Die if you can't pay...

The problem isn't just with selfish doctors...

Recently mother of a student in my university died because her family was not able to afford the expensive treatment. The doctors had recommended a liver transplantation which costs around Rs. 25 lacs in Pakistan (prices are almost the same all across the world, means a large chunk of the population cannot afford this much). All the students from the campus, tried to raise funds, however despite all the effort the complete amount was not raised in due time.

The incident forced me think and ask a lots of questions. How is it possible for someone to be so much selfish and materialistic? But its not that simple. A little bit of contemplation allowed me to see through two things. (a) What forces prices of such specialized treatment to go out of reach of the majority, (b) How the seller is forced to charge it from the buyer? Are they really butchers, or the problem is deeper than we think it might be?

The root of problem lies in the way modern world compartmentalizes knowledge in to small and small specialized parts, any individual with specialized knowledge is considered to be a specialist. The unique his knowledge base and skill set, the more he would be able to charge for his work. This is the law of Scarcity!

This is simple economics, lower the supply, higher the demand, higher the economic value! In the modern capitalistic world, it becomes justified to demand more salaries, profit, etc when your service or product is scarce. Now when the entire industry is using this double edged sword to find a niche and demanding more in exchange for it, then prices of a individual machine or piece of equipment, which requires lots of different individuals to manufacture, each with a specialized skill set, each of them demanding higher prices in exchange of their skills and commitment to deliver what is required, would increase the price of that piece of equipment higher. Demanding more for your specialized skill is not just considered legitimate but also assumed to be moral.

For example, if I am an engineer, who design precision sensors to measure very slight variations in temperature or weight, and I do a quality job which is unmatched, which makes the nature of my services really scarce, then I would be considered stupid to not to charge much money in exchange of my skills. My professionalism would demand me to deliver my services or product as required in exchange of the appropriate price. If someone purchases my offerings at the right price, I have done my job. It doesn't really matter where my product is eventually used, it's none of my concern as long as it is not illegal.

Now consider the process of manufacturing of equipment used in liver transplantation! Its not difficult to imagine it would be some unique and sophisticated set of machinery. Constructed by hundreds of components, each involving specialization. For example, it would have molded plastic components manufactured by some vendors; some metal parts manufactured by a different set of vendors, some electronic circuits manufactured by another set of vendors etc. etc... all of them assembled by a different individual... or maybe this is how one of many sub-assemblies of that big machinery.

Now in this process of extreme compartmentalization, it is not possible for individual manufacturer to wonder the bigger purpose where his products are being used for. Even if he a nice guy and gives a decent percentage from his salary into charity for the medical treatment of poor sick people, the layers of compartmentalization would never allow him to see how his high value specialized skills might be creating problems for someone else at the end of the chain.

This compartmentalization is defined and justified as division of labor, which Adam Smith advocated, due to its ability to increase productivity. The concept of compartmentalization later penetrated into the fields of knowledge by dividing it into smaller and smaller areas of specialization, and then into the domain of moral responsibility. The incentives in the market further added motivation for specialization. This pursuit of self-interest was considered very much legitimate and moral in the modern world, thanks to work of Adam Smith. The compartmentalization of ones morality and it's confinement into one's professional lives only, is the gift of modernity to mankind.

Leading political philosophers of our time including John Rawls and Amartya Sen, shift the responsibility of taking care the poor to the government, for which it is suppose to tax the rich. But in reality, the same rich is exempted from tax, as he is the one who is either in the government himself, or have financed election campaign for the president. So now the poor is left on their own, so when they get sick, and can't afford they better die. They are not fit to survive, welcome to the realm of Social Darwinism!

So what's the way out. Frankly I am not yet qualified to provide a solution. However problem correctly identified is already half solved, and it's a wake up call for all concerned stakeholders. Lets think together to workout a solution...

Author is an academic researcher, author, blogger, social entrepreneur, activist, mentor and tweets @javaidomar