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ON Sunday, PM Modi formally announced the launch of an audacious experiment in near-universal healthcare — Ayushman Bharat — that promises to provide free health insurance to 50 crore Indians. This scheme consists of two parts. The first is revamping the decrepit primary health centres, and the more ambitious second strand is free health insurance for the poor. The flag-off by PM Modi gave no indication about Ayushman Bharat being a bigger social safety net programme than Obamacare. Only 10 of the 1.50 lakh wellness centres were declared open while many of the liaison officers in 10,000 identified hospitals will have to wait till funds and treatment packages are finalised.
The blips have already appeared. Some states with schemes of their own suspect PM Modi of trying to steal the electoral thunder. Hence Odisha with its Biju Swasthya Kalyan Yojna has already backed out. Private hospitals have raised the flag on meagre compensation packages, for instance Rs 9,000 for a caesarean is not remunerative. The biggest issue is funds. For a government fussing with current account deficit, will it be able to provide 2.5 per cent of the GDP when the programme is in full bloom? The biggest fear is that a half-baked scheme will undermine whatever healthcare system that exists.
Ayushman Bharat will also have to grapple with the difficulty of identifying the beneficiaries. At a time when even the top 10 per cent is railing against reservation, it is not too difficult to guess the reaction of 60 per cent of the population that will be asked to fend on its own. Private hospitals who will shoulder the bulk of the in-patient scheme already face a trust deficit because of instances of fleecing. Can they be trusted and persuaded to walk the narrow path of ethics and morality? The phased rollout indicates that the government may have learnt its lessons from the trajectory of its demonetisation and GST initiatives. But the loose ends trigger a feeling of deja vu. A considerable distance remains before Ayushman Bharat evolves from being just a grand but tokenist populist gesture to a useful social safety net.
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