25/11/2016 11:58 AM IST | Updated 28/11/2016 9:47 AM IST

Why Only A More Poor-Friendly Budget 2017 Can Help BJP Save Face Post Demonetisation

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Being poor in India is a strange phenomenon. By sheer numbers one actually belongs to the majority, but by how the country runs, one is anywhere between completely neglected and transiently acknowledged. Even the middle class—by which I mean people with regular salaried jobs and all kinds of insurance—suffers from desensitisation when it comes to the poor. This desensitisation has been on full display post-demonetisation.

For India's hundreds of millions of underprivileged, demonetisation is NOT "a little inconvenience": it is more like a government-mediated nadir in the course of their lifelong consistent suffering.

BJP politicians and their supporters have been mercilessly downplaying serious reports of the decision's adverse fallout. They say this is only "a minor inconvenience" to citizens, "just for a short time", and that it is all for the "benefit of the nation". What they conveniently forget is that India's poor have actually faced a lot of inconvenience, all the time, even as the rest of the nation marched ahead with benefits. So asking them (forcing them?) to face "a little more", that too for highly uncertain and vague benefits, is enormously insensitive. Reports of poor planning and mismanagement are daily exposing this insensitivity. An unhealthy penchant for theatrics made the government completely ignore that well-thought-out policies matter more than dramatic but ineffectual "masterstrokes".

In the huge compound of the government hospital where I spent my formative years, poverty was more prevalent than disease, and suffering more prevalent than physical pain. Destitution was a recurring tragic soap opera, with scenes at times of half-naked abandoned patients unwilling to get discharged, and at other times of attendants of patients sleeping in the open air come rain or cold. At any given moment, millions of India's poor are in similar situations all over the nation's notorious sarkari hospitals. We all agree these people are perpetually and gigantically "inconvenienced", but we rarely wonder why they live with it.

It's because, just like with demonetisation, the nation leaves them with no other choice. We let government hospitals crumble, and force our poor to go to those, ostensibly for the "greater benefit of the nation". Because the money that our government could and should be spending (and that we as responsible citizens should be pushing it to spend) on staffing and upgrading and restocking and maintaining these hospitals is being spent elsewhere for the country's supposed development—which, as we can see, mostly excludes the poor. On the other hand, the government provides top-class health facilities to ministers, MPs, and central government employees through the CGHS scheme — using citizens' own tax money! To add insult to injury, the NITI Aayog, chaired by the Prime Minister himself, even wishes to "outsource" primary healthcare — the most important aspect of a nation's health system — to private doctors. There is thus no discernible desire in the government to first itself build a robust public health system, even when the notorious resistance of healthcare to private market rules is well-known. We have naively begun chasing "Cashless India" and "Digital India" before ensuring something even as fundamental as "Healthy India".

In the 2016 budget, the allocation to the Ministry of Health was just 1.92%, nine times less than the Defence Ministry's 17.24%. The government spends on average ₹5000 per year on every person covered under CGHS (who are a few lakh), while the average public spending for the health of all Indians (who are some sava-sau karod, to use our PM's phrase) is about a fifth of that. A lot of it goes not to hospital upgradations and patient welfare directly, but to salaries of health sector employees. While the rest of India marched ahead and started availing stable health insurance benefits, our poor were stranded in sarkari hospitals with weak government schemes and erratic supplies of medicines and doctors. While our employers started paying most of our hospital bills, the poor were left miserably paying out-of-pocket ("catastrophic health expenditures"). While we began sitting in AC waiting rooms for medical appointments, our poor continued waiting and sweating in long and often rowdy queues.

Come Budget 2017, the government either can set India on the path to universal health coverage, or open itself to the inescapable criticism of being elitist and anti-poor.

Thus, for India's hundreds of millions of underprivileged who have more or less been inconvenienced all their lives, demonetisation is NOT "a little inconvenience": it is more like a government-mediated nadir in the course of their lifelong consistent suffering. It was made worse still by how both the government and its supporters derided their genuine problems. But all is perhaps not lost. Though the BJP might feel it can well face this crisis through its time-tested methods of online and media propaganda, it will actually have to do a lot more concrete, and real, work this time.

Like going back to social welfare basics, and taking the much-required initial steps towards universal health coverage (UHC). UHC is the only sustainable cure to ensure that a country's poor do not suffer financial shocks through healthcare expenses. Besides, no gargantuan investment is required for the initial UHC implementation, since as public health experts have been urging for years, we need to make the implementation gradual and sustained, and begin via pilot UHC projects in every state. This wouldn't be too costly, especially for a government with considerably expanded "remonetised" coffers now. Importantly, it could spawn rich political dividends in terms of softening the demonetisation fury of India's rural and urban poor. For them, a lifelong protection from catastrophic health expenses — which pushes 63 million people below the poverty line each year — will be a much-needed and -deserved relief that can potentially eclipse the misery of the cash crunch period.

Come Budget 2017, the government either can set India on the path to UHC, or can open itself once again to the inescapable criticism of being elitist and anti-poor.

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