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The Atal Ayushman Uttarakhand Yojana, an ambitious extension by the State Government of PM Modi’s national scheme, is a game changer, and not just in political terms. It envisages the beginnings of universal healthcare. If – and it is a big if – the scheme is implemented the way it should be, it will not just have economic and social impact on the state, it will also prove a pioneering step in modern governance. In fact, its very implementation will require political and administrative ability that is not usual in the Indian context.
It is an established fact that one of the major reasons for working class and lower middle class families to fall into poverty is unexpected medical expenditure. Since it also affects future ability to earn, either because of death or disability, it has long term consequences. If this variable can be eliminated as much as possible from people’s lives, it would give a big boost to the economy, leading to overall generation of wealth. Other inequalities too would be eliminated. As such, a health scheme of this kind more than pays for whatever legitimate expenditure it might entail.
The problem, of course, is that the system is full of loopholes. So many government schemes and subsidies have been diverted by small and big time racketeers into their own pockets. So much of the present Union Government’s tenure has been spent on plugging these loopholes. An essential element in this process has been the use of information technology in its many aspects. Using this process as a learning experience, the Uttarakhand Government should embed the scheme with checks and balances that prevent misuse, but at the same time do not bog it down in red-tape. It is being seen that the government is announcing on an almost daily basis various relaxations to get the scheme up and running so that an immediate impact is felt in people’s lives (the elections are nigh). However, the larger objective should be kept in mind so that the Yojana gets institutionalised and functions honestly and smoothly.
Vested interests will, of course, try to either sabotage the scheme or turn it into a cash cow. A nexus is very likely to build up between government doctors and private hospitals. Fake patients will be referred and admitted, cuts taken all around with no work actually done, and the government will end up paying. The real patients will actually become encumbrances in this racket and be treated like a nuisance. And a great idea will come to naught. A suggestion would be to form an independent body to check on the ground what is actually happening in a random selection of around five to ten percent of the cases. The earlier it is done, the better and longer lasting the scheme will prove.