– Mr. Ashit Kumar Shrivastava (Assistant Professor of Law NLUO)
The present article critically evaluates the programme initiated under the present budget of 2018. Under the present article I shall be evaluating the much praised government initiative of ‘Rashtriya Sawstha Bhima Yojana’ or acronym ‘RSBY’ which has received an additional grant of Rs. 2000 crore under the present session to go along with an additional cess of 4% (Educational and Medical Cess to be specific) against the 3% cess charged previously. As the title of the article suggests we shall also see as to what extent the Indian version of health care seems viable, knowing that its counterpart (Obamacare) in U.S is coming to a dismal end under the Trump regime.
Among other various duties which a State can be charged with; the duty to provide education facilities and medical benefits are of primary responsibility. Therefore, it will be highly un-natural that the world’s largest democracy deprives its citizens of these comforts. In order to consolidate the social security net, the Government of India (GoI) initiated the National Health Insurance Scheme, under which it promised to benefit the participants with an insurance claim of up to Rs. 30,000 (which has been increased to Rs. 5 Lakh now) on a mere insurance premium of Rs. 750 per annum, the GoI is expecting that the benefit of the scheme will reach around 500 million households who previously couldn’t avail of the benefit due to low income or un-availability of Insurer. The main target audience of this scheme are generally people falling below the poverty line, however, GoI proudly boast that it is largest Health Insurance Scheme Launched in the history of mankind -which as per the population of India is quite true- and will soon encompass a substantial portion of Indian citizens.
RSBY – A SOCIAL SECURITY NET
The very purpose of RSBY is creation of a social security net around every individual who couldn’t afford adequate medical help due its low income or couldn’t afford expensive insurance premium, with the initiation of this scheme a sort of backing is provided to an individual who previously feared falling sick or rather chose to ignore his health conditions, knowing that he couldn’t afford to get sick.
Voluntary Participation but Mandatory taxation (The Libertarian Revolt)
The unique trait of this scheme has been that to avail the benefits of this scheme one has to apply for the scheme at a frugal rate of Rs. 750 per annum -keeping in mind that the scheme is made to target people below the poverty line- and then the individual participant can avail of the benefits of the scheme, however, the burden of providing this benefits is not limited to the insurer but is equally shared by the citizens, the additional cess of 1% which has been added to the previously levied 3% cess on direct income and corporation taxes (GoI is going to raise an additional Rs. 11,000 crore from this cess) has encouraged the government to increase the amount of insurance claim from Rs. 30,000 to Rs. 5 Lakh per individual. In easy words this welfare scheme is truly running on the shoulders of its citizen, however, the benefits of it are only limited to the participants of the insurance scheme (substantial people belonging to below poverty line).
One of the ardent counters to all social schemes has been why the people at large shall be taxed so that a few under-privileged maybe comforted. The ideology is an offspring of the Libertarian, who see every welfare step of government as an extra burden on the pockets of people. People, who have done nothing wrong to the under-privileged, so why the brunt of additional cess are faced by them for benefiting others, the eternal fray of socialism and libertarian will always keep the debate alive. However a solution to libertarian perplexity might have been answered in Obamacare, which we deal in next heading.
What RSBY can learn from OBAMACARE
Affordable Care Act or famously known as Obamacare was a dream project of the former American President Barack Obama, however he was not the first one to push for a Universal Medical Scheme but he surely was the one who got it running efficiently –however short a period. Although the Obamacare is fading away slowly with the passage of time under Trump Regime, but it surely holds some valuable lesson which India can absorb. Like RSBY, Obamacare also provided for mandatory fund. The only difference was that in India a cess of 4% is been levied under the name of Education and Medical cess whereas in Obamacare, the government had made mandatory for every American citizens to buy a health insurance or face a penalty. The framework of Obamacare was to create an assimilated Insurance Pool which was to be used to provide for the medical benefits (this was called in America as ‘Independent Mandate’) under Obamacare, all the money collected under the scheme, then will be used in providing health benefits to the needful, namely the elderly or people with lower incomes, but the great thing about the scheme was that the benefit of the scheme was not limited only to elderly or low-income earners but any citizen of America could avail the benefits of the scheme, which is not the case with RSBY in which the benefit of the insurance claim is limited only to the participant or claimant (people below the poverty line). Therefore, unlike India the citizens of America could have held government accountable for the money spent by them under Obamacare.
The ingenuity of the Obamacare lies in the fact that they knew that the use of scheme for medical reason will mostly be done by elderly persons or people suffering from chronic diseases. The possibility of a youth or healthy person availing of this scheme is proportionally less than to an elderly person or a person suffering from a chronic diseases, therefore, by de-facto the money put in by all in the insurance pool will eventually be used by few of the countrymen, creating a proportionate and balanced health scheme.
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