Public Health and Healthcare in the age of a pandemic

As India, home to 1.2 billion people, begins to see the first-wave of Covid-19 cases, the question of “healthcare” and “public health” finds a new dimension. The struggle between who to give the reigns of power to, the state or private players, is paramount, especially in a country where if left unabated, the virus could wreak havoc.

With cases flooding in, preventing measures adopted, and lockdowns imposed, it’s easy to loosen the contract between the individual and the state. In these times, such trade-offs are even preferred. The contagion does not see any intrinsic difference between a collective of individuals, rather sees it as a ‘single public,’ one that depends on and is defeated by itself.

After all, why are people vociferously appealing to their community to adopt ‘social distancing’? Because the misdeeds of one can have grave consequences to the family, neighborhood, and community, of another.

Should this force us to reevaluate how we look at the public and its relationship to an individual? Should this change the way we look at the most pressing service right now — healthcare? Should this change the way we asses what “healthcare” and “public goods” are?

Crisis of ‘healthy’ proportions

On May 17, Nitin Pai, the director of the non-partisan Takshashila Institution, a public policy-oriented think tank tweeted healthcare is a “private good” while public health is a “public good,” which prompted a heated reaction on the social media platform. Politics and economic-models aside, this divide, during the spread of a fatal virus bears introspection, if not strong debate.

Before delving into my side of the argument, I must admit, at the time of writing, I am pursuing a graduate certificate on technology policy from Pai’s Takshashila Institution. That being said, this post should be treated as my opinion and my opinion alone.

Source: Twitter

To provide context, Pai’s statement was in reply to his tweet on testing for Covid-19, which he asserted is a “public health issue.” A reply to this tweet tabled his 2015 disagreement with Amartya Sen’s claim that India needs a right to healthcare.

In a 2013 blog, Pai penned his above assertion of healthcare not being a “right.” Given the essential nature of education, healthcare, and jobs, he stated that the line between “necessities” and “rights” disappears. He adds, “The only true rights are those that do not come at anyone else’s cost.”

I don’t intend on agreeing or disagreeing with Pai’s arguments, I simply plan on addressing my own rationale.

Socialize the distance

No decision should be interpreted without the context of its times, neither should anyone’s personal statements. The reason why Covid-19 has forced countries to shut-off from the world, people to self-quarantine, and authorities to panic, is because of its infectious-nature and the efficiency of international movement. If the virus could be contained, or identified through visible symptoms, the case for “community protection,” could be easier, enforcement lax, and the crisis avoided.

This begs the question, “What does this mean for public health at a time when the term ‘public’ is far more nuanced than before?”

Public health is at the core of any nation’s welfare. The better the health of the people, the better the health of a country, its economy, security, and society. In the face of an infectious disease, with asymptomatic patients, latent symptoms, in a hyper-connected nation, public health, as protection against Covid-19, becomes all the more important.

Here, public health refers to the ability of the public-at-large to maintain a standard of health, sanitation, and even distancing, to ensure the betterment of the rest of the ‘public.’ There is no individual, or community standard here, separated from the rest. There is just one standard, the public standard.

Sympathetic calls are being made from prominent societal members to adopt social distancing, self-quarantine, and avoid organizing large public gatherings. Why? What is their incentive? Because they are members of the public as well, they too have a stake, and they too are at risk. A single carrier could infect a flock.

Source: Twitter

Public health is a public good in-so-far as everyone has a stake in it. Given the infectious nature of the virus, the stake that a laborer has is the same as a politician. The case for treatment, however, is a matter of healthcare.

Privatize the treatment

His aggressors argue that Pai is incorrect on ‘healthcare,’ especially at this crucial time, and the case of ‘public health’ should be expanded to conflate the service of healthcare. While coming from a source of concern towards those disproportionately affected by a lack of resources, that argument ignores the premise of the ‘economics of cure.’ This conflation would socialize not just the means of infection, but also the means of treatment.

Treatment, in the scenario of a pandemic, does not begin before detection, but after. Once a patient has tested positive for the virus, they should have the right to seek the sort of healthcare they want, within the means available to them. This is where the premise of ‘healthcare as a private good’ lies.

Source: Twitter

Pai himself asserts that healthcare is “rival & excludable.” Two people cannot use the same healthcare services denominated by units of beds, ventilators, or intensive care units [ICUs], hence there is a rivalry utility. Similarly, only one person can reap the benefit from a bed, at the cost of someone else who could’ve used that service.

In ‘health-care,’ the private focus should be on the suffix, ‘care,’ as a determinant of quality. Care, for any underlying service, is different across countries, economic-classes and between private and public ownership. Here, ‘care’ denotes the amount a person is willing to pay to avail ‘care,’ and by attaching a monetary value to it, it can be used to out-bid, out-rival, and exclude someone else from availing the same ‘care.’ This is true for every service.

Even in the realm of healthcare during a pandemic, private testing and private treatment when permitted by the government will adopt the concept of ‘economics of cure.’ Here, treatment will be dependent on how much you value that ‘care,’ and if you’re willing to outbid the other. Healthcare, in the process of treatment, would be a private good and limited according to the resources and manpower supplied.

Rationalize the argument

In the wake of a pandemic, everyone’s stake in the health of the other rises by a factor of n, where n denotes the number of people in the public. Public health cannot be more ‘public’ than this.

Private healthcare, at this time, is a private concern, in-so-far as we are talking about ‘treatment.’ This form of treatment is a private good because it can be altered depending on the private capital of the patient, in which the stake is limited to the person seeking treatment, i.e. n=1, and not the rest of the public.

This does not mean that healthcare should be exploited to that point where only those with sufficient capital can pay for it. We must, for the sake of the nation’s health and our own, demarcate between the virus as affecting a monolith, where the health of the public is concerned and treatment as individual, where the health of a single person is concerned.

Private goods and public goods have never looked more far apart, than in the time of a pandemic.

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