Universal health coverage (UHC)

• UHC is firmly based on the WHO constitution of 1948 declaring health a fundamental human right and on the Health for All agenda set by the Alma Ata declaration in 1978. UHC cuts across all of the health-related Sustainable Development Goals (SDGs) and brings hope of better health and protection for the world’s poorest.
• Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
• There is no single, best path for reforming health financing arrangements to move systems closer to universal health coverage, i.e. to improve access to needed, effective services while protecting users from financial ruin.
• In most countries, the government pays for health care provided by private companies. These include the systems in Australia, Canada, France, Germany, Singapore, and Switzerland. United States also provides subsidies to health insurance companies through Obamacare. 
• When the government both pays for and provides the services, that is socialized medicine. The United Kingdom has this. The United States has it for its veterans and the armed forces.
• Countries often combine universal health coverage with other systems to introduce competition. These include pay as you go, prepay, and private insurance models. Allowing these options can lower costs, expand choice, or improve care.

HEALTH CARE IN INDIA

• Health care is a service that people would very much rather not have to use. Of the total health spending in India, the government contributes just 29%. In the UK, the government's share is 83%. For many other countries, this figure ranges between 45% and 55%. As a proportion of GDP, India spends just 1.2% on health while US spends about 8.3% of its GDP. 
• For ensuring health to all, the government's health care spending must be increased from the present 1.2% to 5% very quickly and to 8-10% if necessary. As government sector fails to provide primary and secondary medical care, around 80% of these services were being provided by the private sector and 70% by the small hospitals and individuals doctors. 
• Only a healthy nation can be happy, productive and prosperous.
• Private healthcare expenditure amounts to around 4% of the GDP. Of this, health insurance accounts for 5-10% of expenditure, employers account for around 9% while personal expenditure amounts to an astounding 82%.
• Barely 10-15% of the population has some form of insurance coverage. 40% households report loss of income during illness. Nearly 8-9% of households takes loans to meet their medical expenses. Meeting healthcare expenses is one of the major concerns for households.
• Nearly 22% of urban and 33% of rural households (all India 30%) are financially-vulnerable with negative surplus income due to private healthcare expenses. For such households, a medical emergency would tip them over the financial edge. The present 30% vulnerable households will rise to 86% in case of an additional burden of Rs. 1 lakh towards medical expenses.
• Only 34% households in India said that they can “easily” meet their medical expenses. More than half of metro households (53%) fall in this category.
• While private health insurance coverage is on the rise, this system is far from efficient to meet the needs of diverse population segments. The absence of a comprehensive health insurance is pushing already vulnerable households below the poverty line at the rate of 3.4% (4 crores) of population, annually.
• The sheer cost of providing quality health care makes universal health care a large expense for governments.
• The key issue is when a large majority of population is feeling overwhelmed by the cost of healthcare, should it be left to the supermarkets to promote healthy living and create systems where medical services can be attained in a timely and cost-effective manner? Or do policy-makers need to look at “healthcare” as a key element of the economic well-being of the country?

Read source article 1

ADVANTAGES OF UHC

• When governments pay for health care, they work to ensure doctors and hospitals provide quality care at a reasonable cost. They must collect and analyze data. They can also use their purchasing power to influence health care providers.
• UHC lowers health care costs for an economy. The government controls the price of medication and medical services through negotiation and regulation.
• UHC eliminates the administrative costs of a dealing with different private health insurers. Doctors only deal with one government agency. It standardizes billing procedures and coverage rules.
• UHC forces hospitals and doctors to provide the same standard of service at a low cost. In a competitive environment like the United States, health care providers focus on new technology. They offer expensive services and pay doctors more. They try to compete by targeting the wealthy. They charge more to get a higher profit. It leads to higher costs.
• Universal health care creates a healthier workforce. Preventive care reduces the need for expensive emergency room usage. Before Obamacare, 46% of emergency room patients went because they had no other place to go. They used the emergency room as their primary care physician. 
• Early childhood care prevents future social costs. These include crime, welfare dependency, and health issues. Health education teaches families how to make healthy lifestyle choices, preventing chronic diseases.
• Governments can impose regulations and taxes to guide the population toward healthier choices. Regulations make unhealthy choices, such as drugs, illegal. Taxes, such as those on cigarettes and alcohol, make them more expensive.

DISADVANTAGES OF UHC

• Universal health care forces healthy people to pay for others' medical care.
• Chronic diseases, like diabetes and heart disease, make up 85% of health care costs. These diseases can often be prevented with lifestyle choices. The sickest 5% of the population consume 50% of total health care costs. The healthiest 50% consume only 3% of the nation's health care costs. 
• With free universal health care, people may not be as careful with their health. The don't have the financial incentive to do so. Without a copay, people might overuse emergency rooms and doctors.
• Most universal health systems report long wait times for elective procedures. The government focuses on providing basic and emergency health care. 
• Governments limit payment amounts to keep costs low. Doctors have less incentive to provide quality care if they aren't well paid. They might spend less time per patient to keep their costs down. They have less funding for new life-saving technologies.
• Health care costs overwhelm government budgets. Some Canadian provinces spend 40% of their budget on health care. That reduces funding for other programs like education and infrastructure.
• To cut costs, the government may limit services with a low probability of success. It may not cover drugs for rare conditions. It may prefer palliative care over expensive end-of-life care.
• On the other hand, the U.S. medical system does a heroic job of saving lives, but at a cost. 
• Care for patients in the last 6 years of life makes up one-fourth of the Medicare budget. In their last month of life, half go to the emergency room. One-third wind up in the intensive care unit. One-fifth undergo surgery.

Read source article 2

The Heritage Index of Economic Freedom 2018, which ranks the pecuniary freedom of citizens, found that the top ten nations in the list all had universal healthcare schemes. Hong Kong, Singapore, Australia, New Zealand, Canada, Switzerland, and Denmark are among the the top ten countries. The United States is ranked 12 and India ranked 130 out of 180 countries. Medical insurance is one of the systems most abused anywhere in the world. In India, it is more so. The drug companies, corporate hospitals, doctors and diagnostic services form cartel and loot gullible patients and inefficient insurance companies. This leads to ever increasing health insurance premiums with no matching quality services. This must stop. 

UHC in India with annual spend of over Rs.800,000 crores (@5% of GDP of $2.6 trillion in 2016) requires gigantic organisation(s) and is no easy task. But that is the least that should be done for India to become healthy, productive and prosper. Every year we find an impassioned paragraph in FM's budget speeches and that is the end of it. But so far governments have neglected health care and private sector exploiting and pushing 4 crore people annually below poverty line is a matter of national shame. 

Health insurance increases the costs, burdens doctors, patients compelled to follow their procedures and promotes corruption. Government taxing its citizens to pay for health care where services are government-owned, and service providers are government employees is the least cost and best option but requires intense efforts are needed for managing multiple layers of the organisations efficiently, transparently while being vigilant. Primary care must be in public sector only, while secondary health and tertiary health care could be in both public and private sectors.

World Health Organization Ranking of India  is at 112 of 190 countries. USA is at 37, Pakistan at 122, Bangladesh at 88, Sri Lanka at 76, Nepal at 150, China at 144 indicates pathetic conditions prevailing in our health care sector.

Parliamentary processes diminished

• What is our conception of Prime Minister Modi when he called parliament “the temple of democracy”? Is it merely a place to ratify decisions made elsewhere in party cabals or cabinet meetings? Or is it a chamber where the representatives of the Indian people assemble to express their considered opinions and thoughtful disagreements, before coming to an outcome in the interests not of a party but of the country as a whole? I guess for Modi it is the former.
• In parliament, the Government will propose. The opposition will oppose. If matters come to a head and a vote is called, the Government’s brute majority will dispose. Merits of the matter hardly matters. This is how our parliament works these days.
• Parliamentary debates have become a ritual. On most issues whip is cracked and MP's duly vote on party lines.
• Even sensible suggestions by the opposition are never adopted.
• With overwhelming majority the Government simply chooses not to listen.
• The Anti-Defection law was passed with good intentions and with which the road to hell is paved. It was intended to stop the aaya Ram-gaya Ram practice of legislators crossing the floor in pursuit of power and pelf. The idea was noble, and rested on sound principles: governmental stability matters; people must stay loyal to the party on whose platform they contested; the intent of voters must not be betrayed by defections.
• The Anti-Defection law 1985 enabled a practice of party whips on all issues, making receptivity to the ideas of the other side punishable with expulsion from the House. The ‘argumentative Indian’ is on display only when he is arguing strictly according to his party’s position.
• The Anti-Defection law has not eliminated the defections, but dramatically reduced them. It only made defections a group affair, more costlier and at the mercy of Speaker, without fear of legal scrutiny.
• Parliament is supposed to be a forum where individual MPs of ability and integrity met to discuss common problems and agree upon solutions.
• MP's are supposed to advocate the wishes of their constituents, rather than themselves. MP betrays himself and his voters while surrendering his own better judgement to the dictates of his party leadership. This is a travesty of the parliamentary process.
• In the UK no whip was issued on a vote for Brexit. No whip was issued for UK supporting the US in the Iraq war. Dissent was freely and honestly expressed on both sides of the aisle. Such freedom is unknown to the Indian MP with the Anti-Defection Law.
• Government and legislation are matters of reason and judgment, and not of inclination. And what sort of reason is that, in which the determination precedes the discussion; in which one set of men deliberate, and another decide.
• Parliament is a deliberative assembly of one nation, where not local purposes, not local prejudices ought to guide, but the general good of the nation. 
• In the early days a prime minister could even be challenged by MPs from his own party -- think of Nehru being attacked by Feroze Gandhi, Finance Minister TT Krishnamachari being forced to resign by his own backbenchers, or Mahadev Mishra challenging his Prime Minister’s China policy. Today conformity rules the roost. So why give parliament an importance its performance does not warrant?
• The first three Lok Sabhas saw as many as 140 days sittings a year. We are now at about half that number, and it is reducing every year. BJP Government clearly has very little time for the distractions of Parliament. State assemblies are even worse: many sit for fewer than 30 days a year, and in Haryana the average is 12 days.
• In the last Lok Sabha, 25% of the bills were passed with scarcely any discussion. Barely 15% of the Union budget is discussed in detail. Our government is spending taxpayers’ money without the taxpayers’ representatives having a meaningful say in how it is spent. 
• Once bills are passed they become Acts, and these are implemented through the promulgation of rules drafted by the Government and are supposed to be placed on the table of each House. The rules are subject to parliamentary scrutiny. Guess how many rules have been discussed in the current Lok Sabha? Precisely zero.
• Our Prime Minister Modi spoke of introducing ‘minimum government, maximum governance’. Instead, we are heading to a system of ‘minimum parliament, maximum government’. The judiciary is stepping into the breach, taking initiatives that should have been done by Parliament. Unelected judges substituting themselves for the people’s representatives. It’s nobody’s fault but our own, but it’s not the democracy.
• It is time to look at our institutions and ask if they are really providing the foundations on which our democratic freedoms must be built. The crisis assailing our legislative representation in Parliament makes this task imperative and urgent.

Beware of ministers who can do nothing without money, 

and those who want to do everything with money

Thrift should be the guiding principle

It is essential that a democracy must function with transparency & accountability and rule of the law must be followed. No expenditure should be allowed without prior approval of parliament or legislature except while dealing with specified emergencies. Ordinances must be discouraged and must be subjected to detailed scrutiny. No Act shall be passed without detailed discussion and rules framed for implementation must be ratified or modified by Parliament or Assembly with in 60 days. Discretion must be eliminated and replaced with well defined processes. Executive decisions must have either cabinet and/or legislature ratification. Projects must be granted by a 'Planning Commission' or 'Niti Aayog' type expert bodies but never by any individual office bearer. Government must focus more on Governance rather than money matters. Nothing should be done unless it benefits larger masses. Extravagance should be despised.