Recently there has been much debate about the PPP. If we ask google what is PPP, we will be informed: Purchasing Power Parity, Private Public Partnership and so on, anything but Pakistan People's Party which shows the state-of-the-art AI.
The first PPP means an exchange rate that equates the purchasing power of different currencies, showing how much of a good a currency can buy in different countries. Suppose the cost of two oranges is 100 rupees in India and 2 dollars in USA, the PPP of India is higher than that of the US even though the currency exchange gives about a dollar and a quarter for 100 rupees. Obviously not all oranges are the same and the price varies by location and time.
The second PPP means a project or service operated jointly by a government and a private company. By one reckoning, the Government of India has nearly 2000 PPPs worth 2,495,568.44 crore rupees. The process of picking the companies for partnership involves complex tenders and of course, a great deal crony capitalism.
Given that the hindu pantheon is like various bureaucracies of GoI, what is PPP like in Devaloka? The Asvins mentioned in vedas are the divine physicians whose ken extends over all aspects of biological forms, whereas Dhanvantari is the head of Ayurveda meant for the humans which makes him a PPP.
It is well known that before modern universities emerged, knowledge was transmitted in a gurukula. Thus, Ayurveda was passed on in a guruparampara starting with Dhanvantari who emerged from the milky ocean when devas and asuras churned it to obtain amrit or elixir of life. Bhagavata has all the esoteric details about how Lord Vishnu, transformed as a nymph called Mohini, hoodwinked the asuras to handover the amrit exclusively to devas that made them immortal, hence disease-free.
Who paid for gurukulas? While the knowledge taught in a gurukula is of divine origin, the cost of running a gurukula was borne by the rishis who grew food and necessities from their own cultivation at first and later received largess from local lords or kings. This is called an endowment. Many American universities have land grants, endowments, trusts, etc. to manage the day-to-day university expenses. There are issues on the definition of non-profit universities and their investment in stock markets around the globe, that is for another day.
Over the years, Ayurveda was replaced by Allopathy but the basic model of gurukula continued. That means the elected officials replaced the overlords and kings. The cost of training a medical student in a 4-year course today, for example, is nearly 2 crore rupees in Andhra which is ultimately paid for by the Andhra taxpayers.
When graduates choose to immigrate to other countries or move within Bharat to another state, want to serve only in urban areas and prefer corporate hospitals over government hospitals, the average taxpayer in Andhra who depends on government hospitals is left at a disadvantage. Basically, he is not getting the return on investment Andhra made with taxpayer money.
Having established the unequal distribution of medical care even if access to medical care through aadhar and such ID's is not considered, the issue is how to ensure that the taxpayer is justly served. It is in this context that the previous state government floated the idea of PPP. They wanted to keep 50% or so percent of the student intake for taxpayer subsidies and the rest to be distributed among those who can afford to pay. This seems like a win-win solution.
According to the critics of the existing system, the tenders floated by the state government are too restrictive and assume the capitalists will prefer to invest in medical education and care over other sectors of the economy out of good samaritanism. It is not clear how much of the investment will be borne by the state. If the state subsidizes 50%, even though it seems lower than before, still it is a burden for the taxpayer. How to alleviate the taxpayer burden?
Many of the critics look up to the American model of medical education where students need to take loans either with collateral by their parents or government guarantee, to pay for their education if they can't afford it. Since the infrastructure is built up with land grants and endowment, the cost of medical education is reasonable if not the optimum.
Another aspect of some student loans is, they are offered contingent on the service in rural areas after graduation for a certain number of years. This will mitigate the need for hiring immigrants by offering them visas on J-1, H-1, F-1, etc. for serving exclusively the rural population which is 18% of the total US population. The reality, however, is different. When there are 8 physicians for 10,000 residents in urban areas, there are only 5.1 in rural areas. In India they are 10 and 1 respectively with more than 60% of the population living in rural areas.
One can ask, why can't the for-profit medical insurance and pharmaceutical companies, who are the ultimate financial beneficiaries, pay for the medical education? While it is not entirely clear, there is the concern about unwanted nexxus or collusion spiking the cost of doctor's visits and prescription medicine even more than current astronomical numbers.
Then there is the access and affordability. There are tens of millions Americans who don't have access to medical care. That is, they don't have a physician to go to for routine check ups. Even with access, the so-called co-payment is unaffordable for them. Thus, there is inequity and condemnation of the poor to ill-health and its societal manifestation as violence when it concerns lack of mental care.
So the critics, by choosing the American model of rationing of medical care, will have to answer how they can augment or replace the present system given the deficiencies. If the collective will is to coerce the medical graduates to serve the rural population, then subsidizing medical education makes sense. On the other hand, when serving the rural areas becomes mandatory, or education is with strings attached, many may choose other career paths further skewing the physicians to patient ratio.
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