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Excesses of power Revolt in the hills |
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New era dawns in
Yemen
Pak judiciary not
at fault
Micky versus Bo
Obama
At The cost of health
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Revolt in the hills
The
split in the Bharatiya Janata Party unit of Himachal Pradesh could well snowball into a major crisis with neither the dissidents nor their silent mentor ready to bite the bait of the appointment of a new state president proffered by party president Nitin Gadkari. His peeve mounting after being elbowed to the outermost sidelines of the state’s politics, veteran politician Shanta Kumar, it appears, will settle for nothing less than the Chief Minister’s own head. He made this clear first while blessing the Himachal Pradesh Bhrashtachar Mukti Manch – an outfit floated to expose ‘corruption’ in Chief Minister Prem Kumar Dhumal’s administration – and then looking the other way when his loyalists, led by four times MP Maheshwar Singh, quit the BJP to launch the Himachal Pradesh Lokhit Party. He has now also spurned overtures initiated by Gadkari and conveyed through national general secretary J.P. Nadda and secretary Shyam Jaju. Himachal’s saffron rebellion is clearly provoked by Dhumal’s continuing attempts to concentrate all power around himself while systematically weakening and sidelining party veterans and compromising the BJP’s organizational structure in the process. While it must be stated that no major corruption scandal has surfaced during the present regime, BJP insiders, including the lot that has formed the new party, seem more riled with Dhumal for shielding some “corrupt” ministers and evidently promoting a successor in his own son Anurag Thakur. Nitin Gadkari’s failure to assuage veteran Shanta Kumar’s ego and get him to smoke the peace pipe with Dhumal may reflect a greater malaise in the BJP: the leadership’s apparent incapacity to reconcile problems that seem to have relatively simple solutions. The rebels in the hill state have but one objective – to bring Dhumal and his powerful coterie down. They do not seem to have had much success for the moment, but if they keep at it the Chief Minister’s growing band of dissenters may well draw blood during the state assembly elections later this year.
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New era dawns in Yemen
The
Yemenis have finally got rid of over three-decade-long rule of President Ali Abdullah Saleh, the dictator who had been clinging on to power on one pretext after another. They fought for over a year to make him see reason and allow a democratically elected government to be formed. Yemen will now have a transitional national unity government headed by former Vice-President Abdrabbuh Mansour Hadi. It has been constituted for two years to get a new constitution drafted and then organise a multi-party election. Hadi won the election-cum-referendum on Tuesday with little difficulty. In fact, his election was a foregone conclusion as no opposition group fielded any candidate to fight the battle of the ballot against him. They all expressed faith in his ability to start a process of rebuilding of the poverty-stricken country. However, it is going to be a very challenging job for Hadi, a Nobel laureate. Yemen suffers from widespread unemployment, acute water and food shortages and an intense tribal rivalry. But the more difficult battle the new President will have to fight is against well-entrenched militant outfits like Al-Qaida in the Arabian Peninsula, which has its headquarters in Yemen. The presence of a strong Al-Qaida factor is the primary reason why the whole world is interested in the return of normalcy to Yemen. The transitional government has been assured of adequate financial and other kinds of help by the international community so that the militants are unable to exploit the situation to their advantage. Hadi, who enjoys a good rapport with the US administration, had already been there at the helm as acting President since last November when Saleh flew to the US for the treatment of the injuries he had suffered in an unsuccessful assassination attempt. Hadi has got the opportunity to remain in the saddle for two years under a Gulf Cooperation Council-promoted deal for the transfer of power. This shows that not only the Yemenis but also the international community expect much from him. He, therefore, has a herculean task ahead.
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Develop success from failures. Discouragement and failure are two of the surest stepping stones to success.
— Dale Carnegie
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Pak judiciary not at fault The
successful lawyers’ movement in Pakistan in 2008 was, in a way, its first war of independence. The formation of Pakistan was the result of a peaceful agreement which it signed with India under the aegis of the British government. The primacy of Pakistan’s Supreme Court is because of that movement. There was a time when the Supreme Court would uphold the army coups as it did in the cases of Gen Mohammad Ayub Khan and Gen Zia-ul-Haq. A new interpretation to the constitution, the doctrine of “necessity”, was provided to give legitimacy to the coups. The court has now graduated to be a powerful entity so as to arraign even Prime Minister Yousuf Raza Gilani for contempt and indict him. He, in turn, has challenged the judgment and has decided to prove the charges wrong. The Supreme Court Chief Justice is the same person, Iftikhar Mohammad Chaudhry, who suffered at the hands of the army because he dared to go against the wishes of the then Chief of Army Staff Gen Pervez Musharraf. Justice Chaudhry was confined to one room, along with his family, for months and made to undergo more or less solitary imprisonment. In a country where all other institutions are tottering, the emergence of the Supreme Court is indeed evoking hope for the future of democracy. After all, the judiciary is the bedrock in such a system. Yet I have not been able to understand the logic of criticism that by strengthening the judiciary, the polity is weakening because such a process is at the expense of the power that the executive and parliament enjoy. For instance, the institutions in India have gained because of a series of judgments. The recent one, which Gilani’s lawyer Aitzaz Ahsan has quoted to defend the Pakistan Prime Minister, is the cancellation of 122 licences of allotment in the 2G spectrum (mobiles) scandal on the ground that Prime Minister Manmohan Singh did not know about the letters which his office (PMO) had received from indicted former Telecommunications Minister A. Raja. The blame was put on officials and advisers. So has been the tenor of Aitzaz Ahsan’s arguments before the Pakistan Supreme Court. In India, the judiciary has gone to the extent of laying down that Parliament cannot change the basic structure of the Constitution, meaning thereby that secularism, federalism and the parliamentary system. True, Parliament represents the people but in the heat of the moment or any vociferous movement, Parliament can be swayed by the mood in the country prevailing at a particular time. The same principle --- that the basic structure of the Constitution cannot be violated --- holds good for Pakistan as well, even though its Supreme Court has not said so unequivocally. By kicking up the dust, the real issue of corruption cannot be obscured. President Asif Ali Zardari is said to have laundered billions of dollars and stashed in Swiss banks. The fact that then President, General Musharraf, condoned the crime through an ordinance does not mean that Zardari can appropriate the money which really belongs to the Pakistani exchequer. Gilani is only Zardari’s face. He owes his office to him and, therefore, it was natural that he should take the responsibility of Zardari’s acts of omission and commission. Gilani’s defence that Zardari enjoys immunity under the constitution may be all right for legal purposes, although the Supreme Court would probe whether immunity is absolute or whether it can be questioned in any way. At least, the Supreme Court can order that the money stashed abroad be brought back to Pakistan even if it “remains” in Zardari’s account. Immunity means that no action can be taken against Zardari since he is the President who enjoys such powers under the constitution. Yet immunity cannot be stretched to a point where Zardari is not directed to transfer back the stashed money to the Pakistani banks. Chief Justice Chaudhry was not lessening the stature of the executive by asking Gilani to write to the Swiss authorities to reopen the case of Zardari’s assets in banks in that country. That Gilani sits over the court’s order for more than two years shows his disdain for the judiciary. And this also shows the arrogance of the executive. To characterise a case of corruption as an attack on the government or, for that matter, Parliament, is not to see the wood for the trees. The corrupt, however high in position, should be brought to book to revive people’s faith in democracy. Too many instances of graft in South Asian countries involving top people have disfigured democracy in the region and there is worthwhile legislation coming for combating graft. It is difficult to guess about the fate of Gilani’s trial for contempt. But it will be an embarrassment for Pakistan. Already the court has appointed Attorney-General Anwar-ul-Haq as the prosecutor. This amounts to pitting the government’s top legal adviser against the Prime Minister. The ruling Pakistan People’s Party (PPP) has rightly said that it is a sad day in the history of Pakistan since the serving Prime Minister has been charged. If one were to look at the case from a different angle, the court’s judgment could be described as a day when democracy touched the greatest height in Pakistan-a country where the judiciary was a party to the rule of the armed forces. This is something rare in South Asian countries. The black money stashed abroad is going to haunt the Manmohan Singh government, too, because the Director of the Central Bureau of Investigation (CBI) has said at a public forum that the Indians have unaccounted money, as much as Rs 24.5 lakh crore (about $500 billion), in banks abroad. He has also been frank enough to say: “If the king is immoral, so will be the subjects.” The normal reaction after the disclosure would have been an all-out effort to get back the money. Yet there is no worthwhile action because many depositors belong to political parties, including the ruling Congress. The CBI Director has himself admitted that it would be difficult to bring back the money: “The probe is complex, time-consuming, costly and requires political will.” Now that the example of Pakistan’s Supreme Court is before us, some individuals can approach our Supreme Court to direct the government to bring back the money to India. Here the hurdle of immunity does not come in. The committee which the Supreme Court appointed in an earlier case to look into the matter is too slow in processing. Some shock treatment to the government is
needed.
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Micky versus Bo Obama WHEN Michelle Obama dropped a bombshell last month during a chat show on ABC Television, its bombardment was heard even in Chandigarh. Our Pomeranian pet Micky turned hysterical when the First Lady revealed that she would like to incarnate as her pet in her next birth. Interestingly, Bo has been anointed as the First Dog by the White House. As I rolled into slumber, being dog-tired, a dogged Micky dog-trotted into my dream to escort him to a dog show, being organised under the aegis of the American Kennel Club later this year. Micky’s Mission America, I could sniff, was inspired to ground Bo Obama in a direct dogfight and floor Michelle to choose him instead. Having lifted golden laurels in two successive events in Chandigarh and Panchkula, Micky appeared confident to trot away with the “Best in Show” award, ousting Bo by his dog-collar. Like an unbending professional, Micky stood firm on his hind legs and adduced dogmatic arguments to convince me. He was honest to admit that Bo’s Portuguese water dog breed was certainly rare but no less was his either. Recalling his nativity from Pomerania along the Baltic Sea, and royal breeding by Queen Victoria, he counted Napoleon’s wife and King George IV as majestic owners, among others. Micky acknowledged that Bo’s breed was hypoallergenic and that was the reason for his selection in view of allergy Obama’s daughter suffers from. Micky, however, ridiculed Bo’s genetic lineage as a working dog for Portuguese fishermen since he did not know swimming despite having webbed feet while Micky cherished his two ancestors who were among three dogs to survive the sinking Titanic. I confronted him with Bo’s profile, hosted on the White House website, eulogising him as “…a handsome little guy. Well suited for formal occasions, he’s got tuxedo-black fur, with a white chest, white paws and a rakish white goatee”. Micky retorted that he too was a female-dog-killer with golden feathering forming a ruff of hair, pure bred with his pedigree registered at the Kennel Club of India. A sarcastic Micky taunted that Bo was neutered and could not raise his progeny whereas he remained in great demand for the servicing of bitches. While I failed to stop the unstoppable, Micky kept harping that Bo brought disgrace to his trainer, Millan, when he was captured walking ahead of the master on a leash. He had even defecated once under Obama’s table staining the Oval Office carpet. He was also insensitive to his brother, Rico. Simply because he was named after a renowned singer, Bo Diddley, and gifted by Senator Ted Kennedy did not add to his esteem. Carving out a niche in Michelle’s heart would script a new epoch in Indo-US relations, claimed Micky. How was he so sure? “I’m a believer in Obama’s dictum: YES, I CAN”, came the reply. I started fantasising that after succeeding in his mission, Micky was being carried in a canine procession from his native place, Pomerania, to my native village, Bawal. Meanwhile, when my daughter woke me up, I found Micky staring into my eyes. I was moved by his persistence. I winked in
confirmation.
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At The cost of health
Healthcare costs are escalating all over the world. In India, where a major chunk of the population lives below the poverty line, the rising costs have made medical assistance almost prohibitive, even for the middle class
It
is well-known fact that the current health-care system has miserably failed not only in developing countries (including India) but also in developed nations like USA, UK, and others. The cost of everything is going up and up and the health-care cost is no exception. The rising cost has a different impact when health-care cost is taken into consideration because one can reduce expenditure in many things like in kitchen, on vehicles or holidays but not when you or your loved one is having a medical problem; neither you can delay it nor you can opt for poor quality care.
From 1996 to 2006, the health-care cost has doubled in US. In 2007, the cost was $ 2.2 trillion, or $ 7,421 per person, which was 16.2 per cent of the GDP (twice the average of other developed countries). This is projected to rise to 25 per cent in 2025 and 49 per cent in 2082, i.e., almost 50 per cent of the total budget, which even the US will not be able to afford. While India’s healthcare costs look affordable to medical tourists, they are costly, almost prohibitive, for the average Indian citizen. The healthcare expenditure of Rs 1500 for a poor family — may seem like a measly amount, but it is 50 per cent of their monthly income. On many occasions, patients even sell their jewellery and property to pay their medical bills. Effect of escalation
In India, most government medical centres are over crowded and private health-care is very costly resulting in diminished access to any form of health care for an average person. A large number of patients reportedly die every day without getting any medical assistance. Transplantation for diseased organs, management of chronic diseases (including cancer), cardiac, neuro, joint replacement, cosmetic surgery etc. are available only to rich or to those whose health care is covered by their employers or insurance companies. As per modest estimation each of these procedures cost between Rs 2 lakh and Rs 20 lakh. The follow-up maintenance cost is separate. How many Indians can afford this? The Indian insurance policies are such that their first attempt is to avoid the payment or pay only a fraction of the bills of the corporate hospitals. The main effect of the rising cost is, therefore, either total non-availability or availability of poor quality health care; patients are even pushed to quacks. The skyrocketing cost of health care not only affects the budget of the families, but also the state and Central Government budgets and also the business ventures. The General Motors (GM), USA, spent $4.6 billion on health care of its employees in 2007, more than the cost of steel. And this is translated into increase in the cost of every vehicle by $1,525, whereas for each Toyota vehicle it comes to $125 only. This high cost is one of the reasons for GM and other US automobile companies to lose their market share.
Expensive private care
Government institutions can look after only a small percentage of patients, waiting period is enormous, add to this indifferent attitude of staff, prevailing unhygienic conditions, gross discrepancy in the demand and supply of facilities, and the picture looks dismal. It takes a few months to get a CT scan done in AIIMS, New Delhi, each bed in the labour rooms at the PGI, Chandigarh, is shared by two patients in advanced labour, thousands of cancer patients pass into inoperable stage waiting for surgery. It is a Herculean task to get a private room in the PGI or the AIIMS. At any given time scores of patients requiring ventilators are on ambulance-bag ventilation and a majority of them die because of this. A patient, thus, has to knock at the doors of private institutions. The corporate hospitals are beyond the reach of even middle-class people, the room rents or ICU bed alone cost between Rs 6,000 and Rs 12,000 per day, add to this another Rs 10,000 to Rs 12,000 per day for drugs and disposables, visits, investigations, and the total becomes beyond imagination. A normal delivery costs around Rs 1 lakh, gall bladder or appendix removal cost upward Rs 60,000.
Unnecessary surgery or tests
Unnecessary surgical or investigative procedures are carried out routinely, angiography for any patient visiting cardiology, any patient complaining of abdominal discomfort is subjected to endoscopy, upper GI and may be colonoscopy. Undertaking operations for conditions, which can be easily treated with drugs only, knee replacement
is the latest in this list. Multiple, repetitive, costly investigations and use of disposable items are other contributing factors that one has to face in a private hospital. Multiple cross-references for
trivial matters are another factor adding to the cost. Health care has become a lucrative business venture. Most corporate hospitals are flourishing, expanding, opening new ventures all over the globe but charity, discount, help do not exist in their dictionary. Many of these hospitals have got prime land on subsidised rates, in lieu of which they were supposed to provide free beds to poor and deserving patients. But hardly any of them does that. There is no reason why the corporate hospitals can not bring down the cost. If these hospitals can charge almost 40 to 50 per cent less from ECHS (retired army personnel health scheme), CGHS and insurance agencies than why can’t they bring down the normal charges. An ECHS patient pays a consultation fee of around Rs 60, whereas a normal patient pays anything between Rs 400 and Rs 600 per visit. The room rents, cost of operations etc also follow the same pattern. Price variations are not adequately explained by differences in hospital costs of delivering similar services at similar facilities. Price variations are correlated to market leverage.
Doctors or businessmen?
Barring aside a few, most corporate hospitals have nothing to do with academics, these are concerned with money only. The highest paid professors in prestigious government institutions like the PGI or the AIIMS (where they are involved in patient care, teaching and research) get a basic salary of Rs 85,000 and the total may touch Rs 1.25 lakh
per month whereas a private hospital specialist may earn Rs 2 to Rs 25 lakh per month. A specialist working with a corporate hospital at a salary of Rs 2 lakh or more per month is constantly reminded that he has to procure a business of at least Rs 20,000,00 per month. And for this he may do anything – unnecessary investigations, undertake operations that may be avoided, longer hospitalisation stays, costlier drugs, more use of disposable items etc.
Drugs and disposable items
Drugs have become costly and it significantly enhances the cost of health care, both in the out patients and in the wards; but the following facts may not be known to many: Most of the medicines are available at a heavy discount, varying from 15 per cent to 50 per cent (at the PGI all chemists are bound to give 15 per cent discount on drugs). The private hospitals //nursing homes get these drugs directly from distributors at a much cheaper rate but they coolly charge the MRP of the medicine plus 10 per cent more as service or handling charges. There is no uniformity in the MRP even for the same pharmaceutical drug, for example Adriamycin , a commonly used drug for cancer, a 10-mg vial is available between Rs 900 and Rs 1,400. The tendency of most private hospitals is to stock costly drug so that their margin is more. Similarly the costly drugs get preference over the cheaper ones although the beneficial effect may be hardly appreciable. For example injection costing about Rs 300 has replaced injectable Paracetamol / Aspirin costing only Rs 3. Imported acellular DPTP + Hib vaccine costing about Rs 2,200 is being used in place of another well established vaccine costing only Rs 1,000. There is a growing tendency to use costly medicines like Albuminol, TPN and others on flimsy indications. Some of the corporate hospitals do not stock whole blood. They get the whole blood and separate components – red blood cells, plasma and platelets. These are again supplied on demand even for surgical patients who require whole blood and the hospital coolly makes a profit of four or five times. The disposable items are necessary for patient care and on these also the discount on MRP is available up to the tune of even 50 per cent. For example a pair of gloves, with an MRP of Rs 27, is easily available in the market for around Rs 7. The number of gloves required for each patient is in dozens. As in investigations, many drugs are unnecessarily prescribed without sound indications, antibiotics, vitamins, tranquillisers, analgesics, food supplements are the common ones.
(The writer is a former Senior Professor and Head of Surgery, PGIMER,
Chandigarh)
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