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Some critical reasons for growth in medical tourism

August 10, 2007

A few years ago one frequently heard of patients from the middle east coming to India for quality medical treatment, but of late there seem to be a lot of people from developed countries like the US, UK and Canada coming here. Countries known for their excellent hospitals and medical care. At first I thought it was all about cost, and while that does seem to play a role in driving medical tourism to poorer countries…to my surprise I found out that there are other complex reasons…

Patients in Canada (Canada has a free government run health system, something which India can only dream of) have to wait even for an x-ray or an MRI!! I couldn’t quite believe it because here, even though we are a poorer nation, people can can get an MRI almost instantly, if they can afford it. And for an operation a Canadian might have to wait for about 18 weeks. As its free, everyone has to wait, money or not. However Canada’s dental health system runs on private insurance and patients generally get faster treatment.

The Americans feel their system is better because it runs on private health insurance. But its been exposed to some extent by Michael Moore’s documentary Sicko. The film shows how “middle-class families cannot afford medical care and profit-driven insurance giants go to extraordinary lengths to limit payments.” He has also detailed the number of people without insurance and partial insurance and also deaths due to delays in treatment or lack of treatment.

But this is the system that India is heading for! Private health insurance companies here are struggling to keep their head above water and are being finicky about payments. Seeing America’s plight, I wonder what the future holds for us. Right now industry analysts here are saying that once the system stabilizes and more people join the health schemes (few people can afford private health insurance in India) then the insurance companies will make money and everything will be alright.

But if what’s happening in America is anything to go by, its that part of the US medical system that is government run (Medicare – for the elderly and disabled or Medicaid for the very poor) which works. In fact its said to be working better than the government run system in Canada as its better funded. America’s Medicare system however has long waiting times. Here it says that waiting periods can be as long as two years.

But overall, critics feel that Sicko, which tears the American health system apart, has not given the complete picture. Those who hold down jobs (companies pay for the insurance then) have good health care and medicare takes over in old age. Others believe that Moore has exaggerated the figures on uninsured people, has not talked about those who deliberately choose not to insure themselves even when they can afford it and has not mentioned the free emergency care available for all. A business week article gives a balanced picture. Their take on Moore’s portrayal of America’s health-care:

In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems… If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston…Got a knee injury?…the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days.

As for Britain, about 50,000 people left the country for medical treatment in 2006 and this is set to increase because of “lengthening waiting lists.” Britain’s public health service (NHS) is not able to meet the demand.

Thats what it is about finally. Supply verses demand. Not enough doctors…and too many patients.

But ironically India which is providing medical care to those leaving their own country, has the same problem! Not enough doctors and too many patients!! The only difference is that people (those who suffer are at the bottom of the economic pyramid) can do nothing about it. Why, many can’t even afford to travel (or are too sick to travel) from their remote village to the town which does have the doctor they need. And even if they manage to to go there, they cannot afford the fees. And if they can afford the fees, they cannot afford the treatment or the hospital bed. Its not uncommon for private hospitals here to refuse to release cured patients or even dead bodies unless bills are paid. Patients who cannot afford private hospitals can always try the public health system (but one has to pay for the medicines) – if a hospital bed is available. Our public health system (used mainly by the poor) is over-crowded. So much so in fact that a lot of the lower middle classes prefer the smaller private clinics which have mushroomed everywhere…even if the treatment burns a hole in their pocket and the doctor’s treatment is suspect. The majority of Indians do not have health insurance. Worse, the laws in place against medical negligence do not always work, not the least because the courts are slow.

One of the reasons why this medical tourism thing never impressed me is because elitism makes me uncomfortable, at least where healthcare is concerned. Thats why I think the Canadian system is ideal…if only it worked! But medical tourism aside, the idea that the rich can monopolize doctors is something which is already happening in India. At least the patients who are coming from abroad are adding to our exchequer. About 200,000 people came to India in 2006 for medical treatment and this number is set to increase. The medical tourism industry in India will be worth Rs 100 billion by 2012.

And we are still luckier than them I think…because middle class people here get doctors’ appointments the very next day, can get a knee surgery done in a few weeks…why, even a working class person here can manage to cough up enough money for a minor operation. And he can get it done quickly. And as for major operations, when my mother in law was diagnosed with breast cancer, the biopsy was done in 48 hours and an operation in the next 8 days! If we had had to wait for say 3 months, it would have risked her life…not to mention the tension of waiting.

In this scenario I think the recent attempts by the US and British governments to discourage their citizens from coming to India because of travel hazards aren’t going to work. Not as long as people are suffering.

(Photos are for representative purposes only and copyrighted to me)

Related Reading:Indians want the government to increase health spends
Growth is not leading to development in India
Indian doctors not keen to work in rural areas
Life expectancy and incomes across the world
Alternative medicine in India fills the gap in allopathic healthcare

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39 Comments leave one →
  1. August 10, 2007 2:00 pm

    There is a very real push to socialize health care in the US right now, which should tell you a lot about how happy the citizens are with the private health care system. I am not saying that socializing is the only way to go, but it is clear that the current system does not work.

  2. August 10, 2007 7:38 pm

    I strongly disagree with the viewpoints that gloss over the main strengths of the American system. The main strengths are research and development, and evidence-based medical practice. The strong legal system provides a constant disincentive to a greedy physician who might want to be more commercial than professional with his patients. That said, they are suffering from being a country of lawyers, with litigation threatening to drive out good doctors from practising in many states. It is important to realise that the American system is NOT a free market system. It has a strong socialised component, like the Indian one. It is the presence of the socialised medicine that has also had a role in dragging the growth of the private health care. This, of course, is a typical fallout of Government intervention in any segment of the economy, as has been repeatedly demonstrated.
    As far as Sicko is concerned, it has very clearly shown that the facts have been changed to fit Moore’s leftist theory. I have briefly dealt with it here.
    There have been a couple of other blog threads that would be of interest to some, and I recommend you this.
    In India, the system is too primitive to bear comparison with any of the developed world. Whatever you are talking of in terms of no waiting periods, etc. is true of the enterprising private sector, but this is accessible to only around 20% of the population, I guess.
    Sorry for the long comment!

  3. August 10, 2007 9:35 pm

    Rambodoc, long comments are quite welcome 🙂
    Re sicko, i have not seen the movie, but after reading the business week article I tend to think that while Moore has exaggerated and has given a one-sided view, he does bring out some of the flaws in the american system. No system is perfect…
    and ofcourse the american system has a socialist component…thats clear in my post.
    However I definitely think a comparision with the American system is valid, because it seems to me that we are heading in that direction although we are far away from it…but how far really? 25 years? I think less. Private insurance companies here are flooding the market. I have written several articles in the Times of India on health insurance in India and if you like you can check it out here and and here. I have done a fair amount of field research on the subject by meeting the representatives of the insurance companies. Ofcourse the articles do not contain the latest information. But just today I read that private insurance companies expect to start making profits in their health products in another two years…and like the american system we will always have a part of the system which is run by the government.

    Aikaterine – yes I guess it doesn’t work that well. I have a lot of relatives in the US and they tell me the same thing.

  4. Gimly permalink
    August 10, 2007 10:15 pm

    One of my friends did an industry study on medical tourism and India. Her study was more based on the tourism side of it and not the social aspect of the local population. I’m glad I came upon this post because I also want to hear the other side. My own country, Croatia, is experiencing a boom in medical tourism from all over Europe and since India has more experience with it, it’s encouraging to hear your experience.

  5. August 10, 2007 11:38 pm

    I don’t know much about medical systems in other countries, so I can’t do a comparison, but I do want to make a few comments about the American system. There are waits for routine things or non-emergency care, but in emergencies generally there isn’t any waiting.

    My father went in a few years ago because he was feeling tired and dizzy. It turned out that his arteries in his heart were 95% blocked. He had a quadruple heart bypass the next day.

    On the other hand, I went to the emergency room a few years ago with stomach pains. They didn’t have anyone on staff to take an ultrasound, so I was sent home with pain killers and told to schedule an ultrasound. I called and got an appointment for the next day. It turned out that the doctor’s suspicions were correct and I needed my gaul bladder removed. I saw a doctor that specialized in the practice shortly after that and had surgery within a couple of weeks. There were risks with waiting, but small risks. If it had been an emergency I would have had surgery right away.

    But, we had insurance and that’s the key. Health care is good here if you have good insurance that your company pays for (I’m lucky, I pay no out of pocket expenses for insurance for my husband and me) or you qualify for medicare/medicaid.

    But even in medicare there are gaps. It wasn’t long ago that there was no coverage for out-patient prescriptions. Even with the new prescription coverage, there are gaps. My father must take medicine every day. It costs about $1000/month without insurance. My mother finally retired (my father is disabled due to a stroke) when my father qualified for medicare. Still, after a certain dollar amount of medicine is spent they must spend $4,000 before they qualify again. $4,000 is a lot of money for someone with prescription costs and a fixed disability income.

    The bad thing is that many people have to keep working even when they are sick and old because they can’t afford to lose their insurance coverage. Retirement isn’t an option when insurance costs (or prescription costs) will be half of what you make in a month.

    Our government seems afraid to expand medicare, even to cover many children without health care coverage. It’s inexcusable for a rich country to not take care of its poor and needy. It’s inexcusable for medical care to be based on whether or not a person is rich.

  6. August 11, 2007 6:23 am

    When you imagine the future of the Indian healthcare system vis-a-vis insurance coverage, we are possibly another century away, unless someone some day makes this a capitalistic paradise. One of the reasons is that the quantum of people to be insured is humongous, to use an overused word. If around 1% of the Indian population is presently covered by insurance, their target is possibly not realistic if they target more than 3%. Covering even 50% of the Indian population (the US is somewhere around 70%, but I am not sure of these figures right now) is going to be impossible till the standard of living improves considerably across all economic classes.
    In India, to whatever extent these players insure new people, they would try and control the service providers like the HMOs do elsewhere. And that is already beginning to happen. Even if you have a coverage of five lakhs, if one goes to a premium surgeon in a premium hospital to indulge in the best care, one might be shocked out of one’s knickers to see only a piddling amount of 20K sanctioned for the whole thing, on the grounds that ‘this surgery ordinarily should not cost more than this. Please justify why….blablahblah”. So one either spends the rest out of pocket or scrounges for discounts. Very disturbing, this arbitrariness and intrusiveness of these companies!

  7. August 11, 2007 8:22 am

    @Ordinary Girl,
    You say ” It’s inexcusable for a rich country to not take care of its poor and needy. It’s inexcusable for medical care to be based on whether or not a person is rich”.
    May I ask WHY?
    What gives a person (poor or rich) a right to expect others (taxpayers) to pay for his/her medical expenses? The same way should I expect others to take care of my clothing, my rations, my housing, and sexual needs?

  8. August 11, 2007 8:57 am

    Rambodoc, as I agree with Ordinary girl, let me try and answer the question (though I would like Ordinary Girl’s reasons too).
    The reason is: Ok, humanity is one of them, but an imp reason is:
    Because otherwise there will be a revolution.
    Lets take it globally. America helps poor countries. Do you think it helps them simply because of charity but because it feels that by helping them become more comfortable and richer, it will be less of a threat to them? And I am not even talking of other reasons like OIL etc.
    No man is entirely unselfish, unless he is a saint.
    On a micro level, I want my maid to be comfortable because my experience with maids over the years has been, that the more desperately poor they are, the more they hate, the more they are likely to steal. No, not with everyone…but the temptation remains. However, I believe in helping people help themselves, rather than charity.
    what do you feel Ordinary Girl?

  9. August 11, 2007 9:16 am

    I hope I am not intruding by chiming in on Rambodocs question. I too agree with ordinary girl and agree with what Nita has said. But I have an additional reason.

    I pay taxes in order to be a part of a society (government) that provides some level of benefit above and beyond what I could expect if I were ‘going it alone’ or if I were left to defend myself in a lawless world. At the very least, I want for the government to provide the necessities. Food, a place to live and health care. These are the most important things in life. If we are struggling to meet any of these three things then very little else matters. These are the basics. If a government were to make sure that each citizen had these three things, then the social contract would be significantly stronger.

  10. August 11, 2007 11:09 am

    As far as the libertarian or Objectivist views (which I subscribe to) on rights and role of the State is concerned, the role of the State is only to protect individual rights. Therefore the Government has no legitimate business to intervene on anything other than law and order, defence, and minimal else. The basic right to life, liberty and pursuit of happiness is THE only thing the State should ensure, and the rest is the concern of individual citizens. In free states, you see the most benevolence and charity. There is no Governmental gun-pointing and extorting (in the form of taxes and cesses) in the name of various derived rights (right to health, right to shelter, etc.). In a free society, poorer people can and are benefitted by the benvolence of the prosperous. If I am poor, and cannot afford the best medical treatment, I can hardly claim it as a right that you should pay for it. And, believe me, there is no end to this. If you talk of health ‘rights’, you CANNOT draw the line. Keeping a virtual vegetable indefinitely on a ventilator and other life-support systems, organising liver transplants for alcoholics, etc…there are so many claimants to Governmental largesse that health care, as a milch cow, will drain the economy. That said, my primary objection is philosophical, and the ‘right to health’ cannot be separated from the maintenance issues of healthcare.
    Of course, there is no such free country on earth like the one I refer to, but the capitalistic economies are faintly closer to this concept. And you can see where they have reached. Today, America can afford to be benevolent to poorer countries (irrespective of allegations of political and economic imperialism) only because of capitalism.

  11. August 11, 2007 11:13 am

    You are illustrating my point quite accurately, in fact. You, as an individual, are doing something in your own interests, and your maid is benefitting from your rational self-interest and benevolence. But what if I point a gun at your head and ask that you send the maid’s five children to school and get her eldest daughter’s operation costs covered because it is their ‘right’. The question is: why should someone’s well being (real or perceived) be your responsibilty, unless you are a consenting partner in it?

  12. August 11, 2007 12:56 pm

    Uh oh, you feel that giving free health care is akin so socialism and communism. but i am totally against those type of economies! in fact i am a die hard capitalist. if you talk to most people in capitalist countries or those who believe in capitalism they too will feel that health care should be free.
    however i understand the point you are making Rambodoc. you are saying that the healthcare thing can be taken to an extreme, but then everything extreme is bad isn’t it? doesn’t mean we shouldn’t practice in what we believe in moderation. draw lines so to speak.
    and as to the question of the maid, ofcourse no one likes a gun pointed at their head. but if if i was employing the maid full time (which I am not) then certainly she has the right to point a gun at my head and demand health care…no not education. because a state provides for education in india at minimal costs. i think it is necessary for the state to do this but again in moderation. primary and perhaps even secondary education should be provided by the state at minimal cost. beyond that it is up to the individulal.
    ofcourse, in our country individuals cannot afford to pay for health care for maids – at least not the middle classes even if they employ them full time…that is probably why maids in dev countries are hard to come by. they get better jobs mostly. in india because of poverty they are not in a position to demand anything and here the middle classes are hard pressed to pay for their own medical bills. i must confess to you that this is the reason why i never employed a maid full time, even when i had a fulltime job. when i was out working 12 hours a day and had a family to look after, i came home and i husband worked even longer hours than me.
    i would feel very guilty not being totally responsible for anyone I employed full-time…so I simply avoided it because we were struggling with a house loan.
    actually i carry with me this massive guilt feeling about the poverty in our country…i can’t help it. i feel in some vague way guilty for being born in a priviliged family and I know its not rational, and your argument is certainly a rational one…
    but i am now supporting a poor child’s education. I have also taught slum kids English…though right now I have stopped it because of other commitments. But doing it gives me satisfaction. but yes its voluntary…you know I hate this education cess that the govt has imposed on us even though i believe in the right to education.
    overall, a very complex subject Rambodoc and there are no right or wrong answers!

  13. August 11, 2007 1:05 pm

    Rambodoc –

    The concept of rights is fraught with problems that have led to some major atrocities in our time. And I am very grateful that the US is finally pulling away from the libertarian thinking of Keynes, Locke and to other enlightenment era political philosophers. But all of that aside, I will say this very important thing:

    “right to life, liberty and pursuit of happiness is THE only thing the State should ensure”

    Without food, a safe home and health care, then none of these rights are meaningful. A starving person does not have the luxury to think about rights, they are dying, they can only think about food. A person who is dying of a disease for which he is denied treatment as others receive it cannot fathom a right to happiness, his days are spent waiting helplessly to die. And liberty, liberty means nothing without a safe home.

    If you truly believe that a government must ensure those rights, then you are saying that the government must ensure that people have the opportunity and ability to exercise them. As I have said before, without food, a safe home, and health care – that is impossible. Rights do not exist in a void.

  14. August 11, 2007 1:10 pm

    aikaterine you have put this far better than I have. Thank you!

  15. August 11, 2007 1:19 pm

    I wish I could take the credit. I have had to take way too many political philosophy classes in my university career (and at this point it is a career). It is an argument that many political theorists use and one that is gaining a lot of ground here. I happen to agree with it, rights are not absolute. They only make sense in the context of an an individuals ability to exercise the right in question.

  16. August 11, 2007 1:21 pm

    I hit submit too soon.

    You made your point quite well. You touched an emotional cord that made a lot of sense to me. And ultimately, your points will mean more to most people.

  17. August 11, 2007 2:28 pm

    And, that is the crux: Aikaterine makes an emotional point, not a rational one.
    Basic individual rights cannot be over material objects beyond one’s private property. They are essential rights in principle.
    So, my right to free speech does not imply that the Government should provide me with a newspaper, a website and a TV station. My right to marry does not imply that the government should pay for it or organise it in any way. My right to education, similarly, is merely a right for me to pursue. A right cannot be implemented by violating the rights of capital generators and extorting taxes out of them to send me to school or University.
    Therefore, freedom means I am free to laze around moaning my fate and remaining hungry, or able to spend a thousand dollars on a single meal. I am free, similarly, to live under the sky, or build a penthouse in Manhattan. It is only the road that is free, but each citizen will have to travel according to his or her own situation. If someone is unable to on his own, he can hope or ask for help from others. He cannot demand it as a right!

  18. August 11, 2007 2:35 pm

    Sorry, I meant that individual rights are essentially rights in principle.
    And, BTW, John Maynard (“In the long run, we are all dead”) Keynes will roll in his grave if he is called a libertarian! So will many free market philosophers if they find him included in their team!

  19. August 11, 2007 5:43 pm

    Rambodoc –

    My point was both rational and emotional. The proposition that rights are meaningless outside of the context of an individual’s ability to exercise those rights is a rational and reasonable one. In fact, I would be more than happy to provide a proof of the logic for you. Complete with prepositional logic symbols and all the venn diagrams your little heart could desire. Freedom, as well, is meaningless outside of social constructs and attachments. The pure raw widely excepted scientific rational theory wrapped in peer reviewed paper with a big old scientific community bow is that without shelter, food and health human beings do not consider higher order concepts (like happiness and freedom and liberty). They are too busy surviving. So, my proposition is a rational one.

    It is also an emotional one. Which makes it all the stronger, because both reason and emotion are important.

    And as much as Johnny boy would not like to be called a libertarian, the label fits. Libertarian theory was pulled directly from his thesis. Yes, he had a great Keynsian utopia in there, but it was a crock. And it does not erase the meat of what he said, which is libertarian to the core.

    And yes, there are some free market economists who are not, but I did not mention their names. But they are all crazy. Crazier than me. And I am taking meds for my craziness. So there. (Just kidding)

    Here’s the deal, you and I are going to disagree on this until the end of time because you believe in an autonomous individual and I do not. And I don’t think either of us wants to start down that path.

    The fact is I think rights talk, as a whole, is pointless. And I would love nothing more than to see the word disappear all together. But it’s not going to happen. So I get to sit here in my ivory tower and wave the word around like I know what I am talking about. But when push comes to shove the word ‘rights’ does not make much sense to me at all. But what does make sense is that if it means anything at all, it has the be in the context of an individual’s ability to exercise them.

    Now, you are fabulous. If I need surgery for any reason, will you do it for me? I bet we could have great debates while you are working on my innards.

  20. August 11, 2007 6:01 pm

    Oh, one more thing. I would so be an elephant if I could live in the Taj Mahal.

  21. August 11, 2007 8:45 pm

    “Libertarian theory was pulled directly from his thesis. ”

    I stated that wrong. I should have put that modern libertarian theory has found justification in Keynesian theory. My statement was too harsh. And saying that is theory was libertarian to the core was also too harsh. I just think that he leaned too far towards the libertarian side in the balance he was trying to strike.

    And I used ‘excepted’ and should have used ‘accepted’. I should probably proofread my comments more carefully.

    Sorry for any confusion.

  22. August 11, 2007 11:51 pm

    Summing up yet another of our wildly popular debates in others’ private properties (were we husband and wife in a previous birth?), we conclude that, as usual, I won, so am graciously accepting your defeat and giving you the opportunity of having the last word.
    Now, I would love to chop your innards up very creatively and bill you big for it, so don’t forget!
    (all tongue-in-cheek)

  23. August 12, 2007 8:01 am

    I have to respectfully take issue with RamboDoc. I do live in Bombay now and have had the blessing to “test drive” three of the hospitals that AMS (America’s Medical Solutions –
    recommend here in just the Bombay area. First, the insurance companies that I know of are saying that you can use their policy to enter any hospital of your choice and there is no fine print about saying what the procedure “should” cost. Also, the idea that Indian medicne is “too primitive to bear comparison with any of the developed world” is simply not true. Now, of course, if you’re talking the general run of the mill hospitals, no one will argue, but even they are coming out of their doldrums by the wiser hospitals who are getting JCI accreditation, etc., and many changes are being seen. But the idea that it’s “too primitive” is a completely wrong picture. Those I’ve personally been in surpass anything I ever knew in the States by light years. Of course, they cater to the medical tourist, but they are leading the way to make India THEE medical tourism capital. Yes, perhaps only 20% of the general population can take advantage of these “costly” health services, one must acknowledge the demands these standards place on the entire health care industry in India. –Dan

  24. August 12, 2007 9:45 am

    rambodoc –

    Fine, if you want to win then you win. How libertarian of you.

    Thank you for the debate, I do love it when people make me think.

  25. August 14, 2007 12:45 am

    I should check back on my comments more often!

    OK, here’s my quote:

    “Our government seems afraid to expand medicare, even to cover many children without health care coverage. It’s inexcusable for a rich country to not take care of its poor and needy. It’s inexcusable for medical care to be based on whether or not a person is rich.”

    I used to think that the government didn’t have the right to impose anything on people, but maybe I’ve changed a little as I age. I tend to think of government as an organization, or manifestation, of society. Or maybe that’s just what I think it should be. I think society has the responsibility of taking care of the basic needs of its own, whether that’s food, shelter, or medical care. That can be done through charity, private ventures, or government. I really don’t have a huge problem with government being involved if it’s a reflection of society’s desire to do these things. If society doesn’t wish to take care of its own disadvantaged citizens then well, I don’t think too highly of that society.

    I think you believe that people that don’t have the ability to take care of themselves are lazy as your quote, “Therefore, freedom means I am free to laze around moaning my fate and remaining hungry…” The implication that poor people are lazy appalls me. Sure, in some cases that is true, but much of the time poverty is caused by unfortunate circumstances beyond an individual’s control (for example, being born in a poor country, or with a medical condition or disability, or an unlucky major life-impacting event). Because I am more fortunate in my life that makes me more deserving of survival than others? Perhaps in a purely naturalistic viewpoint, but I think we as humans have risen far above the restraints of nature.

    I’m not talking about giving everyone a mansion or a car. And in bringing up those things you raise a fallacy. You should throw an entire system away because someone might abuse it or it might be taken to an extreme?

    So tell me, where have I gone wrong?

  26. August 14, 2007 7:57 am

    Ordinary Girl, when you say:
    //The implication that poor people are lazy appalls me//
    I agree. I do not believe that poor people on the whole are desperately poor because they are lazy. Maybe one man or woman is less successful because he may be more or less capable than the other, but where poverty is concerned, I believe a lot of the poor need help. There is just a small percentage of the population who are the ‘bum’ variety. This has been proved by statistics in developed countries.

  27. August 14, 2007 6:49 pm

    Oh, come on, I never said that poor mean lazy!
    I just gave you a random example.
    And where you go wrong (in my not entirely humble opinion) is that you forget that one man’s needs cannot morally be fulfilled by extracting forcefully money from better off people. Yes, you can do it by law, fiat or moratorium, but unless I want to give that money to the poor, you would be taking it by force. Automatically, in morality, this becomes a violation of rights, a crime.
    Majoritarian rule does not make everything morally acceptable. The majority opinion in Nazi Germany was to give hell to the Jews. The majority opinion in Serbia may have been to butcher the Bosnians. In a righteous society, a society of morals, the right of each and every individual should be sacrosanct and inviolate. There are certain basic rights (life, liberty, property and pursuit of happiness) which cannot be touched even by majority opinion.

  28. August 14, 2007 11:56 pm

    “There are certain basic rights (life, liberty, property and pursuit of happiness) which cannot be touched even by majority opinion.”

    …unless you are poor. How can you pursue life if you can’t afford the medical care that could save your life? There are going to be conflicts there. Not everyone can have all three without. Someone has to be deprived for someone else. Either someone poor is deprived of life for you to have liberty or you are deprived of liberty in order for them to have life. Thinking otherwise is naive.

  29. August 15, 2007 11:46 am

    Ordinary Girl:
    There are some errors in your basic premises:
    Life is a right, livelihood is not.
    You also repeatedly miss the point that these rights are essentially principles: for example, the ‘right to property’ does not mean you will get a piece of land from the State or from your rich neighbor. Similarly, life is sacrosanct in that no one is allowed to take a life. But how to sustain that life is nobody’s business except the person concerned. In other words, I cannot kill you, but I am not obliged to help you stay alive. I can choose to help, but not forced to. If I still fail to get this point across, we could do it outside of this blog, if you wish! 🙂

  30. August 15, 2007 4:48 pm

    Ordinary Girl and Rambodoc –

    You guys are never going to convince each other. The heart of your difference is in a view about the autonomous individual. Rambodoc, your view is a very male, and it has some major limitations. It is not a good model of the human self and is; consequently, a weak foundation for arguments meant to elucidate human-made concepts such as ‘rights’. I sense that your heart is in the right place. And your ideas have a ring of ‘universal equality’ that, in a world with autonomous individuals, makes perfect sense. Alas, that is not the world we live in.

    But we all have some valid points here. Points that can be looked at to help us acknowledge the problem and; hopefully, ways to make it better.

    Bravo Us.

  31. August 15, 2007 8:00 pm


    I hear what you’re saying, but I don’t agree. It’s not that you’re not getting your point across, but that I don’t agree with the point you’re making. We’re just going to have to agree to disagree.

  32. Bhushan Lele permalink
    September 6, 2007 2:29 am

    Hi Nita,
    I find the idea of ‘encouraging’ medical tourism repugnant, especially when India does not have health coverage for majority of its people. India’s focus should be on increasing health coverage. The Gov. doesn’t have the money, but this is where philanthropy can come in. What if, for example, the 1000 richest people in India contribute a small % of their wealth to create a corpus, and finance a chain of affordable hospitals across the length and breadth of India?
    In fact, this NEED not be philanthropy, this could be a good business model, for all you know! Sort of ‘udupi resutaurants’ of hospitals 🙂

  33. September 6, 2007 7:38 am

    I am not sure I agree with you here Bhushan for the simple reason that I do not think it is not right to force anyone to part with their hard earned money for philanthropy. A citizen does his duty by paying his taxes, and yes he should pay his taxes properly according to the law, but anything more than that is voluntary. You say it need not be philanthropy, it can be a good business model, but then we can leave it to the businessmen to think of it! Actually the fact is there simply aren’t enough doctors who would like to work in a tiny place and get little money, and frankly I don’t blame them. They have worked hard, perhaps harder than those who want free treatment, and they deserve to make as much money as they can. And the government is encouraging medical tourism for purely business reasons, the foreign exchange..which in turn is in national interest. I do believe that the government should improve public health care though, I feel that it is absolutely necessary in any civilized country…and medical tourism can go hand in hand.

  34. Bhushan Lele permalink
    September 7, 2007 2:57 am

    Hi Nita,
    Thanks for the response! Perfectly agree with you on doctors not wanting to go to small towns. If I was a doctor, nor would I. However, I feel our country lags behind in philanthropy. As you have rightly said, philantrhopy can’t be forced, otherwise its theft, but the rich don’t seem to think of themselves as ‘leading citizens’ of a city and take a lead in civic life. Mumbai, for example, is home to India’s best, in terms of money, skills, aspirations, still, I don’t think these people try to influence civic life. They are just passive observers of the misery surrounding them, right in the heart of the city, not in Kalahandi! This indifference of the rich is saddenning. They don’t build hospitals, nor do they pressurise the BMC (as a matter of civic duty) to channel its money to basics like public healthcare or water or sanitation. It is in this light that this enthusiasm for medical tourism gets on my nerves.

  35. September 7, 2007 3:08 am

    And Mumbai is better than most other cities, pune for example! The number of PIL’s from mumbai citizens, their RTI applications, their forming citizens groups is far more prevalent than in cities like Pune and most other Indian cities. Things are changing in Mumbai, a lot of citizens are taking an interest in civic life…the papers report something like that almost every week. In fact even donations to charity are quite high in the country…but we cannot compare ourselves to foregn countires. Out there, buying a car and a house is much easier than here. Over here life is a struggle and therefore people think of themselves first and I don’t see anything wrong with that. And the very rich do have their pet charity projects like schools for example.

  36. Bhushan Lele permalink
    September 8, 2007 4:50 am

    Of course, we can’t compare ourselves with say, Switzerland and I am not denying the good things about Mumbai, but there are some things that I find disturbing and puzzling. I’m sure we can compare ourselves with China or Indonesia, and to the best of my knowledge, in these countries, even poor people live with dignity and hygiene. In Mumbai’s slums, people are forced to give away their basic dignity, and still they don’t riot against these conditions! I find this deeply disturbing. Not even the poorest Chinese or European will defecate in public day in and day out, as a matter of course, and still not protest or riot against it. Why is this not the case in India? I don’t know the answer, is it illiteracy? is it the caste system? Not sure… But it is disturbing, nonetheless, and material poverty alone is not a good enough explanation.

  37. September 8, 2007 5:32 am

    Thats a good question Bhushan, as to why Indians are so dirty! I think it is rooted in the weather…in a cold country if you have the kind of filthy living as we have here, there will be an outbreak or diseases. The sun here kills bacteria, even polio bacteria in puddles of dirty water! That is why traditionally our society has remained dirty…and old habits die hard. Hygeine needs to be taught to taught and made compulsory by the government.
    I visited China recently and there the people are much cleaner than in India, in the northern regions specially. Ofcourse not up to the western standards.
    anyway, mine is just a theory as I guess there are many reasons for the filth. But the fact is, that there is filth!! and people have got used to it.


  1. India » Blog Archive » CLIMATE SCIENCE INDIA
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