While in the United States, in between wedding festivities I also had a chance to catch up with US politics. Besides the ‘Impeachment Inquiry’ being conducted by the House of Representatives against President Trump, the other important matter on the political landscape is the primary campaign in the Democratic Party to choose the candidate to contest the 2020 presidential election.

The Democratic Party is essentially a ‘moderate to a centre-left coalition that includes ‘centrist-moderate’ candidates like former Vice President Joe Biden and hard left candidates like Senator Elizabeth Warren and Senator Bernie Sanders, the latter being a self-avowed ‘democratic socialist’.

Most candidates in the Democratic race agree on most issues. The issues that are common with some small variation include: a guaranteed living minimal wage, support for trade unions, progressive taxation, gun control, abortion rights, a humane immigration policy, and affordable healthcare for all citizens.

It is on the issue of healthcare that the biggest ‘divide’ between centrist and hard left candidates like Senators Sanders and Warren occurs. Both Sanders and Warren support universal healthcare provided free for all citizens by the federal government. They also call this initiative ‘Medicare for all’.

Medicare is the US federally funded programme that provides healthcare to all US citizens above the age of sixty five. Medicare costs much less than private health insurances but it is not free, so Medicare for all is unlikely to be really free either.

More importantly, the cost of a universal healthcare programme run by the federal government in the US is estimated to cost between 25 and 35 trillion dollars over a ten year period. To put this in perspective, just one trillion dollars would pay off all of Pakistan’s external and internal debt as well as fund all of CPEC and a few major dams too.

The US supporters of universal healthcare point out that all modern developed countries provide guaranteed and free or heavily subsidised healthcare to all citizens through different mechanisms. And in these countries, healthcare is considered a right and not a privilege.

The US is an exception in the developed world and it has almost one in ten citizens without any health insurance. And if we include legal and illegal immigrants, the number goes up. However, any person that turns up in a hospital emergency room will be treated.

In the state of New Jersey where I practised cardiac and thoracic surgery for twenty years, uninsured patients were treated and the state provided hospitals some reimbursement as charity care. Doctors taking care of charity patients of course did not get any money.

A universal healthcare programme run by the federal government in the US is estimated to cost between 25 and 35 trillion dollars over a ten year period. To put this in perspective, just one trillion dollars would pay off all of Pakistan’s external and internal debt as well as fund all of CPEC and a few major dams too.

That brings me to the idea of free or almost free healthcare for all in Pakistan. At least in the Punjab where I have worked in the public sector for a number of years, I know that an infrastructure exists that is capable of providing heavily subsidised universal healthcare for all comers. From basic health units (BHUs) all the way up to our tertiary care teaching hospitals we have the capability to provide all levels of healthcare to all citizens.

The sad thing is that for all the years since this system was put in place, it has never been developed to its full potential. The recent attempts at privatising parts of this system cannot really work since people that work in these facilities are government employees and cannot work for the government as well as a private non-government entity at the same time.

There has been much talk that the present government wants to privatise our major teaching hospitals. I do not even need to read the law against which the doctors were striking recently but having worked in Mayo Hospital I can say one thing for sure. No sane business entity is ever going to take over this hospital and try to run it as a ‘for profit’ institution.

Almost fifteen years ago King Edward Medical College (KEMC) became a university (KEMU). Until that time the budgetary control of the affiliated hospitals including Mayo Hospital was under the principal of KEMC. However, when KE became a university, the Vice Chancellor (VC) lost that power over the affiliated hospitals.

The medical superintendents (MS) of the affiliated hospitals including that of the Mayo Hospital were appointed by the Health Department and were answerable only to their bureaucratic masters. During my tenure as professor and chair of the department of cardiac surgery in KEMU I also functioned as the head of cardiac surgery in Mayo Hospital.

Once during a discussion with the MS of Mayo Hospital, I was reminded only partly in jest that I was the ‘chief consultant’ for cardiac surgery but still only a consultant. I was also informed that the person actually in charge of my hospital department was the senior registrar who of course reported directly to the MS!

Whatever happens, as long as the doctors as well as all the other staff of our public hospitals are employed and paid by the government, there can be no semi or partial privatisation of the public healthcare sector.

The point I am trying to make is that the government run health sector is capable of providing good quality subsidised medical care to most people if only it can be properly developed. A few years ago I asked a senior medical bureaucrat about the medical facilities like the BHUs and the rural health centres (RHC). He said that a third of them are fully functional, a third are non-functional and the rest are somewhere in between.

Universal healthcare is relatively expensive though nothing even close to the ‘trillions of dollars’ mentioned above. However, it is possible to provide a reasonably appropriate level of universal healthcare to people living in the Punjab if the existing networks of public medical facilities are improved literally from the ground up.

These healthcare facilities from the BHU all the way up to major tertiary care teaching hospitals can only be improved if the people that form the backbone of these institutions are empowered. And that means that the doctors, the nurses, and the paramedical staff must be paid a decent living wage and provided a proper autonomous service structure.

The sad truth is that the so-called permanent bureaucracy that runs this country and has so far run it into the ground will never be willing to allow medical professionals to function beyond the bureaucrats’ control.

The proof of what I say lies in an interesting discussion I had with a former health secretary of the Punjab who really had no idea what an ‘open heart’ operation actually entailed and yet he tried to convince me that he actually knew more about open heart surgery than I did! Comically sad was the fact that he actually believed himself.

It is my opinion that until the person(s) running a major teaching hospital can tell the difference between a Positron Emission Tomography scan, Computerised Axial Tomography scan, Magnetic Resonance Imaging scan, and a Mimosa Vivacia scan, they should not be let anywhere near a major medical facility except as a patient.

The writer has served as Professor and   Chairman, Department of Cardiac Surgery, King Edward Medical   University