Taking the debate on affordability of health care off its high pedestal... and into homes

Accessibility, availability, and affordability. Long words, with that extra dash of alliteration. If you have sat in on as many debates about these cardinal faculties of health care delivery systems, you might be able to say this in a sing-song in your dream.

Take it off the airconditioned auditorium, take it off your dream and bring it into the nightmare of S. Velu. That is where it stops being blasé. That is where it starts getting real.

Doctors have told S.Velu that his daughter's bone marrow transplant will cost Rs. 30 lakh. Velu's salary is Rs. 14,000 a month. He is the sole income earner, and his modest assets have dwindled to nothing from the burden of paying for his daughter's chemotherapy sessions and running a family of four.

The reality of affordability or the lack of it all is staring at his face. It is going to determine whether his eldest child lives or not. Tamil Nadu is among the states with the highest out-of-pocket spending on health care.

Velu is not insured, and neither is his family. He does not qualify for the CM's Comprehensive Health Insurance Scheme either, with his income of Rs. 14,000 a month from a job in the private sector. The scheme is restricted to persons whose income is less that Rs. 72,000 per annum (Rs. 6,000 per month). Under that scheme, Lakshmi Priya would be eligible for a free bone marrow transplant operation.

Clearly, healthcare today is available, accessible and affordable for the rich. It is also, significantly within the reach of the poor (in Tamil Nadu, at least. The state has been progressive in its health reforms). It leaves out of the net, completely, the people of the social class of Velu.

Middle class, uninsured, people like most of us who have no clue what to do when disease hits us like a bolt from the blue. OR even when it comes crawling on the back of chronic lifestyle diseases like diabetes, hypertension or cardiovascular disease. That might seem light in comparison to a bone marrow transplant, but out-of-pocket expenditure for, say, diabetes and its complications, has rendered men and women penniless and without assets.

No regulations exist in this country yet for fixing a reasonable, even if not uniform, tariff for health care services. That's really a pipe dream if we consider that there is no mechanism whatsoever to regulate the private health care sector in this country. Health insurance must become as important as life insurance, even if not more.

Tax concessions can even be provided to encourage people to opt for health insurance. Logically it must be attractive to the State which will have a substantial reduction in its overwhelming healthcare burden.

I am not, even for a moment, suggesting that the State abdicate its responsibility on the health care front. It must involve itself in more than mere debates about availability, affordability and accesibilty of healthcare services. Until this is a reality, Velu will continue to have his nightmares, as will the great Indian uninsured middle class.