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M. Dzaky Alfajr D.

15/381728/EK/20450
Business Environment: Sociology and Politics

Why healthcare and medicine should be socialized


How many people do you know that have insurance? I dont think you are going to be
able to list that many, unless their insurance are covered by their employer. People with low
awareness of health might consider insurance as unimportant. That is because government
itself never made insurance ownership as mandatory, until recently with the governments
new program that is called BPJS. Basically, its a very affordable insurance with monthly
subscription starting from about Rp 25,000. Now everyone has to have this insuranceeven
though a lot of people still dont have it since they dont want to go through all the trouble to
register and everythingwhether its being handled by their employer, or themselves if
theyre not working with anyone or still a student. But before then, people normally dont
own insurance, especially those with lower income. It is not to be blamed on them, since
private insurance are quite expensive to begin with, way beyond the reach of most
Indonesians. So truth to be told, it was no surprise.
That is one core issue of privatization of medicine and health care. Private means
business, no matter what, they have to make profit somehow. While insurance could be a lot
cheaper if it was state-owned since state doesnt have to take profit from it. The ethical issue
is that, people who cant afford it then will not have access to medicine and health care,
which should be the governments responsibility. What has happened in Indonesia, is that
patients are being rejected from hospitals and not being able to get proper medicine, which is
very sad. People then often just stay at home, treated through non-medical approach like
traditional medication, when they actually need a surgery performed. When asked, the reason
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is simply because they are worried about how they are going to pay for the bills. This
shouldnt happen. People shouldnt have to worry about how they are going to pay for their
medical bills. I believe this is the government responsibility. And the fact that these people
dont have access to healthcare and medicine which is a basic need, is truly a pity.
The situation would be a lot different if healthcare and medicine distribution were
handled by the government, because then these people would easily have access to the proper
medicine and surgeries that they need and deserve. There wont be a saying, that is very
popular in Indonesia which is Orang miskin dilarang sakit roughly translated as The poor
are banned from being sick if it wasnt for the crappy healthcare system Indonesia has (it is
getting better now). That saying came from this image that only the rich can afford hospitals,
while the poor have to be content with Puskesmas (district health center) which is subsidized,
so its relatively cheap. But of course they cant perform advanced surgeries or things like
that. They are only meant for non-serious illnesses. But Puskesmas often become the only
choice, since it is literally the only option available. Patients must accept the fact that they are
only given antibiotics or painkillers, since theres no way to perform surgeries or the more
advanced treatments there.
And just like every other insurance, health insurance often, if not always, have rules
regarding pre-existing conditions. Pre-exisiting condition is a medical condition that existed
prior to joining the insurance company. Most insurance companies use one of two definitions
to identify such conditions. Under the "objective standard" definition, a pre-existing
condition is any condition for which the patient has already received medical advice or
treatment prior to enrollment in a new medical insurance plan. Under the broader, "prudent
person" definition, a pre-existing condition is anything for which symptoms were present and
a prudent person would have sought treatment. Pre-existing conditions can include serious
illnesses, such as cancer, less serious conditions, such as a broken leg, and even prescription
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drugs. The ethical issue here is insurance companies might reject you if you have serious
illness (because obviously it wouldnt be profitable for them), or the very least will charge
you with more money. Or they would just accept the healthiest patients of the bunch, who are
easiest, and obviously cheapest to treat, this is like their favorite customers, because these
customers have the least chance of using their service, and in the end, guarantee profit for the
insurance providers.
One other ethical issue from this is that some people may be under insurance coverage
all the time while some are on and off insurance depending on factors such as employment
continuity. Imagine if you were to resign from your current company that has always paid for
your insurance, and then when youre trying to sign up for an insurance plan yourself, you
might be rejected because you have an illness that you got during the time when you worked
in your former company. Because the problem with private insurances is that you cant
transfer insurance record from one company to another. After all, its a competition between
those insurance providers. Then youre going to have to pay for your own medical bills,
which can be very expensive. Especially when you got out of your company at a later age,
with more health risks. Youre just then a big red flag for insurance companies. But, if the
government were to handle the healthcare, then it wouldnt matter if one day you decide to
work for another company, or even if you choose to not work, or work for yourself, because
everything would be integrated that way, theres no need to worry if youd still be covered.
The hospitals or clinics that have contract with insurance companies often drain the
limited supply of doctors and other health professionals from the rest of the health care
system, lengthening waiting lists and reducing access (Duckett 87). This way, they will have
less professionals to pay, thus maximizes their profit. This results in patients not being able to
get immediate treatments. This is a serious ethical problem, because what if theres quite
some people that needs immediate surgery, but theres not enough doctors or professionals to

treat all them. These patients may not able to get treated in time, that could end up losing
their lives because of this blood-sucking industry. And this isnt a hypothetical question,
because it does happen, a lot. Long waiting list is not a news in Indonesian healthcare system.
And since they are profit-driven, obviously they will try to find the cheapest hospitals
or clinics available, which usually arent that good, and have questionable reputation. These
hospitals usually dont have proper facilities and not-so-experienced doctors and
professionals. The patients are at loss because they dont get the quality that they deserve,
instead theyre just thrown at hospitals that theyve probably never even heard of before. Its
not uncommon to have insurance sent you to hospitals or pharmacy that is very far from the
city, that only opens at certain days. Its clearly made that way to discourage people from
going there. Some people just give up and go to bigger hospitals with their own money. That
is, if they can afford the bills themselves. Sadly, a privilege that not everyone has.
Another common issue with privatization is that, they wont serve markets that they
dont find profitable, like remote areas and rural parts of the country where people are living
below the poverty line, and dont have very healthy diets. Why? Because these people are in
bigger risk of chronic diseases. Those patients are definitely not fruitful thus are avoided by
these private companies. Instead, they focus on patients who are living a more modern lives
in urban areas, which cost them less to treat. The irony is, the people who lives in the remote
areas probably need it more than those in the urban areas. Healthcare and medicine are basic
needs just like food and shelter. It should be available to everyone, and not just those that are
chosen by ridiculous standards set by these insurance companies. Because that using
standard wont leave much qualified patients left.
Lack of insurance is an inevitable barrier to getting healthcare. The uninsured suffered
from many disabilities: significantly lower visit rates, inadequate care when they got injuries
or chronic diseases, lack of routine health examinations & screening from a regular source of

care, and poorer quality of treatment related to absence of a usual source of care. People who
then give up going to doctors when they have no insurance, will then have to suffer with
developed complications in the later future, which would cost more money, and cause bigger
issues. Its a never ending streak that could only be stopped from the core problem, which is
privatization of medicine and healthcare.
Health insurance had an impact on the balance of preventive and curative services in
the protection of life. Men who had insurance were more likely to have early disease
screening. Low-income and/or uninsured women continued to have the lowest
mammography screening rates. Health insurance status explained racial/ethnic disparities in
access to routine physical and dental examinations. Private insurance companies capitalized
on the cost efficiency of preventive services by deliberately including coverage of preventive.
Health insurance and the ethical issue of equity measures or including a prevention bonus in
the health insurance program that decreased health spending per enrollee because of early
detection and treatment of disease. Insurance assures continuation of care after an emergency.
In the absence of insurance coverage, untreated complications following an emergency
episode bring the patient back to the hospital (Kasule 64). That is why its so important for
everyone to have easy access to healthcare.
Theres also an ethical issue with new medicine develpoment. Since its performed
highly private by pharma companies, they make the calls about what drugs to develop next.
And even though they also weight in what cure is the world in need of at the moment, theres
no doubt that how much the drugs will bring income plays a major role whether or not they
will develop a cure for certain disease. Do they develop medicine for profit or for the people?
I think you know what the answer is.
They can choose to develop the cure for brain cancer, that will bring significant
amount of profit for their company, or develop new drugs for people suffering from the most

neglected diseases such as sleeping sickness, leishmaniasis, and Chagas disease. The answer
is obvious, what brings the most profit is what they are going to focus on developing.
People who suffers those neglected diseases are usually found in developing countries
like India, which most people wont be able to afford expensive drugs. So why would they
make a cure for that? Meanwhile, brain cancer is more often to be found in western countries,
where people are more wealthy, and are a better target market for their business.
Lets put into perspective if government were to form a state-owned research &
development team for medicine that focuses on the more neglected disease which cures are
yet to be discovered. This way then people of all social level will be able to reach medicines
that they need, and drugs wouldnt be something that is considered exclusive for the rich,
because that is how the situation seems like for now.
There are definitely too much ethical issues tied with privatization of medicine and
healthcare. First, they are very expensive and unreachable by people with lower income, they
only accept the healthiest patients, and reject patients with unfavorable pre-existing
conditions. They also dont provide service to rural areas. Medicine development are also in
big trouble because they are private-owned and they only develop drugs that the rich will buy.
So, I strongly agree that healthcare insurance should be socialized as it will fulfill the purpose
of protecting life by increasing access to health services, and will provide the best and not
just economical solutions to treat patients. I believe every citizen deserve equal rights to
medicine and health care and by letting private companies take care of it is definitely not the
way to go.

References

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fees

and

guideline

adherence

to

follow-up

interval.

Can

Gastroenterol 2011;25(2):78-82.
8. New England Journal of Medicine, 1997, 337:169

9. Kasule, Omar Hasan K. "Health Insurance and The Ethical Issue of


Equity". Journal of Taibah University Medical Sciences 7.2 (2012):
61-68.