The Cost of Living

It was late night when the accident occurred. He roads were supposed to be empty, or so the car driver thought as speeded through the main road without noticing a rickshaw slowly crawling carrying its lone passenger, the weary driver getting ready to set his last passenger down before heading home.

The inevitable happened and the two crashed. The cycle rickshaw was reduced to a mass of twisted metal while the driver was thrown of his seat but escaped with a few minor scratches. The lone passenger, a doctor heading back after along day was however hit hard and lay writhing in pain. Some one from the gathered crowd, called his wife by recovering the doctor’s cell phone that ran out of her home and rushed her husband to the nearest hospital casualty.

The young doctor on duty ordered the mandatory X-rays and discovered more than one broken bone. He consulted the orthopedic surgeon on call, who advised immediate surgery and suggested that the patient be prepared for this while he arrived. In due course, after the patient was administered pr anesthetic procedures, the surgeon arrived. But just as he was about to begin, a messenger rushed in from the Billing Section to inform that the cash deposit paid on arrival was insufficient and the operation could not begin till an adequate advance was paid.

It was midnight and the wife was in a fix. Her husband was lying on his surgical table, the surgeon was waiting to start but money was short. The amount of money required was not available at home, the ATM would dispense would only a limited amount; and so the only way finally was to phone all of her office colleagues living in the area and some how take up a collective offering. The money deposited, the surgery finally took place after a harrowing wait of close to two to three years.

After recovering the ordeal, the family has become one of the most strident advocates of health insurance, which they did not have as they were entirely dependant on medical reimbursements offered by their employers. Of course the family hardly lacks company. According to National Council of Applied Economic Research (NCAER), health insurance penetration in India stands at a dismal 1.2 percent. On a macro level, very few households in India have contingency plans to meet their health expenses. Health risks in India are perceived differently than the western population. Prior planning in health issues is yet to be a major priority.

Without an aggressive thrust on insurance, things can only get worse. India is the most privatized health market in the world. Public support for healthcare has been historically low in India, averaging less than 1 per cent of the GDP, but what is worse is that in the last decade public health investment and expenditure has seen a secular declining trend.

The poor have to increasingly resort to taking debt or selling assets to meet costs of hospital care. It is estimated that 20 million people each year fall below the poverty line because of indebtedness due to healthcare. This is worrisome given the fact that more than two-thirds of the country’s population is already either poor or living at subsistence levels

There are a couple of reasons that Health insurance has not taken off a great deal in the country. Firstly, unlike life insurance, which is marketed in India, largely as an investment product , the value o health insurance kicks in only if and when one is seriously ill ; or else the premium is paid is seen as a waste of money. In some places, talking explicitly about illnesses and planning to deal with them is considered a sure fire invitation to sickness and an ill omen. So with al these complexities, the private insurance industry in India is still at a nascent stage and growing. To date, only approximately 20% of the total insurable population of India is covered under various life insurance schemes. Let us hope that the health insurance industry will not exploit this market but also educate it about the social net that health insurance can provide.

please do not spit

One of the announcements that are being blared out on the public address system of the Delhi Metro these days is rather stark. It pleads repeatedly a simple message “please do not spit”, meaning of course, please do not spit in the train. For effect, they are being aired over and over again in both English and Hindi. interspersed I between are other messages of course, like for instance, one requesting passengers to leave seats for the elderly and the infirm and another asking passengers not to squat in the standing area of the train but the message about spitting sticks out in the spic and span but crowded train.

You look around the train and wonder who would spit within the Metro coaches; things look pretty clean and neat. There does not seem to be any one who is puffing up their mouth as a prelude to letting off a blob of spit. But obviously there are those who do, hence the necessity of the message.

More relevant is the other message that is coming on: please do not play loud music on the train. Lots of wired people around with the wires disappearing into invisible mobile phones, iPods or other MP3 players. Again, you never really hear any loud music, but again, one never knows- there must be a reason for those repetitive messages.

Back to the train again, although I still don’t spot any one spitting , I do notice elderly gents with their crutches and walking sticks grimly holding on to a rung which is just out of their reach with one hand while they clutch their stick with the other. Muscular and mustachioed young men occupy the seats which have signage both in English and Hindi marking them reserved for the women and the elderly. As the train stops at a station, a bunch of girls who are too far away from the hand rails and are basically holding onto each other lose their footing and crash in a heap, a few of them sheepishly landing in the laps of the eager young men who are thrilled at this unexpected moment of bliss.

The doors open and a fresh crowd surges in. there isn’t any more space to stand; well not really. There is space really, except that in a portion of the floor, oblivious of the milling crowd, there is a heap of people who have sprawled out with their legs stretched out. There is a pack of cards being shuffled and then being laid out on the front page of today’s Hindustan Times which serves as a portable card table. There is lots of fun and laughter among the group; but they are quite oblivious to the mass of passengers clinging to each other’s shirt tails like bees in a hive because that is all the space there is.

The train resumes and the repetitive messages begin again. “Kripaya thukiye nahin” “please do not spit”, “please do not squat”, please do not play music. Piteous, pleading messages hoping some one, some where would look up from their game of cards and listen. Listen to them day after day, trip after trip and take note one day. But looking at the crowd and its demeanor, it looks that it could be quite a long journey.

India , the emerging imperialist ?

The old style imperialist that we all know about used to eye a nice, prosperous piece of land and then find some means of possessing it. The means have varied from time to time; a couple of centuries ago, it would have meant sending in your army to capture that piece of land and govern it my sending in your own people. That is the most classic form and that has now fallen in to disuse. However, a modified version is in place. Here you identify a stooge who is from the local people and get him to dance in your tune as you play the music. This form is still popular and quite in vogue and here the army plays an important but supposedly subservient role. And a more recent form is the economic variety of imperialism where countries subvert the economic backbone of a country to protect its own interests. This too has been in vogue in recent decades but is of course more subtle.

We in India have always considered ourselves as the victims – and so the annual breast beating rituals that occur on the 26th of January and the 15th of August. No disrespect to the freedom fighters and all those who laid down their lives for the cause. The point here is that perhaps the Indians of today – no doubt to protect the interests of Indians like myself are going about doing the same thing as the British did in their time. What did the East India Company primarily do? Trade, right? The political action that buzzed in the background was all to ensure that trade interests were always protected. We read all that in our history books – nothing new so far.

Have you imagined India in that role? Probably never. But India, plagued by an increased specter of food shortages is joining a growing band of Asian nations in eyeing the last continent left to be still eyed for trade – usually one sided trade. Weak nations with even weaker governments are willing to trade in arable land for the right prices so that we in India as well as other such emerging giants might eat well. How much land has been sold? Between 15 million to 20 million hectares, which is more than all of Germany’s farmland it seems.

Many governments, either directly or through state-owned entities and public-private partnerships, are in negotiations for, or have already closed deals on, arable land leases, concessions, or purchases abroad. Is agricultural land only available in Africa? Of course not! But it is relatively speaking much easier to strike deals with governments or more accurately individuals who control government in Africa where institutional checks and balance mechanisms are weak and prices are cheaper. So the Indian government and several companies have intensified the chase for farmland abroad and even farmers from Andhra Pradesh have gone and invested in land in Kenya.

Now our patriotic sensibilities will be deeply offended at the thought of some one calling us and our motivations imperialistic for we all like to walk the high moral ground and this is perfectly understandable. But in our neighborhood at least, India is quite known the as the neighborhood king, strutting and flaunting its strength in the tiny part of the world called South India. Check out Nepal, Sri Lanka and Bangladesh and what they have to say about how India throws its weight around in its immediate neighborhood. The national interest is supreme as it was then, as it is now. From trade to imperialism, India can not be faulted on not learning its lessons from the East India Company!