Media activism – pros and contra

In contemporary India the media, both print and especially the television media with so many 24x7 news channels, are often found playing a rather active, sometimes bordering on aggressive role. Gone are the days when news casting was this staid objective reporting of news stories, description about an event that has taken place or one about to unfold such as a sports tournament, about government policies, laws being legislated, or information about the success or failure in implementing those that have already been enacted. The news reporting has become interpretive, pretending to be an analysis of what has happened or is likely to happen, who the main dramatis personae are in this news-as-unfolding-drama on the national stage, what their motivations are and what social and political forces their actions represent. The news watchers have often been told on many such channels about their programmes being ones that are supposed to take the viewers behind and beyond the bare bone news stories. They are enlightened by background information, helped along with analytical sounding presumptions, hypotheses, to understand, or as they say, make sense of the stories. A question often being raised and debated within the media itself is what to make of such an activist trend and whether it is good or bad. 

It is probably undeniable that during the last few decades (especially since India’s open espousal of the liberalized economic policies during early 1990s) there has been an impetus to the ongoing modernization and the media has been both an active agent for democratization of Indian society, bridging the distances and breaching many social barriers and in the process is itself transformed in radical ways. Increasing media activism is a reflection of the social activism growing over the last several years among sections of Indian Middle classes who are growing in importance within the Indian polity.

News media by way of informing empower people. Increasingly media is taking on the role of an interlocutor (if not an interrogator) on behalf of the people in ‘asking questions’ to and ‘getting straight answers’ from those in charge of governance, others involved in political actions and maneuvering, holding and acting on ideological positions, reformers and renegades, evangelists of progress and modernity on one side and bulwarks of tradition and conservatism on the other). One is reminded of the rhetorical flourish in the way the popular anchors of the TV channels would often like to preface their news analysis: Tonight the Nation wants to know.

Technology today has enabled people, especially in urban and semi-urban areas of the country most exposed to the television and the print media, not just to consume news as readers, listeners and viewers but also to participate in its analysis and dissemination by way of interactions between the news broadcasters and the TV audience, phone-ins with and setting up questions for the anchors and expert panelists at the TV studios, apart from the readers’ response surveys and feed back columns (not to forget the traditional letters to editors) in their print versions.

An important part of this media initiated democratization is an apparent bridging the gap between the patricians and the plebeians, the high and mighty on one side and the lowly proverbial ‘common man’ on the other in the discussion arenas (e.g. TV studios) characterized by an ambience of irreverence. Any body can ask any critical or damaging questions of any body else, cross swords with and lampoon the rich and the powerful and tear down the carefully cultivated façade of lies and hypocrisy built by them over the years to hold down the masses of voiceless people. Class conscious niceties, need for decorum, maintaining a pecking order and orderliness are often dispensed with in no-these holds-barred shrill debates.

A clear danger associated with the inquisition format of much of the television debates is that media (and the consuming public whetted by it) is increasingly displaying a Madame Defarge like tendency, reveling in the downfall of and stridently baying for blood of the high and mighty in the society, the celebrities. Notice the hectoring style being adopted by many television anchors where they ask tendentious leading questions to trap selected participants and extract ‘confessions’. So much so that some people have called these debates/discussions trial by media.

Some people have also discerned a newfound urge for vigilantism in the zeal of the media in indulging in investigative journalism to buttress the generally held opinion on corruption cases involving big politicians and bureaucrat, conducting unorthodox ‘STING’ operations, making disclosures based on unidentified ‘sources’ and ‘leaks’ from those (whistle blowers) who are  sometimes part of the government administration. There is insufficient attention on the part of the media to balance people’s right to know vis-à-vis possible defamation of presumed wrongdoers in government, politics and business.

There is also a set of inescapable follow up questions. Is media becoming a parallel center of power not just by occupying a moral high ground seeking ‘truth’, but also because of the financial muscles of some media houses sustained independently of the government largesse, acting/operating outside the pale of government? This supra-government positioning of the media may appear to be beneficial for keeping a watch on the government, which is increasingly appearing to become non-transparent and unaccountable to very people who elect them. This kind of outsider vigilante view of the old style, ‘corrupt’, inept democratic polity is popular with the vocal urban middle class elites

But who is the media accountable to? Is their truth seeking completely value free? Are the big media companies not mixing commerce with conscientiousness? Can the media be a threat and cause destabilization of the other organs or pillars of democracy? These are questions that can not be unequivocally answered.

        

Comments on the recent article “India’s middle class awakes” by Pavan Varma

Pavan Varma, an author and former diplomat, and currently an adviser to the Chief minister of Bihar, has recently written an OP-ED article in Times of India (23^rd November, 2013). Interestingly the article has made several points about the growth in importance of the middle classes in the Indian society and polity, which are almost the same or similar to those I made in my post “Rise of the middle India” (February 2013) appearing in this blog.

For instance, he notes, like us, the growing participation of the middle class in the massive public protests in the national capital on a number of issues, such as, miscarriage of justice (e.g. Jessica Lal murder case), corruption in public sphere (most notably during the Anna Hazare agitation), and more recently in a remarkable display of the public anger about the government’s insensitivity and callousness in respect of the Nirbhaya case which was symptomatic of a larger malaise. Clearly there has been a noticeable coalescence of public disaffectation with the way our democracy is being conducted. Varma, however, has not mentioned the three or four other factors (which we felt were equally important for the emergence of the middle class) like the stellar role of the news and the television media in communicating the true facts and vital details of the criminal and the corruption cases; government’s various acts of commission and omission and the people’s fights against this malfeasance through an effective use by the activists of the newly enacted RTI law; a proactive CAG (Comptroller and Auditor General of India) which is Government’s own audit watchdog and the law courts, and last but not the least, the emergence of the social media.

Varma has noted quite correctly that the middle class has gradually come to acquire even a numerical significance, a sort of ‘critical mass’, that it had earlier lacked and in some broad sense has also a India-wide homogeneity in tastes and aspirations. And as we suggested in our own post, the political parties today might find it no longer expedient to ignore this class. We also believe that it would be better to describe the confluence of various social groups and economic categories, as underlined in Varma’s article in terms of a range of earnings, as the middle ‘classes’ rather than an abstract conceptual category such as ‘middle class’.

The point of departure in Varma’s article is the weaknesses he finds within this emerging ‘political class’ and the lacuna it has displayed in its disparate protests and agitation movements and its apparent lack of political vision to provide an alternative to the objectives of and the ways and means adopted by the two main political formations, Congress- and BJP-centered coalition of political parties. He talks about their organizational weakness, lack of pan India presence as an organized force and leadership, apparent inability to go beyond pointing fingers at the multitude of scams and follies indulged by main political parties and not coming out with strong alternative policy options on a national scale. Presumably, Varma does not think much of the newly launched Aam Admi Party and its imminent political initiation by fire in the upcoming elections for the New Delhi assembly early December, 2013.

Varma fears that in absence of a well-articulated set of policy blue prints of national scope and significance, wider coverage of issues other than just a principled stand on corruption, the middle classes and their newer political representatives might not appear as effective to the electorate and fair badly in the elections. On the other hand unscrupulous political parties might use the anger of the middle classes about mis-governance or the governance deficit (lack of goods and services and the economic development the governments are expected to deliver) and manipulate their emotion to their advantage by subsuming and co-opting sections of the middle classes and winning them over to their partisan and disastrous self-centered and sometimes autocratic or fascistic policies.  

I think one can broadly agree with Varma’s reservations about the further and more important political role of the middle classes. It is true that while they (if you take the Aam Admi Party as representing them) now have waded into overt political action (like fighting elections) these representatives should probably avoid the simplistic reductionism entailing all economic, political, social issues facing the people of this country to the fountainhead of corruption. They must also make their position clear about the form of capitalist economic development model that the present ruling political parties are committed to and have a good support base among the elite and even sections of the middle classes. Many would argue that some of the major cases of corruption in high places arise out of the crony capitalism and because the kind of unregulated greed of a section of the impatient entrepreneurs is taken to be synonymous with the new aspirational ethos believed to be sweeping India during these past two decades. Since also much of India’s recent economic progress has come about after aligning the country gradually, probably inexorably, with the international trade policies (and quite a few dogmas), and relying on a sizable infusion of foreign capital and much of the domestic economic policies today have to be in consonance with the pulls and pushes generated at the behest of the big global power blocks (like US, European Union, etc) a clear-sighted foreign policy enunciation, that is neither subservient to these blocks nor totally isolationist like in the past, would be a prerequisite for a matured political formation that aspires to rule India. Coming months (or even years) will show if the middle classes have acquired that maturity.  



Narendra Modi’s grip on the electoral arithmetic in Gujarat

Despite strong public opinion prevailing in other parts of the country, successive elections to the Gujarat assembly in 2007 and 2012 were handsomely won by Narendra Modi. Not just critical opinion, there seems to be quite a lot of documentary evidence of the not-so-great performance of Gujarat over the years in terms of the human development, government policies openly favouring the rich and the very rich businessmen and industry groups flouting normal fiscal prudence and administrative norms (running up sizable fiscal debt), the widening of the urban-rural divide, government doing everything to delay and deny justice to the 2002 riot affected and displaced Muslims apart from the official insensitivity towards them and neglect of their rehabilitation needs. Despite all these facts, many of which the congress party brandished as the part of their propaganda at various times before the 2012 elections, 48% of the valid vote polled went in favour of BJP (and in Gujarat the party does not mean anything without Modi), with Congress polling about 39%.

The Muslims constitute only about 9% of the population of the state. For the sake of a simplified analysis, even if Muslims vote enblock against him that hardly affects Modi electorally, as long as he could garner the majority of the remaining votes on the supposed strength of economic development of the state, apparent priority accorded by the government to business and industry (which goes well with the traditional Gujarati ethos), well developed urban infrastructure, good availability of electricity and electronic connectivity, etc. From the reports critical to NaMo and his policies and programs, it may appear that Gujarati society is after all not monolithic and his actions did affect sections of the population in negative ways, especially the poor and the marginalized and those inhabiting the rural Gujarat. Do the voting percentages and patterns in different parts of the State, the regions and the districts demonstrate the disenchantment of these sections? Only a detailed statistical analysis of the poll data can establish that or refute the hypothesis.

Since the voting patterns in 2012 election show a fairly complete polarization between those for and against NaMo (all other parties in the opposition neither significant in gathering votes nor seats) obviously there is a fairly clear divide in the state – it remains, however, to be demonstrated as to whether this divide is indeed between those apparently benefiting from the stress Modi placed on the economic development  (coinciding with the benefits visible in the urban and semi-urban areas of the state) and others being denied of the same. That BJP won comprehensively in the urban areas, cities in particular, is beyond dispute as shown by statistics. But the party also appeared to have got majority of seats – if not greater vote percentage- in most of the 5 major regions of the state.

The 8-9% difference between the BJP and the Congress votes during the last election is too large to have happened without a benefit that accrued to Modi on the back of the perception of a development dividend delivered. There are some indications of the role played by the so-called neo-middle classes of the Gujarati society in this election. There is a sizable section of the population from the poorer classes of the rural areas forced to migrate to urban and semi-urban areas as a result of economic difficulties and backwardness. It is quite possible that they have been attracted by the promise of an economic revival of their fate in the wake of the development ‘magic’ they are consuming as new entrants of the burgeoning middle classes in the cities and urban clusters of Gujarat. And for them the perception is that entrepreneurial ethic is getting the desired attention and support from the government. And naturally they became the latest vote bank for Modi.

Lastly, the recent delimitation of the assembly constituencies may also have played a role in tilting the electoral balance by way of redistributing the purely rural areas and combining them with relatively more urban areas and generating a new constituency with both urban and rural category of voters. This again needs more detailed examination provided relevant statistics are available.

Hope to revisit Modi’s magic formula for wining elections and how it could impact countrywide if at all some other time.



Tsunami of public opinion and the response of the marooned political class

The political class in this country has always moulded the public opinion and is used to commandeering it by (dividing them into religion or caste-based communities,) appealing to raw and the basest and the most archaic instincts of people and historical schisms between communities in terms of their caste, cultural and religious identities. Lack of information, education and enlightenment among the people in broad swaths of the country which foster superstition, outdated outlook and conservatism came in handy in perpetuating this hegemony. And in this they have always had implicit support of the ruling classes, the economically rich and powerful, both in the cities and villages.

But the development breakthrough brought in by the emerging capitalism in India since the 1990s through the policies of liberalization has changed this force field. India is changing with growing aspirational urban middle classes, whose ranks are slowly but surely being swelled with new entrants from poorer and historically and socially backward classes. Ironically, this is helped by the affirmative policies embraced by successive governments and that of positive discrimination that is the staple of the serial political drama played out by the political class for the last three decades. With the growth in the urbanization, education, enterprise, exposure to international standards through television and mobile telephony (probably two major drivers of demands for consumer products that indirectly helped economic growth) came the need for information. At least urban Indians (especially those in semi-urban, tier-2 or tier-3 cities and towns) - and their numbers are no longer miniscule or could be safely ignored in political calculations - are getting to know about the products, standard of life, standard of services available in the most developed and metropolitan cities of the country. They are also getting informed how the best of capitalism is brought out in the first rate cities in the first world countries by harnessing it through intelligent and efficient regulation and steadfastly following the rule of law. 

This underlies the importance and increasing role of the media (especially the electronic version) in highlighting the deficiencies, inequities, unreasonableness in our political system and amplifying the popular impatience about the status quo sought to be maintained by the establishment – the government bureaucracy and the political class – and delays in redressal of the public grievances.

There is also the new technological developments in internet based communication and dissemination (social media platforms, blogosphere) that has made this tide of anti-political class sentiment due to its speed and extent of spread – through spontaneous articulation, repetition, recycling, resonance, lack of a command structure, runaway unpredictability – resemble a tsunami, that of public opinion (something the political class has not yet learnt to commandeer to its selfish goals).

It is in the light of the above that we could analyse what might appear as a beginning of a rethinking by the political class on the bill and later the ordinance to retain the lifeline available in the existing Representation of the People Act (RPA), proposed to be snatched by the Supreme Court in its July judgment, to the convicted members of the parliament and the assemblies. Is this a belated recognition of the strength of public opinion against the criminalisation of politics? It is difficult to be sure, though. Indications are there about the political parties individually readjusting their public posturing, especially keeping in view the imminent need to face the electorates for the assembly elections in four states during the end of this year and for the big parliament election early next year. 

It was the Congress party that actually took the lead through an all-party meeting to reach a consensus about bringing about a bill in the Parliament making the requisite changes in the Representation of the People Act (RPA) so that the elected representatives can continue to hold their position despite conviction, with some marginal restrictions. Practically every party, including the BJP, supported the move. But somehow between that meeting and the actual debate in the Parliament when the bill was introduced, the principal opposition party and also smaller parties like BJD, CPI etc, were smart enough to sense the public mood (to be more accurate the mood of the articulate and educated middle classes) and opposed the bill brought by the ruling party. When at the end of an acrimonious day of debate the bill was referred to the standing committee, it was clear that the political class bought some time for themselves.

Pressures from the parties supporting the UPA, like the SP and RJD, whose leader Lalu Yadav was looking at the spectre of disqualification as MP after his possible conviction in the fodder scam case, partly forced the hand for Congress. There was also this arrogance of power, feeling of hurt among some cabinet ministers who pride themselves as the legal eagles being forced to bite dust on their own legislative turf. One found a determined government pushing the so-called Congress Core group into resolving to bring the law by the backdoor of an ordinance to be regularized later in the parliament’s winter session.

The response of the BJP was crafted on the basis of their cynical estimate that their current losses, if any, due to the application of the new legal provision, would be more than made up by cornering the Congress in the forthcoming assembly elections later this year if they can get on to the right side of the enormously negative public opinion about the ordinance. They went to town crying hoarse (including protesting to the President) about the Congress party’s mala fide intentions in pushing the bill as an ordinance and parading their own consistent stand opposing the bill since the parliament debate.

Congress party’s own prevarication was finally ended when they realized firstly that persuading the President, if not about the legality but the morality of the ‘criminal’ ordinance, would not be a cakewalk. Secondly in some quarters of the party, especially its youth enclaves, the realization had set in that pushing through this ordinance would alienate the party from the young India of the social media, the new voters, aspiring among other things a better definition and practice of the rule of law. Certainly they were loath to loose the game to the opposition even before it began.

Thus the two main political parties, though not voluntarily, showed for once a remarkable alacrity in deferring to the undercurrent of a progressive public opinion in favour of a more lawful political space where the electoral exercise might aspire to become cleaner and fairer. If this trend can be sustained it will certainly be good for our democracy.



Rationalizing negative and evil deeds of fellow-men



It is perhaps not too difficult to notice a common enough tendency today in many of us in India to rationalize (if not exactly justify) certain obviously negative traits in people around us, our friends, enemies and those in between. This is done sometimes apparently with a detachment befitting a disinterested observer, although the emotional underpinning of the analysis is not always easy to hide. It is as if people do not anymore expect other people to behave in an ethically correct and consistent manner and most of them are more likely to be in breach of a moral code our elders so painstakingly tried to instill in us during childhood (and in turn us reprising the same futile effort vis-à-vis our children) in schools, at home, in the community and so forth than to adhere to these. With every passing generation the hold of the norm having become less constraining, aberrations stop raising eyebrows.

Thus we are not surprised to find airplane passengers, apparently educated, civilized and smartly turned out people like you and me trying to move ahead towards the exit through the aisle within the aircraft jostling and pushing fellow passengers, elbowing them or trampling their feet with oversized bags brought down from the hastily opened overhead luggage hold against express appeal from the cabin crew for greater patience and sensitivity for ‘others’. We hardly expect motorists on partially waterlogged and pot-holed city roads during the rainy season to drive with moderate speed so as not to endanger lives of drivers of other vehicles (and even their own) let alone try and avoid splashing people who could not avoid walking down the footpath with dirty muddy water. We have rather learned to expect a biker or an auto-rikshaw driver to come to grief if by a slight error of judgment his vehicle so much as touches the glistening posh (possibly imported at a great cost) ‘CAAR’ (just not a car you know, remember the ad on the TV!). An actual scratch can easily lead to a case of ‘involuntary manslaughter’ (or ‘culpable homicide not amounting to murder’), with bear bottles, baseball bats, pistols and such handy weaponry stocked in the CAAR giving fullest expression to the great Indian ‘Road Rage’. 

When women are molested while negotiating our crowded public mass transport system, or are abducted and gang raped with impunity day in and day out, we as onlookers or readers or viewers of such news stories feel dismayed or even outraged. But at heart of hearts many of us are convinced that it is perhaps difficult to control this primeval male proclivity and hence it is hard to wish it away, particularly in view of the unavoidable proximity and visibility of so many women, in modern urban and semi-urban settings, everywhere in public all day long and even during late evenings and sometimes even later. We do not believe it is feasible to teach our sons to behave and not stalk, bully, molest, disfigure women, to learn to take no for an answer. But asking our daughters to follow stricter dress code, restrictions on time and place to move about, as indeed even careers to choose appears as a practical way out.          

Some of us, being believers of the adage ‘prevention is better than cure’ would rather advise women about the danger of turning out in ‘modern outfit’ (inviting lecherous male attention), finding themselves at the ‘wrong time and at wrong place’. Some, if they had their way, would even wish they would not turn out at all without male family members, though how much protection that might offer against a pack of desperate louts and rowdies is anybody’s guess.

 

Some of the more thoughtful among us would rationalize crime against women in terms of a clash between the tradition and the modernity, the inevitable cultural backlash, the male angst in the backdrop of all round female assertiveness and progress that has surfaced as a part of this era of ‘India Growing’ narrative. And of course it might not be too difficult to explain how all manner of religious preachers, godmen, heads of ‘cultural’ organizations, politicians and the policemen have invariably converged as the upholders of the so-called ‘Indian tradition’ against the onslaught of modern tendencies like freedom of speech and freedom of choice, especially by women.

Narendra Dabholkar was felled by the bullets of an assassin on a quiet morning street in Pune. Decades earlier, Safdar Hashmi was clubbed to death on stage during a street play in a village near Delhi. They dared to enlighten people, asked them to wake up and keep the light of reason from being extinguished.  Scores of other social activists, RTI campaigners, green crusaders are routinely assaulted and sometimes put away permanently by hoodlums and hitmen let loose by politicians, builders, promoters and contractors who feel threatened by potential disclosures of their misdeeds through RTI or affected by interventions by Courts. In this long running morality play on the real life stage the real villains manage to have their way most of the time over the dead bodies of the good guys and the rest of us demoralized and fearful for our own lives pass by wearing the cloak of neutrality as if what happened to Hashmi or Dabholkar do not really concern us. And to neutral observers like us what had happened was perhaps as logical or inevitable as the Newton’s laws. 

Getting past the shadows of the past

Lamenting about the loss of a time in the past is generally considered futile and a part of the natural wistfulness of a fogey about to be permanently archived. The values and the culture people were then comfortable with could at best be a historian’s curiosity and is certainly ineligible to provide a relevant perspective to our present-day attitude or demeanour.

In terms of the rapid changes occurring in the recent times in India and even in the neighbouring countries, fifty or hundred years are a long time in the past indeed.  A writer in The Hindu Sunday Magazine section (dt 3^rdAug 2013) first wonders aloud as to why there is hardly any celebration (official government sponsored or otherwise) on the occasion of the birth anniversary of an once famous Hindi short story writer and novelist Munshi Premchand, and then finds the answer in the innate disconnect between the values of the writer and his contemporary readers. On the one hand Premchand appears too rooted in his times and the society (largely that of villages and small towns of India of late nineteenth and early twentieth century) that appeared almost static and immutable. An India that almost seems to be too primitive and remote, hence not of much relevance to today’s ‘shining’ India. The young readers today are certainly far removed from the mileu Premchand described and was concerned with and hence are probably unenthused about his work (many may not have even heard about him). What might have additionally contributed to the quiescence is that he is not uniquely identified with or appropriated by any currently dominant political constituencies like dalits, scheduled castes and tribes or the Muslims or the women, although much of his writings held up a mirror to the caste oppression and the plight and the position of women in the Indian society with unmistakable empathy for the downtrodden.

Ironically, while The Hindu magazine writer entitled his article ‘Cast into the shadows’ referring to the fate of  Premchand, one has the uneasy awareness about the dark shadows of worst forms of cast discrimination being insidiously continued and ingenuously revived in much of the dark hinterland behind the neon shine of the progressive and contemporary India. Undermining of women’s rights and position in society is continuing unabated despite big charades of government-initiated tokenisms perpetuated by power-hungry politicians of all hues. If anything, the humiliation of women have become much more open, brutal and ubiquitous. Are we sure we are getting out of the shadows of our past ?

By a curious coincidence, in another page of the same Sunday Magazine, there was a discussion with Tash Aw the acclaimed Malaysian writer discussing the context of his recent   novel “Five star Billionaire” (that made to the Booker Prize long list), that of Malaysians migrating to Shanghai seeking to change their life, make a fortune, pretty much with the same motivation that drives much of the voluntary migrations within and from the post-colonial Asia. But, Tash makes the point, coming out of the shadows of a stagnant underdevelopment in the native country and embracing the new, the glittering, the desirable, has not always been easy despite valiant and somewhat tragic effort. To quote from his analysis of the problem, “I think that there’s a tendency in many Asian cultures to be very ruthless with the past, both in a national and a personal sense. Partly this is because our recent histories have been difficult narratives to deal with; often involving upheaval, violence and, above all, the lingering and badly-articulated humiliation of having been colonized, or defeated in some sense. So we tend to focus on the shiny new ‘Now’, in which our countries are on an upward curve, certainly in a material sense; the past is at best irrelevant, at worst a bit shameful. Which means that we cut off parts of our narratives and, in so doing, cut off our emotional roots.” According to him Asians in countries like Malaysia, Singapore, China have generally found it difficult to deal with their past in an honest and rational manner with the desired detachment despite pretending to do so. That in some sense is also true about Indians in India and those described to be the diaspora Indians.



Morally ambiguous choices in governing a democracy

Life in India today often presents one with a difficult and morally ambiguous choice. Proscription of illegal and environmentally dangerous sand mining, quarrying etc which is rampant today in many parts of India may be the ‘right’ action on the part of the government, if and when it chooses to do so. But outlawing and putting effective curbs on this pernicious practice might result in two economic consequences. It is known that thousands of trucks are being used in transporting these illegally mined sand to the end users – mainly building contractors – and sizable number of workers are being used for mining as well as for loading, unloading, transporting this commodity. Curbing illegal mining would also mean loss of job for many directly connected these activities.

Secondly, there is a spurt over the last couple of decades in the infrastructure development and other building (residential, commercial) activities, which are directly related to urban prosperity and economic growth in the country. The latter is also responsible for employment generation to some extent, the argument about ‘jobless growth’ notwithstanding. The spectacular rise in the demand of sand is at least partly occasioned by the contractors’ profit motivation which gets its legitimacy within the prevailing dominant capitalist worldview sweeping the country’s corridor of power. Irrespective of whether one agrees with that worldview or not and even if one chooses to say yes to the moral imperative of saving river beds, lands, forests from the predatory and patently illegal mining, it is difficult to ignore the immediate negative impact of curbing the sand mining on the employment, apart from the loss of revenue (in the form of royalty) to the government

This question is symptomatic of much of the current and larger debate in the country : how can the economic development and growth be achieved without letting capital a free hand (or through enabling governmental actions including legislations) in acquiring land (and also forest lands if required), mineral deposits, spectrum for telecommunication and many such resources on its own terms. And how can that be balanced with possible or potential damage to the environment and natural resources, curtailing of rights of the tribal communities, workers and farmers in general.

Can we endanger our natural resources by allowing wanton exploitation in the name of economic development and growth ? The aggressive sand mining in the riverbeds or banks are being held responsible by many experts for changes in direction of the natural course of a river. But the ‘animal spirit’ of the builders of the new India, the ‘growth constituency’, would be dimmed if their voracious appetite for sand is not met at a rate of their choosing. As a result, we are told, there would be no modern roads and expressways connecting our burgeoning cities and towns teeming with little entrepreneurs, the promoters and the contractors of construction projects throughout the length and breadth of urban India. How will, then, the new and massively architectured slick glass-and-concrete office buildings, call centers, back offices and other commercial complexes, shopping malls come up at the rate at which Indian and foreign investors would like it so as to be competitive in the global market ?

A couple of months back, many parts of the state of Uttarakhand were visited by unprecedented rains, cloudburst followed by tear-away flash flood that caused landslides and brought about an avalanche of mud water, boulders, uprooted trees that practically erased many of the ‘Chardham Yatra’ routes and caused death and disappearance of thousands of pilgrims. In the process the flooded rivers also destroyed much of the mushrooming external economy – the hotels, guesthouses, restaurants, shops that have grown not only along the routes, often precariously constructed and perched on slopes or unsound foundations, but sometimes also right inside dried up river beds around the shrines. As watched on television by millions through out the country, these constructions came down like a pack of cards during the deluge in Uttarakhand. In course of the media-led postmortem in the aftermath many well known facts came to be highlighted about utter illegalities, flouting of norms, collusion with local municipal authorities or government administration looking in the other direction apart from sheer ignorance and lack of awareness about the impact of widespread and unregulated building activities in this eco-sensitive region (like causing blockage of the normal flood plains of the rivers like Mandakini).

All these were allowed in the name of growing business activities, prosperity of the locals feeding on the religious tourism. It is undeniable that the tourism in Uttarakhand, especially that related to religious pilgrimage, provide livelihood to a sizable population of the state. In view of the widespread damage to the trekking routes and the infrastructure in and around temple towns this substantial loss of jobs would be definitely an important motivation for reconstruction and reopening of the pilgrimage routes. But like in the case of sand mining, should the livelihood question be posed in a way so that those questioning the laissez fair attitude of the proponents of unregulated construction activities can be disarmed easily ? In some sense this reminds one of the use of Shikhandi, a character in Mahabharata by Pandavas in Kurukshetra war to disarm a major warrior on the side of Kauravas.

You can win a growth vs environment debate in a TV discussion, or be able to cynically maneuver majority in Parliament to ensure the passage of economic legislations like Forest Rights Act or Land Acquisition Bill and others related to Power and Infrastructure Development. But it is the poor, tribals, farmers, migrant labourers and itinerant small service providers and finally common citizens seeking salvation of their souls in gods’ abodes in the Himalaya region who would eventually be at the receiving end as in the above instance, as indeed nearly always, growth or no growth.

Checklist of critical issues about selection of a medical insurance policy

This is in continuation with an earlier blog on the medical insurance currently being offered by many companies for the elderly in India. Here is a summary of the more critical elements of the policy on offer that one (especially a senior citizen) should be watching out for and be careful about.

• Sum insured (range and the maximum amount)
• The annual premium for individual/family floater scheme as the case may be
• Maximum entry age
• Maximum renewal age (For some policies the renewal is said to be guaranteed life long. However, the relevant policy wording usually allows for the insurer to put the insured under “the then prevailing health insurance product or its nearest substitute” as approved by the insurance regulatory authority, IRDA. This may effectively mean enhancement of the premium or other conditionalities not present in the original policy)
• Is there a loading of the renewal premium depending on the claims
• Percentage co-pay for the age-band concerned and that for treatments in a non-network hospital (make sure the hospitals of interest in a given location are included in the list of network hospitals)
• Sub-limits on various components of medical expenditure incurred as an in-patient (accommodation, especially the type of accommodation, nursing, medicines/drugs, diagnostic tests of all kinds, OT charges including equipment, consumables, medicines, anaesthesia gases, blood, oxygen, prosthetics (if implanted inside or fitted externally on the body, fees for surgeons, anaesthesists, additional specialists (if required for the procedure), technicians and attendants)
• Sub-limits/package rates applicable to specific surgical or other procedures and special diagnostic tests
• Check the definition of ‘one illness” and the number of days (usually about 45 days or so) before which a repeat hospitalisation  for the same disease or a relapse may mean that this will have to be part of the ‘one illness’ and therefore one claim (this may adversely affect in case of sub-limits such as above)
• Pre- and post-hospitalisation benefits (check the sub-limits and other conditionalities)
• Check the list of day care procedures (Usually these are allowed only as in-patients and not taken in the hospital OPD. Advisable to check with the insurer if they will make an exception if either the hospital concerned does not agree to such an admission due to non availability or other reasons and offer to carry out the procedure at the OPD instead)
• Mandatory waiting period (30 days/90 days) for the first proposal
• Special waiting periods (usually two years) – check the list of diseases for which these waiting periods are applied (in this way treatment of many common diseases and surgeries that may be of interest to everybody, especially senior citizens, are expressly disallowed for as long as 24 months, while one keeps paying the premium)
• Waiting periods related to the pre-existing diseases (usually four years) – check carefully what the insurer defines as a pre-existing disease
• Policy about the waiting periods in the event of the portability from an existing policy with another company
• Claim settlement process – whether in-house or through a TPA
• Response time in the case of cashless hospitalization procedure – both for pre-authorisation and during discharge

Anti-corruption – whose movement is it anyway ?

At the height of the anti-corruption movement during 2011, there were at least some commentators in the media who, apart from expressing serious doubts about the form of the movement and the remedy it suggested to curb corruption (in the form of an all-powerful, extra-governmental institution like Lokpal) also questioned the relevance of the movement to the toiling masses who form the majority of the electorate. The essence of the latter part of the argument was that while it was undeniable that the people at the lower economic rungs of the society pay a disproportionately large price for getting any service from the government machinery that was rightfully theirs, in their cruel daily grind to somehow survive (if necessary by paying a little bribe or speed money) they could not possibly accord a large priority to a high-minded protest agitation to eliminate corruption in the entire government machinery or the establishment, an impractical and utopian goal. A suggestion that the movement was elitist was probably implied.

The jury is still out as to the positive and definitive effect of the current mood of intolerance about corruption in the national capital, big cities and urban centers, among the educated, the intelligentsia, media and specifically that of the Anna Hazare led movement on the electoral outcomes in the assembly elections held since 2011. The results as always in the recent years had been dramatic in terms of biting the dust by the incumbent governments, but it might be disappointing to look for a clear indication of a countrywide uniform anti-corruption mood tilting the electoral choices. Although DMK’s decimation in Tamil Nadu may be ascribed to an extent to the culpability of A Raza (and others in the party) in the 2G scam having occupied both the national center stage and in the state adding to the general perception of DMK as a party full of corrupt politicians, it may not be fair to single out this cause for their fall, especially as governance wise DMK did reasonably well during their tenure. In Tamil Nadu emotive issues like the atrocities against the Sri Lankan Tamils and the perfection of the alliance arithmetic by Jayalalitha might have played equally or more important role. In Goa, a much smaller state, with a more focused political issue around a huge mining scam under the Digambar Kamat government, one might be more justified to flag the corruption as a major issue.

In UP and earlier in West Bengal the issue of regime change was probably the central one. Though the recognized left leadership in West Bengal may have been largely untouched by personal corruption it can not be anybody’s case that the left rule, especially during its last one or two stints had not spawned corrupt local satraps at the district and the block levels. The public anger at Lalgarh in demolishing the CPM’s party office and the opulent residence of the local party leader bore testimony to the popular disgust at their disproportionate wealth while the people they were supposed to serve were utterly impoverished. Still what was at stake in West Bengal in May 2011 was the possibility of ending a long-standing left rule in the state, ushering in what was euphemistically called ‘Poribartan’ (the change). Similarly, notwithstanding the latest indictment of several ministers in her government under corruption charges including Babu Singh Khuswaha earlier in the health mission scam, corruption in Mayawati led BSP government during its five year rule from 2007 was not the dominant issue in the 2012 UP assembly election nor the reason for her downfall.

Congress may be claiming that the spectacular downturn for the BJP in the recent Karnataka election is a vote against a corrupt government run in major part by Yeddyurappa whom the state Lokayukta indicted and the scams and loot, at the state’s connivance, by the mining lobby led by the Reddy brothers. But if corruption happened to be at the top of their mind the Karnataka electorate certainly could not have ignored the humongous record of financial scams and corruption notched by the Congress led UPA-2 government at the Center for the past four years. The election results do not seem to demonstrate such evenhandedness. Similarly, a little earlier, Virbhadra Singh who had to resign (or persuaded to do so by the Congress party) as a minister from the union cabinet under mounting corruption charges against him in his native Himachal Pradesh led, contrary to expectations in some quarters, the Congress party to victory in the state assembly election late last year and triumphantly became the chief minister yet again.

Thus the recent election results do not appear to provide any evidence of the heightened intolerance of the mass of Indian electorate (at least those who actively participate in the elections) about corruption as a priority issue. The commonplace and the cynical view is that for the broad electorate the caste or the religious identity (associated with the magnified assertion of a group’s self-worth, ‘asmita’ or pride), prospects of self-preservation (including physical safety in the face of hostile groups and communities, economic interests but not leaving out preservation of specific socio-cultural practices), and election-time monetary and other largess matter more. Chetan Bhagat in a recent OP-ED article in Times of India (18 May 2013) mentioned these issues as ones possibly overriding the concern of the Indian electorate regarding corruption.

Bhagat in his article suggested (without exploring it beyond it) an interesting angle to view this apparent disconnect between the progressive aspirations of the educated, enlightened, upwardly mobile middle classes and the stodgy and sheepish acquiescence of those occupying the lower depths to the corruption in high places. Ironically, according to him, this may be characterized as a sort of indirect revenge of the masses of the downtrodden on those miniscule sections of the Indian society who have always moved way ahead of them in terms of material prosperity. If anything the liberalization process underway over the last two decades has accentuated this inequity. Wages for the progress and the privileges cornered by these classes due to advantages of birth, education, rich inheritance, networking of classes or groups of higher economic and social standing, are being paid today to the less fortunate Indians for whom a morally spic and span society is possibly less of a priority than an equitable one. That is why they would elect a candidate promising them caste reservation in education and employment (hence making possible an improvement in their economic upliftment) or protection of minority religious rights (often an existential concern for many) despite allegations of financial corruption or criminal charges against him or her.

Ashis Nandy’s somewhat outlandish comments during a seminar within Jaipur literature festival earlier this year highlighted this same dichotomy. This school of thought shared by sections of the avant-garde Indian elite seems to believe that the increase in corruption indulged by the so-called ‘backward’ classes (SC/ST/dalit etc) is to be justified as a historical readjustment wherein the normatively ‘oppressed’ classes are finding ways to turn the tables on their erstwhile oppressors by learning and becoming more adept at the same game of corruption. It follows therefore, derived from this view point, that a principled opposition against corruption by the rich and powerful, especially those involved in the political governance of this country, is not only a distraction, but may eventually prove to be a stumbling block for the natural readjustment that the vigorous capitalism freshly unleashed by recent policies of liberalization. Dalit capitalism, according to these thinkers, is the way forward for ending the caste apartheid in India. And who does not know a little primitive accumulation of capital would serve this cause very well. One need not be squeamish about corruption if it helps this process.

Medical insurance in India for the elderly – II

(This is a follow up to my earlier post dated 31-3-2013 dealing with a government sponsored insurance scheme for the central government employees and pensioners)

In India medical insurance policies are currently being offered to public by several Public Sector Undertaking (PSU) insurance companies like National, New India, United India or Oriental, etc or by a host of private companies like Bajaj Allianz, Max Bupa, Religare, etc). Collectively these can be grouped as MEDICLAIM type insurance wherein an insured customer is covered mainly for claims arising out of the expenditure incurred by him/her as an in-patient in a ‘network’ of private and government hospitals recognized by the insurance company. Most of these companies either have policies specifically configured for the senior citizens or are extended to age-bands that include the elderly. This is a welcome development.

The customer may choose either a post-hospitalization reimbursement of the expenditure claimed or, more assiduously marketed by the insurance companies, a system of ‘cashless’ direct payment of the incurred expenses by the insurer to the hospital. Many companies, especially those in the public sector, actually outsource the claims management (initiation/intimation, authorization and final settlement) to an interface organization, euphemistically called ‘Third Party Administrator (TPA)’ that is supposed to have the requisite technical and medical expertise to settle the claims. Others declare that they have efficient in-house teams to take care of the claims.

In terms of the sum insured amounts, range of coverage and the corresponding premium, clearly, the policies offered by the public sector companies are much cheaper than the ‘products’ (yes, the policies are offered or being sold as insurance products !) brought to the market by the private players. But premium should probably not be the only criterion to select a health insurance policy. In any case these types of policies target and cover middle and preferably higher income group people usually not eligible or not opting for insurance cover offered by the central and some state governments. Together the total coverage may not be more than about a few percent of the population of the country. 

Be that as it may, here is a checklist for anybody looking for a useful medical insurance in India today to carefully consider (looking beyond the advertisement blurbs, glossy brochures and persuasive agents) before making a proposal to an insurance company. One may not have much of a choice as regards many of the terms and conditions governing a policy. But at least one should be fully aware of them and make a more informed choice among the various policies available in the market.

The issues are important for everybody. For the elderly, the general importance stems from the usually limited funds available to them. But there are many issues specially relevant to them, like the limit of indemnity, maximum age of entry, premium loading and the co-pay requirement with progressing age, the waiting period for the pre-existing illness that are more typical of the old age and the permanent exclusion for what the companies (i.e. their panel of doctors) judge as the congenital disorders.

Moreover, it should be emphasized that these policies do not, usually, cover expenditure for visits either to hospital OPD or to dispensaries of neighborhood general practitioners or consulting offices of specialist doctors for regular treatment of chronic diseases like diabetes or hypertension or osteoporosis, etc, some or all of which could be of major concern to the senior citizens. 

• Sub-limit/ceiling of expenditure (as a % of the sum insured, SI, or the limit of indemnity per illness, defined as a specified period of continuous treatment as an in-patient in a hospital) under any head – accommodation, ICU stay, medicine/drugs, nursing, pathological/laboratory tests, radiological tests (X-ray, etc), scans, CAT lab diagnostic procedures, surgical procedure, operation theatre, anaesthesia, surgical materials/gases used for anaesthesia/drugs used in OT, any procedure to put a prosthetic on or inside the body as a part of the treatment, etc.
• Limit of expenditure on or exclusion of any drug (generic or branded), vitamins, supplements, etc.
• Limit of expenditure on or exclusion of any prosthetic (type, material) put on or inside the body as a part of the treatment.
• List or schedule of day care (less than 24 hrs) procedures (such as dialysis, chemotherapy, radiotherapy, etc) covered. Can these be taken in the OPD of a recognized hospital or only as an in-patient ?
• Co-pay (% of the actual expenditure OR % of the admissible claim) due to any reason – treatment in a non-network hospital, claims arising in cases of pre-existing illness.
• Of especial importance for the senior citizens, (a) is there an entry age limit (70 or 75 or 80 years ?) for joining a plan beyond which insurance coverage will be refused; (b) will the premium be progressively enhanced with aging of the insured (sometimes there are pre-defined premium loading on renewal after a specified age limit is crossed, say, 65 years) or will the % co-payment increase ?
• One should find out the overall/ultimate limit of indemnity (usually a small multiple of the SI) even for a policy that is continuously renewed and no further coverage beyond that limit would be provided for the particular insured [It should be noted that this milepost of denial of cover by one insurance company may eventually be (like a credit rating a credit card user develops with one card company) freely shared by others in deciding to provide or deny the cover in future. This also means that the promised automatic lifetime renewal may be just that – a promise.]
• Senior citizens joining a policy should be especially aware that most companies disallow coverage for some very common disorders (like kidney or gall stones, hernia, piles, benign prostatic hypertrophy, any condition requiring hysterectomy, etc) for at least 12 months after joining, some 24 months (called specific waiting periods)
• What is a pre-existing illness ? Complete list of pre-existing illnesses and the mandatory waiting period before each of these are covered (say, a continuous claim-free period of 24 to 48 months) should be scrutinized before joining the plan. It may mean, for instance, that a diabetic entering the plan at the age 61, with an waiting period of 48 months, will have to keep paying the premium for up to 4 years but can not make any claim against any hospitalization related to any and every disease or health issues (say, peripheral vascular disease) that can be shown to arise due to diabetes. By the time one becomes eligible for cover, higher co-pay might kick in due to one’s reaching an age band of 65 years and above ! Some plans may cover pre-existing illness after a lower waiting period (say, 12 months) but with a co-pay requirement of say, 20% or coverage limited to 50% of the sum insured.
• Can an independently happening diseased condition be deduced or connected to a pre-existing condition (e.g. a cardiac problem happening to a diabetic patient – if such an eventuality occurs within the waiting period will the claim be denied ?). It may be advisable to clarify such issues with the panel of doctors of the insurer before buying the policy. 
• If a pre-existing illness is covered after a waiting period, it should be clarified whether the coverage is for any and every disease or illness that may be associated with the defined pre-existing disease ?
• Congenital disorder/illness and any related treatment are usually permanently excluded. It should be clarified if a correctional treatment or one arising out of such a disorder be considered as a pre-existing illness after a specified waiting period or excluded ?
• What happens when the insured gets hospitalized for some emergency medical condition and on final diagnosis this turns out (based on the medical diagnosis) as a result of a pre-existing or congenital disorder genuinely unknown to the insured? Will his claim be denied outright ?
• While most companies allow a small percentage of SI as expenditure for both pre- and post-hospitalization treatment, further tests etc, if these treatments and tests are not taken at the OPD of the same hospital (in which case the TPA or insurance department of the hospital may help) the claim form sections/documentation required to be filled by the attending doctor or his private clinic may pose practical difficulties (without satisfactory filling of the forms the claim may be denied or settlement delayed).
• In many emergency room (ER)/casualty ward scenarios (before formal admission to the hospital) the patient’s relatives are often not provided with the complete and official prescriptions for medicines to be urgently procured for administering to the patient or the detailed heads (like a blood test/ECG/MRI or ER bed charges, consumables, etc.) not specified under which bills are raised and expected by the hospital to be paid immediately (cash/CC). In absence of a proper prescription consistent with the bills and the amounts paid, claims for reimbursement may be denied or settlement delayed. The relatives either may not be knowledgeable enough or in a stable metal state to insist on such details. Check with the company and the hospital, whether the expenditure incurred in the ER is covered as pre-hospitalization expense or as an integral part of the hospitalization claim.
• Is the ambulance charges part of the hospitalization or the pre-hospitalization claims (is there any medical authorization required ?)
• Is there a provision of annual health check up within the scheme and how is it paid for ? Is it subjected to continuous renewal of the policy for a specified number of claim-free years ?
• Is there a renewal bonus and if so how does the benefit accrue to the insured ?
• Finally, one should be aware of the reality of the cashless claim settlement in a hospital scenario vis-à-vis reimbursement of claim made post-discharge (documentation required in the latter case should be clearly understood and diligently procured to avoid harassment).

Despite assurances by the insurance company officials, their agents and the customer care staff of the third party administrator (TPA) agencies actually administering the medical claims, the so-called cash-less procedure is anything but painless. Prior to (or on the day of hospitalization) the insured patient has to get an authorization from the TPA for the hospital treatment, which requires filling up a prescribed pre-authorization form. Help of the hospital (one would be lucky if the hospital has a dedicated TPA department) is required to fill this form and send it to the TPA for their approval.

Usually it is expected that the insured waits (may be for 3-4 hours or more), may be at the hospital reception or some other convenient place till this approval comes and is admitted only after the financial commitment by the insurer is available to the hospital formally. In case the insured gets admitted pending the approval (which may be needed in emergency cases or where the insured requires to undergo urgent diagnostic tests, procedures as per medical advice) he/she may have to either opt for the reimbursement of the claims post hospitalization or give an undertaking to pay the difference in the hospitalization charges between the actual and the amount to be approved by the TPA in due course.

Post-discharge all the medical and billing information will have to be sent to the TPA (usually  this is done by the hospital) for their perusal, evaluation against the insurer profile with them (most notably about the exclusions due to pre-existing and congenital diseases, if any) and according to their norms regarding what charges mentioned within the hospital bills  (especially some overheads like documentation and office work or some consumables and excluded items included in the bills) are or are not be payable. This processing may take, together with the hospital bill and document preparation, upwards of six hours, as per common experience). Only after the final approved settlement from the TPA, as the authorized representative of the insurance company, is received by the hospital, the insured patient may get his/her discharge, if necessary, by paying any shortfall in payment as required by the hospital.  

Atrophy of ethical common sense - Your wrong doing versus mine

Everybody knows that two wrongs do not make it right. In other words the wrong things, say, of similar nature done by somebody else in the past cannot justify wrongs inflicted by you or me at the present time. This is an ethical common sense hard to escape for anybody. Yet in most conversations between the political adversaries in India this value is conveniently given the go by. At times it does look like a fight between children or silly ego clashes between temperamental adults. But we are talking about serious matters often involving death, destruction and destitution of a large number of poor and helpless people who are anyway living at the edge and mark their time at the mercy of the nature and some powerful men.

Whenever one side criticizes the other of some wrongdoing as of today, rest assured that swift riposte from the other side mentioning similar or related misdeeds of the critic would be invited. If my party is accused of post-Godhra state-sponsored Gujarat pogrom killing two thousand Muslims in 2002, be sure that I will put you on the mat about your party’s active role in organizing and conducting butchering and burning of three thousand Sikhs in 1984 and the government machinery, most notably the police, being complicit in allowing the carnage to happen and sabotaging the dispensation of justice over the next 30 years. If you are going to discuss Gulberg or Naroda Patiya massacre and be silent on the burning of the Sabarmati Express near Godhra that will be an one-sided talk and an indication of your lack of fairness and balanced outlook. If there are a flurry of corruption scandals, during our regime, and losses of public money due to the acts of omission and commission of some of our ministers and bureaucrats working under them, how can we let anybody (including our interlocutors) forget similar misappropriation of funds and cases of financial misdemeanor and sweetheart deals, tailor made policies to suit your crony industrialists and businessmen under your watch in different parts of the country. And so does unspool the blame game.

The amazing thing is that each party feels vindicated by the wrong doing of the other. And once the other party could be maligned with sufficiently strong coat of accusations one could feel relieved and live with one’s own share of the charge sheet. One also has to admire the elephantine memory on both sides of the political divide, helped as they are by technology and perhaps some professional support. Except that such skills are not used to accumulate statistics of hunger, malnutrition and stunted growth with equal perspicacity when the affected population live and die under our political dispensation. All our analytical acuity and statistical prowess would rather be used to prune the number of people taking their lives in our villages from the category of ‘real farmers’ having proper land deeds in their names (and not in the name of their old and infirm fathers), and not just anybody and everybody connected to agricultural activities because they have no other employment, the target being ‘zero farmer suicide’ as reported by some states.

Certain amount of self-righteousness is perhaps at the heart of any political action. But aren’t we overdoing it on all sides ? Moreover, being right should also entail not being wrong on all or most counts that we accuse our opponents about. Sadly, that happens rarely, if at all. As a result no one can occupy the moral high ground any more. If the energy expended and ingenuity marshalled in fault finding exercise directed to others, for a change, would have been redirected towards ourselves and our own decisions and actions, that in turn would have motivated us to take the corrective actions, hopefully, the initiation of the chain of blame would have been much more muted or even stalled from growing by inviting and adding to a similar chain of reverse polarity.  

Pursuing authoritarian rule through democracy : Narendra Modi

Despite the elitist skepticism about the electoral politics in India and many infirmities in the practice of democracy in our country, few will dispute the fact that both Narendra Modi and Mamata Banerjee had roared to win their respective state assembly elections with massive democratic mandate. Modi for the third successive reign, Mamata for the first time after demolishing the red citadel of 34 years standing. The pathways to power were very different. As persons they have many differences in characteristics, so also may be in their officially projected worldviews including political ideologies and affiliations. But there appears to be a singular unanimity in certain basic features of temperament and style of functioning when one observes these two currently prominent politicians in India. In this first part we deal with the peregrinations of Modi. We hope to devote a future post to Mamata.

-         Modi’s initial gambit was to project a hardline Hindutva face to encash the majoritarian anxiety and anger sweeping Gujarat like many other parts in the country following the communal riots post Babri Masjid demolition in Mumbai and elsewhere and then the Mumbai blast 1993 and thereby create a strong base in Gujarat. The Hindutva dividend accrued to him through a clear-cut democratic process, namely, the assembly election in 2002 that took place with the backdrop of the Gujarat carnage.

-         In the next stage, the challenge of wide spread national and international condemnation and criticism that the state government and administration faced with regard to its acquiescent role during the pogrom and willfully partisan rehabilitation policy it followed in the aftermath, was cleverly turned into an opportunity for consolidating his vote bank among the majority community in Gujarat in the name of defending the ‘asmita (pride)’ of the five crore Gujaratis and promoting the cause of Hindutva under attack from the ‘pseudo-secularists. In course of time by a subtle spin Hinduvta was made synonymous with nationalism. Fighting Islamic terrorists, axiomatically assumed to be Pakistan-supported, by any means, extra-judicial or otherwise, was a duty a truly nationalist chief minister and his administration was justifiably proud of executing. The 2007 assembly election results handing him an absolute majority mandate gave him confidence in continuing more vigorously his ongoing experiment with a model for an economic development of Gujarat he had already embarked on and that he would later claim as a panacea for the whole country.

-        The third stage was the economic transformation of Gujarat along the clear-cut capitalist prescriptions. The liberal economic policy pursued by the government coupled with the traditional entrepreneurial zeal and the business skill of the Gujaratis helped the state notch up a very good macroeconomic growth rate (among the highest achieved by various states in India). The stick-at-nothing approach to achieve this goal made Gujarat the most business friendly state in the country, acquiring land for infrastructure (roads and connectivity) and other ‘public purpose’ that included private industry and other entrepreneurial activities, encouraging cash crops, allowing preferential share in scarce water resources to agri-business and industry. There was no ambivalence as to who and what the government stands for and no pretension for equity or inclusiveness. Income disparity, children malnutrition, water scarcity and agricultural distress in many drought affected districts, increasing segregation of the urban population along the religious lines, poor and dwindling rehabilitation of the 2002 riot victims and to top it all increasing debt that the government incurred in order to live up to its promise of business friendliness – all of these and more were brushed aside in the name of achieving the enviable growth statistics. An impression has been created among the upper and middle classes, not only within Gujarat but in many urban centers of India that an economic miracle has been engineered in Gujarat. 

-         Through these ten odd years of rule Modi had managed to decimate opposition Congress party electorally through huge democratic mandates which was rationalized as a popular response and support of the state electorate to first his Hindutva ideology and later his image as a leader of an efficient business-enabling state administration taking the state to great and demonstrable prosperity. That he had always had his detractors within his party, BJP, and wider organizations of the Sangh Parivar was always known. There were both muted and open criticism within the party and the Sangh about some of his policies, biases and most importantly his autocrat like brook-no-opposition style of functioning. But the spectacular way he had managed to sideline senior state party leaders like Waghela, Keshubhai Patel and others and alienated an important Sangh apparatchik like Sanjay Joshi and eventually pushed them out of the party and even hounded some of them out of the state politics confirm his Machiavellian prowess and the determination to remove any obstacle to the path of his preeminence in the party. Interestingly, he has even reconfigured his relationship with the Sangh Parivar, maintaining a studied distance from some of its important organizations like VHP, the ones that gave him his initial break.

-         Modi’s brand of democratic functioning is most illuminatingly demonstrated recently in the new Lokayukta bill he is said to be piloting in the state assembly which he hopes to turn into law by dint of his ‘democratic’ majority. He is clearly trying to sabotage the currently nominated Lokayukta (his dogged opposition to the decisions of the Governor, legal challenges at the High Court having failed to yield desired result, i.e. a Lokayukta of his choice) by bringing in a new law where a new selection procedure is being suggested that will clearly be subservient to and controlled by the chief minister.

-        Post his third time anointment as the chief minister after winning absolute majority in the 2012 assembly elections his script is showing up a trajectory of him coming up with increasing frequency to Delhi and many other places (recently Haridwar). These involve occasions of not merely attending important BJP party meetings and functions of national significance but special seminars, meets, discussions for projecting himself, quite successfully, towards the party rank and file, to media and the public at large as the one and the only alternative for BJP’s the prime ministership candidate. If the topmost leaders of BJP are already feeling the heavy breathing of an ambitious and ruthless leader like Modi on their shoulder they are not showing it and making brave noises about democratic functioning of the party. But the first capitulation has already happened in that Modi has bulldozed his way into the top decision making body of the party, namely, the parliamentary board which, at the appropriate time, is expected to ‘democratically’ nominate one among the many equals as the potential prime minister of the shadow cabinet.

Thus in many ways Modi’s is a saga of using his apparent democratic advantage to allow him to pursue a type of authoritarian rule that has many historical parallels with classic developments of fascism in Europe during the last century. One waits with bated breath if the country's democratic system could be subverted yet again to construct the second attempt at installing a quasi-authoritarian dispensation at the center.

Medical insurance in India for the elderly - I

Health Scheme for the Central Government pensioners

(This is the first part of a multi-part post on this subject. This is not meant to be a comprehensive source of information on various insurance schemes for the aged in India as of now, but rather tries to offer somewhat of a critical appraisal from a user perspective cutting through the received wisdom and advertisement blurbs. The present one talks about one of the most important government funded schemes, a subsequent post will take a look at some of the other health insurance policies available in the market.)

A major escalation in the drug prices and the cost of an increasingly privatized health care in India that has occurred over the last two decades and the liberalized economic policies pursued by the government are significantly correlated, notwithstanding the expected murmurs of protests from the liberalization fetishists against this inference. There seems to be enough wisdom within the government (PMO/panning commission) and advice from outside propelling the government propelling it to get out of the welfare commitment to supply public health care as much as possible and allow private health care providers to take its place and let the market enjoy a free run. This is more than clear both by the various policy pronouncements and through experiences on the ground. Ample statistics exist in the public domain to demonstrate the ballooning of what has been rather graphically described as the OUT-OF-POCKET (OOP) expenditure for health (generally accepted to be about 70% of the total) for the majority of Indians. This is a significant and potentially disastrous burden especially for the poor and of course the elderly and may lead to penury and destitution. I have had occasions to discuss these issues in some of the earlier posts in seinjuti (see, “Drug prices escalation potential in India”, November 5, 2011, “OOP health expenses of India”, November 6, 2011) and more recently elsewhere (“Price of health”, silvertalkies, October 6, 2012).

In this connection, one has only to look at the dwindling utility and effectiveness of the Central Government Health Scheme (CGHS). This is one among the few relatively well-organized government sponsored schemes through which a modicum of medical insurance benefit is provided to the employees (and their dependents, total beneficiaries estimated to be about 4 million or so) working in various central government departments and offices all over the country and autonomous institutions like CSIR under the government of India. CGHS scheme and the rules governing it [under the broader Central Services (Medical Attendance) or the CS (MA) Act of 1954] cover both serving government employees and the pensioners. For the latter, since we are concerned here about the elderly, this service is usually available after retirement either by paying a sort of annual premium or (what is becoming the norm more recently) by making a one-time lump sum payment. In this sense this is like a usual medical insurance offered by private companies for the elderly.

Over the last several years, because of the deliberate reduction (as a government policy) in the CGHS approved rates for a large number of diagnostic tests and procedures (both taken as in-patients or in the OPD) and generally not accepting the market rates charged by good private hospitals, many of these are opting out of the CGHS scheme or are being de-recognized by the government. Even where the treatment in some of these hospitals are not completely disallowed, the CGHS insured has to agree to pay the difference between the rates charged by the hospital and those allowed under the CGHS schedule, even before the admission or undergoing a procedure. Hospital bills may also create such differentials due to the price differences between branded drugs sometimes prescribed by the hospitals and the equivalent generics allowed within the CGHS schedule. The same is true about some critical prosthetics (certain high end drug eluting coronary stents used in angioplasty are ruled out under the revised CGHS schedule). More often than not this may mean 40-80% in OOP. Alternatively the insured has to go and get treated at the restricted number of CGHS recognized hospitals where the test and the treatment facilities may not be up to the mark or one does not get to choose his/her preferred or recommended doctors (who are not necessarily associated with or may not choose to operate in these latter hospitals).

The service is operated either as a cash-less (or the direct payment) facility or as a reimbursable one. In the former the pensioner produces document authorizing the hospitalization and the treatment (office memo, letter from an authorized medical attendant, etc) acceptable to the hospital whereupon the treatment is provided without charging the CGHS beneficiary (except for the differential payments explained above that can be substantial in some cases and some hospitals). At the end of the treatment, the hospital sends bills, details of treatment and other documents to the concerned government office/authority for verifying and accepting the expenditure and finally sanctioning the payment as per its accounts office calculations. In case the office disagrees with some parts of the bill in the sense that these are not admissible under the current CGHS schedule these amounts are recovered from the pensioner.

Many elderly pensioners, especially those not having much human support system (relatives and friends) often find obtaining the correct authorization document from the CGHS dispensaries or the city headquarter time consuming and not devoid of harassment, especially as these offices are not always close to their residence or near the hospitals of interest.  

In the case of the reimbursable route, the pensioner makes the payment upfront to the hospital and submits the bills (including complete break up of all expenditure) and the supporting documents like test reports, prescriptions for medicines and tests   appending the same to the application to his/her accounts office. The latter after scrutiny and verification with the hospital, reimburse the expenditure, which could be much lower than the actual depending on the admissible rates of treatment, recognition level of the hospital where the treatments are taken. It may strain one’s credulity, but it is true that if a pensioner, because of his/her salary level at the time of retirement has the medical card branded, for instance, as “semi-private”, he or she would not just be entitled to a hospital accommodation in the semi-private ward or some other below that grade, entitlements for many of the critical treatment costs (including surgical or other procedure charges) are also graded in terms of admissible charges under the CGHS schedule. If one uses a higher than entitled accommodation for some unavoidable reasons or that the hospital does not allow for such gradations of charges and insist on levying standard charges the differences are not reimbursed and the pensioner has to make this payment. Thus it is not difficult to appreciate that despite availing of a government sponsored medical insurance the pensioner may end up incurring substantial OOP expenses.

Anecdotal evidence (based on the actual experiences of many pensioners) indicates that the claim settlement in the case of reimbursement often gets delayed by the cavalier attitude of the hospitals in providing incomplete documentation along with the final bills and completely rigid and often indifferent and non-cooperative handling of such deficiencies in the reimbursement applications by the government accounts offices. Though the pensioner is not really to blame, he/she must personally at his/her own cost get the required documents from the hospital billing department in order to expedite the reimbursement process.

The bright side of the CGHS scheme for the pensioners is that the OPD treatments and tests taken at and medicines prescribed by the designated CGHS dispensaries are practically free of cost (covered within the terms of the scheme). Similar tests and/or treatments can be availed at the recognized hospitals or by doctors from a CGHS empanelled list of the so-called “authorized medical attendant”s or the AMAs  generally at subsidized prices. Unfortunately, however, such dispensaries and AMAs are comparatively few in number and concentrated more in the main cities (about 25 or so) considering the countrywide validity of the scheme.

The number of recognized (empanelled) hospitals is coming down by the year. Many of these being government hospitals, which have to cater to the disproportionately large number of patients especially the poor and those from the lower strata of the population, are ill equipped, lack sufficient facilities, cleanliness and hygiene, important medicines, blood products and sometimes even good doctors. Many pensioners wishing to avail the scheme perforce have to choose to go to these hospitals.