Health, education failures signal deep strain

Mohan Bhagwat, the head of the Rashtriya Swayamsevak Sangh (RSS), has noted that health and education are out of reach of ordinary Indians, and in saying that he has, to use a cliché, hit the nail on the head. Speaking earlier this month at the inauguration of an affordable cancer care facility at Indore, Bhagwat was quoted as saying: “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.”

Some will see this as veiled criticism of the policies of the Narendra Modi-led BJP government and its model of development, coming from the head of the RSS, which is the BJP’s ideological parent. The remarks, after all, touch on a key facet of development being packaged and sold by the government – a Viksit Bharat sans affordable education and health, the two legs development needs to stand on.

But away from any political reading, Bhagwat’s and the RSS’ amplified voice under BJP rule serves in this case to highlight a burning issue, one that is felt in the bones by ordinary citizens. It is a plain fact that education is getting out of reach without 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 on both legs of development.
At the same time, India also has pockets of world-class facilities in health and education available to the privileged few so that we live with islands of global excellence in a sea of mediocrity, even misery.

It is not uncommon to see some professions or services as noble because of what they do – education impacts a new generation of citizens and medicine heals the sick. The aspiration, then, 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. The RSS chief echoed this in a way by saying, “Earlier, (health and education) were done as a service, but today both have been commercialised.”

But calling out to 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 an overly marketised society. Noted academic and author Michael Sandel speaks of the distinction between a market economy and a market society – the former can bring efficiency while the latter puts a price on everything so that there is nothing that money cannot buy. It is possible to argue that India has become almost a de jure market economy but de facto works as a market society, which is remarkably out of place for a nation that has the word ‘socialist’ in the preamble of its Constitution. There is hardly anything the top 1% cannot buy – pay your way to safety, security and success. But since only some can pay, the rest will suffer and bring on the lament and the pain of how inequality plays out in every field, but most notably in hospitals and in schools.

Exclusionary model for imagined growth

In such a system, how do health insurance companies not collect their pound of flesh, how does the thriving industry in medical education survive without exorbitant fees and why should doctors or teachers settle for lower pay? Doctors and teachers, like the others, also need housing, travel, equipment, material and learning – all of which are outpriced and marketised. Sectoral charity will work 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 the idea of duty, responsibility or in general a non-money mindedness selectively refuses to recognise that the ills are much wider. The failing health and education sectors are a symptom of a larger disease, of an imagined growth story and a fantasised giant economy that sees numbers but not the purpose, that has ignored those at the lower rungs of the ladder in the quest to shine in its fancy airports and bullet trains. It is this approach that leads to the statement of a minister quoted by Bhagwat as saying that education is a trillion dollar business, or indeed the NITI Aayog writing in a paper that noted the following: 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 $94 million (2011) to $1,275 million (2016) – a jump of over 13.5 times.

To stay on this path is to court disaster. No private equity or venture capital comes to serve. To get away from this trap, the government will have to rethink and re-ask the purpose of the growth story. India is the world’s fourth-largest economy but what does that mean when the top 10% of its population holds more than 75% of the national wealth while the poorest half of the population sees only a 1% increase in their wealth, as Oxfam noted in a recent report.

Yet, around us are models that have worked wonders. They show a path not only to India but to the world by building on what is the true meaning of dharma. It takes a different resolve, rooted in a high sense of purpose and humility to achieve that, not marketing hype or machismo talk that has become the currency of India today.

(The writer is a journalist and faculty member at SPJIMR; Syndicate – The Billion Press)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.