On Mohan Bhagwat's mann ki baat

Mohan Bhagwat, head of the Rashtriya Swayamsevak Sangh (RSS), hit the proverbial nail on the head when he noted that health and education are out of reach for ordinary Indians. Speaking earlier this month at the inauguration of an affordable cancer care facility in Indore, Bhagwat said: “Good healthcare and education facilities and all its schemes have become a necessity for every person in society today, but unfortunately, quality services in both sectors are beyond the reach and financial capacity of the common man.”

Coming from the head of the BJP’s ideological parent, some see this as veiled criticism of the development model being packaged and sold by the Narendra Modi-led BJP government. Without affordable education and health, the promise of ‘viksit Bharat’ is legless.

In this case, the RSS’s amplified voice under BJP rule serves to highlight a burning issue in India, felt in the bones by ordinary citizens. It is a plain fact that education is getting out of reach without necessarily getting better and health is a business increasingly spoken of in terms of investments, IPOs and incentives rather than patient care.

Some scandalous practices thrive in both sectors. For the privileged few who can afford them, India does have world-class facilities in health and education, so that we live with islands of global excellence in a sea of mediocrity, even misery.

It is not uncommon to view some professions or services as noble — education imparts learning to new generations of citizens and medicine heals the sick. Therefore, the aspiration is to keep these activities outside the arena of the market, safe from the dog-eat-dog dynamic that works in other sectors to give us what we call growth. In a way, Bhagwat echoed this when he said, “Earlier, (health and education) were done as a service, but today both have been commercialised.”

Counting on society to support these functions, to keep costs low or to broadly ‘de-marketise’ them without radical policy change is to ask for charity and hope for kindness in a society that has been overly marketised.

The right to vote and the fight to live

Academic and author Michael Sandel speaks of the distinction between a market economy and a market society: the former brings efficiency while the latter puts a price on everything, so there’s nothing that money cannot buy.

It is possible to argue that India has almost become a de jure market economy while de facto working as a market society. This is remarkably dissonant for a nation that has the word ‘socialist’ in the preamble to its Constitution. There is hardly anything the top 1 per cent cannot buy. This includes paying your way to safety, security and success. As only some can pay, the rest suffer. The lament and pain of inequality plays out in every field, but most visibly in hospitals and in schools.

In such a system, how do health insurance companies not collect their pound of flesh, how does a thriving industry in medical education survive without exorbitant fees and why should doctors or teachers settle for lower pay?

Like other professionals, doctors and teachers also need housing, travel, equipment, material and learning — all of which are overpriced and marketised. Sectoral charity will work only in part, and indeed some of India’s best hospitals and educational institutions are officially classified as charity institutions. But very few are truly charitable. Market imperatives rule and ensure that, over time, most ordinary Indians are excluded.

A reductionist approach that seeks to inject ideas of duty and responsibility, and calls for the opposite of money-mindedness selectively refuses to recognise that the ills are much wider.

The failing health and education sectors are symptomatic of a deeper malaise — an imagined growth story and a fantasised giant economy in love with numbers without purpose, a model that has ignored the needs of those on the lower rungs of the ladder in the quest to dazzle the upper echelons with fancy airports and bullet trains.

Putting people at the heart of economic policy

It is this approach that prompts Bhagwat to refer to Yogi Aditynath’s ‘trillion-dollar economy’, or the Niti Aayog to note (in a recent paper): ‘The healthcare sector has received heightened interest from investors (venture capital and private equity) over the last few years, with the transaction value increasing from USD 94 million (2011) to USD 1,275 million (2016)—a jump of over 13.5 times… A slew of investments by global health players… have strengthened the perception of India as an attractive healthcare investment destination.’

To stay on this path is to court disaster. No private equity or venture capital comes to serve. To get out of this trap, the government will have to rethink the purpose of the growth story.

India is the world’s fourth largest economy but what does that mean when, as a recent Oxfam report noted, the top 10 per cent of the Indian population holds more than 75 per cent of the total national wealth while the poorest half of the population sees only a 1 per cent increase in their wealth?

There are models around us that have worked wonders. Among them is the renowned Aravind Eye Care System. A network of eye-care facilities in India that does not spend a rupee on marketing its services but instead pours its resources into reaching the farthest and the weakest, taking a leaf out of Gandhi’s favourite book, Unto This Last, John Ruskin’s collection of four essays that argue economics, like art and science, must have a moral basis.

It takes a different kind of resolve to achieve that, a higher sense of purpose and humility, not the marketing hype and machismo that has become the currency of India today.

Views are personal

Jagdish Rattanani is a journalist and faculty member at SPJIMR. More of his writing may be found here

Article courtesy: The Billion Press