Time and again, critics do not hesitate in drawing attention to the poor quality of healthcare and the lack of a social health safety net as the failure of the government.

It is also frequently heard that the Indian health system must rapidly adapt to a new order, but what is that order of things, we struggle to define.

Around the world, there have been plenty of proposals for curing what ails healthcare. All aim to tackle a universal challenge: improving the quality of healthcare and reducing, or at least curbing, its soaring cost.

But regardless of what happens to the many experiments and reform efforts, the reality is that the basic structure of the healthcare system in India and most other countries will remain in place for the foreseeable future.

The only realistic hope for substantially improving healthcare is for us to launch a revolution from within. The more responsible we are as individual citizens, the better we would be in healthcare financing.

The recently promulgated reforms of the US healthcare system have an early warning for us in India. The health insurance legislation passed by the US Congress and signed by President Obama may not be perfect, but democracy is often about the art of the possible.

Making health insurance compulsory for all Americans and placing penalties on those who do not purchase it is a move that Indian government too should think about seriously. Subsidising the cost of providing health insurance for SMEs and allowing them to participate in larger ‘pools’ to increase buying power, while penalising them if cover is not provided is a model that India should consider emulating in some measure.

The US healthcare system has been working on a three tier system where the government provides medicare to poor and medicaid to senior citizens. Others are mainly covered via corporate plans from their employers, with an opportunity to top-up and/or choose additional benefits.

This obviously was not good enough as it left about 32 million Americans uninsured either because of unemployment or because their existing insurance policies were insufficient to cover the gap. Add to all these, the cost of medical treatment in the US is perhaps the highest in the world.