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Healthcare: Total nationalisation can mean 'strengthening' bureaucracy, state power

By KP Sasi*
Nationalisation of healthcare is not a simple idea to be pushed. Even with the existence of the private sector and the public sector in healthcare we are not in a position to deal sufficiently with the healthcare that is required. The non-government sector includes a large number of charities and missions in deep areas in India.
Apart from this, there is a whole range of indigenous healthcare systems also which need not cater to a centralised state or profit-oriented private capital. Therefore, we should be clear about what we are asking for. It is not like nationalisation of banks or any other sector of our economy. We are in a situation where the comparison for healthcare can not be provided neither by the State nor by private capital.
Healthcare in such a context cannot be simplified within the framework of earlier political jargon. If you say nationalisation of pharmaceutical drug industry, I am all for it.
But if you say that a number of charities motivated by the elements of compassion or many small experiments in Ayurvedic hospitals or the hospital initiated by Shankar Guha Neogi for mine workers or the hospital initiated for Bhopal survivors outside the clutches of government and private capital or for that matter many Adivasi healthcare traditional institutions operating without the degrees or stamps of private capital or government -- I would say I am against it.
What should be promoted more is community healthcare where compassion towards patients can be expressed more on personal terms, since both the doctor as well as the patients would be accountable to the community. But even that can not be a formula for India today.
Therefore, this should be treated as a discussion between the concerned sections rather than as a debate between privatisation or nationalisation. Before publicising, I think we should put our minds together collectively, not just within ourselves, but also among the like minded friends.
But that does not restrict us in making concrete demands like demilitarisation and investment of such money on healthcare. We are directly demanding to strengthen life and peace instead of war and destruction of life.
I would like to thank Dr Maya Valecha for initiating this discussion. The scope of the discussion can also go to some kind of evaluation on why a very revolutionary slogan called ‘Health for All by 2000 AD' collapsed after initiating major hopes all over the world. Many countries including India stood by this slogan. Countries where healthcare was nationalised also stood by it. The World Health Organization (WHO) itself had projected some reasons for its failure. But I have not come across any serious critical evaluation after its collapse from the activist circles.
The model of healthcare in Cuba is certainly promising and providing us hopes. However, we must also remember that healthcare was part of the Cuban revolution itself. In Indian context, politics and healthcare stand as two separate entities. Therefore, we must strengthen the discussions on the politics of healthcare and the existing available alternatives to us at this moment.
What should be promoted more is community healthcare where compassion towards patients can be expressed more on personal terms
Our public healthcare system is still within the framework of a western model, where environment is not a part of healthcare. In country like like India where the largest population of hungry people in the world exist today, health, environment and economics must go together.
There are concrete hopes coming from some Scandinavian countries also. Some of them have come from the traditions of social democrats. These hopes are also worth investigating. How many of these countries pushed their governments to take care of the old and disabled (differently abled is the correct word) is something that activists can do even before nationalisation in India.
I do believe that if active mobilisation and campaigns are initiated in India for the government to take up the responsibility of such concrete areas, changes can be made without much delay. Our own activist traditions need to be oriented to understand the political relevance of such campaigns.
I would say such steps are necessary before we reach a stage of demanding a total nationalisation. And a total nationalisation ignoring many of these areas can only mean strengthening of a bureaucracy and strengthening the power of the state over human bodies. In today's situation of the entry of technological growth for surveillance and its power to control human body, it is too important to discuss the implications of control of body by the State.
***
My input here is only as a part of a discussion, more as a search rather than a finalisation of a political stand. From that perspective, I would like to ask Maya Valecha, how should one look at our rivers, lakes, forests and hills. We are dealing mainly with two interests here -- of the state and Capital.
Chief Seattle
If you look at many of the indigenous traditions (Chief Seattle's statement is an example), they cannot be `owned' by anybody. What is required is to provide the rights of the communities where communities will not lose their rights to 'take' care and not 'own'. The Forest Rights Act was drafted in this perspective.
We are in a similar situation when we talk about human health. It is too important at this stage when both state and private capital has been insufficient to deal with our health requirements. There is also a danger of the existing community health practices to be ripped apart, if we provide total control to any of these sectors.
In Bangladesh, Gonosasthaya Kendra under the leadership of Dr Zafarullah Chowdhury has executed some remarkable progress from the perspective of community health. What we really need is such efforts with a strong ethical vision on health. We are yet to talk about health leaders with strong foundations of community.
If people cannot control health, then what makes one think that a nation or capital can control it and take it to a positive direction? Honestly, do you really believe that if healthcare is nationalised a leader like Modi can take it to a positive direction?
Therefore, it is time that we start thinking slightly away from the existing paradigms of state and capital before we offer our bodies for their control. Having said that I would still argue that nationalisation is a good dream which is desirable. But it is just like asking for a revolution when people are in no mood for it.
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*Film maker, writer, activist. This is in response to Dr Maya Valecha’s article in Counterview “Case for nationalising India's healthcare system amidst 'strong' private control”. Dr Valecha's reply to follow

Comments

Dr Maya Valecha said…
I agree with most of your points on ecology. Will reply in detail.
I am a strong supporter of rights of aadivasis, was part of NBA in a limited way. Propagate widely for stopping climate change and limit the use of even so called renewable energy after stopping fossil fuels, because overuse in long term can have adverse effects. Locally promoting biogas.
I am not against any indigenous treatments, rather their promotion is either hampered by existing commercial allopathic empire or overuse again for creating commercial products.
Nationalization will stop this anomaly. If people take things in their own hands, including political power, the results will be different.
If any demand stirs people, political awareness increases. I am not seeing this as being implemented by Modi.
It's a long way. But we have to start.
All your worries seem to arise from the fact that you see nationalisation superimposed on all systems unchanged. Whereas I see at a time when during the course of the movement for it, with increasing political awareness scenario will be different.

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