As a media researcher one looks at how public discourse is being shaped, particularly concerning issues of public policy and how facts, lies, spin, and propaganda is used to further ideologically-driven agendas, all the while couching it is in the language of reason and argumentation. Take the case of public healthcare.

Economic-liberals (or neo-liberals if you like) globally have their knickers in a twist over healthcare. They argue against any public funding of healthcare using their favourite talking points of “governments can’t deliver but markets can”. Supporters of unfettered economic liberalism in India have been trying to make a similar case. In this case “facts” are bandied about and privatisation is presented as an irrefutable argument. In the elite public sphere, the general liberalisation, also referred to as reformation, of the healthcare regime concerns itself with the government pulling out of healthcare provision and the gap being filled by private players. It is suggested that the state restrict itself to objective roles such as direct cash transfers to the needy (who can redeem them in any commercial healthcare establishment of their choice). It is futile digging oneself into a ideological position and hoping for a war of attrition. One needs to peel back some of these arguments about efficiencies and effectiveness and challenge some of their claims. It appears it isn’t a transparent case of genuine concern with healthcare. Public healthcare systems in Cuba (yes, a Communist country) delivers better healthcare on all indices than the privatised health care of US. The United Kingdom and Canada have public healthcare systems that provide world class healthcare systems for all. On the other hand a market approach to healthcare fails the poor and lower income groups in the US. Thus, the question is why this blind support for privatisation, especially when you have proven alternatives to the liberal-economic model. We can forcefully argue that it is ideological. Capitalism as the aribter of all social relations has become so normalised for some sections of the Indian elites heavily influenced by American libertarian thought that they even copy the propaganda models –  keep repeating the same things over and over again and it will eventually become the truth. Why are the Cuba, UK, and Canadian models, for example, denied any space in the debate? Because they beat the idea that ‘generating wealth is the fundamental precondition for improving health’.

While no sane person would defend poor governance, it would be foolish to throw the baby out with the bathwater. Doing away with government’s role without wanting to reform its functioning and applying scientific principles of management can be argued to be ideologically driven. It barely masks the desire to usher in capital as the sole arbiter of social relations. I digress, but this subtelity needs to be understood if we need to unpack the public debate, spin, and propaganda on healthcare. While it is a fact that the current system does not provide adequate, in time, and quality healthcare to all — it should be a starting point to ask why other government models have worked? What systemic changes can be brought about to bring the Indian healthcare system in line with egalitarian models worldwide?

Lancet has come out in support of the Cuban health care system. And there are other independent voices from the west who are now stepping out to do research and validate what is already known.

- “Global health-worker crisis: the UK could learn from Cuba” The Lancet, Volume 371, Issue 9622, 26 April 2008-2 May 2008, Pages 1397-1399

- “Going where no doctor has gone before: The role of Cuba’s Latin American School of Medicine in meeting the needs of some of the world’s most vulnerable populations”,
Public Health, Volume 122, Issue 6, June 2008, Pages 552-557, Robert Huish (Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6)

We need not dismiss the economic liberal approach. Reform and make efficient the existing government system and run it on a trial alongside a cash transfer system. Now that could be called a genuine concern for debate and reform, not presenting one side of the argument and even telling lies, as Dr Sanjay Gupta did in the US when he told lies to smear Michael Moore on CNN. This is what Nobel Laureate and New York Times columnist Paul Krugman had to say about this public exchange:

But I do remember his mugging of Michael Moore over Sicko. You don’t have to like Moore or his film; but Gupta specifically claimed that Moore “fudged his facts”, when the truth was that on every one of the allegedly fudged facts, Moore was actually right and CNN was wrong. (link)

Watch Dr Sanjay Gupta on CNN admit he lied here and then spin it to say it was an error of transcription. An error of transcription? I am not a healthcare specialist, and I was able to conduct research and obtain facts, which are on my fingertips. Dr Gupta deliberately presented one-side of the whole issue, which may be his prerogative, but ends up harming his cause because the overwhelming impression is that he has something to hide or conceal. The point is such acts are typical of smearing, lies, and deception that goes on in public discourse, especially when it comes to policy issues. Watch as Gupta spins the entire issue even as Moore provides evidence that he had given Gupta’s producer all the relevant information. For a good summation of the controversy head to ABC News‘ Jake Tapper’s article (here):

Having failed to initiate shock capitalism in India and now stung by the string of “shocks” capitalists have delivered to capitalism in the developed world, votaries of economic-liberalism are using a different tactic. Cash transfers, instead of government spending, is the new buzzword and the communicative strategy here is to appear as welfare oriented, while systematically working to erode government role in public life. There is a definite case for the latter, especially in the cultural sphere where the government should have as little role as possible. Thus, cash transfers are made to appeal to those undecided or sceptical of capitalism as the arbiter of all social relations. The project here is not cash transfers but public influence, which by itself is not a bad thing. Everyone seeks to influence hearts and minds of others (like this article is attempting to do). However, in the age of modern and intensive communication, it is not easy — for anybody — to engage in falsehoods, like the one undertaken by Dr Sanjay Gupta.

Even the most ardent supporters of cash transfers in the West do so with significant caveats (Overseas Development Institute: link, German Development Institute: link). On the other hand, only one side of the debate is being presented to push a particular agenda.

However, while being critical of the economic-liberals, one has to take the left to task for not pressing for changes in the system. Bloated and bureaucratic organisations with political meddling are no solution to India’s healthcare problems. The left needs to re-invigorate the debate by proposing bureaucratic and systemic reforms. You cannot dismiss the role of the executive in managing the healthcare system and trying to banish them from the scenario would be dangerous. There are government models within India that have worked — take Railways for example.  There is a serious interest in UK academia to study the commonalities between the Indian Railways and the UK’s NHS.

Some links on media debates about healthcare and cash transfers/healthcare vouchers

“Vouching for health vouchers”, The Financial Express, 11 May 2008, Authors: VV Singh, Pradeep S Mehta , Link

“The crisis in rural healthcare”, Economic Times, 24 Jan 2008, Arvind Panagariya, Link

Some facts about Cuban healthcare system

Infant mortality, under 5 mortality, and life expectancy in cuba matches that of us (and is even lesser when it comes to infant mortality, which in 2006 was 7 vs 5.3).

In 2005 healthcare spending in cuba was $260/capita (uk $3065 US $6543). Cuba makes use of a three tier system — consultorios (here each doctor serves about 150-180 families), polyclinics, hospitals. All easily accessible. Consultorios are in the immediate vicinity of the communities.

Cuba has the lowest HIV prevalence in the world. It beats the idea that ‘generating wealth is the fundamental precondition for improving health’. The cuban system roots are in provision rather than purchase of health care. Its system is vertically integrated, with each consultorio (the immediately local family doctor) linked to a specific polyclinic in the neighbourhood. NHS in the UK is also discussing implementing polyclinics and is now copying their approach to prevention.

The Finlay institute in Cuba is amongst the world’s best when it comes to vaccine research and production. the biotech R&D is similarly amongst the world’s best. For example, the institute was the first to manufacture and produce the Meningitis B vaccine.

Cuban healthcare system is just not part of the English debate, largely due to the complex socio-political and economic framework within which the former healthcare system is provided.