
India Wants to Give Half a Billion People Free Health Care - poloolop
https://www.nytimes.com/2018/02/01/business/india-modi-health-care.html
======
tejaswiy
The govt. of Andhra Pradesh (a state in India) has pioneered a state backed
insurance program several years ago with reasonable success
([https://en.wikipedia.org/wiki/Aarogyasri](https://en.wikipedia.org/wiki/Aarogyasri)).
The problem however with these programs is that corruption within the
healthcare industry is still endemic and doctors create fake diagnoses and
perform unnecessary surgeries on patients to get their reimbursements from
Aarogya-sri. If this program is to be rolled out a national scale, the govt.
needs to address the systematic corruption in the healthcare industry first.

That said, I think Aarogyasri was overall a huge success in my state and has
saved millions of lives and I'm excited to see it being adopted at a national
level.

~~~
kumarm
Definitely Aarogyasri in AP saved millions of Lives. Current administration
tried to remove the program since its not introduced by them and can't take
credit for. So they are trying to kill it slowly (By removing people from
program, cutting benefits etc).

I wonder what will happen to this Free Health insurance program when central
government changes next time.

~~~
victor106
The current state government is pro business and don’t have any money to
implement or continue any past programs. Whatever money they have is spent on
pet projects and making themselves rich.

The previous government even though was corrupt at least did something for the
poor. I personally witnessed AROGYASHRI being used by the poor and the amount
of stability it bought to their daily lives.

I also agree that there was lot of corruption in the program. If the choice is
between saving the lives of the poor with corruption vs letting them die
without I would choose the former any day. After all, the healthcare system in
the US is filled with corrupt participants.

Let’s us not make the perfect the enemy of the good.

P.S:- I am not a citizen of India or don’t have any Indian roots but I lived
there for a few years doing volunteer social work to help the poor.

~~~
coliveira
> If the choice is between saving the lives of the poor with corruption vs
> letting them die without I would choose the former any day

This is very important. We need to finally realize that corruption is endemic
to the system, and when corruption is raised as an issue it is generally to
disadvantage the poor (last time I looked Wall Street is still doing fine even
under the highest levels of corruption one can imagine).

------
ucaetano
Giving free healthcare is a good step, but the important question is how good
will it be and how much will be covered.

Brazil has 100% of its population (210M people) covered by free, single-payer,
universal healthcare, resulting in a life expectancy of 75 years (US is 79,
Japan and Switzerland with 83 IIRC).

But your experience can vary dramatically. It all depends on how much money is
actually being put on it (in healthcare-costs-PPP-adjusted $/capita).

~~~
mickelsen
Not necessarily a counterpoint but Chile's dual system -private and public,
both with copay for most- gives them a life expectancy of 81.79 years,
surpassing a lot of more developed countries with free universal healthcare.

~~~
vidarh
Almost every universal healthcare system is has some degree of mix of private
and public.

Norway is on the far extreme with it's strict restrictions on private
healthcare. Almost every other country has private healthcare insurance as at
least an option.

The question tends to be how much you end up contributing towards public
healthcare if you take out a private option - ranging from no difference (you
pay the same taxes no matter what), to only healthcare for poor/unemployed
coming out of general taxation.

~~~
tyfon
Strict restrictions? I can chose whatever hospital I want and the government
will pay for it regardless as long as a GP has referred me to them. If you
want you can just pay out of your pocket as well without going through a GP.

There is even a portal where you can search for your ailment and choose
hospital (private or public) based on their waiting lists.

[https://helsenorge.no/velg-behandlingssted](https://helsenorge.no/velg-
behandlingssted)

The government also buys up a lot of the private spots to reduce public
waiting lists. Last time I was in due to sinus infection, I went to a private
and a public clinic both paid for in full by the government.

~~~
ucaetano
Restrictions aren't just on users, but on providers as well. If you don't see
restrictions as an user, it's because most of the restrictions are on the
providers.

And nothing wrong with that, I actually support that model, just like in
Switzerland, where healthcare is private, but mandated by the government and
heavily regulated (with less-regulated private complimentary insurance
options).

It allows for innovation and competition between providers, without the harm
to users due to the asymmetry of power.

Oh, and births are free.

~~~
tyfon
Yeah, the the post I replied to claimed there were restrictions on private
clinics specifically, but the public clinics/hospitals have to follow the same
rules.

Also: are there any places that charge for births???? That sounds ridiculous
and insane to me.

~~~
ucaetano
> Also: are there any places that charge for births???? That sounds ridiculous
> and insane to me.

Then the entire US healthcare system will sound ridiculous and insane to you
:)

And, to be honest, it is. I have American friends who had accidents while in
developing countries (broke an arm in Costa Rica) and were puzzled that they
were treated and didn't have to pay anything, or very little (broke feet in
Croatia).

------
whack
A key paragraph from the article which better explains the finances behind
this policy:

 _" The health care plan ... would offer 100 million families up ... $7,860,
of coverage each year. That sum, while small by Western standards, would be
enough to cover the equivalent of five heart surgeries in India."_

It's much easier to provide universal healthcare, when medical costs are low.
Finding ways to bring down costs in the US, would go a long way towards
improving the healthcare situation here.

~~~
yesforwhat
China, too

------
thewhitetulip
I might be sounding negative, but the current PM is known to be someone who
just promises a million things. This is just a prop for 2019 because he has
absolutely destroyed the economy and the RBI.

I seriously doubt if this will actually be implemented ever. This is the magic
of India, They won't deny insurance, but when the people will go to create
insurance, there will be some or the other issue with the system and they
won't be able to apply for it.

Also the media is a sycophant of the govt so nobody will question it and on
the exterior, it'll be shown that they did provide insurance although nobody
got anything.

------
thisisit
I just hope it works very well because it seems every year there is one new
populist measure. There is already:

a. Food Security which provides food to nearly 2/3rd of the population or 820
million people.

b. Minimum Support prices for grains which was hiked in this budget. Farmers
also get loan waivers.

c. National Rural Employment Guarantee which provides employment to over 100
million people

~~~
dv_dt
Universal healthcare is cast as a 'populist' measure in the US. But if you
look at data of cost of healthcare for nations applying universal healthcare
vs those who do not in developed nations, India might rationally look at it as
an economic efficiency measure.

Agricultural supports also can be looked at with a political filter, but the
US provides government back agricultural insurance as a positive economic
measure. Otherwise there may be a dwindling population of farmers and farming
companies and increased food instability. One could argue about private vs
publically funding these stabilization and boosting measures but it's much
simpler/stabler to provide some forms long term guarantees via gov't policy
than hoping a private market does it and does it correctly (without wiping out
or consuming their customers). Are all these measures the same? No, but you
have to look deeper than populist bad, private markets good.

~~~
thisisit
Isn't universal healthcare that all people and communities have the same
access to healthcare? India's population is 1.3 billion and this says it will
cover 500 million people. So, it doesn't cover all people and communities. It
covers some part of the population.

Let's say Obamacare covered only a specific section of US what would have
happened then?

To clarify my stand here, I am in favor of Universal Healthcare but not this.

Edit: I saw your edit on agriculture later. So, let me count that out too. We
should do everything to support agriculture but the whole policy is skewed
towards grains and every bump happens helps to ingrain the fact that grains
good but vegetables bad. Do we really want that? So, I am in favor of a policy
which works for all and not for specific sections which at least Indian laws
tend to do.

~~~
vidarh
In a lot of countries with universal healthcare it is provided by the
government insuring the poorest and the unemployed, and requiring everyone
else to insure themselves. The idea being that it gives those with the means
who might want to pick and choose higher levels of coverage can do so, but
nobody gets left behind.

~~~
thisisit
Thank you for highlighting that.

Food Security bill provided coverage to 2/3rd of population which was
estimated to be 850 million people.

This bill says it will cover up to 500 million people.

So there are 320 million people who are poor that they can't eat but not poor
for health care. That is the question on inclusive-ness.

Though we have to see the full bill to actually find out what exactly is going
on.

------
thetruthseeker1
They say Proof is in the pudding.

I am wary of applauding before seeing how well this is implemented. India is
known to come up with lot of big programs that make good rhetoric, but not all
of them are implemented with equal amount of vigor or commitment.

I am sure part of the motivation may be to help next election cycle which is
coming soon.

------
devnonymous
This is a blatant lie. The devil is in the details and the detail is there has
been no specific funds allocated in the budget for this nor are there any
specifics about how the funds will be allocated in the future.[1] This is just
a vague expression of intent. Precisely the type that _every_ politician will
make when in desperate need of good will - exactly what Modi is in need of.

[1] thread about this
[https://twitter.com/Memeghnad/status/959026718722768896](https://twitter.com/Memeghnad/status/959026718722768896)

~~~
devnonymous
To whoever downvoted, here's an exercise -- download all the pdfs from
[http://www.indiabudget.gov.in/index.asp](http://www.indiabudget.gov.in/index.asp)
do a quick search in any of the documents for "National Health Protection
Scheme" and let us know if you find it any where other than the speech.

------
ethagknight
>> The health care plan, part of the government’s 2018-19 budget presented on
Thursday, would offer 100 million families up to 500,000 rupees, or about
$7,860, of coverage each year.

Thats roughly $800B dollars, or over 30% of India's GDP. What am I missing?
Most people won't participate?

EDIT: according to the article, the Finance Ministry has allocated $314
million (or 4 hundredths of a percent of the theoretical max total benefit).
As in, the funding they acknowledge is non-existent.

~~~
randcraw
500M people times $7860/yr is $3.93 trillion (the max possible coverage). But
if only $314M is authorized, the average person will receive only 314M/500M,
or about 63 cents.

~~~
shripadk
That's not how you calculate when it comes to insurance. You can't divorce
life from maths. In your calculations you are assuming 500 million people will
all fall ill at the same time and each will claim the full $7860 for the year
which is next to impossible. In my opinion, $314 million is more than enough
for now unless India is struck by an epidemic.

------
sukhadatkeereo
I highly recommend reading this answer to understand the Indian budget better.
I hope this helps clear a few questions. [https://www.quora.com/How-do-you-
see-the-union-budget-2018-1...](https://www.quora.com/How-do-you-see-the-
union-budget-2018-19-presented-by-Arun-Jaitley/answer/Balaji-
Viswanathan-2?share=e00f6859&srid=CQoI)

------
t1o5
To be read as - the elections are coming. Mr Modi is seeking a second term.

[https://en.wikipedia.org/wiki/2018_elections_in_India](https://en.wikipedia.org/wiki/2018_elections_in_India)

NYT article to be read in tandem with this one

[https://www.reuters.com/article/us-india-budget/with-
electio...](https://www.reuters.com/article/us-india-budget/with-elections-
coming-up-indias-government-will-aim-to-woo-rural-voters-in-budget-
idUSKBN1FH0GJ)

~~~
chris_wot
If Mr Modi has rolled out free health care to 500 million people, saving
millions of lives, probably a good thing and I hope it wins him some votes!

~~~
t1o5
India already has free healthcare for all the citizens. Its just that its not
efficient and well managed.

[https://en.wikipedia.org/wiki/Healthcare_in_India](https://en.wikipedia.org/wiki/Healthcare_in_India)

------
themihai
To have any chance of success they should fix the corruption first, otherwise
it will become yet another way to waste taxpayers' money.

------
anuraj
This is a sham. There is no specific allocation for the same in the budget.
State Governments have been instituting insurance cover for population for
ages and it is available around the same quantum. Generally insurance in India
like any other country has the effect of artificially inflating healthcare
cost. India would do well to spend money on improving public health
infrastructure instead.

~~~
anuraj
[http://www.firstpost.com/business/budget-2018-arun-
jaitleys-...](http://www.firstpost.com/business/budget-2018-arun-jaitleys-
modicare-health-scheme-is-music-to-the-ears-of-50-crore-indians-but-its-too-
good-to-be-real-4332001.html)

------
allpratik
Until the details are revealed, I won't buy this. It seems to have been
introduced to take advantage of upcoming elections.

The reason I'm skeptical about this step is because there are simply no
specific blueprint whatsoever. And with recent government implementations,
their biggest failure turns out to be ambiguity. Good example is GST. After
it's launch several month's ago, almost every big/small industry is finding it
hard to get the specific details.

I highly doubt about government's ability to implement it. This insurance
should have been given on basis of economical standing. Choosing a random 500M
number is good for making headlines but again it is not clear on who will gain
this insurance benefits?, what will be covered?, how to claim it? I foresee,
"divide and rule" :p

On another note, please have a look at Sensex. It's near all time high. The
reason behind such rally is not FII but DII. Infact, FII has actively removed
over $20Bn since 2015. There was slight influx of FII money post two months of
demonetisation but again outflow increased in following months. But still
Sensex didn't crashed because of the counter balance from DII or read it as
mostly mutual fund companies. Also, I had noticed an increased expenditure in
mutual fund investment ads on TV and almost all types of media. And these ads
were sponsored mostly by govt bodies and associations. There is nothing wrong
to invest in mutual funds. But when I heard about long term and short term
capital gains tax today, things got much clearer for me as to why DII raised
some much cash in very short period of time. To check the validity of above
numbers, you can refer to sensex related stats on moneycontrol.com and check
out the YoY sensex FII/DII activity. It has a very well explanatory chart
about it.

~~~
shripadk
> Good example is GST. After it's launch several month's ago, almost every
> big/small industry is finding it hard to get the specific details.

I don't get what problems does industry have with regards to GST apart from
simpler return filing and changes in rates. The implementation was itself
smoother than expected. Just compare with other countries that implemented GST
and you'll realise that it took almost 2 years for things to stabilize.
Comparatively, the implementation and addressal of most issues took only few
months! Today, Hasmukh Adhia also hinted at automatic preparation of GST
returns and simplification of invoice entry by directly entering details into
the system which is pretty amazing if you ask me. I'm actually quite happy
with how GST has shaped. Especially when compared to other governmental bodies
which have error prone systems. I have faced no issues filing GSTR-3B returns
and with simplification of GSTR-1 and GSTR-2 I guess all worries are taken
care of.

~~~
sbmthakur
GST is only complex for people who don't have to file it.

------
pankajdoharey
For a population of 1.3 Billion this is less than half the population. Other
countries cover 100% population with such schemes.
[https://en.wikipedia.org/wiki/List_of_countries_by_health_in...](https://en.wikipedia.org/wiki/List_of_countries_by_health_insurance_coverage)

------
zaroth
TFA: “India’s government spent just 1.4 percent of the country’s gross
domestic product on health care in 2014, little changed as a proportion of the
economy in 20 years, according to the World Bank. China, by contrast, spent
3.1 percent of its G.D.P. on health care in 2014; the United States spent 8.3
percent in the same year.”

CMS.gov: “U.S. health care spending grew 4.3 percent in 2016, reaching $3.3
trillion or $10,348 per person. As a share of the nation's Gross Domestic
Product, health spending accounted for 17.9 percent.”

World Bank puts total health care expenditure at 17.1% for the US in 2014 and
4.6% for India...

They must mean just US _government_ spending, not counting private
expenditure.

[https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014...](https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&locations=US&start=1995&view=chart)

~~~
dragonwriter
CMS is reporting _total_ US healthcare spending; TFA is discussing
_government_ healthcare spending; total (federal, state, and local) government
spending was 45.2% of all health expenditures in the US [0], which applied to
the 17.9% of GDP for total US healthcare expenditures gives 8.1% GDP public
expenditures in 2016, very similar to the 8.3% TFA reports for 2014.

EDIT: Ah, my post crossed your edit, which recognizes the issue, but:

> They must mean just US government spending, not counting private
> expenditure.

The part you quote from TFA _explicitly_ says it is comparing government
expenditures.

[0] from the same CMS page you seem to be using:
[https://www.cms.gov/research-statistics-data-and-
systems/sta...](https://www.cms.gov/research-statistics-data-and-
systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-
sheet.html)

------
perseusprime11
Cheap, fast and great generally don’t go together. Depending on the problem,
you have to pick either one or two but not all three. It will be interesting
to see how this experiment pans out in India. I wholeheartedly wish success
for them because this is something we have to put behind our back before we
enter the next decade.

------
known
Half-baked [https://qz.com/1195447/budget-2018-what-students-from-iim-
jn...](https://qz.com/1195447/budget-2018-what-students-from-iim-jnu-and-isb-
thought-of-arun-jaitleys-budget/)

------
IncRnd
The article reads as if this is health insurance, however it uses both terms
health care and health insurance. Those are entirely different from each
other.

One believes that preventative care will increase health, limiting the need
for procedures and pills. The other believes that one can pay a lower premium
(possibly through the state), betting on getting sick. These are opposite of
each other.

I'm not saying this is bad - just that people have to know what is being
discussed, or inevitably people will be disappointed.

------
Compurx
Prescription Pad is a clinic management software provides all types of
facilities for hospitals & doctors.

The best part of the software is Prescription writing facilities for doctors &
drug & brand interaction checker tool.

For more info please visit:

[http://www.prescriptionpad.in](http://www.prescriptionpad.in)

------
crimsonalucard
India doesn't get it. Defending the world from terrorism is 1000x more
important then basic health insurance. How can health insurance defend the
people against suicide bombers? The only thing that can defend people from
suicide bombers is the 1.5 Trillion dollar F-35, the greatest war plane ever
made.

~~~
gandutraveler
Number of people dying in india due to health is ~1000x more than ones killed
in terrorism.

~~~
crimsonalucard
I was being sarcastic.

------
padobson
_to 500,000 rupees, or about $7,860, of coverage each year. That sum, while
small by Western standards, would be enough to cover the equivalent of five
heart surgeries in India._

If something like this is implemented, I'm curious to see what it does to
prices - will a heart surgery continue to cost less than $2,000?

Healthcare seems like a supply problem to me, not a demand one. Where
healthcare is affordable, demand should be stable year-to-year. It seems like
what's needed is more doctors and devices, not more ways to pay.

~~~
mgbmtl
> If something like this is implemented, I'm curious to see what it does to
> prices - will a heart surgery continue to cost less than $2,000?

In most countries, the cost of such operations are fixed by the state (ex:
Canada).

> "Where healthcare is affordable, demand should be stable year-to-year.

What do you mean? There are so many factors that could explain higher
healthcare costs, including an aging population, or better health coverage.

I'm also not sure what it means for healthcare to be affordable. In most
countries, the cost seems proportional to the general wealth. The US might be
the exception, since it's one of the few countries with great wealth disparity
and with a non-universal system (more bureaucratic overhead/costs).

------
jimjimjim
in a lot of countries having a government provided health care system (with
private if you wish to pay more for quicker/better) is Normal rather than a
political idea that only 1 side is allowed to support.

------
debt
I love that that's not even half of India.

------
exabrial
India has 1,320m people. This headline is slightly concerning, given the caste
system in place that engineers poverty. Who is paying for it and who is
getting the benefit?

------
FairDune
Why is this posted on HN?

------
nodesocket
I can't see how India is going to afford this. As stated in another comment it
could cost up to $800B dollars, which is 30% of India's GDP. If this causes
India to have financial issues as a country, it's their own fault for not
doing basic accounting and number crunching.

~~~
i0exception
That's like saying if everyone maxes out their health insurance, insurance
companies will go out of business. In any given year, not everyone is going to
use the ~$8000 allocated to them. Also, healthcare in India is cheap. $8000
goes a long way.

~~~
dingo_bat
> healthcare in India is cheap. $8000 goes a long way.

Yeah I think ₹5 lakh is excessive. I have a ₹2 lakh cover for me and my wife
and unless we both are diagnosed with bone cancer simultaneously we are in no
danger of maxing it out.

------
known
Indian regime should impose 30% Inheritance Tax to fund the free healthcare

------
holydude
We got free healthcare in europe that i pay for with atrociously high taxes.
Yet whenever i actually need to visit a doctor i always go to a private one.

~~~
baby
oh, where do you find private doctors in France?

~~~
holydude
I do not know I do not live in France.

~~~
baby
You said europe like it represents every country

------
dmix
I really dislike when professional journalists call it "free healthcare", this
should really needs to stop. It's not free, half the country will be paying
for it with their taxes. In countries with public healthcare up to a third of
their taxes expenditure goes to healthcare services, it's a significant
expense and far from 'free'.

Journalists should really start using "public healthcare" or "public health
insurance", otherwise they are making their agenda quite clear. And I say that
in support of gov subsidized health insurance.

~~~
jimmaswell
This is a pointless and pedantic complaint. It's obvious to everyone what
"free healthcare" means. Words have multiple meanings, and free in this
context means tax-funded. Prescriptive language policing never works.

------
dominotw
One of my uncles got paralyzed on his whole left side of body because of
carelessness of govt hospital, lack of sanitation, corruption, and the general
don't give a fuck attitude of the employees( if they cared to show up to work
in the first place).

There is a running joke in India that "You can only go to a govt hospital"
implication being that you'd not return alive.

I suspect this is another scheme concocted to gobble up public money via
corruption. A gift that would keep giving for decades to come. For politicians
to promise jobs in bureaucracy to their caste members.

Ofcourse, Nytimes piece mentions none of this in its effort to push "See even
India has 'free' healthcare" ideology.

~~~
sumedh
> There is a running joke in India that "You can only go to a govt hospital"
> implication being that you'd not return alive.

I have never heard this joke atleast in Mumbai or Pune.

~~~
dominotw
Do you or your folks go to govt hospitals?

~~~
sumedh
I have not been treated in govt hospital if that is what you are asking but I
have been to govt hospitals to check up friends and others who were treated
there.

