PPP (Pretty Private Profits)
Given the right salaries, incentives and facilities, super-specialist doctors will join GMC, says Dr OSCAR REBELLO.
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Should health care be a social obligation or should it be purely a commercial enterprise? The question befuddles the best of minds in the most sincere of environments. There are no easy answers.
In the Goan context, let me try to wade through the swamp. Broadly, there are two systems of health care across the world:
(1) The Socialist model: The best example is Fidel Castro’s Cuba. Though the docs there cannot afford private yachts and holidays in Capri, many believe that it is perhaps the best health delivery system. In Michael Moore’s movie ‘Sicko’, he shows how patients denied health care by insurers in good old, capitalist USA, smuggle their way into Cuba, to get fabulous eye surgery done at reasonable prices.
(2) The Capitalist Model: The dazzling example is the celebrated American system: brilliant health care, cutting edge research and the latest gizmos and drugs keep you alive and kicking. There is a huge caveat, however: You must be able to afford it, and it costs a BOMB. If you cannot afford health insurance, you could end up dead beef on the streets, or try to sneak into Cuba.
In Goa and India, as always, we choose to be deliciously schizophrenic. As in every other field, over the last two decades, we have junked our socialist robes and jumped gleefully on to the gravy train of cowboy capitalism.
So, why should health be different?
We have seen the mushrooming of world class private hospitals like the Apollo, Fortis and Reliance chains, with fantastic medical personnel and the latest facilities. We’ve also seen the alarming speed at which government hospitals are crumbling, from lack of infrastructure, resources and manpower.
The equation is simple: If you can afford it, you get the best health care. If you cannot (after blowing your entire salary on dal/rice), you could be crushed to death by the surging crowds in a government hospital OPD. Live by the capitalist sword and die by the socialist one. Wiser words were never spoken before.
Make no mistake, if it wasn’t for the ceaseless, untiring and valiant services of doctors in government hospitals, who have to handle hordes of patients daily, teach students, spend time on research, attend night emergencies and be the whipping boys of government officials and citizens alike, our socialist model of health care (the PHCs, CHC, District Hospitals and GMC) would have completely collapsed long ago, and most patients in Goa would be at the mercy of the private lobby (who can charge you a government doctor’s monthly salary for a single appendectomy).
Logic would tell you that as health care becomes increasingly more expensive and unaffordable for the vast majority of Goans/Indians, the socialist, public health care system would need to be strengthened by the government, certainly ‘not’ the private capitalist health care system
But in Goa, logic always seems to be in short supply. Instead of bolstering the government health system, we have a peculiar predicament where crores of rupees are spent on specialized health care in the private sector through the Mediclaim scheme. And now there’s this infamous sweetheart deal with Elbit (an Israeli arms dealing company that will put up its first tertiary care hospital in India), which seeks to put public health in a particular private hand at taxpayer cost, putting all other super-speciality hospitals in Goa to a significant and unhealthy disadvantage.
The argument of the Health department is that when you just cannot find super specialists willing to join GMC, how does one go forward? Let me list the super specialists in GMC that are doing heroic, exemplary work: Neurosurgery, Urosurgery, Plastic Surgery Endocrinology, Paediatric Surgery, GI Surgery, Neurology, Nephrology… The list is endless. Given the right salaries and incentives (a fraction of the outgoing Mediclaim expenditure), all other departments can also attract talent. It is abundantly available, if properly sourced (many super speciality departments have been initiated owing to the remarkable efforts of the current health minister).
But Elbit and other private hospitals love the Health Department primarily for the Mediclaim monies it generously doles out. They will not do anything gratis for the love of the Goans. But the Mediclaim scheme will ultimately have to crack up, simply because it is completely unsustainable; just look at the cost overruns it incurs.
Solutions
Give all private players a level playing field. The best talent will attract the most patients. Cardinal rule of Capitalism: No Sweetheart PPPs.
Phase out Mediclaim and use the funds to upgrade facilities and salaries for high end, high tech work at government hospitals.
Strengthen and motivate PHCs/CHCs. It is unfair for a patient from Valpoi to have to travel all the way to GMC for a common cold.
Handsomely pay government doctors, especially those working in far flung areas, and provide them all basic equipment and drugs. Allow private practice after duty hours in a regulated fashion, but haul over the coals those doctors indulging in gross dereliction of duty.
As Health Minister, it may seem to make sense to put most of one’s health eggs in one private basket at this point of time. But if this experiment fails, Elbit pulls out, and the government hospitals (particularly GMC) are allowed to float rudderless till they run aground, there will be plenty of eggs on the face when the Health Minister aspires to become Chief Minister.
Oh those nudes!
It was pouring mercilessly the other day. As I looked out of my hospital window at the Campal ground, I saw two young migrants ‘ghati’ kids completely in the NUDE, wet and freezing in the rain.
My sensibilities were deeply offended, so I dialled the Hindu Tan Suraksha Samiti, the Catholic Forum against the Gay Da Vinci, and the Popular Islamic Front that chop-chop hands, for help.
They all refused point blank, claiming they do not deal with children of a Lesser God.
I was, of course, too busy counting my pennies earned on the plight and misery of fellow human beings, so I postponed my conscience for tomorrow.
And then the moment of epiphany…
The slimy local politician with white shoes arrived on the scene and covered the two little ‘ghatis’ with a shawl and some clothes.
Whether he did it out of an act of kindness or to increase the size of his vote bank, I will never know, but the smile on the faces of those two kids was the only moment of genuine sunshine peeping out from the clouds on that monsoon Monday.
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Parallels
By Bernardo Elvino de Sousa
These past weeks have been enlivened by the FIFA World Cup Football and the 32 participating teams are analysing their matches – so-called post-mortem analysis – to draw lessons and improve performance. My analysis reveals interesting parallels between the World Cup and Goa events.
Italy’s dismal performance and early exit incensed this proud nation. The team was greeted back with boos, catcalls and insulting banners. The fate of its coach, Marcello Lippi, was even more pathetic. When he set off on a holiday in his yacht to recover from his immediate dismissal and voluminous hate mail, he was insulted at every port where he docked, and was forced to go into hiding.
Maffei’s English–Konkani dictionary translates ‘hide’ as ‘lipai’. It is a historical fact that prior to the Portuguese arrival, a flourishing trade existed between the Muslim rulers of the Indian subcontinent and Europe, with Venice in Italy as a major trading port. It was the promise of fabulous wealth from this trade that attracted the Portuguese to Goa.
Though no proof exists, it is conceivable that Lippi’s name is derived from a Goan ancestor, who was hiding from the authorities and escaped to Italy in pre-Portuguese times. Hiding, after all, seems a genetic trait in Goan polity. Lately, the press reported the disappearance of an influential minister, immediately following an ex-minister and his OSD, which came after a losing candidate. Like Lippi, their sanctuaries were chosen to enable them to consult their attorneys and file court cases, yet remain undiscoverable to the police. It is not known if, like the ex-minister, Lippi is also afflicted by hypertension, jaundice and urinary tract problems.
No life is possible without water. In a recent Herald article ‘Saving water for the future’ (Herald, 8 July), Freddy Dias emphasises the urgent need for water management. The quadrupling of the population, tourist influx and general development are straining Goa’s water resources, and erratic water supply makes this essential commodity more precious than gold.
Not surprisingly, ground water is rapidly being depleted, because Goans are digging deeper and deeper bore wells, a technique that clearly did not escape the trainer of the German national Mannschaft, Joachim Löw, who in pursuit of strategic inspiration, was captured in flagranti on reporters’ cameras at the World Cup, digging ferociously into his nasal orifices.
Löw can produce a bronze medal as proof of the successful implementation of this technique, whereas Goa’s 1,423 government committees, over half of whom never met, have been assiduously applying Löw’s approach for decades, but without demonstrable results, whether for treatment of garbage or removal of the River Princess. A conference call between the Goa Chief Minister and Löw to investigate the causes of this serious discrepancy is urgently called for. Perhaps, the oracle Octopus Paul could also be consulted.
Nothing was discussed more animatedly during the World Cup than the major refereeing blunders. Perfectly valid goals were disallowed; unwarranted yellow and, more significantly, red cards were handed out for imaginary offences; extra injury time of five minutes was added when even three wasn’t justified…
FIFA President Sepp Blatter, a Swiss citizen, was torn to shreds by the Swiss media and charges of FIFA’s and, in particular, the referees’ incompetence and corruption did the rounds. This is akin to the statements of the All Goa Private Bus Owners Association (AGPBOA) General Secretary, who spelled out the exact figures and beneficiaries of the bribes they paid.
Blatter came under heavy pressure to introduce modern technology, like fitting an electronic chip in the footballs and viewing of video clips by an off-field referee when in doubt. After initially refusing to entertain such proposals, he changed his mind and agreed to discuss the topic at the next FIFA meeting, but has again recanted… This is similar to Goa’s chameleon policies, for example, with respect to Mopa.
Goans are infinitely patient and resilient, and faithfully re-elect the same candidates, no matter what. Goa’s world continues to go ‘round like a football’.
The author can be contacted at: [email protected]
