20 Jul 2018 06:29am IST
Preparations for the 2019 elections are in top gear. Various schemes are scheduled for launch on August 15, and a Government of India (GoI) leaflet “Transforming India”, listing the governments’ achievements under eleven headings has been distributed.
The first “achievement” of “putting farmers first” includes the recent Minimum Support Price (MSP) scheme. This appears to convey some sort of guarantee to farmers like the promised “doubling their income”. The Commission of Agriculture Costs and Prices (CACP) has cost the production of various crops and declared an MSP as a percentage above that cost. For example paddy gets a 50.09% hike over the cost of production; bajra gets a 96.67% hike. Such simplistic solutions promise more than they can deliver. The cost of production has not been assessed on comprehensive costs (C2) as demanded by farmers’ organisations. Costs vary in different parts of the country, and leading agriculturalists have stated that the MSP should have been C2+50%. Furthermore the measures do not address the core issues of food supply, namely procurement and storage.
The Shanta Kumar Committee reported that only 6% of all farmers approach the procurement agency, preferring instead to go directly to the open market. Undoubtedly procurement agencies serve an important function of food security of the poor through the Public Distribution System (PDS), mid-day meals, etc. But all of us will recall the horrific pictures of grain rotting in the open exposed to the elements because of inadequate storage facilities. Besides, the MSP system may violate World Trade Organisation (WTO) rules. All this could have been avoided by adopting a version of the Rythu Bandhu scheme from Telengana which pays the farmer Rs 4,000 for every acre cultivated before every crop season after assessing prevailing costs.
There were self-congratulatory drumbeats over World Bank rankings which put India ahead of France in GDP; ignoring World Bank data that also says our per capita income at $1,820 ranks 144th in the world, below Bhutan, Switzerland and Sri Lanka. France by comparison stands at $37,970. Even on a Purchasing Power Parity based comparison, we rank 123. We need more of the promised jobs, more women at work and a better work culture in terms of productivity; not pipe dreams.
As for Goods and Services Tax (GST), it is a text-book case study of the need for adequate preparation when introducing major changes. There have been more than 300 clarifications on various issues in one year till June 2018; with a further 46 proposed amendments waiting. About 80 countries have GST; of these. 49 have a single rate, 28 use two rates and 4 have four rates. We have five slabs. The PM’s view that milk and Mercedes cannot have the same rate does have merit. But matters could have been simplified by having a zero rate for essential items for the low income groups, a second slab for the middle income group and a high rate for the super luxury items. Keeping in mind of course, that things like televisions, refrigerators and gas cookers are no longer considered “luxury” items. At present sectors like banking and housing are being encouraged to ensure universal coverage, yet hit hard by the GST.
The leaflet also lists the Ayushman Bharat insurance scheme as the “world’s largest initiative to cover 50 crore villages”. Years of neglect of healthcare cannot possibly be papered over by cowboy insurance schemes. Government services in primary healthcare remain abysmal, and the private sector fills the void. As a result, of the world’s 100 million people pushed into poverty by out of pocket health care costs, 49% are Indian. And now the government seeks to shove the responsibility onto insurance companies. Like corporate hospitals, these work for profit; no insurance company will take over the government’s responsibilities and incur losses. Hence the failure of all previous schemes.
The National Health Protection Mission which spawned the scheme will be faced with a conflict of interest wherein the insurance companies have a vested interest in reducing payouts and the government in increasing them. Cutting down on irrational profit margins on stents and other implants was long overdue. But the government then went further and drew up an unrealistic schedule of hospital charges for various procedures. Cesarean section was pegged at Rs 9,000, Laparoscopic gall bladder surgery Rs 15,000 and so on. Complications and unforeseen events were not catered for and the price caps are predicted to result in manipulation of bills leaving the patient out of pocket and back to square one. The rates were decided without any consultations with the very same private sector that is expected to provide these services. Following protests and prolonged discussions with the IMA, a compromise was reached with a commitment to review the rates based on costing, etc, at regular intervals. This will end up as yet another “jumla” once the elections are over and the scheme will be scrapped like others before it. The government must pay attention to primary health care and ensure it reaches all parts of the country and all communities.
Now to matters the leaflet remains silent on. An Union minister garlanded 8 men convicted for cow vigilantism; a day later another minister greeted VHP and Bajrang Dal workers arrested for communal violence. And before that two JK ministers joined a protest against the arrest of the accused in the Kathua rape. Any wonder that society has degenerated to brutally lynching 27 innocent people on the basis of fake WhatsApp messages. Is there a connection? Is this a trial run for the shape of things to come? One shudders at the possibility.
The SC in a judgment related to informed consent by patients stated “The patient may be uneducated, that does not mean he is unintelligent”. Political parties would do well to keep that in mind for voters too.
(The author is a founder member of the Voluntary Health Association of Goa)