Editorial 1 : Politics of the day
Introduction: the recently held parliamentary elections threw some interesting results. The landslide victory of President Muizzu’s party is a concern for its neighbour India.
What was the significance of the election to President Muizzu?
- There was much at stake for Maldives President Mohamed Muizzu in the country’s parliamentary elections.
- First, it was a test of his popularity: Muizzu beat his predecessor Mohamed Solih in the competitive second-round poll in September last year.
- Muizzu has also faced some dissension from within the ruling alliance and party, especially from supporters of former President Abdulla Yameen, who was under house arrest on corruption charges.
- In addition, the fact that Muizzu’s People’s National Congress (PNC) did not have a majority in the Majles (or parliament) meant that the Opposition had considerable room to scupper the executive’s plans.
- The ruling party’s comprehensive win in the parliamentary elections, then — the PNC has won 70 of 93 seats and its allies three more — has given it the “super majority” and political capital it desired moving forward.
The anti-India stance of President Muizzu
- There is little doubt that their anti-India stance is one of the pillars of the politics of Muizzu and the PNC.
- Muizzu had campaigned for the presidency on an “India Out” theme and in office, his government has asked for the minuscule number of Indian troops in the country to be withdrawn.
- He has scrapped the 2019 agreement under which India could carry out hydrographic surveys in Maldivian waters.
- Muizzu has also drawn Male closer to Beijing, including through his maiden visit soon after being elected president.
- China has received contracts for infrastructure projects.
- However, it is important to remember that the Maldives Majlis election is a domestic issue.
- It was fought on issues of corruption, the economy, housing, employment and shifting political alliances.
- The acquittal of Yameen, for example, likely helped firm up the ruling coalition.
India must not overreact
- The Indian government has done well not to overreact and to treat the attempts to distance Male from Delhi with soft hands.
- It hasn’t over reacted to provocative statements from members of Muizzu’s party in the recent past.
- A neighbour’s domestic politics are its own affair and as the preeminent regional power, India must take the churns in Maldivian polity in stride.
- If “India Out” is Muizzu’s calling card today, Solih was criticised often by his detractors for his perceived “India First” policy.
India should draw its red lines for Maldives
- Delhi must, draw red lines on matters that undermine its security and core interests.
- Just 70 nautical miles from the Indian coast, the Maldives is and will be an important part of India’s Neighbourhood First policy and the government’s SAGAR initiative.
- No matter the government of the day in Male, it must continue to engage with the country.
- That is the surest way of making bilateral ties “politics proof” in the long run.
Conclusion: India must take changes in politics in Maldives in stride. India must not overreact, but communicate its red lines to Male. Delhi must continue to engage with Male despite its anti-India stance.
Editorial 2 : The cost of health
Introduction: Out-of-pocket costs and impoverishment due to illness are among our gravest societal tragedies. Resentment towards costs is a big factor in the growing hostility, including violence, against healthcare workers.
Recent, Supreme Court decision on Out-of-pocket expenditure
- The Supreme Court recently spoke strongly on this issue.
- The Bench was hearing a PIL by an NGO praying for direction to determine charges in hospitals across the country in terms of Rule 9 of the Clinical Establishment Act.
- The Court threatened to impose the Central Government Health Scheme (CGHS) rates on all hospitals as an interim measure.
- It gave the state six weeks to act.
Affordable healthcare must be the foremost welfarist policy of any state
- If there is one policy that should be prioritized by a nation that genuinely cares for its citizens, it’s the elimination of money as a precondition to relieve suffering in an illness.
- What comes closest to this aspiration is a publicly funded health system that gives timely, effective, and free care, irrespective of social class.
- Countries with universal healthcare ensure that no one pays at the point of care.
- Funding comes from taxes.
- Thus, the rich subsidize the health of the poor and everyone uses the same facility.
- So, if you are knocked down on the road or suffer a heart attack, needing instant lifesaving care, whether you live or die is not determined by money or social status.
How did private hospitals grow from neglect of public hospitals in India?
- Following Independence, India’s professed policy was to attain universal health care.
- However, deliberately or through benign neglect, the state underfunded public facilities, making space for an alternative to emerge.
- The elite, desiring healthcare designed for their needs, started building big hospitals.
- Some started as charity, but most soon realised that healthcare is lucrative.
- They were also unwittingly bailing out the state by establishing high-end curative services which had been ignored in the preoccupation with primary care.
- This process took a big leap after liberalisation when for-profit hospital chains funded by investors and global capital entered the fray.
- Private hospitals provided efficient, sanitised and high-tech care compared to public hospitals.
- The middle class shifted to them. The poor also soon began to prefer private care.
- India now has the distinction of having the largest private healthcare sector in the world.
The factors that led to private hospital boom in India
- There are other characteristics crucial to understanding private healthcare in India.
- First, a universal truth: Healthcare does not follow market rules. It involves unpredictability, distress and relies on empathy. That’s why even dominant market economies insulated healthcare.
- Secondly, healthcare in India is one of the least regulated. Anyone can start a hospital anywhere, promote irrational treatment and thrive without accountability.
- Finally, it is characterised by a deep co-option of medical professionals. Doctors’ own hospitals and income are linked to profits. Hospitalisation, prescriptions, tests and procedures, even if unnecessary, are rewarded. There can be no more dangerous conflict of interest for citizens seeking care.
- Thus, ordinary Indians are caught in a pincer of costly, excessive care in the private sector and crowded, slow, suboptimal care in state facilities.
The dilemma of governments regarding fixing the healthcare system
- The task of reinvigorating the public sector seemed difficult and too long for quick electoral dividends.
- The next best policy was to buy care from the private sector through mass insurance schemes for the poor, like AB-PMJAY.
- But for such schemes to be viable, the health sector had to play by some rules and costs had to be rationalised.
- The growing private health insurance sector also demanded regulation.
- The Clinical Establishment Act was introduced in 2010 partly as a response to these needs.
- It seeks to bring a semblance of order by registering all health establishments, setting minimum standards and even rationalising costs by setting ranges.
- Predictably, it met with resistance. Many state governments have not yet implemented it or done so half-heartedly.
Can private hospitals be coerced by governments?
- It is argued that forcing the private sector is unfair when it is the government’s job to provide healthcare.
- Whilst this may seem in intuitive its disingenuous because governments subsidise private healthcare in more ways than one.
- Besides training of health care workers in state institutions, this also includes several infrastructural concessions.
- In a sense, private health is subsidised by public money.
Will fixing costs in the healthcare system be successful?
- Previous efforts to control private sector costs have largely failed.
- The Supreme Court’s intervention is potentially powerful but it is entering tricky territory.
- Any effective intervention will face resistance not only from industry, but also influential doctors, many of whom are entrepreneurs.
- If the Court wishes to promote affordable healthcare, capping costs could be a small step.
- But no nation has improved substantively in health equity without adequate state investment.
- And India’s state share in health funding continues to be one of the lowest in the world.
Conclusion: Affordable and universal healthcare was never a political issue in India. The fixing of out-of-pocket expenditures needs political will and not the court’s directive. However, lack of political enthusiasm led activists to knock on the doors of courts. Only time will tell, how effective courts’ directives are.