Reality of ambitious 'Modicare': Foolhardy at best, dishonest at worst

It is increasingly becoming clear that the mega health scheme announced with much fanfare in the Union Budget 2018-19 is based on not one but multiple misplaced premise. With more details out on the scheme, this has become clearer than before.

The government has disclosed that the National Health Protection Scheme (NHPS) – that promises a health cover worth Rs 5 lakh per family per year for ten crore families – will require funding to the tune of Rs 10,000 crore.

In this, the centre has kept it at 60%, while it wants state governments to provide the rest of the amount. States would merely be given the option of merging their own schemes with NHPS or provide parallel funding for it.

The scheme is nowhere even close to the ideal of universal health care and many problems can be detected merely by looking at the announcements.

1. Faulty approach - First of all, the inherent approach to healthcare in the scheme is faulty. The scheme shows the government's priority area is secondary and tertiary care in large privately run hospitals. The crying need of the health sector is the opposite – a well-funded, large and efficient public health infrastructure.

The annual outlay of Rs 10,000 crore that the government wants to set aside for this scheme can instead be used to fund the shortage of health centres at the level of villages, districts and urban neighbourhoods across the country.

What this scheme will do is to ensure a ready market for private players in the sector, who will charge the government a lofty premium. Public money will be used to serve private interests, with no guarantee of quality healthcare for the poor, at affordable rates (https://thewire.in/220070/poor-will-not-true-beneficiaries-worlds-largest-health-programme/).

2. Inadequate allocation – Even if one comes around to accept the premise, the allocation envisaged appears woefully inadequate. The government has estimated that the scheme will entail an annual premium of Rs 1,000 to 1,200 per family.

This doesn't sound realistic. The currently running central healthcare scheme, the Rashtriya Swasthya Beema Yojana (RSBY), promises health coverage of Rs 30,000 per family at a premium of Rs 500. Can coverage be hiked over 10 times by merely doubling the premium?

3. Violation of federal principles – State governments, which are supposed to bear 40% of the cost of running this scheme, have not even been consulted before announcing their commitment. This is violation of federal principles and misuse of power by the Union government.

State governments must have been consulted before imposing such a huge fiscal burden on them. A large number of state governments run their own healthcare schemes. Why should they be expected to subsume their schemes or provide extra funds for a new scheme? How state governments respond when consultations begin will be a major obstacle.

4. Dishonesty of time-line – NITI Aayog officials have reportedly said that the scheme may get Cabinet approval by March, stakeholder consultations should begin soon thereafter, work on tenders is likely to happen in July and a partial launch can be expected by Gandhi Jayanti, 2 October, 2018. 

Full launch of the scheme is at least one and a half years away and by then this government would have already ended its tenure. Who knows who will come to power next? What is the guarantee that the next government will uphold schemes launched by its predecessor?

It is for these reasons that the scheme is being panned from multiple quarters. When the discussion on the budget in Parliament begins, Opposition parties are quite likely to expose the scheme and demand that money be better spent.