When politicians and policymakers worry about the cost of health care, the affordability of prescription medications is often front and center. Given the present focus on prescription drug costs, it may surprise some readers to learn that medications were not included in the original Medicare program enacted in 1965; there were not enough expensive drug treatments to concern policymakers. Indeed, it was nearly 40 years until drug benefits were finally included in Medicare coverage in 2006.

For most young people and their parents who live in high-income countries, the decision to attend school is an easy one. School is universally available and free through high school, schooling is mandatory through the age of 16, and most jobs require at least a high school degree. Dropping out of school all but ensures a lifetime of relatively low income.

The rate of diabetes and hypertension among adults in India has grown at alarming rates in recent years, with diabetes increasing ten-fold rate over the preceding three decades. In particular, 10.4 percent of adults in the state of Tamil Nadu are diabetic or pre- diabetic, and 27 percent have hypertension, according to 2014 estimates (Anjana 2011, Must et al. 2014). These disease rates not only place a heavy burden on patients and families, but their growing incidence also adds tremendous costs for health care providers and the government.