On February 1, 2018, the finance minister during his Budget speech declared, “I am pleased to announce two major initiatives as part of ‘Ayushman Bharat’… We will launch a flagship National Health Protection Scheme to cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries) providing coverage up to Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. This will be the world’s largest government funded healthcare programme. Adequate funds will be provided for smooth implementation of this programme.” The whole House applauded the initiative. However, when the Budget documents came in, there was no elucidation of how the announcement would be implemented. Even the amount that was earmarked for the project was only `2,000 crore. It all did not add up. How come such an ambitious programme had been announced in the Budget without a scheme to back it up? Then, as the day wore on, in the incessant cacophony of TV analysing the Budget to death, it emerged that a scheme had to be formulated as yet though some of the “babus” of the government, who also masquerade as spokespersons of the ruling dispensation, attempted to spin the embarrassment by claiming that some work ostensibly had been done on it.
A reputed financial journalist, M.K. Venu, tweeted a rough back-of-the-envelope calculation of the cost of the programme. He said and I quote, “Obamacare healthcare subsidies covering 26 million families was estimated to cost $42 billion in 2017. Modicare covering 100 million families allocates $300 million! Even assuming healthcare in India costs one-tenth of US, Centre will still need at least $15 billion a year!” Decoded and translated into Indian numbers it means that, Obamacare, a health insurance programme in the United States that President Donald Trump has desperately tried to repeal and has been unsuccessful so far and thank God for it for it is a good noble programme, in the year 2017 alone would roughly cost about Rs 3 lakh crore for covering 2.6 crore families. The Indian programme in the Budget, that would cover 10 crore families, has an allocation so far of only Rs 2,000 crore. Assuming that the healthcare costs in India are one-tenth of the US, the programme would still roughly cost about Rs 1 lakh crore to implement. The national convener of the Jan Swasthya Abhiyan, Dr Abhay Shukla, was quoted in a newspaper as saying: “If the allocation is meant for 50 crore people, then the premium works out to Rs 40 for each.”
After brouhaha for two days that the emperor announcement of the Budget does not seem to have any clothes, source-based reports quoting some unnamed officials appeared in newspapers suggesting that the health plan would be funded in the ratio of 60:40 between the Centre and states and may be rolled out nine months down the line, on October 2. Various guesstimates by various officials have pegged the quantum of funds required to implement the scheme at a ridiculously low number. However, the fundamental point remains that if the proposed health insurance plan was to be implemented in a federal-state paradigm, then were the states consulted before the announcement? Were they taken on board? States like Rajasthan, Karnataka, Andhra Pradesh and Tamil Nadu run their own medical insurance schemes. Are they and other states willing to give up their own schemes for a partnership with the Centre? If a Centre-state partnership was the template of the scheme, why was there no mention of it in the Budget speech?
Herein lies the problem with this government. Usually, when something as ambitious as this is conceived, there are intense consultations within the government and with other stakeholders. Approvals are taken, if required at the level of the Union Cabinet also, funds are earmarked and then a budgetary announcement is made. A classic example being the loan waiver scheme for farmers by the UPA government in 2008 that was announced by the then finance minister in his Budget speech. The Budget provided for the Rs 60,000 odd crore that were required to implement the announcement. This is not something unusual. This is the standard template of government functioning that is followed across the country and even the better part of the world. However, all these traditions and conventions have been consigned to oblivion by the current dispensation. Take the case of demonetisation that was announced on November 8, 2016, by the Prime Minister — a decision that in a span of couple of hours rendered 86 per cent of the legal tender redundant, plunged the nation into economic chaos, made every individual virtually penurious for his own money. Even two and a half years later it is not known whether the Cabinet approved the decision ex-facto or gave only post-facto clearance? Whether there was any substantive consultations within the government on the three benchmarks enumerated by the Prime Minister in his grandiloquent pronouncement to the nation, namely that it would unearth black money, proscribe fake currency or contain the financing of terror outlets? It took the Reserve Bank of India many months after repeated prodding to reveal how much of the demonetised currency was deposited back in the banks.
Finally when the figures came in, they told a very amusing tale that 98.96 per cent of the scrapped currency was re-deposited in the banks by the people of India. Therein also, the RBI, rather than being up-front about the single most painful economic measure, chose to bury the data in its annual report. Even then the bank chose to caveat its response in the following verbology “subject to future corrections based on verification process when completed”, the estimated value of the banned notes it “received” was Rs 15.28 lakh crore. This compared with the Rs 15.44 lakh crore of the banned notes that were in circulation as of November 8. The government is now trying to spread a canard that the Opposition is envious and therefore critical about the health insurance initiative. Nothing could be further from the truth. The only thing that the Opposition wants is that this “jumlaisation” of governance must cease forthwith. If you announce a measure, fund it properly. Walk the talk.