Deaths that will not count

Wednesday, March 15, 2017

by Dr Neeraj Nagpal

Now that the stent prices have been capped, there is an “artificial shortage” of stents in the market leading to delays in conducting angioplasties. Government, of course, has responded with threats of strict action against hoarders and profiteers who cause an artificial scarcity. This is selective socialism with Government deciding what should be the price of a product when it does not contribute to its research and development, manufacture, distribution and sales. It is not a case of a public sector unit manufacturing and selling stents at a low price but of letting some private enterprise to develop the technology, manufacture the same, invest in marketing and then impose its will in the name of welfare state.

Dr Neeraj Nagpal

Obviously, people dealing in stents to earn their livelihood will choose some other business rather than continue dealing in stents, incur losses in the name of national good. Meanwhile, some patients will die for want of timely angioplasties and quality stent placements but like the deaths in ATM/Bank queues during the demonetisation they will be consigned to small print inside pages of newsprint as collateral damage. In our country where rapes, murders, arson disappear from records and public memory if it is politically expedient like during the Jat agitation, death of these cardiac patients will also not make any difference to the votes being sought by populist measures like capping the stent prices.

If the state was so concerned about the welfare of its citizens why were stents supplied until now by government institutes like PGIMER to ESI/CGHS patients at approximately Rs 65,000 per stent. Government says stents are procured at price less than Rs 7,800. So, why can the Government not make stents freely available to everyone in government hospitals at this rate? Let the Jan Aushadhi stores sell the stents at this price. Problem is that even the much trumpeted pronouncement of Rs 6,000 to be given for every delivery to mother soon crumbled under the weight of poor budgetary allocation. This scheme will now include only the first child and 50% of this amount will now be given by states. Similarly, the pronouncement of stent pricing without adequate budgetary support will create a chaos and cause preventable deaths and later there will appear a black market with the cooperation of authorities. Unfortunately, our rulers will not face the problems as they can be flown anywhere in the world in a moment’s notice for stent placement should they need it, at public cost.

Health is an area where the focus of successive Governments is restricted in its vision and scope. Forcing the private sector to provide what is the duty of the Government is a formula which has been used by Governments from Smt Indira Gandhi’s time to the current incumbent seeking to imprint his name on the pages of history among the Greatest of Great Leaders. Nationalization of banks, assets of erstwhile rulers, airlines are all examples of highhandedness of Governments at the cost of private individuals and enterprises. With time came the lesson that free market economy stimulates growth, which can never be achieved in the socialist model, and private banks, airlines and new age czars again appeared and flourished. Selective socialism now in the field of healthcare will cause disruption of existing order without a backup plan leading to unforeseen casualties.

Free market forces would have stabilized prices of goods including disposables and implants if Government incentivized research and development in India. The Make in India programme seems at present only limited to making doctors of modern medicine only to be forced to work in other countries because their own country does not want them. I wonder whether the Government would have the will to cap the prices of any other essential commodities. Erstwhile ration shops are relics of an era long gone. However, lessons are never learnt the easy way so let us pray and hope that we do not need a stent in the next few months.

Dr Neeraj Nagpal
Convenor, Medicos Legal Action Group
Ex-President, IMA Chandigarh
Director, Hope Gastrointestinal Diagnostic Clinic, Chandigarh

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