

I reckon medicine could be the same,
you could have degrees in say radiology, internal medicine, or general practitioning

it would reduce the training time and hence cost

M o n k e e |9.5.09 @ 9:59AM|#

"So, maybe a couple libertarian groups could get together and come up with an alternative plan? Make a nice YouTube video about it - something that could appeal to the center, left, and right?"

The British "libertarian" Conservative MEP Daniel Hannan seems to rate the Singapore system of healthcare
he wrote a chapter of a book on it

http://en.wikipedia.org/wiki/Health_care_in_Singapore

@|9.5.09 @ 11:07AM|#

Indian doctors are very Hari.

Elemenope|9.5.09 @ 11:52AM|#

And don't forget about the Dhalsim attacks.

Yoga FIRE!!

micro2000|9.5.09 @ 12:31PM|#

Tigers, snakes and bears are nothing compared to the infectious diseases countries like India have to deal with. Any Tropical Medicine textbook will show you parasitic, mycotic, bacterial and viral diseases that the average US doctor never sees in his/her whole career.

micro2000|9.5.09 @ 12:35PM|#

Don't forget all the bull sharks in the Ganges.

I'd be more worried about the dead bodies in the Ganges.

Naga Sadow|9.5.09 @ 12:50PM|#

SIV,

You are truly a man of mystery.

|9.5.09 @ 2:17PM|#

The poor touchable/untouchable have access to excellent care thanks to the work of some very devoted and committed Hindus. In Calcutta the largest charitable hospital and nursing school is run by the Sri Ramakrishna Mission, which is almost 80 years old. From a humble beginning in a rented house as a maternity-cum-child welfare centre in July 1932 it has grown to become a multi-speciality healthcare centre with a
General Hospital, School of Nursing (the Ma Sarada College of Nursing), a Community Health Service and the Vivekananda Institute of Medical Sciences(Post Graduate Medical Collage and Research Centre) A training centre for Paramedics and Lab Technicians.

In the Southern city of Madurai, the Aravind Eye Hospital has grown to become the world's largest eye care centre in the world thanks to the foresight and dedication of the late Dr.G.Venkataswamy. It has been such a success that the Harvard Business School decided to write a case series on the organization. In Madras-Chennai Dr.Badrinath has set up another eye care centre whose growth and success parallels that of Aravind. Dr.Badrinath has in collaboration with the Kanchi Sankara Matham (or Hindu Centre) has set up eye hospitals in Calcutta and Guwahati, after they noted that a very large number of patients were travelling to Madras from these regions. Apart from that there are several government run hospitals apart from the central government run centres of excellence, AIIMS Delhi, and PG Centre Chandigarh and JIPMER Pondicherry. Now the government has decided to set up about 20 such centres all over the country. Apart from these there are a number of privately run hospitals such as the Apollo Hospitals group, the Manipal Hospitals, Dr.Devi Setty's Sree Narayana Hrudayalaya in Bangalore (where a poor girl with a birth defect caused multiple limbs was recently treated). But then these hospitals are largely confined to treating serious and life or body threatening cases. And even though they work with the efficiency and professionalism that would put any Western Hospital on notice, they do little towards preventive care. The Ramakrishna Mission itself a Hindu inspired charity is now working with public health economists to develop a long term strategy to address primary care and wellness.

That said, the private and Hindu charity run institutional setup in India works almost like the socialist/single-payer/government administered systems in Canada, Cuba and the G-8/9/10. The systems are patient centric not health insurance company or drug/device manufacturer centric. Doctors get to decide how the patient should be treated not a Associate Degree qualified bureaucrat with a Health Insurance company. Drug prices are negotiated and driven down to keep drug manufacturers in line and honest. And politicians too are not beholden to corporate interests as they are in the US with citizens groups and unions maintaining a strong influence over the political process. The courts too work better in countries like India where indefinite patent extension schemes are given the short-shrift. Thanks to this Indian drug manufacturers like CIPLA, Reddys, Ranbaxy, Wockhardt and Piramal have brought generics quickly to the market and helped the fight against infectious diseases. In fact India's remarkable success in controlling HIV is among other things thanks to aggressive generic work of India's drug makers.

The US has the worst health care system in the world because it is riven with inefficiencies - a corrupt and out of control health-insurance sector, and a rapacious medical device/molecule industry. Although all the useful research in medicine (I mean useful not the development of aphrodisiacs) is funded by the Federal Government, the drug makers get to price their products as they wish.

A four step process over a period of a decade is required to set right healthcare in the US. Although I know this will never happen here goes,

-Admit we are badly wrong and study the systems of our healthy neighbour Canada, France, UK, Germany and Japan
-Open up Medicare to the entire population, not just seniors and have Medicare negotiate aggressively with all service and product providers
-Tax employer subsidised healthcare, and provide a tax credit to all purchasers of healthcare

This will shake up the healthcare -rather the deathcare- business and make health insurers compete like crazy. Become cheap and affordable or else fade away.

But first find a politician who is honest enough to admit that healthcare in this country is boondoggle and cesspool and has the smarts to get elected. Fat Chance!

Sean W. Malone|9.5.09 @ 4:44PM|#

"The US has the worst health care system in the world"


I'm not happy with aspects of health care... but are you retarded?

Sean W. Malone|9.5.09 @ 4:47PM|#

...Canada, France, UK, Germany and Japan, who's systems are bankrupt and who's people endure some 60-75% tax-rates, who produce even less than we do, who benefit immensely from US innovations, and US military protection, and who have some 18 month waiting lines for even routine treatments... Yes, let's emulate those.

|9.5.09 @ 10:38PM|#

I worked on an industrial video program a few years ago showing live endoscopies from hospitals around the world. One of our live suites was in India. They were doing a colonoscopy. Know how they kept the price low? No anaesthesia. For that you need at least an anesthetist or an anaesthesiologist, and they're expensive. Then you have to have the drug itself, which costs a lot. Then you have to have someone watch the patient afterwards to make sure they're OK or spend more money dealing with it if they're not.
The answer? Hire a couple guys to hold the patient down while they run a 6' hose up your ass.
/just sayin'

kanaadaa|9.6.09 @ 1:00AM|#

Sean Malone,

The all in tax rates or "ombined central and sub-central government income tax plus employee social security contribution, as a percentage of gross wage earnings" quoting OECD is 15% in the US compared to about 17% in Canada and Japan, 32% in Germany (which gets you almost free university education, excellent unemployment and retraining benefits and bounteous pensions). So that tax argument is a dodge and can simply be ignored. The health systems in these countries are doing very well thank you and are solvent for many years hence. All these countries enjoy better health indicators than the US even for marginalised populations. For instance the health indicators for France's North African immigrant population are better than those for the US's newly immigrant population. The waiting times in Germany are least among OECD countries. Achieving that by spending about 50% as much on healthcare as a part of GDP as the US is a remarkable feat worthy of emulation. The waiting times statistic is not even fudged it is simply pulled out of thin air. US innovation is funded by the Federal Government by way of basic research. Drug and device makers spend most of their budgets developing newer aphrodisiacs and on marketing. Almost every OECD country has a thriving drug and device industry and in most cases have comparable molecules for almost every drug made by a US company. And in any case since all OECD countries are signatories to international patent and IP law, all sales are fully priced.
The rest of the OECD is having a good laugh watching us trying to shoot ourselves in the foot by torpedoing healthcare reform. You should visit Canada sometime and watch everyone from BC to the Maritimes doubled up in laughter over our conspiracy theorists and "death panel" propagandists! Seeing the frenzy we have worked ourselves into over the mare's nest of "market based solutions" to healthcare, the other OECD countries are doubling down on their public healthcare systems.

Guynoir, colonoscopies are rare in India because colon cancer is almost unheard of. So if you want to pull a fast one try something else.

B|9.6.09 @ 2:25AM|#

"The US has the worst health care system in the world"


Anyone who writes the above sentence can immediately be dismissed as a retarded idiot, unworthy of paying even the slightest attention.

Sean W. Malone|9.6.09 @ 3:34AM|#

No kidding... Anyone who is also unaware of Canada's medical system's insolvency (according to the Canadian Medical Association) or that most people in the EU has an average of around 30% income tax rates + 15-25% VAT, and a host of other taxes is also a retarded idiot not worth paying attention to... I must assume said idiot is from Canada, and it never ceases to amaze me how some people can simply remain in denial about these things. I mean, it's not just the empirical reality of these things being broke all over the world and chalk full of unfunded liabilities that are going to cripple many currently "first world" nations' ability to function in a few years, but it's also the denial of the basic math and logic involved which should tell any sane person that these kinds of programs are completely unsustainable.

Sean W. Malone|9.6.09 @ 3:52AM|#

It's also funny to watch people denigrate US innovation. Go find any list of the most significant innovations in medicine and you'll find the US at the heart of most of them.

|9.6.09 @ 4:23AM|#

You Americans just can't have a discussion about India without bringing up Dhalsim.

"I will meditate AND THEN destroy you!!"

Dhalsim's healthcare

|9.6.09 @ 11:45AM|#

Fabulous! Let's adopt a system where lower life expectancies are the norm. To say nothing of voodoo medicine, etc. woo hoo

Art-P.O.G.|9.6.09 @ 12:27PM|#

Voodoo is from Haiti, not India. Baron Samedi hangs out in Haiti, while Dhalsim sets fools on fire in India.

|9.6.09 @ 2:27PM|#

Let's adopt a system where lower life expectancies are the norm.

India's lower life expectancies are the result of them embracing socialism and the caste system through most of the 1900s, and still having a less free political system, thus resulting in ongoing poverty which is starting to turn around.

Going further toward socialized medicine would result in the U.S. embracing the same things that cause the poverty and consequent lower life expectancies in India you noted.

Is it really your contention that "if any country is less advanced than ours for any reason, then the logical conclusion is that every single practice they are engaging in must be inferior to ours"?

Sean W. Malone|9.6.09 @ 3:12PM|#

Nah Prolefeed - it's all just coincidence. India was about as socialist as you get.... Citing:

"Indian economic policy after independence was influenced by the colonial experience (which was seen by Indian leaders as exploitative in nature) and by those leaders' exposure to Fabian socialism. Policy tended towards protectionism, with a strong emphasis on import substitution, industrialization, state intervention in labor and financial markets, a large public sector, business regulation, and central planning.[37] Five-Year Plans of India resembled central planning in the Soviet Union. Steel, mining, machine tools, water, telecommunications, insurance, and electrical plants, among other industries, were effectively nationalized in the mid-1950s.[38] Elaborate licences, regulations and the accompanying red tape, commonly referred to as Licence Raj, were required to set up business in India between 1947 and 1990.[39]"

...and as a result pure coincidence, their economy was stagnant, and most of their people were impoverished and starving.

After the collapse of the USSR (the loss of their major trading partner), India's market liberalization from 1991-present has resulted in just happened to coincide with steadily improving conditions...

See... Allllll coincidence.

|9.7.09 @ 8:00AM|#

Healthcare reform is not about healthcare. It is a ploy to put government in charge of your life. They are so conceited enough to think they know the cure than your doctor.

|9.7.09 @ 10:57AM|#

The salary statements are, of course, misleading. Yes, my husband -- a 2nd year surgery resident -- is making about $2000 a month, but he's working 80 hours a week; he's making $10/hr. Not exactly massively overpaid for someone tasked with saving lives. Once he finishes residency, the pay will go up -- but he'll also have to pay his own liability insurance out of pocket, and hours will no longer be restricted, so his workweek will also get much longer (the best surgeons, like Dr. Red Duke, have no family and basically live at the hospital, working non-stop). A good friend just quit to seek another line of work when liability insurance was quoted to him as more than he expected to make in a year... But no, the president says surgeons are all selfish money-grubbers who want people to go untreated so that they can get bigger and more expensive treatments later. And he must know more than the surgeons know...

(Heh -- incidentally, my sister-in-law did her medical school in India, and can't pass the licensing exams here. Having seen the inside of hospitals in India [admittedly, not Bangalore, which I hear is fine], I'd rather be shipped home than have to stay there!)

Karen A. Wyle|9.7.09 @ 12:15PM|#

Just chiming in on the one small point where I have first-hand knowledge: I've had a colonoscopy without anesthesia of any kind, by choice, and it wasn't that bad. I prefer the discomfort during the procedure to the after-effects of sedation. Doctors and nurses assume that no one will want to make this choice. I wouldn't be surprised if there are other cost-saving options that people would embrace if they knew more about them.

|9.7.09 @ 12:39PM|#

India's lower life expectancies are the result of them embracing socialism and the caste system through most of the 1900s, and still having a less free political system, thus resulting in ongoing poverty which is starting to turn around

The lower life expectancies are due to the effect of colonialism and socialism. early 20th century, a quarter of population died in many districts because of poverty brought during british rule.
A lot of continued in the socialist rule that followed.

Caste was in India when it was richer than europe, when religion was much more open and powerful...it is community organization, it has nothing to do with lower expectancy. Usually socialists and colonial power would blame caste for all the ills of India.

Whatever healthcare we have acceptable, is because of markets. The socialist designed hospitals are death traps. Usually the unfortunate ones go there, unless these are teaching hospitals.

|9.7.09 @ 12:58PM|#

Competition, the numbers:

"Almost 25,000 doctors graduate from India's medical schools every year. Because there is so much competition, doctors and hospitals are forced to keep their prices low to get patients."

US pop. = 300+ million. India = 1.16 billion. US schools graduate about 16,000 MDs per year, or about 1 MD per 19,000 citizens. In India they graduate 1 MD per 46,000. How does that lead to more competition and lower prices for MD services in India? If my math is correct, India would have to graduate at least 60,000 MDs a year just to equal the graduation rate per capita of the US.

|9.7.09 @ 1:53PM|#

At any rate, learning from a country doesn't mean copying it wholesale. It means adapting the things it's doing right to a different social context -- by, say, reducing our reliance on insurance and eliminating our artificial restrictions on the supply of medical providers.

This is very well adapted and reasoned. Price would be more affordable, if individuals have more say in their own healthcare cost options.

Sean W. Malone|9.7.09 @ 2:35PM|#

"US pop. = 300+ million. India = 1.16 billion. US schools graduate about 16,000 MDs per year, or about 1 MD per 19,000 citizens. In India they graduate 1 MD per 46,000. How does that lead to more competition and lower prices for MD services in India? If my math is correct, India would have to graduate at least 60,000 MDs a year just to equal the graduation rate per capita of the US."

Again, that's not a fair comparison to make. It wasn't until 1991 or so that India actually started instituting market reforms. No one is saying that India's health care system is on the whole better than the United States' what we're saying here is that their system is steadily improving by engaging in the types of policies libertarians have been advocating for decades - while our system is deteriorating by engaging in the policies we keep warning against.

|9.7.09 @ 3:24PM|#

I appreciate your look at the Indian healthcare model. It's thinking outside the Congressional box.
But, when looking at the US healthcare situation, you have to keep in mind 2 things: government compelling private institutions, hospitals, to provide healthcare to those who can't/won't pay for it (being private, hospitals have to make a profit-so we pay extra for them), and the whole tort-reform/lawsuit/insurance go 'round. Of course, with congress full of lawyers, there won't be any chance of tort reform.

|9.7.09 @ 3:45PM|#

Jesse Walker left out a rather important point in this debate- namely the sense of entitlement among many American citizens.

Most people in this country who have health insurance dont like to pay more than 20$ for a doctor's visit - they want the insurance company to pick up the tab. no matter the cost.Why? they are of course entitled to it.! and of course, their employer is expected provide them insurance !

Even when you hear the people who want public option, one argument that stands out is "WHY CAN I NOT GET the health insurance that i want when i am living in the richest country in the world"?

You see health care has become a "right". Just as affordable housing is a right.

When the sub prime mortage crisis erupted, I asked myself if it would happen in India - my family didnt start living in our own apartment until I was in 7th grade - till then, my parents were saving up the money for it. And of course no bank would give them the loan without.. wait fot it.. 60% downpayment !

Cultural attitudes are different and play a huge role. Its amazing that in a country that

A)has 4 times the population of the US and

B)people living under the poverty line alone outnumber the entire population of this country

C) does not have the concept of health insurance

D) and has more tropical diseases to fend off

we dont have a crisis.

May be people should understand that when you dont know and dont bother to know the cost of what they are buying in the form of products/services, the costs ARE bound to go higher... where is the incentive to reduce the costs? after all, insurance is "paying" right?

May be we need the Freakanomics guys to come out with a book that explodes the health care myths in this country.

kanaadaa|9.8.09 @ 7:18AM|#

Sean Malone and Co., go ballistic when the talk of Canada comes up. Believe it guys, the Canadian politicians and the people on average are smarter, leading to vastly more effective law making. Accept it. Unfortunately in the US for every Ted Kenedy, Kucinich, Sanders and Franken, we have kooks like Bachman, Inhofe or Stevens or even shamelessly compromised types like Tester and Warner. The Canadian system isn't close to insolvency, you misread it. Healthcare accounts for a higher proportion of the budget today than it did earlier. But with all that Canada spends only about 10% of GDP on healthcare compared to the US's 16%, and only about $3500/year/person compared to the US's $6500/year/person. I am not denigrating US research and innovation. Only that almost all of it comes from basic research funded by the federal government, while the private sector simply lives off it. The US private sector's commitment to basic research has always been weak, and good reason, shareholders are shortsighted.

Healthcare of course is a right and Universal Healthcare is an imperative. In this day and age of increased life expectancy etc., it is more necessary than ever. You have an impossible task defending a system - US healthcare - tha tsi responsible for th ebulk of personal bankruptcies over 80% of which occurs in the case of people with health insurance. Try squaring the circle, it is easier shilling for the deathcare industry aka US HEalth Insurance Sector

|9.8.09 @ 10:21PM|#

Healthcare of course is a right and Universal Healthcare is an imperative

kanaadaa, if you really wanted to have a debate you would not be saying such laughable rhetoric... what's next ? right to food ?

Canada has a population of 30 million - one tenth of US -and when you Canadians cross the border to come to Buffalo and Washington State and Florida because your wonderful system cannot guarantee health care, we dont mock your sanctimony.

|10.27.09 @ 1:21AM|#

I spent a week in the hospital in Bangalore 3 yrs ago while traveling on business there. I was in the nicest hospital room I have ever seen anywhere. I was treated for an unrelenting high fever. The total bill including Doctors fees, Ultrasound and Xrays was $790. The nurses were very responsive and were in the room within seconds of pushing the call button every time.
I have a friend here in the US who was just in a hospital here for a week with a somewhat similar problem and the hospital bill alone was $40k.
You can talk about the difference in life expectancy between the US and India, but it doesn't mean much if you spend that last 10 years of your life here working just to be able to pay for health care.