I am reading An Uncertain Glory by Amartya Sen and Jean Dreze. I first read some excerpts in a magazine. The fact that these eminent authors said what I have been clamouring for years was somewhat comforting. I am stilling reading the book as it is not an easy read for me who is a greenhorn in Economics. However I would like to quote to comments that jumped at me as I was skimmed through the book. What makes these quotes interesting is that I can put them in a context I have experienced.
The first quote is about health. It says: the commitment to universal health coverage would require a major transformation in Indian health care in at least two respects. The first is to stop believing against all empirical evidence that India’s transition from poor health to good health could easily be achieved through private health care and insurance. Two real life incidents have just occurred in my life and they cover the present scenario of health in our times. When husband was diagnosed of cancer it was a blow to all of us. Our family’s health issues have till date been dealt with by our family Doc who is all our specialists rolled in one! But this was a big one because biopsies and then chemo was involved and needed specialised care. Doc P, as I affectionately call him gave us the names of a specialist and we managed the first testings ‘in house’. The bills were steep but still doable. But then I realised that this was not a 100m sprint but a marathon and had to tiptoe into the much heralded insurance panacea. Thankfully my husband has an Insurance from the PSU he worked in for more than 3 decades. It is not a cashless card but a perfect example of the maxim: why make it simple when you can make it complicated. For every consultation, test, investigation, surgery, medicine someone has to make a trip to the airport, wait for hours and then get a printed piece of paper with a carbon copy attached. Now the paper is valid for 3 days only and if for someone reason, like a low blood count, your chemo is postponed as may be the case tomorrow, then someone has to make the trip to the airport to get a new paper. I cannot begin the count how many trips poor Mamaji has already made and how many more he will have to!
But now let us talk about the famous insurance + private care which is suppose, according to the powers that be, to solve India’s health problems. I do not know how the medical insurance for the poor (RSBY) works. I understand it does for BPL families but then we fall into the whole saga of who is BPL and whether the poorest of the poor have the knowledge, accessibility and targets all the beneficiaries. Or will it, like many other projects that begin well, wither away from neglect. The people covered seem far and few. What it gives is 30 000 Rs for hospitalisation! I can tell you from first hand experience that none of the BPL and lower families we work with have access to this scheme. Do have a look at the success stories page of the official website of the scheme!
Medical Insurance is for hospitalisation, be you rich or poor. All other health issues are covered either by the state run dispensaries and hospitals which can be excellent but are overcrowded and you could die waiting for your turn. One of our kids needed a brain surgery. We went to the prime medical institute in India (AIIMS) and were told of two options: one where we needed to pay and one free. We chose the first one and got a date 6 months later. The child passed away before his turn came.
But health is not only hospitalisation. There are some who would never need to be hospitalised and yet need health care. The rich have a wide choice of good doctors and specialists and go there even if the fees increase exponentially. The poor have quacks some better than others, often recycled compounders who have open shop as doctors. One has to say they are able to deal with every day issues having watched their erstwhile employers for long. Some of these quack-cum-doctor even give medicine! One wonders how good they are when one knows the price of medicines in India. Oops I forgot, just like with education, a certain number of beds are reserved – how we love reservation – for BPL card holders in swanky hospitals, but then how many people does that cover!
The one field that is totally neglected is that of social and preventive health. A sound preventive health programme could being the health bill down and make a huge difference in the lives of many, even avoiding unnecessary deaths. Access to clean water, hygiene campaigns, importance of washing hands, storing food etc could rid us of many ailments that proliferate across the land.
Insurance is a money maker for big players and not the means of transition from poor to good health.
The other quote from An uncertain Glory is about education, my pet subject and bete noire. The authors state: Perhaps the most hidden penalty of greater reliance on private schools is that it tends to take away from state schools the children of precisely those parents who are likely to contribute most to the critiques and demands that could make state schools more responsible and accountable. (An Uncertain Glory Amartya Sen – Jean Dreze) says exactly what I have been saying for years. The death knell of state run schools rang the day education became a business with the entry of private stakeholders. If you stole a glance at the CVs of most of our senior bureaucrats and other professionals of above a certain age you will find that they have all been educated in state run schools. Government schools were at one time the only choice you had. Other than that, for the elite, they were boarding schools that had been set up by the British for their children and somehow continued with Indian children replacing the fairer ones.
If you look around you in our very city, you will see at least one Government school at walking distance from your home. They are all on prime land. It is another matter that they are dilapidated, often shacks with tin roofs and sometimes just a tent in the middle of a large plot of land. Some schools have good buildings and still impart sound education. These are the ones located in colonies that still send their kids to state run schools. I do not when, but it was a sad moment for education, greed took over and the privatisation saga began. Government run schools were neglected and all shades and hues of English Medium schools began mushrooming everywhere. Slowly, even lower middle class parents were seduced by this new motley crew that offers education @ of 300 rs per month to 10 000 rs per month! The magic words are ‘English Medium’, even if no one speaks English in the entire staff. This is not baloney but something I experienced in a school a few years ago.
Government schools today, particularly those that are located near slums and resettlement colonies where most parents are illiterate or at best semi literate and in awe of authorities and unaware of their rights, run almost amok. Overcrowded classes, no facilities, corporal punishment, teacher absenteeism and more as they know that the parents of the children can never be a pressure group and hold them responsible. This is something I have written about time and again.
In my humble opinion privatising education and reserving a few seats in swanky school that anyway are usurped by clever middle class parents is never going to give a fair Right to Education to every child. What is needed are good quality neighbourhood schools, run by the State with a mixed social profile of kids. But then the question is: will you accept your driver’s kid sharing a bench with your child!
