When the Government machinery is breathing free, the nation is on a ventilator

WHEN THE GOVERNMENT MACHINERY IS BREATHING FREE, THE NATION IS ON A VENTILATOR

Introduction:

The Indian health care system is crumbling under the strain. Government has failed miserably in providing proper health care management amid the covid surge. Patients are dying waiting for hospital beds and oxygen cylinders. This is clearly the result of underfunding. India spends only $73 on health care per capita, versus the world’s average is of $1,110 in 2018. All Indian citizens can get free care at government facilities but that’s only on paper, in reality there is a heavy shortage of staff and supplies, even when the country is not engulfed in a raging pandemic.

Race to Survival:

This is the story of a man, Cliford, a Goa resident, who lost his mother due to COVID. His mother was made to wait on the floor for 3 days due to unavailability of a bed and later she was shifted to a “stretcher” because there were no beds available in the best medical facility of the state, Goa Medical College and Hospital (GMC).Mr. Cliford further informed the sources about the pathetic condition. He said that there were more 30-35 patients waiting outside the hospital on wheelchairs. An oxygen cylinder used to last for 4-5 hours and then the families had to worry for the next supply. The hospital authorities used to stop the oxygen supply at nights to save it for the next day.  The doctors don’t even attend the patients until somebody from the family constantly goes to them and pleads for help. He said that the Dean of the hospital asked them to “wait for someone to die, to get a ventilator.”

He witnessed people dying and crying in their ward when he spent a week along with his mother in the hospital. There was only one oximeter running all over the hospital. Even the prominent news channels are not covering this drastic and devastating ground condition.

Goa is the smallest state of India with a population of less than 20 lakhs. It is shocking that the government could not provide oxygen cylinders to even fifty thousand people accommodated in the best hospital of the state. Government is clearly not realising their accountability to the taxes and donations being paid by the residents. And nobody is asking where it goes. The health minister and chief minister should be interviewed and asked why they couldn’t provide suitable facilities at the main state government hospital.

Ayushman Bharat and the False Promise of Universal Healthcare

What implications will a health insurance scheme that relies on private capital have for India’s healthcare system?^[1]

The COVID pandemic has exposed the failure of a healthcare system among numerous other structural failures of the government. BJP’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, 2018, states to “leave no one behind” by providing health cover up to ₹5 lakh for over 10 crore people. However, amidst coronavirus, this health cover has not proved effective. National Health Authority’s report notes that average weekly claims have dipped by 51% during the lockdown period. So far, only 300-odd COVID-19 treatments have fallen under the scheme.

• An Absence of Private Healthcare Infrastructure

• Analyzing data from the Registry of Hospitals in Network of Insurance (ROHINI), it has been found that only 3% of private hospitals are eligible for this scheme. By this estimation, there are only 1.28 empanelled hospitals available per lakh population. Of these, about two-thirds had less than 30 beds. ^[2]
• The research shows that concentration of empanelled hospitals is limited to the richer states of the country like Andhra Pradesh, Telangana, Tamil Nadu and Karnataka^[3]. In states where the empanelment of private hospitals by insurance companies is low, the distribution of private hospitals is also concentrated in a few pockets. ^[4]
  • Problems on the Ground 
• During the scheme’s first year of implementation, there were 1,200 cases of corruption related to AB PM-JAY beneficiaries.  Investigations have been completed in 376 hospitals and FIRs filed against six hospitals. After the investigations, a penalty of Rs 1.5 crore has been levied and 97 hospitals have been delisted from the scheme.
• Inequity in access is also a serious issue, especially for the poor who suffer from serious ailments. Patients who are chronically ill are being denied care under the plan since their disease isn’t “listed” among the medical packages offered by AB PM-JAY. Despite having legal paperwork, this is the case.^[5]
• It should be noted that the AB–PMJAY programme only covers drugs after discharge for up to 15 days. A large number of patients, particularly cancer patients, require long-term medication on an outpatient basis. This has restricted the reach of the benefits to the poorest of the poor.
  • A Push towards the Privatisation of Healthcare
• At present, AB PM-JAY covers less than 30% of hospital charges. The project, according to Shailender Kumar Hooda, is doomed to fail without significant investment. Out-of-pocket payments for medical care are not covered under the scheme, those who are mostly unable to afford healthcare remain excluded from the insurance coverage.
• The government may be forced to include all areas of society under the insurance umbrella to satisfy both inpatient and outpatient care demands due to the public system’s unstable state. Political economy comes into play here, where the government feels a compulsion to ensure protection to the entire population and for all types of care.

Flaws in Our Laws

COVID Has Exposed the Supreme Court’s Utter Disregard for the Plight of Ordinary Citizens.

• Last year, SC refused to push for ‘national plan’

• The court has mentioned a national plan to cope with the many services that are required at this time. Unfortunately, no Disaster Management Plan has been developed under Section 11 of the Disaster Management Act. If a plan to cope with a pandemic-induced calamity had been devised, planned, and implemented, the country would not be facing the situation it is today, and citizens would not be dying and suffering as they do now.
• The court had [already] missed the opportunity “to set things right and direct the government on the right course of action as commanded by the statute to save lives and ensure the well-being and welfare of the citizens at large”.^[6]

• Migrant workers abandoned

• The Supreme Court has called for a comprehensive plan to help stranded migrant workers. According to the solicitor general, there were no migrant workers on the road. And the court, once again led by Justice Bobde, had cheerfully approved his claim. People were walking, falling on the roadways, and dying even as the court was issuing its order. The court, on the other hand, claims that all this was a rumour.
• The court has squandered every opportunity to provide the administration guidance. Instead, it has gone to great lengths to delegitimize the government in order to protect it from popular demands.

  • A disturbing pattern

• There are many judgments of many high courts that essentially follow the pattern set by the Supreme Court.
• COVID-19, on the other hand, may be the darkest period in the Supreme Court’s history, when it abdicated its responsibilities to hundreds of millions of destitute and marginalised people, and this record will be hard to beat in the decades to come.

The Supreme Court may have had good cause to act the way it did. However, the government’s incapacity to assist the suffering masses and provide humane justice should not be used as an excuse to block the high courts, which still have some humanity and compassion, from delivering justice.

Case Laws:

Compilation of Judicial Pronouncements during Covid Outbreak

Suo Motu V. State of Rajasthan.

Safety measures and precautions to be maintained for prisoners at Jaipur district.^[7]

Challenge in brief:  PIL was filed when reports broke on several Rajasthan news stations that a large number of inmates (about 55) had tested positive for the virus in Jaipur district jails.

Order: The state government was ordered by the court to maintain high standards of care for the imprisoned inmates. It also issued specific directives in this regard, such as incorporating the COVID-19 SOP for jails, so that the accused would be checked for coronavirus by local medical authorities, and only the accused will be remanded to jail/custody if the test results are negative.

Japinder Singh V. Union of India and others.

Private unaided schools cannot collect tuition fees if the student is not attending online classes.

Challenge in brief: Private unaided schools were allowed to conduct classes online by the state government. Parents were allegedly coerced into paying tuition fees at various schools, according to the allegations.

Order: Because Uttarakhand is a hilly state with poor internet access, many students are unable to participate in online classes. As a result, those children’s parents cannot be forced to pay the tuition cost. If a complaint is received, the concerned Nodal officials will take action as soon as possible.

RashtriyaShramikAghadi v. The State of Maharashtra and others

Principle of “No-work No-wage” not applicable in present extraordinary situation.

Challenge in brief: The petition is about the non-payment of security guards’ and health workers’ salary; these individuals are willing to work but are unable to do so due to the unusual lockdown circumstances.

Order: The District Collector was ordered by the Court to guarantee that all wages are paid for the months of March and May, with the exception of food allowance and transport allowance (for employees who are not expected to report for duty).

Conclusion

The Government of India owes an answer to the people. As we can clearly see the condition was similar to a 3^rd world country. These catastrophic circumstances are no more tolerable. This pandemic should be the ‘eye-opener’ for the government who has performed miserably. It seems that the life of a common man doesn’t matter in this country. Improving the health care system is the need of the hour. India is clearly supposed to invest more funds in the health care sector rather in the elections or election rallies. When the GDP was soaring high nearly 8%, the government had been having campaigns and taking credit for the growth. Why in such a crisis, the government does not stand as a true leader and take the responsibility?

What can be done?

• Improved Public Health Funds and Communication

The federal government must step in and give the resources necessary for states to respond to local outbreaks.

• Health System Overhaul

In the long run, India’s health system will necessitate a significant financial investment. Only 10% of all hospitals in the country are run by the government. Private facilities do exist, but they are exclusively available to a select group of people. To avoid a reappearance of the virus or future pandemics, the poor quality of public health services and infrastructural limitations must be rectified.

• International Support

Despite its participation in the COVID-19 Vaccines Global Access (COVAX) programme, the United States needs to be more brave and imaginative when it comes to equitable global distribution. This is not simply a humanitarian act, but it is also in the best interests of the United States’ health and economy.

^[1] https://www.epw.in/tags/health-insurance

^[2] https://www.gov.ie/en/service/ca5d7-live-performance-support-scheme-2021/

^[3] https://tfipost.com/2021/04/andhra-and-karnataka-are-up-in-arms-over-the-birthplace-of-bhagwan-hanuman-but-its-actually-a-good-thing/

^[4] https://www.epw.in/engage/article/ayushman-bharat-and-false-promise-universal

^[5] https://www.epw.in/engage/article/ayushman-bharat-and-false-promise-universal

^[6] https://thewire.in/law/supreme-court-covid-19-crisis-centre-high-courts-darkest-phase

^[7] https://www.mondaq.com/india/government-measures/962354/compilation-of-judicial-pronouncements-during-covid-19-phase-iii

Author: Nihaarika Sangwan,
Mody University and 2nd year ( BA LLB )