Table of Contents
Minimum age of
marriage for women:
What is the
national digital health mission?
Insolvency
process will be initiated against Anil Ambani:
National Food
Security Act 2013:
BIS’ draft
standard for drinking water supply:
Indian
Association of Parliamentariants on Population and Development (IAPPD):
National Council
for transgenders:
India does need a Fiscal
Council
Reversing health sector
neglect with a reform agenda
The challenge of catching
elusive taxpayers
Table of Contents:
GS Paper 2:
1. Minimum age of marriage for women.
2. What is the national digital
health mission?
4. Insolvency process will be
initiated against Anil Ambani.
GS Paper 3:
1. National Food Security Act 2013.
2.
BIS’ draft standard for drinking water supply.
Facts for Prelims:
1.
Indian Association of Parliamentariants on Population and Development (IAPPD).
2.
Nuakhai Juhar.
3.
Council for transgenders.
4. What
are flavonoids?
GS Paper : 2
Topics Covered: Government
policies and interventions for development in various sectors and issues
arising out of their design and implementation.
Minimum
age of marriage for women:
Context:
Prime Minister Narendra Modi has announced that the
Centre will decide on the recommendations of a committee set up to reconsider
the minimum age of marriage for women.
1.
The minimum age of marriage, especially for
women, has been a contentious issue.
Background:
The Union Ministry for Women and Child Development set
up a
committee in June, headed by Jaya Jaitley, to examine
matters pertaining to age of motherhood, imperatives of lowering Maternal
Mortality Ratio and the improvement of nutritional levels among women.
1.
It will examine the correlation of age of
marriage and motherhood with health, medical well-being, and nutritional
status of the mother and neonate, infant or child, during pregnancy, birth and
thereafter.
What the law says?
Currently, the law prescribes that the minimum age of marriage is 21 and
18 years for men and women, respectively.
1.
The minimum age of marriage is distinct
from the age of majority, which is gender-neutral.
- An individual attains the age of majority at 18 as per
the Indian Majority Act, 1875.
- For Hindus, Section
5(iii) of the Hindu Marriage Act, 1955sets 18 years
as the minimum age for the bride and 21 years as the minimum age for the
groom. Child marriages are not illegal but can be declared void at
the request of the minor in the marriage.
- In Islam, the
marriage of a minor who has attained puberty is considered valid under
personal law.
- The Special Marriage Act,
1954 and the Prohibition of Child Marriage Act, 2006 also
prescribe 18 and 21 years as the minimum age of consent for marriage for
women and men respectively.
Why is the law being relooked at?
From bringing in gender-neutrality to reduce the risks of early pregnancy
among women, there are many arguments in favour of increasing the minimum age
of marriage of women.
1.
Early
pregnancy is associated with increased child
mortality rates and affects the health of the mother.
- Despite laws mandating minimum age and criminalising
sexual intercourse with a minor, child marriages are very
prevalent in the country.
- Also, according to a study, children
born to adolescent mothers (10-19 years) were 5
percentage points more likely to be stunted (shorter for their age) than
those born to young adults (20-24 years).
InstaLinks:
Prelims
Link:
- Jaya
Jailtley committee was constituted for the purpose of?
- Legal
provisions related to minimum age of marriage for men and women in India.
- Key
provisions of Special Marriage Act, 1954.
- Overview
of the Prohibition of Child Marriage Act, 2006.
Mains
Link:
Do you think minimum age for marriage for men
and women should be raised? Discuss.
Sources: Indian
Express.
Topics Covered: Issues
related to health.
What
is the national digital health mission?
Context:
In his address to the nation on Independence Day, the PM has launched the
National Digital Health Mission which rolls out a
national health ID for every Indian.
1.
The scheme will be rolled out through a
pilot launch in the Union Territories of Chandigarh,
Ladakh, Dadra and Nagar Haveli and Daman and Diu, Puducherry, Andaman and
Nicobar Islands and Lakshadweep.
What is the National Digital Health Mission?
It is a digital health ecosystem under which every Indian citizen
will now have unique health IDs, digitised health records with identifiers
for doctors and health facilities.
1.
The Mission is expected to bring
efficiency and transparency in healthcare services in the country.
- The new scheme will come under the
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
Key features:
- It comprises
six key building blocks — HealthID, DigiDoctor, Health
Facility Registry, Personal Health Records, e-Pharmacy and Telemedicine.
- The National
Health Authority has been given the mandate to design, build, roll-out
and implement the mission in the country.
- The core
building blocks of the mission is that the
health ID, DigiDoctor and Health Facility Registry shall be owned,
operated and maintained by the Government of India.
- Private
stakeholders will have an equal opportunity to integrate and
create their own products for the market. The core activities and
verifications, however, remain with the government.
- Under the Mission, every Indian
will get a Health ID card that
will store all medical details of the person including prescriptions,
treatment, diagnostic reports and discharge summaries.
- The citizens will be able to
give their doctors and health providers one-time access to this data during
visits to the hospital for consultation.
What was the need for this mission?
The mission aims to liberate citizens from the challenges of finding the
right doctors, seeking appointment, payment of consultation fee, making several
rounds of hospitals for prescription sheets, among several others and will
empower people to make an informed decision to avail the best possible
healthcare.
Background:
The ambitious National Digital Health Mission finds its roots in a
2018 Niti Aayog proposal to create a
centralised mechanism to uniquely identify every
participating user in the National Health Stack.
Have there been global instances of such a
centralised health record system?
In 2005, the UK’s National Health Service (NHS) started deployment of an
electronic health record systems with a goal to have all patients with a
centralised electronic health record by 2010. While several hospitals acquired
electronic patient records systems as part of this process, there was no
national healthcare information exchange. The program was ultimately dismantled
after a cost to the UK taxpayer was more than £12 billion, and is considered
one of the most expensive healthcare IT failures.
InstaLinks:
Prelims
Link:
- Overview
of the National Digital Health Mission.
- Components
of the mission.
- Proposed
National Health ID.
- Who
can issue these IDs?
- Key
hit of the National Health Policy 2017.
Mains
Link:
Discuss the significance of the National
Digital Health Mission.
Sources:
pib.
Topics Covered: India
and its neighbourhood- relations.
Teesta
river dispute:
Context:
India and Bangladesh have been engaged in a long-standing dispute over
water-sharing in the Teesta.
Adding to the existing tensions, Bangladesh is now discussing an almost $1 billion loan from
China for a comprehensive management and restoration project on
the Teesta river.
Why India is concerned and worried?
Bangladesh’s discussions with China come
at a time when India is particularly wary about China following the standoff in
Ladakh.
How have relations between Bangladesh and
China been developing?
1.
China is the biggest trading partner of
Bangladesh and is the foremost source of imports.
- Recently, China declared zero duty on 97% of imports
from Bangladesh. The concession flowed from China’s duty-free, quota-free
programme for the Least Developed Countries.
- China is the biggest arms supplier to Bangladesh.
About Teesta river:
1.
Teesta
river is a tributary of the Brahmaputra (known
as Jamuna in
Bangladesh), flowing through India and Bangladesh.
- It originates in the
Himalayas near Chunthang, Sikkimand flows to the
south through West Bengal before entering Bangladesh.
- The Teesta Barrage dam helps
to provide irrigation for the plains between the upper Padma and the
Jamuna.
Efforts to resolve the dispute:
Negotiations on how to share the water have
been going on since 1983.
1.
A 2011 interim deal –
that was supposed to last 15 years – gave India 42.5 percent of the Teesta’s
waters and gave Bangladesh 37.5 percent. Bengal opposed this deal so it was
shelved and remains unsigned.
Bangladesh sought a fair and equitable distribution of Teesta
waters from India, on the lines of the Ganga Water Treaty 1996.
1.
The treaty is an agreement to share
surface waters at the Farakka Barrage near
their mutual border.
In 2015, the Indian Prime Minister’s
visit to Dhaka generated expectations to take forward the issue but
it still remains unresolved.
However, In India, individual states have
significant influence over transboundary agreements, impeding
the policymaking process.
1.
West
Bengalis one of the key stakeholders of the Teesta agreement and
is yet to endorse the deal.
Importance of Teesta River:
For Bangladesh:
1.
Its flood plain covers about 14% of the
total cropped area of Bangladesh and provides direct livelihood opportunities
to approximately 73% of its population.
For West Bengal:
1.
Teesta is the lifeline of North Bengal and
almost half a dozen of districts of West Bengal are dependent on the waters of
Teesta.
InstaLinks:
Prelims
Link:
- Teesta
river- origin, tributaries and states through which it passes.
- Where
is Farakka barrage?
- About
the Ganga Water Treaty 1996.
- Rivers
flowing between India and Bangladesh.
- Tributaries
of Brahmaputra river.
Mains
Link:
Write a brief note on the geography of Teesta
River and the reasons why sharing of its water between India and Bangladesh has
become a dispute.
Sources: Indian
Express.
Topics Covered: Government
policies and interventions for development in various sectors and issues
arising out of their design and implementation.
Insolvency
process will be initiated against Anil Ambani:
Context:
The National Company Law Tribunal (NCLT) has
allowed the initiation of insolvency proceedings against Anil Ambani after two
companies promoted by him failed to pay dues on Rs 1,200 crore that they had
borrowed from State Bank of India (SBI).
1.
The insolvency process will be initiated
against Ambani as he had given personal guarantee against the loans
provided to his firms.
Personal insolvency:
The case is significant as it is one of the first cases of insolvency
against a major business group head.
The rules for initiation of personal insolvency were notified
last year in December.
What is the process for personal insolvency?
As the NCLT has allowed the appointment of an interim resolution professional
(IRP) in the matter, SBI will now approach the IRP with a
list of the assets provided by Ambani as a personal guarantee when his
companies had sought the loan.
In the case of banks providing loans against personal guarantee, the
guarantor has to furnish a list of assets whose value is equivalent to the
total amount of loan being given.
1.
In case of failure to pay these assets, these
guarantees can be invoked.
What happens to Anil Ambani after the
insolvency process is over?
Like corporate insolvency processes, a
businessperson is free to start with a clean slate after a personal insolvency
case against them is over.
The lenders will be eligible to recover their dues only from the
collateral deposited or personal assets belonging to that person.
However, any or all assets mentioned in the
list provided at the time of sanctioning of the loan, even if transferred to
someone else, can also be attached and sold.
1.
Ambani will be free to run other businesses
which are not under insolvency, or which are able to service their debts and
obligations on time.
For details on the Insolvency and Bankruptcy Code (IBC), refer:
https://www.insightsonindia.com/2020/06/08/insolvency-and-bankruptcy-code/.
InstaLinks:
Prelims
Link:
- What
is insolvency and bankruptcy?
- Various
institutions established under the IBC code.
- NCLT-
composition and functions.
- What
are debt recovery tribunals?
- Sections
7, 9 and 10 of IBC.
Mains
Link:
Discuss how suspension of initiation of fresh
insolvency proceedings will help shield companies impacted by the outbreak of
Covid-19.
Sources: Indian
Express.
GS Paper : 3
Topics Covered: Food
security related issues.
National
Food Security Act 2013:
Context:
Department of Food &Public Distribution issues directions to
States/UTs to include all eligible disabled persons under the
National Food Security Act 2013.
1.
It has also asked the states to ensure that
they get their entitled quota of food grains under NFSA & Pradhan Mantri
Garib Kalyan Anna Yojana.
Enabling provisions:
Section 38 of the Act mandates
that the Central Government may from time to time give directions to the State
Governments for effective implementation of the provisions of the Act.
The Section 10 of the National Food Security
Act, 2013 provides for coverage of persons under the
Antyodaya Anna Yojana in accordance with the guidelines
applicable to the said scheme and the remaining households as priority
households in accordance with such guidelines as the States Government may
specify.
1.
Disability is
one of the criteria for inclusion of beneficiaries under AAY households
National Food Security Act (NFSA), 2013:
The objective is to provide for food and nutritional
security in human life cycle approach, by ensuring access to adequate
quantity of quality food at affordable prices to people to live a life with
dignity.
Key features:
- Coverage and
entitlement under Targeted Public Distribution System (TPDS): The TDPS
covers 50% of the urban population and 75% of the rural population, with uniform
entitlement of 5 kg per person per month. However, the
poorest of the poor households will continue to receive 35 kg per
household per month under Antyodaya Anna Yojana (AAY).
- Subsidised
prices under TPDS and their revision: For a
period of three years from the date of commencement of the Act, Food
grains under TPDS will be made available at subsidised prices of Rs. 3/2/1
per kg for rice, wheat and coarse grains.
- Identification
of Households: The identification of eligible households is to be
done by States/UTs under TDPS determined for each State.
- Nutritional
Support to women and children: Children in
the age group of 6 months to 14 years and pregnant women and lactating
mothers will be entitled to meals as per prescribed nutritional norms
under Integrated Child Development Services (ICDS) and
Mid-Day Meal (MDM) schemes. Malnourished children up
to the age of 6 have been prescribed for higher nutritional norms.
- Maternity
Benefit: Pregnant women and lactating mothers will also
be receiving maternity benefit of Rs. 6,000.
- Women
Empowerment: For the purpose of issuing of ration cards, eldest
woman of the household of age 18 years or above is to be the head of the
household.
- Grievance
Redressal Mechanism: Grievance redressal mechanism available at the
District and State levels.
- Cost of
transportation & handling of food grains and FPS Dealers’
margin : the expenditure incurred by the state on
transportation of food grains within the State, its handling and FPS
dealers’ margin as per norms to be devised for this purpose and assistance
to states will be provided by the Central Government to meet the above
expenditure.
- Transparency
and Accountability: In order to ensure transparency and
accountability, provisions have been made for disclosure of records
relating to PDS, social audits and setting up of
Vigilance Committees.
- Food Security
Allowance: In case of non-supply of entitled food grains
or meals, there is a provision for food security allowance to entitled
beneficiaries.
- Penalty: If the
public servant or authority fails to comply with the relief recommended by
the District Grievance Redressal Officer, penalty will be imposed by the
State Food Commission according to the provision.
InstaLinks:
Prelims
Link:
- About
TPDS.
- Who
gets food security allowance under the scheme?
- Provisions
of penalty under the act.
- Maternity
benefits related provisions.
- Overview
of Integrated Child Development Services (ICDS) scheme.
- Overview
of Mid-Day Meal (MDM) scheme.
- The
responsibility of 3. Identification of Households under the scheme.
Sources:
pib.
Topics Covered: Conservation related issues.
BIS’
draft standard for drinking water supply:
Context:
The Bureau of Indian Standards (BIS) has
prepared a draft standard for the supply system of piped drinking
water– ‘Drinking water supply quality management system —
requirements for piped drinking water supply service’.
1.
The draft has been prepared by the
BIS’ Public Drinking Water Supply Services Sectional Committee.
Highlights of the draft:
- It outlines the
process of water supply, from raw water sources to
household taps.
- It outlines the
requirements for a water supplier or a water utility on
how they should establish, operate, maintain and improve their piped
drinking water supply service.
- It states that the
water treatment process should be planned in such a
manner that after treatment the drinking water should conform
to the Indian Standard (IS) 10500 developed by the BIS.
- It contains guidelines
for top management of the water utility, in terms of accountability and
customer focus, establishing a quality policy for
their service, monitoring the quality of water released to people, and
conducting a water audit.
- It states that the
concept of district metering area (DMA) should be
adopted where possible. DMA is a concept for controlling leakages in the
water network, which is essentially divided into a number of sectors,
called the DMAs, and where flow meters are installed to detect leaks.
- It mentions that water
should be sampled at the treatment plant every four hours against quality
parameters. In the distribution system, the sampling
should be done every eight hours at the water reservoirs. Random sampling
should also be done at household levels.
Significance of the draft and need for it:
The standard holds importance as it is expected to make the
process of piped water supply more uniform, especially in
rural and underdeveloped areas of the country where the system runs on various
government orders and circulars.
Sources: Indian
Express.
Facts for Prelims
Indian
Association of Parliamentariants on Population and Development (IAPPD):
It is a national level Non-Governmental organization established
in the year 1978.
1.
The organiztion was formed with an
Imperative to moderating the pace of population
growth for a smoother course of development so as to
ensure an overall improvement in the quality of life of the people and maintain
a proper balance between population and development.
Nuakhai
Juhar:
Nuakhai Juhar is the agricultural festival is
also called Nuakhai Parab or Nuakahi Bhetghat.
Nuakhai is
a combination of two words signifies eating of new rice as ‘nua’ means
new and ‘khai’ means eat.
1.
It is one of the most ancient festivals
celebrated in Odisha, Chhattisgarh and areas of
neighbouring states to welcome the
new crop of the season.
- On this day, people worship food grain and prepare
special meals. Farmers offer the first produce from their lands to Goddess
Samaleswari, the famous ‘Mother Goddess’ of Sambalpur
district of Odisha.
National
Council for transgenders:
The Centre has constituted the national council for transgender
persons.
Composition: Headed
by the Union social justice minister and comprising representatives from 10
central departments, five states and members of the community.
The council is India’s first and
formed under Transgender Persons (Protection of
Rights) Act, 2019.
1.
The
council has five main functions — advising the central
government on the formulation of policies, programmes, legislation and projects
with respect to transgender persons; monitoring and evaluating the impact of
policies and programmes designed for achieving equality and full participation
of transgender persons; reviewing and coordinating the activities of all the
departments; redressing grievances of transgender persons; and performing such
other functions as prescribed by the Centre.
What
are flavonoids?
Flavonoids are a group of phytonutrients present
in almost all vegetables and fruits.
They, along with carotenoids, are responsible for the varied colours of
fruits and vegetables.
1.
They are associated with health benefits
being good antioxidants, having anti-inflammatory
properties and also offer benefits for the immune system.
Why in News?
Recently, scientists from Agharkar Research Institute (ARI), found the
first synthetic route for producing flavonoids molecules related to the
treatment of tuberculosis and chikungunya.
Articles
to be covered tomorrow:
1. Lokayukta
The Hindu
India does
need a Fiscal Council
Though
it is not a silver bullet, it is an important institution needed to complement
the rule-based fiscal policy
The fiscal situation in India has been under
severe stress even before COVID-19 and the novel coronavirus pandemic has only
worsened it. The fiscal deficit of the Centre in 2019-20 as estimated by the
Controller General of Accounts (CGA) was 4.6%, 0.8 percentage point higher than
the revised estimate. For the current year, even without any additional fiscal
stimulus, the deficit is estimated at about 7% of GDP as against 3.5% estimated
in the Budget due to a sharp decline in revenues. The consolidated deficit of
the Union and States could be as high as 12% of GDP and the overall debt could
go up to 85%. When off Budget liabilities are considered, the situation looks
even more alarming.
While the prevailing exceptional circumstance
warrants loosening of purse strings, it is necessary that the government must
return to a credible fiscal consolidation path once the crisis gets over.
Need for transparency
Besides large deficits and debt, there are
questions of comprehensiveness, transparency and accountability in the Budgets.
The practice of repeated postponement of targets, timely non-settlement of bill
payments and off Budget financing to show lower deficits has been common. The
report of the Comptroller and Auditor General (CAG) of India in 2018 on the
compliance of the Fiscal Responsibility and Budget Management (FRBM) Act for
2016-17, highlights various obfuscations done to keep the liabilities hidden.
These include special banking arrangements for
covering arrears of fertilizer subsidy, issuing short-term bonds, unsecured
loans and borrowing from the National Small Savings Fund (NSSF) by the Food
Corporation of India towards meeting food subsidy and its arrears, financing
irrigation projects from the Long Term Irrigation Fund (LTIF) created by the
National Bank for Agriculture and Rural Development (NABARD), and financing of
railway projects through borrowings from the Indian Railway Finance Corporation
(IRFC) are just some examples. We are familiar also with the cases of the Life
Insurance of Corporation of India buying out the Industrial Development Bank of
India and the Power Finance Corporation buying out the Rural Electrification
Corporation (REC) and remitting the money to the government as disinvestment
proceeds.
In order to make the Budgets comprehensive,
transparent and accountable, the 13th Finance Commission recommended that a
committee be appointed by the Ministry of Finance which should eventually
transform itself into a Fiscal Council to “..., conduct an annual independent
public review of FRBM compliance, including a review of the fiscal impact of
policy decisions on the FRBM roadmap” (Paragraph 9.65). The FRBM Review
Committee too made a similar recommendation underlining the need for an
independent review by the Finance Ministry appointing the Council.
The problem is that a Council created by the
Finance Ministry and reporting to it can hardly be expected to be independent.
Therefore, the 14th Finance Commission recommended the establishment of an
independent Fiscal Council which should be appointed by and reporting to
Parliament by inserting a new section in the FRBM Act. Former Deputy Governor
of the Reserve Bank of India, Viral Acharya, in his recent book, Quest for
Restoring Financial Stability in India, also makes out a case for a bipartisan,
independent Fiscal Council.
The mandate
A Fiscal Council is an independent fiscal
institution (IFI) with a mandate to promote stable and sustainable public
finances. Robert Hagemann (“How Can Fiscal Councils Strengthen Fiscal
Performance?”. OECD Journal: Economic Studies, Vol. 1, 2011; p.76) defines a
fiscal council as, “…a publicly funded entity staffed by non-elected
professionals mandated to provide nonpartisan oversight of fiscal performance
and/or advice and guidance — from either a positive or normative perspective —
on key aspects of fiscal policy”. These institutions assist in calibrating
sustainable fiscal policy by making an objective and scientific analysis.
First, an unbiased report to Parliament helps
to raise the level of debate and brings in greater transparency and
accountability. Second, costing of various policies and programmes can help to
promote transparency over the political cycle to discourage populist shifts in fiscal
policy and improve accountability. Third, scientific estimates of the cost of
programmes and assessment of forecasts could help in raising public awareness
about their fiscal implications and make people understand the nature of
budgetary constraint. Finally, the Council will work as a conscience keeper in
monitoring rule-based policies, and in raising awareness and the level of
debate within and outside Parliament.
Diverse role, more acceptance
According to the International Monetary Fund
(IMF), there were 36 countries with IFIs in 2014 and more have been established
since. While most of the IFIs are in advanced countries, emerging economies too
have also shown growing interest in them. Although their common agenda has been
to function as watchdogs, there is considerable diversity in their structure
and functions. The important tasks of these IFIs include: independent analysis,
review and monitoring and evaluating of government’s fiscal policies and
programmes; developing or reviewing macroeconomic and/or budgetary projections;
costing of budget and policy proposals and programmes; and presenting policy
makers with alternative policy options. Over the years, monitoring compliance
with fiscal rules and costing policies and programmes have become major tasks
of these councils.
The OECD (2013) has documented the important
principles needed for successful fiscal councils under nine broad heads and
these are: local ownership; independence and non-partisanship; mandate;
resources; relationship with legislature; access to information; transparency;
communication and external evaluation. These principles are important, ensure
autonomy, being unbiased, transparency, and effective and accountable Councils.
How effective have these institutions been? A
study by the IMF (“The Functions and Impact of Fiscal Councils”, July 2013),
documents that the existence of IFIs is associated with stronger primary
balances; countries with IFIs tend to have more accurate macroeconomic and
budgetary forecasts; IFIs are likely to raise public awareness and raise the
level of public debate on fiscal policy. Case studies in Belgium, Chile and the
United Kingdom show that IFIs have significantly contributed to improved fiscal
performances.
In Belgium, the government is legally required
to adopt the macroeconomic forecasts of the Federal Planning Bureau and this
has significantly helped to reduce bias in these estimates. In Chile, the
existence of two independent bodies on Trend GDP and Reference Copper Price has
greatly helped to improve Budget forecasts. In the U.K., the Office for Budget
Responsibility has been important in restoring fiscal sustainability.
Cross-country evidence shows that fiscal councils exert a strong influence on
fiscal performances, particularly when they have formal guarantees of
independence.
The final word
When the markets fail, governments have to
intervene. What do we do when the governments fail? It is here that we need
systems and institutions to ensure checks and balances. In that respect, a
Fiscal Council is an important institution needed to complement the rule-based
fiscal policy. Of course, it is not a ‘silver bullet’; if there is no political
will, the institution would be less effective, and if there is political will,
there is no need for such an institution.
That is also true of the FRBM Act. While we
cannot state that the FRBM Act has been an unqualified success, it has also not
been an abject failure either. The counterfactual will show that things would
have been much worse without it, and it has helped to raise the awareness of
government, legislators and the public at large. Similarly, the Fiscal Council
will help in improving comprehensiveness, transparency and accountability.
M. Govinda Rao was Member, Fourteenth Finance Commission, and
former Director, National Institute of Public Finance and Policy, New Delhi,
India. The views expressed are personal
Reversing
health sector neglect with a reform agenda
India
cannot afford to be complacent in thinking that the pandemic alone will change
the health-care landscape
Two countries which lead in the COVID-19 cases
tally in the world today, namely the United States (first) and India (third),
are also the ones where the need for health-care reform post COVID-19 has been
most keenly felt. This is due to the lack of effective universal health
coverage (UHC) in these countries, which has broadened concerns beyond the
frontiers of an epidemic response into the larger domain of access, equity, and
quality in health care.
Legacy implications and UHC
This lack of UHC has a long legacy in both
these countries, which they owe to multiple long-standing factors and historical
reasons that have put a damper on the UHC agenda. This long legacy has two
important and inter-related implications when it comes to health-care reform.
First, certain entrenched characteristics of these health systems that have
accrued over decades tend to dictate the terms of further evolution and lead to
a number of compromises. Second, the long legacy itself comprises a
path-dependent trajectory that precludes far-reaching health-care reform.
The US Affordable Care Act (ACA) can be an
example of the first implication. It envisaged a number of overarching measures
to expand health insurance and improve access, including Medicaid expansion,
essential health benefits, and discouraging risk selection in insurance.
However, the foundational aspects of U.S. health care, such as a fragmented
private insurance landscape and a love for expensive specialised care, could
hardly be altered due to their entrenched nature. The ACA reforms were thus
superimposed on such largely non-negotiable elements, which in turn constrained
the nature and scope of those reforms. It is little wonder that the ACA has
been not very successful on multiple fronts, such as ensuring access
commensurate with insurance levels, and checking the rise of premiums and
out-of-pocket costs. A similar set of entrenched and non-negotiable
fundamentals, including weak public and pervasive private health care, will
also impact health-care reform in India.
India’s attempts
The government has looked poised to employ
Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PM-JAY) health insurance
as the tool for achieving UHC, and such calls have only grown stronger in the
context of the COVID-19 pandemic. Plans are reportedly under way to extend
coverage to the non-poor population under AB-PM-JAY, which currently covers the
bottom 40% of the population. Taking the health insurance route to UHC driven
by private players, rather than strengthening the public provisioning of health
care, is reflective of the non-negotiability of private health care in India. This
could have several unwanted consequences, which merits attention.
Stark maldistribution of health-care
facilities (almost two-thirds of corporate hospitals concentrated in major
cities) and low budgetary appropriations for insurance could mean that universal
insurance does not translate to universal access to services, much akin to what
was seen under the ACA in the U.S. Thus far, insurance-based incentives to
drive private players into the rural countryside have been largely
unsuccessful, and experience suggests that the public sector could be the only
effective alternative. Further, the Indian story has traditionally been one of
aiming high with little homework. Envisaging universal health insurance without
enough regulatory robustness to handle everything from malpractices to
monopolistic tendencies is a case in point. This could have major cost, equity,
and quality implications. For example, shouldn’t there be a potent ‘Clinical
Establishments Act’ before embarking on a universal scheme involving large-scale
public-private collaboration?
A similar argument can be made about the
National Digital Health Mission (NDHM) conceived by the Centre. Integration and
improved management of patient and health facility information are very
welcome. However, in the absence of robust ground-level documentation practices
and its prerequisites, it would do little more than helping some private
players and adding to administrative complexity and costs like the electronic
health records did under the US ACA.
One possible advantage for India over the U.S.
could be a relative ease of integrating fragmented schemes into a unified
system. The AB-PM-JAY has this ability, but it would require mobilising
sufficient and sustained political consensus.
The second implication concerns path-dependent
resistance to reform. The bigger and deeper the reform, the more the
resistance. Covering the remaining population under the AB-PM-JAY presents
massive fiscal and design challenges. Turning it into a contributory scheme
based on premium collections would be a costly and daunting undertaking, given
the huge informal sector and possible adverse selection problems. Meeting
requirements through general revenue financing would greatly strain the
exchequer and looks very unlikely especially in the immediate aftermath of the
pandemic. In either case, an effective roll-out of UHC would require a robust
regulatory and administrative architecture, entailing huge administrative
expenses and technical capabilities. Harmonising benefits and entitlements
among various beneficiary groups, and a formalisation and consolidation of
practices in a likely situation of covering outpatient care, are formidable
additional challenges. While these would need to be pursued incrementally, the
question arises as to how to push such a thoroughgoing reform agenda,
especially against a backdrop of decades of frail capacities and neglect of the
health sector.
Upheaval yes, but also action
While upheavals offer windows for pushing
reform, as Johnson notes, “the weight of past and pre-existing paths strongly
constrain and limit the impact of the most radical ruptures”. We cannot afford
to be complacent and think that the pandemic will automatically change the
Indian health-care landscape. This is particularly important since a protracted
presence of the pandemic in the country could undermine its gravity and the
perceived urgency for major reform. It will require mobilising concerted action
from all quarters. Civil society would need to utilise this opening to generate
widespread public consensus and pressure for health-care reform. The fact that
States with higher per-capita public spending on health have fared better
against COVID-19 can be invoked to back the reform argument. At the same time,
politics would need to recognise the unprecedented populist significance of
health and marshal enough will to negotiate organised opposition to change.
Dr. Soham D. Bhaduri is a Mumbai-based physician, health-care
commentator, and editor of ‘The Indian Practitioner’
The challenge
of catching elusive taxpayers
Various
reforms have been introduced over the years, but none of them has worked
India’s tax collection is set to decline
sharply this year because of the decline in national income and fall in
employment due to COVID-19. Simultaneously, expenditures related to the
pandemic are ballooning. Thus, the fiscal deficit in the budget is set to rise
unless other expenditures are cut. However, there are committed expenditures
which cannot be curtailed and the deficit in the budget is set to climb to a
new high for 2020-21. So, there is no option but to try and collect more taxes.
The Prime Minister unveiled income tax reforms
to make the system faceless, painless and seamless. He stated that 15 million
people pay income tax out of a population of more than 1.35 billion. This is
the number for the financial year 2018-19. For 2019-20, the number of taxpayers
may be similar given that the economy was slowing down and unemployment was at
a record high. In 2020-21, the number would drop sharply due to the impact of
COVID-19 and massive unemployment in the organised sector.
Drop in number of taxpayers
The number of tax filers has increased but the
number of taxpayers has dropped. This is a result of the tax concession offered
in the Budget — those filing a return up to ₹5 lakh do not have to pay a tax.
Interestingly, in 2012-13, a year for which the government had released
detailed data in 2016, the number of effective tax payers was 16 million. So,
in spite of an increase in population and the laws introduced in the last six
years to bring the rich into the tax net, there has been little change in the
number of taxpayers. The fact that the direct tax to GDP ratio in percentage terms
is stagnating at about 5.5% is another indication of this.
There are two categories of the well-off in
the country: those who file a tax return and those who completely escape the
tax net. If the former had declared more of their incomes, the tax to GDP ratio
would have risen. If those who were outside the tax net had come into the tax
net and started filing their returns, there would have been a rise both in the
tax to GDP ratio and the number of taxpayers.
A 2016 report says the top 10% of Indians earned
55% of the nation’s incomes. If these people could be brought under the income
tax net and they paid their taxes honestly, at current tax rates, income tax to
GDP ratio alone would have been about 18%. Add to that the collection from
other direct taxes, like corporate tax, and the figure would be more than 20%.
This figure of 55% does not take into account the black income generation in
the country. Clearly a lot of taxes are not paid out of white incomes and none
from the black incomes.
Demonetisation was supposed to bring out the
black incomes and turn them white so that the tax to GDP ratio could sharply
rise. The government made repeated announcements about how many more people had
come into the tax net after demonetisation and about how more tax would be
collected. No such thing has happened as the Prime Minister’s statement
implies.
The government has been trying hard to tackle
the large black economy. As soon as it started its innings in 2014, the NDA set
up a special investigation team under court orders. It renegotiated the tax
treaty with Mauritius to get back to India the money held abroad. But nothing
seems to budge the rich (say, the top 1% in the income ladder) to pay more tax.
Actually, the rich are fleeing the country. More than 23,000 high net worth
individuals left the country in five years up to 2019. Embarrassingly, when the
Defence Minister was in France last year to receive the first Rafale fighter
jet, the CEO of Dassault Aviation said in a speech that India should not
terrorise them with its tax and custom rules.
A considerable part of the tax filing process
was computerised when e-filing and, earlier, PAN were introduced. These
measures tried to cajole people into filing honest returns. Former Finance
Minister Yashwant Sinha introduced the scheme of honouring honest tax payers.
The government is again talking of it. The Vivad se Vishwas scheme was
introduced to settle tax disputes. But none of these schemes seem to have
delivered.
A new system
The government is able to trust neither the
tax department officials nor the rich. So, it has decided to hand over the
process of taxation to computers. The computer will decide who will assess the
tax return of an individual. During the different stages of a case, different
officers will be involved. That is why the new scheme is said to be faceless
and anonymous so that no nexus can be formed between the taxpayer and the
officer involved in passing the return, and money cannot be paid to evade
taxes.
The department is being reorganised into assessment
units, verification units, review units and technical units. There will also be
a small unit to take care of past matters. Apparently a pilot project was run
last year to assess the efficacy of the new scheme of things. However, there is
worry that the software can be manipulated by those who know the system.
There is an administrative problem. The
department is grossly understaffed and officers have inadequate time to
scrutinise cases. A few thousand officers have to deal with lakhs of cases.
What takes a clever Chartered Accountant a few months to prepare cannot be
deciphered by an officer in a few hours. Incomes of salaried employees are
simple to estimate but the problem lies with estimating business incomes. To
estimate them one needs to know the revenue and costs. Both are fudged through
under-invoicing and over-invoicing. Businessmen declare their entire household
expenditure as business costs. Even if a lot of computerised data are available
it may prove to be inadequate. In 2016, before demonetisation, the government
had initiated an Income Declaration Scheme. To scare people, the department
announced that it had data on 93 lakh high-value transactions and would use it
to catch people but this had little impact.
The highest tax rate has been brought down
from 97.5% in 1971 to 30% (plus surcharge) now. After 1991, with new economic
policies, the controls and regulations were sharply curtailed – the Monopolies
and Restrictive Trade Practices Act, the Foreign Exchange Regulation Act, etc.
were removed. But the well-off have constantly complained that tax rates are
high and there are too many controls; that they pay all the taxes but get
nothing in return. This lament is rather unfair since they have gained the most
out of the country’s development. So, at what level would there be satisfaction
that tax rates and regulations are fine?
This is an important pointer to the feeling of
social injustice in every section of the population. The well-off who have
gained the most complain of it and the poor live with injustice. There is
massive alienation in society. The pandemic also points to this – the way vast
numbers have suffered and why they do not heed the authorities.
Arun Kumar is Malcolm Adiseshiah Chair Professor, Institute of
Social Sciences
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