Let's talk about health: India's future at stake

Whatever one thinks of the specifics about this year’s Union Budget, there is one issue on which there is consensus. It has made health a topic of national conversation.

Given that this is the Narendra Modi government’s last full-fledged Budget before next year’s general election, it is obviously politically-loaded. It comes as no surprise that Modi supporters, critics, and ruling party and Opposition talking heads are sparring with each other in newspaper columns and television studios on the merits and demerits of Modicare and other health-related proposals.

While one has reservations about some of the proposals, as someone who has been tracking global and national debates on healthcare for decades, I am thrilled we have finally elevated health to a key  political issue. Let state governments, who will play a major role  in execution, also wade in. Let the fireworks begin.

Look at other major economies — the United States and Britain, to name just two. Battles over health policies dominate their national discourse. Tens of thousands march on the streets to make their voice heard. This week, Twitter is buzzing with comments about the online exchanges between US President Donald Trump and UK health secretary Jeremy Hunt about Britain’s famous publicly-funded national healthcare system, the NHS. In his trademark style, Mr Trump recently tweeted: “The Democrats are pushing for Universal Healthcare while thousands of people are  marching in the UK because their U system is going broke and not working. Dems want to greatly raise taxes for really bad and nonpersonal medical care. No thanks.”

Even a Conservative government in Britain felt compelled to retort. British PM Theresa May was not amused by Mr Trump’s comments on the NHS. And the UK health secretary testily noted: “I may disagree with claims made on that march but not ONE of them wants to live in a system where 28m (million) people have no cover. NHS may have challenges but I’m proud to be from the country that invented universal coverage — where all get care no matter the size of their bank balance.”

I don’t see Mr Modi or health minister J.P. Nadda jousting with world leaders about healthcare anytime soon. But health is now on the policy high table, and we should seize the moment. If the Modi government is making “Modicare” one of the key pieces of its political campaign rhetoric in the run-up to the general election, nothing prevents us from continuously tracking the  finances and implementation architecture, and pushing the ruling party and the Opposition towards a system that ensures that whether you live or die, stay sick or healthy doesn’t depend on the size of your wallet.

India has been the outlier among major economies so far as healthcare is concerned. Despite impressive economic growth in recent decades, it spends a measly amount (about one per cent of GDP) on health. This despite the fact that the vast majority of this country are forced to pay for medical care out of their pockets, and millions go bankrupt in the process. Even middle-class people live in perennial fear of falling sick as insurance doesn’t pay for everything, specially not medicines, which comprise a huge chunk of out-of-pocket expenditure on healthcare. Most bureaucrats and politicians don’t have to worry — the government takes care of their medical expenses.

So why have not we, the aam aadmi/aurat, been banging our fists about it? Blame it on our passivity when it comes to the  real issues.

The showpiece of the Modi government’s health-related plans — National Health Prot-ection Scheme (NHPS) — will at best provide partial relief to the poor struggling with high healthcare costs. As pointed out by several other commentators, the proposed health insurance scheme for 500 million poor and vulnerable Indians, which finance minister Arun Jaitley called the “world’s biggest government-fun-ded healthcare scheme” may be a big bonanza for the healthcare industry but won’t help ordinary Indians weighed down by out-of-pocket medical expenses which don’t entail hospitalisation.

I have nothing against the healthcare industry. But right now what we have is an unregulated private healthcare indu-stry. J.V. Prasada Rao, a former Union health secretary, says he has seen incidents where pati-ents who walked into a private hospital with normal ailments were put on saline drip immediately, without any real diagnosis. Many private hospitals do that, as we know.

If we want the healthcare industry to be a part of the health reforms story, there must be greater accountability and strengthening of the public health system. The main focus should be on the foundation: primary healthcare.

The Union Budget talks about upgrading some 150,000 sub-centres to “health and wellness centres” which will provide comprehensive healthcare  at the primary level. This sounds swish. But as a recent report by the Centre for Budget and Governance Accountability pointed out, where will the manpower come from?  Some telling indicators, culled from the report — about 6.371 sub-centres are functioning without auxiliary nurses and midwives; even if the posts have been sanctioned, many are lying vacant.

With Modicare emerging as a critical political issue, we are also witnessing a debate about the benefits or otherwise of an insurance-based model. The fact is that even in states that have government-supported health insurance schemes, out-of-pocket expenses haven’t gone down. Even in the United States, where healthcare is a corrosively polarising issue, polling has seen increased support for a single-payer, government-run healthcare, although it remains a contentious issue largely opposed by Republicans and supported by Democrats.

Mr Prasada Rao, who worked with the United Nations for years after his stint as Union health secretary, points to models nearer home, in countries like Thailand and Sri Lanka, which have achieved universal health coverage through an excellent primary health infrastructure and provision of referrals to secondary and tertiary care in cases of need.  

Now that we have the opportunity, it would be silly to rest till we get a good deal — universal access to health coverage — irrespective of who is voted to power.