Modicare puts the sick in a dilemma

The proof of the pudding is in the eating. So, whether Ayushman Bharat, Modi’s ‘game changer initiative to serve the poor’ lives up to the expectation will be known only in due course of time. For a start, the launch was marked by less hype than what is normally associated with ‘Pradhan Mantri yojanas’, although the Pradhan Mantri Jan Aarogya Yojana is easily the biggest of Modi’s plans in its reach and size. The lack of fanfare could also be due to the fact that there was no surprise element in it as it was only the formal launch of a grand scheme that has already been debated threadbare.

On the face of it, the plan sounds impressive: the world’s largest government-funded healthcare programme covering over 50 crore beneficiaries. It will address the needs of 85.9 per cent of rural and 82 per cent of urban households which currently have no access to healthcare insurance. It will also provide relief to more than 24 per cent households in rural India and 18 per cent population in the urban areas, which are currently forced to borrow money from private lenders to fend for their medical expenses. As Modi claimed at the launch, the total number of beneficiaries from Ayushman Bharat is more than the population of America, Canada and Mexico combined.

But the plan has not been without its share of controversy. The Opposition-ruled states have already opted out because they probably have similar or better schemes in operation and do not want to share the credit with Modi. This apart, there are some basic fault lines in the very concept of the scheme. Experts have argued that since Ayushman Bharat only covers secondary and tertiary healthcare, it leaves out the requirements of a huge population that is in need of outpatient care, for which they don’t have the means. Modicare, as the new scheme has come to be known, only takes care of hospitalisation. The harsh reality is that most people outside the formal sectors of the economy cannot afford hospitalisation as it means loss of work and of whatever wages they could have earned. A basic fallacy with the Modi plan is that one has to fall seriously ill to get its benefit.

The biggest beneficiaries of the scheme would be the insurance companies and private hospitals who have never been in the business for public good. With an estimated Rs3,500 crore of central funds going into the scheme this year alone, the fallout on state healthcare through primary health centres and government hospitals is not difficult to imagine. As of now, it is difficult to imagine the scheme turning out to be a ‘game changer’ either in providing healthcare or changing the fortunes of the Modi government.