In the future, Indians won't be able to afford to fall sick

Sometimes when you are out of ideas on what to read, you just scroll through the years of gunk you have accumulated in your Kindle library, and find a gem. Such was my experience with finding the book "The Price We Pay" by Dr. Marty Makary. I am only a quarter of the way through it, so I expect to make 1-2 more posts about it. It tries to unpack why healthcare in the US is so expensive and broken. Unknown to me, Dr. Marty was in the news a few months ago, because he resigned (read: was 'nudged out') as the US Food & Drug Administration head...over his refusal to allow the sale of flavored vapes.

Much has been written about this book on the internet, given it is from 2019. What I want to point out is that the overwhelming feeling that this first quarter of the book has left me with is sadness. Pure sadness and grief. About a country I don't live in and a system I don't use. Why? Here's an example: One of the chapters goes into great detail about a hospital in a small rural town suing patients who can't pay, and then WINNING those cases so that they can dip into people's salaries for years to recover an overinflated bill. Btw, the hospital in question had also sued the judge in that town on a similar case.

Closer to home, the item I have been reflecting on is the state of Indian private healthcare. I am convinced that, sadly, 5-10 years down the line, healthcare in India is headed down the same road as the US. A huge part of the economy, largely privatized, tons of useless middlemen, and ripping people off. You will not be able to afford to fall sick. Let me repeat that, you will not be able to afford to fall sick. Here is a non-exhaustive list of starting conditions, all pointing to...holy shit, this is going to be a problem.

1. Quality healthcare, by and large, is only available in the private sector. Only a small fraction of government run hospitals and clinics provide high quality care at low or no prices.

2. Private equity owns or has stakes in multiple major hospital chains, and the industry concentration here is getting worse. In case you haven't heard, when private equity controls an industry, prices for consumers go up. Way up. Private equity also has a hold in other parts healthcare - particularly IVF and diagnostics chains. I guess I am just waiting for PE to start 'rolling up' dentists, dermatologists, physiotherapists...you get the picture.

3. India has absolutely 0 focus on preventive care. Our cities and towns are not walkable, polluted for meaningful parts of year, our extreme summers keep us confined indoors, traffic eats into time that could be spent on health, and when you go to a restaurant you are basically picking between high, higher or highest fat and sugar options. (It's more accurate to say that the 'preventive care' vs 'income' function is a step function. After a certain income level, say top 1%, people do start caring. But that's the problem, it's the 1%, not the 99%.)

4. The pricing, billing, and reimbursement process at a hospital is already batshit crazy. It is an opaque, long drawn, and stress-inducing experience to go through it. And the consumer i.e. patient has ~0 control. The two times I have gone through it, the billing experience was worse - yes worse - than the thing I came in for.