As the Budget presented by Finance Minister Arun Jaitley on February 1 was the last full-fledged budget to be presented by the Narendra Modi government whose term would be over in mid-2019, it evoked considerable political interest. The people expected a lot from the government but, as usual, they got promises in abundance.
“FM prescribes Modicare for Bharat” was the headline in a pink paper, considered the voice of trade and industry in the country. The headline writer would have recalled the medical health insurance President Barack Obama had introduced, which is widely known as Obamacare while giving a catchy headline.
Is “Modicare” something that will benefit 50 crore people as Jaitley claims? The budget papers are silent on how the scheme would work. What could be gathered is that the insurance policy would cover major diseases up to Rs 5 lakh. This means a person who suffers from, say, cancer can get treatment worth Rs 5 lakh in a year.
Can the Indian poor take advantage of this policy? Where are the hospitals which can provide the services? Do the poor have the capacity to make use of the policy and get benefits. What is the amount earmarked for the policy? Is it not less than Rs 2,000 crore? Yes, there will be a health cess which will bring some more money. The state governments are also expected to chip in. So the total amount available would not be more than Rs 8000 crore, as calculated by Swaminathan A Aiyar. He calls it peanuts!
Jaitely also talked about setting up or strengthening 1.5 lakh hospitals, dispensaries etc. Now, let us compare the expenditure with other projects. A decade ago, the New Delhi airport was rebuilt. The contract was for more than Rs 10,000 crore. At the present rate, it would be worth Rs 40,000 crore. The finance minister made a special allocation of Rs 4,469.50 crore to buy two aircraft for the exclusive use of the Prime Minister and the President. It is more than double the amount earmarked for the insurance scheme expected to benefit 50 crore people.
Public health is a long neglected subject in India. The UPA government promised to increase the spending on health to 4 per cent of the GDP. That target was never achieved. Today the spending has fallen below 2 per cent. Neighbouring countries like Sri Lanka and Bangladesh spend more money on public health. Cuba has proved that a country need not be rich to provide the best healthcare to its people.
What a person living in a city or a village needs is access to a hospital or dispensary where he gets care, either free or at affordable cost. People do not realise that in India maximum medical services are provided not by the doctors but by those dispensing medicine. When a poor man has cough or high temperature or body pain, he cannot afford to visit a doctor who would charge as consultation fee an amount which would be twice or thrice the money he earns as his daily wage.
There is also no guarantee that the doctor would prescribe medicine. He would list a series of tests the patient would have to undergo before he can prescribe any medicines. So, what he does is that he goes straight to a medical store where he would tell the store owner his problem. He consumes whatever medicine he sells him across the counter without prescription and without receipt. The medicine may work or make the illness more complicated.
If he is lucky he survives, otherwise he dies. One of the main reasons for rural and urban pauperisation is illness. There are millions of cases in which persons who are not well spend all their money on treatment and in the end they die leaving their relatives with unpaid and un-payable bills.
I had a colleague who underwent a heart surgery in Delhi. He was part of a group insurance policy. He was forced to pay the hospital bill which was more than a lakh of rupees. When he submitted the bill to the insurance company for payment, they said the hospital should provide the bills in a certain, prescribed manner.
He was forced to run from pillar to post and it appeared that he would not get any money. That is when we intervened. I sent one of our executives to meet the hospital management and told them that it was their responsibility to provide the bills in the manner the insurance company wanted. To cut the story short, my colleague finally got the payment.
How many poor people in India would have the services of a person like our executive to follow up on such claims? On January 21, 2018, I attended a seminar on medical insurance organised by the Asean Institute of Insurance and Risk Management and Jamia Hamdard. A young lady who spoke good English stood up and told the august gathering that she had not heard about medical insurance and she did not even know who provided the same.
If that is the case, how are the common people to benefit from the grand insurance scheme? It is not the first time that mega health insurance schemes are announced. There was one where the maximum benefit was limited to Rs 25,000. The premium was a nominal sum. At that time the Chandigarh administration made a claim that everyone in the city was insured. An amount was paid to a general insurance company. That is where the matter ended. I checked and found that nobody could avail of the benefits of the policy. Why? Because they did not even know how it operated.
Around the same time, I had a visitor who was in charge of a hospital in Kerala. He told me how a large number of poor people availed of the benefits of the insurance scheme. He was a great votary of the scheme which failed everywhere else. Why did it succeed in Kerala? This was because, the people there were more educated, knew how to get the benefits from it and there were agencies and persons like my friend who provided knowledge and support to such patients.
What India needs is strengthening of the government hospital system. There should be as many dispensaries and hospitals as possible all over the country. While super-speciality hospitals like AIIMS are welcome, it is small hospitals and dispensaries which are urgently required. Alas, this government is more interested in setting up AIIMS-like institutions.
Unfortunately, the government relies on the private sector to fill the gaps in public health. Let it be clear, the private sector would never be able to meet the needs of the poor. Healthcare is expensive and the private sector is profit-driven. I know a private hospital in Gurgaon where the first thing given to a patient on admission is three remote devices.
One is to choose the television channels, the other to control the room temperature and the third one is to control the bed which is divided into three portions each of which can be raised or lowered to suit the patient’s convenience.
Small wonder, medical tourism has been gathering steam. A poor patient does not need any of these remotes. He needs a clean bed, medicines and proper care by the doctors, nurses and other supporting staff. The insurance Jaitley promises will simply not work. Let it be clear, the government cannot shy away from its responsibility to provide free healthcare to the needy.
Modi loves to travel a lot, especially to Western countries. Why does he not travel to Canada or Australia or Cuba or China to find out how the poor there get treatment free of cost. Why is he interested only in the US model? I remember Obama making a statement that he felt sad when he heard that a person was re-using the needle to inject insulin into his body. That was a measure of poverty for Obama. I re-use the needle till the pain turns severe.
India competes with China in many sectors. Such competitions are fine. But why can’t India compete with China in healthcare and education where it is far, far ahead of India? This requires prioritisation. Not the type where the government earmarks Rs 10,000 crore to build a statue of Sardar Patel, which would be bigger than the Statue of Liberty. What Modi does not know is that while the Statue of Liberty was donated by the people of Paris, it was erected with the money the New Yorkers contributed in response to an appeal made by newspaper editor George Pulitzer. The government did not spend any money on the statue project.
Building toilets continues to be Modi’s obsession. True, lakhs of new toilets were built. Are they being used? Does the government know that a majority of them are not usable? I need to tell the government one small thing. If four persons use a toilet which does not have water supply, the fifth person would find it impossible to use it. That is what a lady belonging to Sulabh International told a conference the other day.
She said her organisation used to charge a small user fee from those using the toilets it ran in the slum areas of Delhi. Sulabh has been prevented from charging any fees. As a result, there is no one to keep the toilets clean. They have become dirty and are not usable by those who cannot sit on shit and add to the shit. A country like Afghanistan has a larger percentage of people using toilets than India. Since we aspire to be like China, let it be mentioned that nearly 100 per cent people use toilets there. So what is the solution to the problem?
The solution lies in spreading education. An educated person knows the value of toilets and would not like to defecate in the open. Alas, this government has been reducing the allocation for education. Again, it expects the private sector to step in and provide education. Even in the Mecca of Capitalism, i.e., the US, the state plays a major role in the education sector.
In India, the Central and state governments are no longer investing in schools. No new schools are being built. Jaitley says he would build Ekalavya Schools for the Adivasi students. Why the name Ekalavya, who was not allowed anywhere near the school system prevalent at that time forcing him to build a statue of the teacher and learn the art of archery himself? Be that as it may, the point to be made is that a person who is educated is a better citizen.
The government, instead, wants to improve the skills of the people. Yes, skills need to be improved in a country where the only tools an electrician carries with him is a tester. However, more important is education. KR Narayanan would not have become the President of India if he was encouraged to improve the traditional skill he inherited. Or, take the case of Dr BR Ambedkar. He, too, would not have become the father of the Constitution if he was given only skill training.
I know for sure that the figures of skill development are all fudged. Let the government continue its Skill India Mission. Let it also improve the quality of school education. Today government schools are known only for the mid-day meal they serve. No teaching worth the name takes place there. ASER reports have been consistently pointing out that a majority of the children in Class V are unable to read the textbooks of Classes I and II. How can such children cope with the pressures when they move to higher classes? They, finally, leave the schools without learning anything.
We often talk about demographic dividend but we forget the fact that we have the largest number of unemployable people. We need more classrooms, laboratories, computers and better teaching in schools than bullet trains between Ahmedabad and Gujarat. The Budget is very clear that the President’s salary would be increased to Rs 5 lakh per month but there is no such clarity when it comes to the support prices to be given to the farmers. It says the support price would be 150 per cent of the cost price.
In short, the Budget is like the speeches of Modi, which are full of words, with little substance. There was a time when his words could move mountains and win elections. The drubbing his party received in Rajasthan the day the Budget was presented shows that the people have stopped listening to him. This Budget is aimed at the voters who may even be asked to judge Modi earlier than they are supposed to. Except for the corporates, whose tax rates have been cut, the Budget does not instil confidence among the ordinary people like you and I.(Published on 05th February 2018, Volume XXX, Issue 06)