Why Is Universal Healthcare Not Possible in India?

‘One of the great mistakes is to judge policies and programs by their intentions rather than their results.’ –Milton Friedman Universal healthcare is often championed as the pinnacle of social welfare – a system where every citizen has access to medical services without financial burden. While the intention behind universal healthcare is noble, implementing such a system in India is neither practical nor beneficial; the dissection of this moral dilemma is only possible through a socio-surgery technique which will involve three of our most important tools: sociology, philosophy and facts. Universal healthcare embodies the ideal of equitable access to medical services for all, regardless of socioeconomic status. However, when we assess the practicality of it in India, we ought to look at the disparities which exist amongst the citizens of India, which disallow such eleemosynary programmes. At the heart of the universal health care, debate lies the philosophical question of the state’s role versus individual responsibility. Libertarian philosophy emphasises minimal state intervention, advocating that individuals should have the freedom to make their own choices, including healthcare decisions. Implementing universal health care in India would necessitate a significant expansion of government control over healthcare provision, potentially infringing upon individual liberties and market freedoms. India’s economy, though growing, does not have the fiscal capacity to support universal health care. As of 2021, India’s Gross Domestic Product (GDP) per capita stands at approximately $2,100, significantly lower than countries with successful universal healthcare systems like the United Kingdom or Canada, where GDP per capita exceeds $40,000. These countries allocate around 10% of their GDP to health care.[1] For India, to match this percentage would require an unsustainable increase in government spending, potentially leading to higher taxes, increased national debt, or the diversion of funds from other critical sectors such as education, infrastructure, and defense. However, only about 1% of India’s population pays income tax, limiting the government’s revenue-generating capacity. Increasing taxes could place an undue burden on the middle class and slow economic growth. Alternatively, accumulating debt to fund health care is unsustainable and could compromise the country’s financial stability. This brings us to a point where we ought to look toward the principle of distributive justice, which argues against redistributive policies that take resources from one group to benefit another without explicit consent. With a population exceeding 1.4 billion, India faces unparalleled challenges in healthcare provision.[2] The sheer number of people needing medical services makes universal coverage logistically and financially daunting. In addition, India’s vast demographic diversity – including various languages, cultures and health needs – complicates the creation of a one-size-fits-all healthcare system. India’s society is characterised by deep-rooted social stratification based on caste, class and religion. These divisions have historically influenced access to resources, including health care. Implementing a universal healthcare system assumes a level playing field, disregarding the complex social hierarchies that affect how services are accessed and utilised. Sociological studies suggest that merely providing equal access does not guarantee equal utilisation due to factors such as social stigma, discrimination and varying levels of health literacy. Tailoring services to meet such diverse needs within a universal framework is impractical and could lead to inefficiencies and inadequate care. India’s current healthcare infrastructure is insufficient to support universal health care. According to the World Health Organisation, the recommended doctor-to-patient ratio is 1:1000. India falls short with a ratio of approximately 1:1456.[3] Rural areas, home to over 65% of the population, suffer from a severe lack of medical facilities and professionals. Hospitals are often under-equipped, understaffed and unable to meet even basic healthcare needs. Implementing universal healthcare without first addressing these infrastructural deficiencies would likely result in overwhelmed facilities and diminished quality of care. A very interesting take that we must consider is that of the principle of subsidiarity, which holds that matters ought to be handled by the smallest, lowest or least centralised competent authority. Applying this principle suggests that healthcare decisions should be made at the most local level possible. A universal healthcare system centralised at the national level contradicts this principle, potentially leading to inefficiencies and a disconnect between policymakers and the communities they serve. This top-down implementation of universal health care may not account for local needs and contexts. India’s vast regional disparities mean that health challenges vary significantly across the country. A centralized system may fail to address these localized issues, leading to ineffective service delivery. Empowering local communities and decentralising healthcare management may be more effective but is incompatible with a universal, standardised system. Effective universal healthcare requires robust administrative systems and transparency. India ranked 86th out of 180 countries in Transparency International’s Corruption Perceptions Index 2020, indicating significant governance issues.[4] Corruption can lead to misallocation of resources, fraud and unequal access to services. Without substantial reforms to improve governance and reduce corruption, a universal healthcare system could exacerbate these problems rather than alleviate them. The social contract theory posits that individuals consent, either explicitly or implicitly, to surrender some freedoms and submit to the authority of the state in exchange for the protection of their remaining rights. However, this contract relies on the trust that the state will act in the citizens’ best interests. India’s history of bureaucratic inefficiency and corruption erodes this trust. Implementing universal healthcare without first addressing these governance issues may violate the social contract, as citizens cannot be assured that resources will be managed effectively or equitably. Even the NHS, with its structured approach and homogeneity of population, struggles under the weight of universal health care, proving that such systems demand more than just policy – it demands alignment of societal values and systemic resilience. Now, transpose that onto India, a nation of paradoxes, where a billion voices speak in unison only during a cricket match. Here, health care is not just about medicine; it is an intricate dance of caste dynamics, economic inequality and cultural belief systems. How does one create a universal framework in a society where illness is as likely to be addressed by a priest as a physician, and where the perception of health itself varies wildly between urban skyscrapers and rural fields? Universal health care presupposes uniform access and equity, but in India, where the disparity is not only economic but deeply philosophical – rooted in centuries of social stratification – can such a concept ever truly take root? Perhaps the dream of universal health care here is not about replication but reimagination, a system that acknowledges and adaptate to the nation’s kaleidoscopic realities, rather than attempting to impose an unattainable ideal. A deep-rooted obstacle that India shall face while implementing this altruistic venture is the population’s preference for private healthcare providers. The private sector currently accounts for nearly 70% of healthcare services in India.[5] Many Indians prefer private health care due to perceived higher quality and better service compared to public facilities. Implementing a universal public healthcare system could disrupt the existing private sector, leading to job losses and decreased healthcare innovation. Moreover, the government’s track record in managing public services raises concerns about its ability to effectively administer a universal healthcare system. Yet, another spectrum to contain shall be India’s rich cultural heritage, which includes a strong reliance on traditional medicine systems such as Ayurveda. A universal healthcare system primarily focused on allopathic medicine may not align with the beliefs and preferences of a significant portion of the population, alternatively, including the traditional medicinal practices within the universal healthcare system would require regulation of all traditional healthcare providers, which shall become a Brobdingnagian task in itself. Imposing a standardised healthcare model could lead to resistance and underutilisation of services, rendering the system ineffective. It must be recalled that cultural relativism emphasises respecting and preserving cultural differences. Imposing a standardised healthcare model could be seen as cultural imperialism, undermining the pluralistic fabric of Indian society. Implementing universal health care can lead to moral hazard, where individuals may overutilise medical services because they are free at the point of use. This can strain the system’s capacity, leading to inefficiencies and longer wait times. In India’s context, where administrative oversight is already challenging due to corruption and bureaucratic inefficiencies, the risk of overutilisation and abuse of services is significant. Philosophically, this raises concerns about the responsible use of shared resources and the potential for collective harm due to individual actions, while practically, it raises the issue of depreciating quality in line with increasing quantity. This shall bring us to the ethical avenue where there is a tension between providing universal access and maintaining high-quality care. In countries with universal health care, increased demand often leads to longer wait times and strained resources, potentially compromising the quality of care. In India, where healthcare infrastructure is already inadequate, universal implementation could exacerbate these issues. Ethicists argue that it is better to provide high-quality care to a smaller population than substandard care to all, as the latter could lead to worse health outcomes overall. While the concept of universal health care is commendable, it is not suitable for India due to economic limitations, infrastructural inadequacies, administrative challenges and cultural diversity. Implementing such a system could strain the nation’s finances, reduce the quality of care, and create inefficiencies that outweigh potential benefits. A more pragmatic approach involves focusing on targeted healthcare initiatives, improving infrastructure incrementally and leveraging the strengths of both the public and private sectors. By adopting strategies tailored to its unique context, India can enhance healthcare outcomes without the risks associated with universal healthcare implementation. To end this debate, I would simply reposition us to the very beginning of this textual tryst, where Milton Friedman points us to his words, and in a way, points us towards economies with Universal Healthcare, such as the UK, which, as of today, are nothing more than a sinking ship, which, the captain himself would like to abandon first. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.