Sitaram Yechury’s focus on universal health care in Chintan lecture is welcome

The vital issue of Universal Health Coverage for Indians was touched upon by Sitaram Yechury, MP and member of the Polit Bureau of the CPI (M) in his 25th year V.P. Chintan Memorial Lecture in Chennai, on Tuesday. It is a big advance that mainstream political parties have begun to talk of universal entitlements in health care, rather than narrowly focus on benefits for some classes of workers.

Since Mr. Yechury’s talk was on "12th Five Year Plan and the common man," his comments centred around the proposals that have been widely reported on health care. "The 12th Plan proposes to move from a mixture of public sector service provision plus insurance to ‘a system of health care delivered by a managed network.’ Such a universal provision of health care envisages two components – ‘preventive interventions’ which the government would be both funding and universally providing and ‘clinical services’ at different levels defined in an Essential Health Package which the government would finance but not necessarily directly provide.

Thus the government, under the 12th Plan, proposes to confine itself to providing a small package of services while virtually all clinical services would be opened up for the corporate private sector. The government would thus, play the role of a provider of health care which is financed by public monies to fatten the corporate sector by handing over profit making clinical services. This is a Plan aimed at progressively winding up the universalisation of public health."

He also refers to the inadequacy of spending only 1.58 per cent of GDP on health, far below the "minimum of 5 per cent" that is recommended by the WHO, and the high out of pocket expenditure that the High Level Expert Group of the Planning Commission on UHC has acknowledged.

Thus far, Mr. Yechury is correct in expressing his worry at what appears to be a subsidy to the for-profit health care sector that has been growing rapidly in India. However, he could have usefully suggested the roadmap for UHC to the audience, which probably has not devoted a great deal of attention to the prospects outlined by the HLEG whom Mr. Yechury quotes on OOP spending.

For one, the HLEG is clear that all health care should be funded through tax monies, rather than private insurance. It also lays out a roadmap for expansion of the public health infrastructure, and training of a massive health workforce which could provide timely referral and monitoring of health of individuals. Crucially, the HLEG also spelt out tight regulatory systems for private providers, which, if implemented, would knock the bottom out of profiteering by tertiary care hospitals that is anyway impoverishing Indians – and on which the Indian left parties have done little even during the time they ruled in two important States, West Bengal and Kerala. Since health is primarily a State subject (and central regulation such as the Clinical Establishments Regulation Bill have been stoutly opposed by the private sector), it would have been welcome had the two Left-ruled states done both things as models of governance: 1. Invested heavily in public health infrastructure and encouraged regulated not-for-profits to flourish 2. Introduced transparent regulation of all clinical establishments (including government-run ones) to provide benchmarks.

Again, Mr. Yechury lost the opportunity to highlight another key intervention that is needed to reduce profiteering by the pharma industry and private expenditure for patients: the distribution of free or nearly-free drugs to patients. The high-level group shows that with a small increase in public spending, government hospitals and clinics can provide essential drugs to all people in India.

It is these dimensions that the CPI (M) and other people-oriented parties must highlight among all classes of people, to broaden the appeal of a socialist system that genuinely transfers income from the wealthy to the needy. That the subject figured in Mr. Yechury’s talk is in itself an advance, and hopefully, will find greater appeal among Trade Unionists and other organised forums who need to look beyond the confines of their own membership.

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