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States unprepared for Modi Health Insurance Scheme
By Lalit Sethi. Dated: 9/14/2018 12:09:49 PM
Is it customary for governments of all hues to make tall promises that on the face of it appear to be too hard to implement? Prime Minister Modi has announced nearly full health insurance for half a billion Indians or100 million families to be provided from September 25 this year, the birth anniversary of Deen Dayal Upadhyaya. But almost all 29 States are unprepared to roll out the programme or pay 40 per cent of the costs, with 60 per cent provided by the Centre. Even BJP-ruled States do not have too many hospitals and doctors to meet the Prime Minister's requirements. Half a dozen States have rejected the plan as they claim that they are implementing their own health care.
Mr. Modi's government is negotiating health insurance policies with private and public sector insurance companies, including Life Insurance Corporation, which has deep pockets; and LIC may be able to lend a lot of money to the government on a long-term basis. But will private companies not insist on advance payment of premium before issuing health insurance policies?
Is the programme too grandiose in its concept and too difficult to implement to show some results in the next six months as India will elect a new Lok Sabha in April and May next year.
At the same time, Arvind Kejriwal, Chief Minister of Delhi, has started 40 mohalla clinics and started delivering documents and providing 40 public services at the people's doorstep so that people do not have to stand in queues at windows of government offices, but they have just to telephone a number, 1076.
These services include caste, domicile, income and marriage registration certificates, driving licences, vehicle licences, identity papers, old age pensions for the poor widows, transport and revenue department appointments and food and civil supplies to the needy. The Hindustan Times reports that on September 10, 125,000 calls were answered on the first day of the scheme. Kejriwal plans to expand the doorstep delivery scheme to 100 public services and increase telephone lines of the 1076 number to 100 to try and provide as full coverage to the people as possible. Applications will be collected from people's homes and the required papers or licences will be delivered by post within a stipulated time. Mail Today has reported that one of the 11 districts of Delhi had some chaos as people were unaware that they could ask for certain services by telephone.
The Modi health care insurance scheme will be largely dependent on private hospitals and they will be reimbursed by the insurance companies. But are there a sufficient number of private hospitals all over the country, including metropolitan cities, to carry out surgeries and admit seriously ill patients needing hospital care? Will it be possible to build new hospitals within a year or two and provide at least a million beds to serve many of the half a billion insured patients, poor or not so poor? At times, those who can pay the hospital a deposit in advance do not easily find a hospital bed.
Every private hospital, which received land cheap from the government, is expected to treat poor patients free of charge, but not one such hospital is able to offer free or subsidized treatment to even 2 per cent of patients in need of crisis management. Government hospitals do indeed offer free or almost free treatment, but their capacity is limited and cannot be expected to serve even five or 10 per cent of all of the half a billion new beneficiaries.
So, is it possible that the Prime Minister will be able to roll out the Modi health care plan this month and come out flying colours by the end of March 2019 before the General Election to the Lok Sabha next year? It is a tall order.
If his scheme shows some results, it would be a miracle and he will deserve much praise and approbation, but the ground realities appear to be far from feasible. Mr. Modi will expect the private enterprises, especially big companies to provide near total health care to millions of their employees, but whether this will happen is difficult to surmise. Already, the government as well as companies employ a large pool of contract labour, which has no entitlements except casual work limited to a maximum of 300 days in a year. The 65-day breaks ensure that they never get a permanent job and benefits.
It is a fact that health insurance, based on Obama health care or Hillary care in the United States, is a huge recession free business, which can overcome an economic slide; the dimensions are very large to save a country from a big downturn in its fortunes. President Trump has cut down the benefits of Obama care and imposed additional initial burdens on citizens amounting to $500 to $1,500 on hospital bills, though top management people continue to enjoy 100 per cent health benefits from their corporate entities around the world, even in India.
It could be a trump card for Mr. Modi, but is it too late a start at the near end of his present term as Prime Minister? Should he have rolled it out a couple of years ago? Or did the planning and discussion take too much time?
But being firm on carrying out the Modi health care programme, the National Executive of the BJP has discussed behind closed doors how to deploy 10 million of the 100 million cadres the party has and RSS cadres to deliver health insurance policies to as many people as possible so that the party and the Prime Minister have something to show during the BJP election campaign he is already leading in Rajasthan, Madhya Pradesh and Chhattisgarh, which go to the polls before the end of the year.
It is true that Prime Minister Narendra Modi has delivered, or claims to have delivered to the poor people of Gujarat 100,000 small housing units in September this year. It may be true that if he is elected again next year, he hopes to release a million houses to some of the 1.3 billion Indians with a roof over their heads within ten years. He has the zeal to do things even though the bureaucracy at many levels and private contractors are far from producing results.
Modi's other signature schemes like 100 million zero balance bank accounts, deposits under Rural Jobs Guarantee Scheme and entitlements as wages or assistance to the very poor or cheap gas in cooking cylinders have been much praised and equally derided as poor housewives in small towns or villages have no money for refills for future use.
Farmer suicides continue and recent floods and drought have done much irreparable damage to crops, farms and housing. Revival of farming and reconstruction will require tens of thousands of crores of rupees, but the same cycle of drought and deluge could recur sooner than later.
Mild earthquakes are adding a new dimension to distress. When will South Asia get hit by a new trembler that will bring in new new levels of death and destruction? Disaster management and armed forces and public support to those who suffer may be substantial, besides government subsidies, but corruption saps much of the assistance money provided.
Lalit Sethi is a Journalist of long standing and a commentator on Political and Social Issues.