With war clouds looming, will the FM walk the talk?

Dr Govind Hoskeri

Once upon a time, a hungry British officer had to spend a night as a guest in a ‘Hindu Undivided Family’. To his surprise, he was offered only a cup of water and a handful of beaten rice, which was a test of his patience as well as of his dentures. All through the night, this Knight, the servant of Her Majesty’s Service, kept on thinking about the various ‘nonaffictures’ he could impose upon this HUF for leaving him in the cold as far as his stomach was considered. And he went into a disturbed sleep only to catch a wink at the wee hours of dawn. That luxury was also to be disturbed, but by the great fragrance associated with the Indian curry and other associated aromas that had driven his forefathers to this great subcontinent. And before he knew what was happening, he was pulled in front of a spread of banana leaf and satiety of a gastronomic experience unparalleled. As he was chewing the after meal betel nuts and pan, his curiosity took him back to the poverty with which he was treated last night, he could not help seeking a clarification. He was given one. "Sir, yesterday was the eleventh day after new moon ...ekadashi... and today is the twelfth day...dwadashi." His immediate question was "Why not this day everyday...?!!!!"

After every four years of experimenting with all that is in the books of economics; to overcome the days akin to ekadashis, a year of dwadashi dawns upon the Indian budgets.

If the budget is ‘common man friendly’ it is called as an election budget and even if the elections are not slated for that year, the immediate conclusion is that the elections are round the corner.

So why not have elections every year, bountiful like the day of feast alluded to in the story above. It will be worth it, in spite of the huge expenses involved in the process of elections, as our finance ministers, then, can think only of the benefit of the common man.

In my last years’ article dealing with the budget, I had mentioned my inability to comprehend the concept of ‘life saving drugs’. My learned colleagues are also aware of the fact that drugs do not cure the conditions and anybody and any equipment does not ‘save a life’.

That apart, I am happy, but at a different level. Some of the drugs coming under this ill-understood group, at least, are becoming affordable. For a diabetic who is on anti-diabetic regime, sugar becomes a life-saving drug in the event of impending hypoglycemia...

If one goes into the finer details of life saving mechanisms, the list of life saving drugs can be anything beginning with a grain of rice to ’unquestioned, immediate medical attention’ itself.

This budget talks of life saving equipment also. The most crucial equipment is the ’presence of a doctor’. How do we ensure it in the rural India is the question? The primary healthcare professionals have an uncanny propensity to be conveniently present elsewhere. Obviously we cannot claim 25 per cent to 40 per cent depreciation on this equipment. This rebate doled out to the equipment used in Pharma industry to boost R&D, is a long-term investment, the benefits of which, I suppose, will reach the Indians in the long term only.

The ’Rs 300-billion-turnover-per-year pharma industry’ that survives on medical profession (is it the other way round?) has another booty in its kitty. The medicines and the equipment to be used in clinical trials will be exempt from customs and excise duty.

The WHO has reportedly slashed down the world population figures by 800 million for the mid-century. The gist of this report is that more people are likely to die of HIV\Aids. It has not taken into consideration the wars. The other interpretation in favour of this conclusion is the ’falling third world fertility rates’.

May be the first statement is likely to be true as the much awaited results of a clinical trial on a vaccine to combat HIV\Aids has proved to be ineffective. I repeat the vaccine has failed... The hope of finding the vaccine to be a ’racially friendly Indian vaccine’ cannot be taken for granted. Will the huge clinical trial slated to take place in India this year be stalled, till more light is thrown on this vaccine and the money earmarked for this be diverted to other purposes? We cannot afford the luxury of an invasion by a known ’non vaccine’.

The second premise that the fertility rates in India are going to come down is a suspect one. We do not like to be identified as a third world country. I think the third world countries coming under the definition, would also not like to be seen in a compromising situation with us.

We have no definite identity as far as this third world status is concerned. Hence our fertility rate need not be affected by such assessments. Even while surviving on paltry food, we have been generous in terms of fertility.

Our projection for the mid-century population will be on the original projections and so the provisions have to be made accordingly, particularly if the ’better food programme’ is going to be implemented in the right earnest. The seeds have to be sown now itself to provide for more in the future.

I am glad that ‘Antyodaya Annaa Yojana’ programme is launched to reach out to the really needy section of the society. Only that, it should reach out as intended. May it reach out to those people who have forgotten what rice looks like and have taken to grass and mango kernels as their staple food.

Senior citizens can be made to believe that they have got a better deal. Their fixed incomes though, have developed more holes in them to be sealed. Well, they can find solace in the fact that they have something serious, like this budget, to discuss throughout the next year. With the interests nose-diving and gold not-so-safe with the proposed rate cuts, they need to have some means with which they can ensure a dignified identity by thinking that this budget has benefited them. Be rest assured, only a talented professional can make them part with their hard earned money. They are the ones who have learnt their lessons the hardest way. That is a huge chunk of retirement benefits not getting their way back to the government treasury. The pension and insurance schemes floated this year may not attract this set of increasing population.

Last year an insurance policy was introduced, whereby by paying one rupee a day, one could insure better medical facilities. This scheme has been given a boost, whereby a premium equivalent to Re.1 per day (or Rs.365 per year) for an individual, Rs.1.50 per day for a family of five, and Rs 2 per day for a family of seven, will entitle eligibility to get reimbursement of medical expenses up to Rs.30,000 towards hospitalization, a cover for death due to accident for Rs 25,000 and compensation due to loss of earning at the rate of Rs.50 per day up to a maximum of 15 days.

To make the scheme affordable to the below poverty line families (the government communiqué calls this group as the BPL group) the Government has decided to contribute Rs.100 per year towards their annual premium. I welcome it, but would like to know the facts and figures in terms of people participation in the last year’s programme.

We have a tendency not to follow up the short-term and long-term projections of path- breaking policies. If people participation has been lukewarm, we need to publicise this more effectively.

The very goal of reaching out to 50 lakhs of BPL families only in the first phase is in itself an indication that enough has not been done last year.

Parents of medical students may have some solace in finding Rs 12,000 per child for two children towards educational expenses coming under tax benefit. Only a fringe benefit, as the cost of education is catching up with other costs of living, like owning a life itself. Does it apply to the parents who can afford the capitation fees also? The physically-impaired patients can be shored up with less-costlier crutches, walking frames, wheel chairs, tricycles and artificial limbs. Hearing aids will be cheaper. For all practical purposes, almost all the taxes on these supports are abolished. In the very first instance, let me ask why should there have been any taxes on these at all?

Financial institutions are encouraged to provide loans for construction of 100 or more bedded hospitals. This should encourage more private participation in the healthcare scenario in future. This is aimed at private hospitals to start satellite hospitals. It should come as a boon for a space-crunched city like Mumbai. Entrepreneurship-rich Mumbaikars would like to build chain of hospitals attached to bigger hospitals. It sounds good to have branches and helps fill the bed spaces. Or reshuffle them.

Surprisingly telemedicine and other advanced cutting edge areas, which could reach the poorest of the poor in the remotest corners of India, have not been mentioned in the budget. May be they come under ’state-of-the-art’ equipment eligible for 25 to 40 per cent depreciation...

This five-pronged budget is offered after ’spending’ a year under the shadows of ’War Against Terrorism’. Medically, I would rate it as a healthy budget and sincerely hope that another war will not throw a spanner in the wheels of the intentions - political or otherwise - of this budget...and hopefully pave the way for a day when no patients are seen around public hospitals, for want of admission, nursing their own wounds with makeshift dressings of plastic sheets (unaware of the fact that unbranded surgical bandages have become cheaper on account of 4 per cent reduction on excise duty) and at the same time swatting flies away from the sores...not a healthy sight for a budget which envisages marketing India as a Global Health Destination...