Op-Ed: Rejecting Ayusman Bharat Akin to Cutting The Nose To Spite The Face

In rejecting outright the Centre’s Ayusman Bharat scheme, the Odisha government has acted like a petulant child. Coming as it does on top of a series of incidents in the recent past in which the state government has found fault with some central scheme or the other and threatened to pull out of it, this does not augur well for centre-state relations. The last such flashpoint was the central scheme for integrated development of 114 most backward districts in the country of which seven are in Odisha.

Health minister Pratap Jena explained on Thursday that the state government would not sign the MoU with the Centre for the Ayusman Bharat scheme because the latter did not accept the state’s demand for inclusion of 70 lakh families in the scheme and agreed to include only 61 lakh of them. But is it not a case of throwing the baby with the bathwater? If the Centre did not agree to include the additional nine lakh families in the scheme, would it not have been prudent to accept what the Centre offered and provide only for the nine lakh left out families rather than foot the bill for all the 70 lakh families? Considering that each family included in the scheme would be entitled to medical expenses worth Rs. 5 lakh, providing free health services to the 70 lakh families would cost a fortune, which a poor state like Odisha can hardly afford. To put things in perspective, even if only two lakh out of the 70 lakh families avail healthcare services worth Rs. 5 lakh, the upper limit, it would add up to an outlay of a whopping Rs. 10, 000 crore! To further drive the point home, the entire annual budget of the state government for the 2018-19 fiscal was only marginally higher than Rs. 1 lakh crores.

Let us consider the case of the state government’s dispute with the Centre over the number of beneficiaries under another central scheme: the National Food Security Act (NFSA). Chief minister Naveen Patnaik wrote to Prime Minister Narendra Modi on May 24 this year seeking the inclusion of an additional 34.44 lakh beneficiaries in the scheme under the scheme, over and above the 3.26 crore beneficiaries already sanctioned, on the ground that the population of the state had grown by 10.22% since the 2011 Census based on which the number of beneficiaries in the state had been decided by the Centre while implementing the scheme. The central government is yet to respond to the demand. But in case the Centre rejects the demand – as is likely since conceding Odisha’s demand would lead to similar demands from other states – would the state pull out of the NFSA as well and provide the benefits to all 3.60 crore people out of its own funds?

Even if the state can afford it, why spend precious resources on something that would have been, in any case, taken care of by the Centre? The money to be spent on providing free health services to the 61 lakh families could have been much better utilised in other important areas like improving the infrastructure for primary education or anganwadi kendras in the state.

Then there is the question of whether the state has the infrastructural wherewithal to provide comprehensive healthcare services to 70 lakh families. Even a cursory reality check would reveal that it doesn’t. There are no more than 18, 365 beds in all government hospitals with the overwhelming majority of public health centres (PHCs) having an average of just four beds and only 16% of community health centres (CHCs) having 30 beds. The gross shortage of doctors poses another major hurdle in implementation of the ambitious scheme. In March this year, the Health minister admitted in the state Assembly that as many as 3119 out of the 6536 (nearly 50%) sanctioned posts of doctors in government hospitals are vacant with 156 rural hospitals having no doctor at all. One can imagine how hopelessly inadequate the existing infrastructure is to serve the needs of 70 lakh families even allowing for the fact that not all of them may need hospitalisation. Remember, unlike a similar scheme launched by the Andhra Pradesh government in 2009, the beneficiaries of Biju Swasthya Kalyan Yojana can avail free medical care only in government hospitals.

Given the nature of Centre-state relations in the country, every state bargains hard with the Centre for the best possible deal for itself. But they don’t pull out of a scheme if all their demands are not conceded and make the best of what they get. Statecraft demands pragmatism, not pique and petulance. In acting the way it has, the state government has presented a classic case of cutting the nose to spite the face.

(DISCLAIMER: This is an opinion piece. The views expressed are author’s own and have nothing to do with OTV’s charter or views. OTV does not assume any responsibility or liability for the same.)