This is in reference to the article: ‘Aarogyasri Healthcare Model- Advantage Private Sector’ (EPW, vol. XLVI, No. 49). That the upper caste leadership-based political parties and governments have been using the State to the advantage of the upper castes at the cost of the marginalized communities is no secret in India. The experience in the implementation of the land reforms, policy of reservations and numerous other State welfare and developmental measures – by the governments both at the Centre and State units – amply demonstrates this scandal. One of the main aspects of this experience has been that in the process of using the State, the upper castes are making every effort to weaken the State and at the same time, exploring all the possibilities in developing and strengthening the private sector. For in the private sector they are in absolute command, run businesses at their will and most importantly they can do away with the marginalized sections. In the sense, there is no provision for reservations in the private sector and hence, they can prevent the unwanted sections from that sector, at least in the higher levels of the hierarchy of organizations, where the pay and prestige is higher.
The case of Andhra Pradesh is a classic example, where the upper castes have encroached upon, controlling and commanding virtually every field of activity. The seeds of this process were sown during the chief minister-ship of late N T Ramarao (NTR) and watered by Nara Chandrababu Naidu with utmost diligence. And this has taken altogether to different heights during the regime of Y S Raja Sekhara Reddy (YSR). Although some people acclaim YSR as the only daring chief minister in the annals of the political history of modern AP, many others are astounded by the novel ways in which he robbed the AP state and distributed the spoils among his kith and kin, particularly his businessman-turned-politician son Jagan Mohan Reddy, and his son-in-law Anil Kumar. Many programmes, such Jalayagnam (irrigation projects) were said to be pursued for the welfare of the people of the state, in reality they are pursued to equip the upper castes. For instance, it has been claimed by the State government that so far it has spent over Rs. 65,000 crore since 2004 on various irrigation projects with the aim of providing irrigation to an extent of 71 lakh acres. Numerous corruption charges have been leveled against this programme that it has been charged by the Public Accounts Committee (PAS) of the state legislature that the contractors have siphoned off anywhere between Rs. 60 crore and Rs. 150 crore in each of the Jalayagnam projects. But two pertinent questions here are: who are the contractors of these irrigation projects, and to whose lands the irrigation facilities are provided for? These questions needs to be probed, for the Dalits and other marginalized sections in the state have been struggling for a long-time with a demand of one acre of land for each family. The state government has been suppressing this land struggle of the marginalized sections most brutally, and so we knew that the land under the irrigation projects belong to the upper castes and to extent middle castes, but not to the Dalits, Adivasi and other marginalized sections of the state. It may not be out of context to mention that while the state is most brutally repressing the land demands of the poor, it has been more generous in allocating hundreds of acres of land to the private companies, particularly companies that belong to the upper castes.
The fate of the Aarogyasri is also no different from the programme of Jalayagnam. The avowed aim of the scheme, it was claimed by the state government, was to provide ‘health for all’. One of the main objectives of the Aarogyasri is to improve access of BPL families to quality medical care for treatment of diseases involving hospitalization and surgery. But the question is, why to involve the private hospitals? It has been stated that the private hospitals have latest equipment and have dedicated staff, who could be available 24 hours and seven days a week. That the word dedication needs to be understood from the point of the fat salaries that the private hospitals offer to its professionals is something that is undisputable. But I certainly failed to understand the reasons for the lack of latest equipment in government hospitals! For me such state of affairs is nothing but the unwillingness on the part of the government to equip its hospitals, the unwillingness that has been inspired by the larger agenda of the upper castes-led governments – weaken the State and place everything under the control of the private sector.
I think one has to assess the Aarogyasri from the points of implications of the programme in the short and long-runs. Viewed from the former point of view, it is absolutely an excellent programme as it allows the poor to avail the corporate healthcare facilities hitherto available only to the upper and middle strata of the society. Personally I knew a few cases among the Malas (SC) and Yanadis (ST) inGuntur, where but for the Aarogyasri they would not have entered premises of super-specialty hospitals and get treatment. Thus, the poor need not die because they cannot afford the expenses of the medical treatment. For me, by facilitating such sort of accessibility the State has restored the lost respect and dignity to the poor.
However, if one were to view the programme from a different perspective, in the name of the healthcare of the poor the corporate hospitals have been the major beneficiaries. Earlier no corporate hospital would give any concession to the poor people, now organizing health campaigns in rural villages and welcoming the poverty-stricken patients with red-carpet. This way the hospitals of the upper castes have been earning huge amounts of government’s money. It should be noted here that a majority of the corporate hospitals, such as Kamineni, Pinnamaneni, Yashoda, Lalitha, Apollo and all others are owned by the Kammas and Reddys in the state. This means that by pumping the money to such hospitals the government is actually equipping the hands of upper castes and strengthening their control over the healthcare in the state. To that extent the government is the key culprit in weakening the government-run hospitals.
Weakening of government-run hospitals has larger implications. To note two of the main implications: first, there is no guarantee for the permanency of the scheme. The chief-ministers that succeeded YSR, who initiated the Aarogyasri programme, paying scant attention to the everyday functioning of this programme. In the next legislative elections if the Telugu Desam Party wins, then there is no guarantee of the continuation of the programme. If the programme were to be withdrawn, then the poor people will not have access to the corporate healthcare, which force them to get back to government-run hospitals. Since, the government hospitals have already became redundant, the poor are left with no option but to sell their meager assets and buy health from the corporate hospitals. In other words, by not equipping the government-run hospitals, the upper caste-run governments are preparing the death-traps of the marginalized sections. Secondly, the weakening of the government hospitals results in the further diminishing of the scant government employment opportunities for the general public, particularly to the Dalit, Adivasis and Other Backward Communities. Such a state compels the trained professionals to touch the doors of the upper castes’ corporate hospitals, where caste not the qualification and merit of the candidates determines their place in the organizations. In a way, the strong State is the only panacea for the oppressed marginalized sections and it is time that the leaders of all the marginalized sections concentrate their efforts towards strengthening State.
(Economic and Political Weekly rejected this response)