Many of my old readers surely know how big a fan I am of Big Government. After all, the tax money collected in the interest of the destitute and the poor needs to be spent on things that are crucial for the poor man on the street. All are agree?, a question Government resolutions are frequently preceded by. Among the various ways our taxes are spent include:
1. Giving employment to unemployable youths.
2. Subsidies to grains, kerosene and sugar so that they can be sold by ration shop owners at a higher price in the open market (after all, the market knows no morals, as everyone knows).
3. Build statues of the great leaders of our country who have saved several billions of dollars of the nation’s monies by transferring them to Swiss banks, thereby ensuring steady and safe growth.
4. Build and run hotels so that the poor relatives and workers of political figures can stay when desire strikes them.
5. Run airplanes that can be used by the poor when regular private airlines are packed to capacity.
6. Pay the bills for helicopter rides and private charter planes that carry our beloved leaders to their farmhouses or mistresses.
And so on. Why rehash this old crap, you ask?
Well, I recently heard of a way whereby another great public service our Government provides us, the Public Transport system, helps us.
(source: http://www.travelindiasmart.com)
Here is an example:
A State Express bus, traveling around 50 kms from point A to point B, is often found to be, in official records, to be running nearly empty. The puzzling contradiction is how those empty buses are never seen in reality. The mystery has been resolved by a group of inspectors who have found that the conductors of the buses are charging a ‘subsidized’ rate, especially from ‘old (monthly-pass) customers’ and allowing them travel without the need to issue tickets. The money is generally split between the hard working driver and the conductor.
Protesting passengers are discouraged– if necessary by eviction from the moving bus. Needless to say, our paying public has found a way to manage this, and a compromise struck with the employees, many of whom have bungalows and cars and marry off their daughters in non-Governmental style. Role models for our wayward youth, surely!
A similarly enterprising group comprises of workers in various Government Hospitals, especially the large teaching institutes.
(source:www.oxfam.org)
A typical example is of a technician in the Radiology Department who performs dozens of x-rays every day, using dyes that are used in the x-ray procedure.
For example, a study called the IVU needs two ampoules of a contrast material (as the dye is correctly called). Now, each ampoule usually contains 50ml. Our enterprising technician uses 40 ml in every case. Every fourth case or so, instead of opening a new ampoule of contrast, he uses the 40 ml of saved material, uses it for the last case, and pockets a brand new ampoule (which has been bought by the last patient).
This ampoule, along with many others that accumulate from his enterprising cost-cutting, is sold to the same neighboring pharmacy from where these patients are asked to get contrast from. Sweet, is it not, how our hard working State employees manage to make some extra money in these hard times?
Extrapolate this to drugs, including third gen antibiotics, anesthesia drugs, suture materials, disposables, implants, catheters, and a hundred other things, and what do you have?
A full-fledged cottage industry of larceny and fraud, complete with 100% tax exemption and 100% job security.
Let us, on this note, dedicate ourselves to Eternal and Enterprising Government!
HEART SCANS: GOOD OR BAD?
The New York Times has carried an excellent article on the rampant use of the CT scan for diagnosing coronary heart disease in patients. It gives a balanced picture of the pros and cons of a healthcare system which thrives on modern and expensive investigations.
The basic argument in favor of scanning your heart would be to detect the plaques (deposits of fat) in the coronary arteries and document any narrowing in the passage of blood supplying the heart muscles, thereby warning the cardiologist and the patient of the need for aggressive treatment like angioplasty or bypass surgery.
On the other hand, each scan costs a lot of money, causes radiation exposure equal to a thousand x-rays (thereby increasing the risk of cancers), and may not be as effective in helping detect the specific case of the cardio-vulnerable patient.
In India, all the premium city hospitals, led by the Apollo group, have procured the 64-slice CT scanners that cost nearly a million dollars. These hospitals aggressively position themselves to patients as leaders in preventive cardiac care, which is just an effective way of marketing the cardiac CT scan.
Additionally, they also position the CT-angio to doctors through CMEs, cocktail-dinner seminars, etc.
The ‘cardiac CT’ has taken center stage along with coronary angioplasty and bypass surgery as major revenue earners for these hospitals. The strategy is to screen patients through executive health checkups and diabetes and hypertension screening camps across the rural-urban divide (through peripheral clinics), get them referred to the center with the CT scan, and following the detection of some lesions in the CT, get the patients ready for the expensive angios and bypasses.
The entire delivery system is now well-oiled, and the number of procedures is rising every year, as are the revenues to these hospitals.
Patients are also benefitting, by and large, though there are (unspecified numbers of) patients who are being scalped or milked by the system. Isn’t it always so?
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