Thursday, October 24, 2013

Compensation for Medical Negligence - Does it solve the problem?

My first reaction to the following news was discomfort - 
The Supreme Court on Thursday awarded a whopping Rs 5.96 crore as compensation to be paid by Kolkata-based AMRI Hospital and three doctors to a US-based Indian-origin doctor for medical negligence ...
It did not feel right. In  fact, it reminded me of Michael Sandel's concerns about becoming a market society where money dominates even moral and ethical issues. 

It feels terribly wrong that the difference is compensation can be so large based on a person's status in life. I wonder how courts will value a child. Will it based on the expected earnings as determined by his or her family background - an obvious reality but hardly the one we should be condoning and encouraging.

The US health care system is not exactly an inspiring example of a system which provides excellent care, without negligence, for all.

The chances are that even in India :
  • the hospital will have an insurance cover
  • insurance company will pay
  • insurance company will raise insurance rates
  • hospitals and doctors will raise their rates
  • we will pay more
  • the doctor will make no fewer errors as it is highly unlikely that the doctor wanted to make a sloppy diagnosis or provide wrong care
  • high costs result in perverse incentive for delaying/avoiding treatment
The same logic is true for motor vehicle accidents. I have not heard of a single person who is a more careful driver because of the compensation he may have to pay in case of an accident.

What may be more effective?
  • A person who makes the error should be accountable and punished.
  • Revocation of a license quickly (not 15 years later) in case it is malpractice or an error which should(not could) have been avoided
  • Limit compensation to a socially valuable amount. A poor victim's family needs financial help a lot more than a rich victim's.
  • Impact of a victim's lost income should be covered by the individual's own insurance policy and not the insurance company covering the doctor (or the driver in case of motor vehicles).
I may even be inclined to favour an insurance cover by the doctors and hospitals where all care costs of the patient are returned in case treatment does not succeed regardless of whether a medical error was involved.

Monday, October 14, 2013

Health Insurance - there has to be a better way

After renewing our health insurance and increased the coverage, I keep wondering about what our actual need is.

The desire, of course, is that we should never need to use the insurance and that is probably why most of are satisfied with just a broad understanding of the policy. But I would expect that if I am ill, the last thing I want to worry about is the expenses related to the treatment. I doubt if that goal is met.

I probably would be happier with a policy which did not cover the expected problems and are not expensive to treat but did not have a limit for the unexpected(and expensive to treat) ailments.

Top up plans may partially be a solution but I do wish there were a simpler unambiguous solution, e.g. excellent public health services for serious ailments and we should not need insurance.

Wednesday, October 9, 2013

Chandigarh - Why make Sector 17, Chandigarh boring?

A few days ago, I had seen several reports in the Tribune regarding Sector 17. A couple of extracts:
  1. Now as malls and hotels had come up in the Industrial area, city’s Sector 17 plaza had lost its sheen. People are now not coming to Sector 17, he said.
  2. shopkeepers in Sector 17 have started restoring the facade of their properties by way of silicon treatment or by other means. Keeping in view the heritage status of Sector 17, the estate office has been issuing notices to the traders.
But I wonder:
  • What would Times Square or Ginza be without the glitter? 
  • Why not move away from the drab grey? 
  • Why not let the area or each block be redeveloped like a mall - with escalators so not just the ground floor is easily accessible?
Why do we need to stick to the original plan of Le Corbusier  without question, e.g.

Le Corbusier’s ideas weren’t all so great. Critics (like Jane Jacobs) argue that his vision for urban life was destructive to the city, alienating people from one another, and elevating the car over the human. He was on the fascist end of the political spectrum for a while, at one point working for Mussolini. And for decades, he tried (and thankfully failed) to get Paris to raze the Marais neighborhood and build one of his city plans (like image 3). Contemporary designers seem less driven by Le Corbusier's modernist idea that “all men have the same needs,” and more into the postmodern concept that everyone has different wants.
A very nice talk on how New York City is re-imagining the streets - Janette_sadik_khan_new_york_s_streets_not_so_mean_any_more.

Roundabouts in Chandigarh

The following statement in "Like parliamentary democracy, roundabouts are a great British export with a risk" struck a chord:
Yet roundabouts tend to work only when motorists observe the British virtues of fair play and stick to the rules. Alas, this is not always the case.
I will never forget the policeman scolding me for not barging in to the traffic at a roundabout. I waited as I did not wish to create a deadlock by blocking traffic in the circle which needed to exit the roundabout.

The policeman may have been right. I may never have been able to enter the roundabout but by shoving and being rude :(

Update: The surprising pleasure of not being rude

I stopped at a pedestrian crossing. I had to request the pedestrians to continue walking as they had stopped in the middle of the road upon noticing my car.

I am surprised at how nice it felt. However, there was no car behind me. How often can I expect that?

Wednesday, October 2, 2013

Much ado about nothing - the fuss over an ordinance.

It is hard go get excited with various news items about the ordinance to not disqualify MP's and MLA's immediately after conviction by lower courts.

After all it gives the convicted leaders an additional time to file an appeal and get a stay. What is another three months after it takes over 20 years to get the conviction or just 17 years in a very high profile case of missing fodder.

As in programming, we emphasize - GIGO. Why worry about when a person gets disqualified. Worry about how such a person gets into the system.

I wish I had statistics to justify my perception.

What is likelihood of the spouse or a child of such a person being elected once the seat is vacated?

Perhaps, the better way to phrase it would be that what is the likelihood of the spouse or child of the convict NOT being elected in his/her place from the same constituency?

Nothing to do with Shakespeare's Much about nothing except that all the drama around the ordinance feels like a farce.

Tuesday, October 1, 2013

Loving mankind is fine but what about its constituents?

What can one say about people? Here was a news item about ambulances -  Meant to ferry patients, road rage victims themselves - an example:
In Balasore district's Hathigad area last month, an ambulance was called for a victim of snakebite. When the vehicle arrived, at least five relatives of the victim tried to get in. When a member of the ambulance staff pleaded that they could not accommodate more than one attendant, he was beaten until he was nearly unconscious. All five relatives of the victim forced themselves in.
A couple of days ago, I found that a car had parked so that the row behind was inaccessible. My anger at the driver's stupidity subsided soon as I had just seen James Flynn: Why our IQ levels are higher than our grandparents'. I wondered instead why a large part of the Indian population seems to think at the level of great grandparents or even worse. How do people learn to think? In schools or the general environment? Either way, we seem to be failing badly :(

The following sentence from Dostoyevsky's Brothers Karamazov has stayed with me for about 40 years now -
 “I love mankind, he said, "but I find to my amazement that the more I love mankind as a whole, the less I love man in particular.”