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.