For Leela the injection symbolizes that she has been taken seriously, even if it may only be, at best, a vitamin shot or, at worst, just saline solution. The doctor sees little point in asking her to take it easy, since he knows she can’t, or exploring other causes which may require treatment he knows she couldn’t afford.
Preeti’s family, meanwhile, can shop for specialists for their mother; doctors who will visit their home. Should the need arise, they could tighten belts and get her treated at enormous expense at the gleaming corporate hospital on the outskirts of the city, the kind that gets free land and subsidies from the government if they promise to reserve a few beds for the poor. It’s the kind of place that even draws Western foreigners who have either been on a waiting list too long or are just looking for treatment they can afford.
Yet Leela, with her placebo injections, is still better off than some of the rural poor in this vast and vastly unequal country. In the survival economy of many villages a person could die because they felt they couldn’t afford to get an X-ray for a diagnosis of tuberculosis, a disease for which a course of treatment can be as low as $20.
India has a public health system, but it is chronically underfunded: the government spends barely one per cent of GDP on health (whereas it is the world’s ninth largest purchaser of arms). As policy analyst Gita Sen put it: ‘Poor people go less and less to public facilities to which they would go earlier because they almost never have the free drugs they are supposed to provide. This is a great irony for a country that has gained respect in Africa for making drugs affordable through our export of generics to them.’1
So a banal and deathly truth pushes itself forward: in India, as in most of the world, the healthcare model that is available is one that is characterized by the stratification imposed by capitalist modes: pockets of technical excellence available to the rich, much more limited options for the poor. Recently, numerous Western commentators have noted that the Indian government is making a commitment to universal health coverage; Indians themselves will only believe it if it starts to happen.
What right to health?