Anjali Ojha, Tikender Singh Panwar
Neoliberalism has lead to mass sufferings in the country. DEAD bodies of human beings floating in the River Ganges, is the latest in the gory stories we have been witnessing for the last few weeks. Frantic calls from friends’ right from the ones who are at high echelons to common people continued incessantly. These calls were made either for oxygen, beds in hospitals, or/and even for getting a place for cremation and burial. Not just that. Keeping the dead body overnight waiting for cremation cost more than Rs 55,000 is not an isolated case, rather innumerable such instances occurred.
A look at social media sites like Twitter tells the story where thousands of messages from people looking for oxygen to beds, plasma, and medicines are flooding the site. While citizens have come together to create resource pools, sharing leads and contact numbers, cross-checking and circulating them, the union health minister, Harsh Vardhan claimed there is no shortage of oxygen.
Commoditization of services in the health sector has taken place for a long time in India. But, since the Modi era, one of the principal modes of accumulation of capital happens to be rampant privatization of services. Education and health happen to be the foremost ones where humongous amounts of capital get generated after fleecing the people. Big giants have entered this field for providing health services and under the guise of better health care services huge amounts of profits are reaped.
In Delhi, while charges at private hospitals for Covid beds, ICU, and ICU with ventilators were capped, at several hospitals patients are being asked for bulk upfront payments even before getting beds. In a south Delhi hospital recently, an acquaintance got a bed, or so they were told. A straight away payment of one lakh rupees was demanded, and the bed eventually allocated turned out to be a stretcher in the corner of a ward that was used to dump ‘used PPE kits’.
The BJP, RSS, and also Modi are known votaries of their strong opposition to ‘state intervention’ in the field of social development and since 2014, with a strong political mandate; they did it all the more vociferously. This government works on free-market principles and some of its advisers for example Sanjeev Sanyal, the ‘Principal Economic Adviser’ to the ministry of finance, the government of India has been openly advocating for a dismantling of the public health system in the country. Now, being an adviser to the government, one can deduce where this government is headed.
In 2017, Niti Aayog came out with a set of guidelines that suggested Public-Private Partnership (PPP) in non-communicable diseases like cardiac, oncological, and pulmonary diseases, under which the private sector would get space for setting up facilities for treatment within the premise of existing district hospitals. At the event to release the guidelines, Niti Aayog CEO, Amitabh Kant batted strongly for private participation in healthcare. In a series of webinars after the union budget, in which the government unveiled its new privatization policy, PM Modi said “government has no business to be in business” and extended the government’s support for privatization.
He also called for the private sector’s participation in Ayushman Bharat Pradhan Mantri Jan Arogya Yojana through the PPP model. The National Health Policy released in 2017, while stressing on increasing the share of healthcare expenditure to 2.5 percent of the GDP, promotes private-sector pitching for “strategic purchase of secondary and tertiary care services” from the private sector. A PMO statement on the new policy said the policy looks at the private sector “as strategic partners”.
So, it is not just the ideological mooring of the BJP and Modi, but the entire team that systematically dismantled the already paralyzed public health sector and its institutions and made way for large-scale abject privatization, or we can say commoditization of health. But how is it important in the present era?
It is because the private sector is completely absent from meeting the challenges of the present pandemic, whereas before the pandemic struck, nearly 80 percent of outdoor patients and almost 60 percent of indoor patients were directed towards the private sector. The private sector developed post-1990s, unlike the Sir Ganga Ram Hospital in Delhi (and such others), have a clear motive of extracting surplus from health and this is being treated as a large commodity.
This piece does not allow us to enter into the domain of how systematically the public sector health was dismantled, but we have a stark picture where voices are once again being raised in the country to bring health under the public good and to nationalize it, because of the failure of the private sector to meet the challenges of the present pandemic.
Apart from basic healthcare being, India’s vaccination drive against Covid19 has also been impacted. The two Indian vaccines developed by the private sector- Covishield manufactured by Serum Institute and Covaxine of Bharat Biotech – are among the most expensive ones in the world. While the PM on several forums promised the vaccine to the world, India’s own drive to vaccinate all adults has been slowed down due to the unavailability of vaccines.
The vaccine prices have shot up as well, while the government was procuring the vaccines at Rs. 150 each, the prices now are between Rs. 700-900 for Covishield and between Rs. 1,200 to 1,500 for Covaxine, among the most expensive in the world. Major private sector hospitals are also making a margin on the vaccines.
But what we are focussed on here is the way Modi and his cohorts including various ‘Sanyals’ at different levels have jeopardized our system and now it is a systemic failure that has exhibited in one of its worst forms, unable to deal with the present pandemic. A question may be asked; Where is the State? I mean not the state governments, but the state as a structure, which is governed by a constitution and has certain duties to perform and safety of lives and livelihood of people, which is a quintessential part of its functioning. Otherwise, what is the State for if it cannot protect the lives of the people?
Let us once again revisit last year’s four-hour notice given for a national lockdown announced by none other than our ‘supreme leader’, Modi. Those stories of long journeys of migrants workers back to their homes still haunts every one of us. But the point that needs to be stressed is that despite the fact that some of the nations’ who couch far closer to international finance capital doled out massive relief to their people in the forms of cash transfers, remitting their rents, and even ensuring that the tenants are not evicted from their houses. But here in India despite the IMF suggesting not to worry about the fiscal deficit, the government provided one of the least supporting systems in the world. We were laughed at.
Action Aid, one of the pioneer civil society groups working in India, did research on migrant workers with a database of more than 10,000 workers. The survey showed 89 percent of the workers did not get any relief from the government. Only a little more than 10 percent were provided benefits. The remaining were supported either by civil society groups, trade unions, individuals, and/or other social groups. Interestingly in an affidavit filed by the union government in the Supreme Court of India, it mentioned that of the total relief camps being run, 65 percent constituted alone in Kerala.
‘State’, is a bad word in the vocabulary of BJP and RSS and worse is ‘State intervention’. They term it to be Nehruvian economics and are blatantly against such policies of State intervention in the social sector, and now we find where we have landed. In just seven years of BJP rule at the center, the ugly forms of governance are more vivid than ever in the past. “Minimum government, Maximum governance,” was the so-called mantra of the Modi government at the center.
While explaining what this means, in an interview to a news channel in 2019, Modi said “Till now, I have cleared projects worth around Rs 12 lakh crore in just an hour. ………… I maintain that it’s not the government’s responsibility to run a hotel, you might have seen that we are doing disinvestment slowly.” From not running a hotel, Modi extended his mantra to not running hospitals and even the entire health system. And hence relied more on insurance-based health systems rather than universalization and publicly strengthening of health care systems. But what we are witnessing at the end of the day is the least governance and complete abdication of responsibilities of the government.
Modi, true to any other fascist ruler of any other part of the world, has similar genetic material within himself. “Rome was burning and Nero was playing the Fiddle”, is perhaps too old a proverb for Modi. He has advanced it in this form: “India was burning and burying and Modi was busy constructing his palace and a new parliament building, the central vista in Delhi.” Despite a near-universal criticism of Modi of his utter failure to tackle the pandemic and in such a background wasting money on a wasteful project, the leader has declared it an “emergency project”, more emergent than the health emergency in the country. More emergent than producing vaccines in the country and even more emergent than providing oxygen to the countrymen.
This is linked to the psyche of any fascist leader who wants to leave an imprint in history ensuring that it be called an era of thyself- ‘Modi’. Whereas, all the projects have been put on hold, but the central vista continues risking the lives of hundreds of workers who are ferried every day from Sarai Kale Khan labor camp to the worksite and then taken back to the camp. This is akin to the gas chambers built by the Nazis in Germany where people were killed en masse. Here is another era where workers are forced to work at the site by holding their wages so that they cannot run away from the worksite and above all putting them at extremely high risk because of the pandemic.
Hence, it is not a surprise that the era we are living in demands extraordinary churning and realignment of forces to ensure that the most civic part of our ongoing civilization and that is to live with liberty, fraternity, and independently as citizens and not as ‘ruler ruled dictum, is not robbed by such zealots. The State which may wither away at some point of time, as Marx points out, in a higher form of society, cannot be allowed to just serve the interests of the large corporates and wither away for the common people.
Hoping that we all survive and fight back against this pandemic and the present discourse.
About the Author
Tikender Singh Panwar, is a former deputy mayor of Shimla and an author who regularly contributes to urban matters. He is also a Visiting Senior Fellow at IMPRI Impact and Policy Research Institute, New Delhi.
Anjali Ojha, is a journalist based in Delhi and currently works with Go News.