1.Get cracking: on implementing ‘Modicare’  (The Hindu)

2.Forging a new nuclear deal (The Hindu)

Get cracking: on implementing ‘Modicare’  (The Hindu)

    Synoptic line: It throws light on the issue of recently launched world’s largest healthcare programme’

(GS paper II)

Overview

 

 

  • Recently the Finance Minister announced two new initiatives under the Ayushman Bharat Programme in the Union Budget 2018. Under the programme, a new flagship National Health Protection Scheme, providing a health insurance cover of ₹5 lakh a family per annum has been announced. The scheme will cover 10 crore vulnerable families, with approximately 50 crore beneficiaries.
  • The health scheme are thought to serves the twin purposes of achieving universal coverage and saving people from high health care costs.

 

 

What is Modicare

 

 

  • The Union Budget presented by Finance Minister saw the unveiling of a mega healthcare project that is being touted as the world’s largest such scheme, in both extent, and expense. The National Health Protection Scheme (NHPS), which has been dubbed ‘Modicare’, has the objective of extending healthcare insurance to 100 million families, and raises the insurance ceiling to Rs.5 lakh per family.

 

 

Assessment

 

  • The programme ‘Ayushman Bharat’ has the components of opening health centres for diagnostics, care and distribution of essential drugs as envisaged in the National Health Policy, and a National Health Protection Scheme (NHPS) to provide a cover of up to ₹5 lakh each for 10 crore poor and vulnerable families for hospitalisation. These are challenging goals, given the fragmented nature of India’s health system.

 

  • Some States already purchase health cover for the poor, but do not regulate private secondary and tertiary care services or treatment costs. The task before the Centre, which has provided ₹3,200 crore for the programme areas, is to now draw up an implementation roadmap.

 

  • Developing countries that launched universal health coverage schemes over a decade ago, such as Mexico, had to address some key challenges like transfer of resources to provinces, recruitment of health personnel, and purchase and distribution of medicines to the chosen units, all these also applies to India.
  • Moreover, the steady growth of a for-profit tertiary care sector poses the additional challenge of arriving at a basic care package for those who are covered by the NHPS, at appropriate costs.

 

  • A national health system will also have to subsume all existing state-funded insurance schemes. This will give beneficiaries access not just within a particular State but across the country to empanelled hospitals.

 

  • In the case of the local health centres that are planned under the Ayushman Bharat programme, there is tremendous potential to play a preventive role by reducing the incidence and impact of non-communicable diseases such as diabetes and hypertension. Such centres can dispense free essential medication prescribed by all registered doctors and procured through a centralised agency.

 

Way ahead

 

  • According to the World Health Organization (WHO) report, ;the Health Workforce in India states that on an average, there are only 79.7 doctors per one lakh people in the country. Modicare would seek to remedy is India’s low per capita expenditure at constant Purchasing Power Parity (PPP). Purchasing power parity is the net expenditure on a particular commodity after normalising the cost by accounting for the exchange rate. This metric is often used to compare income levels or the price of a basket of goods in different countries.

 

  • The early experience with state-funded insurance for the poor shows that some private hospitals may resort to unnecessary tests and treatments to inflate claims. Determination of treatment costs by the government is therefore important.

 

Question- There is need for implementation roadmap for the new health scheme, explain in the context of     Union budget recently launched new health scheme.

 

Forging a new nuclear deal (The Hindu)

Synoptic line: It throws light on the issue nuclear agreement of India and USA.

(GS paper II)

Overview

 

  • This year’s republic day mark the anniversary of another big visit three years ago-the visit by then U.S. President Barack Obama, when he announced a “breakthrough” in the India-U.S. civil nuclear deal, to finally pave the way for a commercial contract. The brief of the content describing the nature of the agreement between India and the U.S. on supplier liability and tracking requirements, which would enable American companies to build nuclear power reactors in India.

Assessment

 

 

  • The India-US nuclear deal was initiated in 2005, after nearly 30 years of US-imposed sanctions since India tested its first nuclear weapon (1974). It is nearly a decade since the memoranda of understanding were inked, and three years after the last wrinkles were ironed out, there is no sign yet of any concrete contract between an American company and the Indian authorities to build a reactor.

 

 

  • In 2009, both GE-Hitachi and Toshiba-Westinghouse had begun talks on techno-commercial agreements for six reactors each in India. These commercial contracts were to be the start of the ‘payoff’ for the U.S. that had considerably shifted its stand on non-proliferation to give India the waivers needed, and they were to herald India’s arrival on the global nuclear power stage in return.

 

  • GE-Hitachi’s plans were shelved after it rejected the Obama-Modi agreement in January 2015, saying GE would not accept the compromise formula on supplier liability. Toshiba-Westinghouse then carried the baton to actualise the India-U.S. civil nuclear deal, but ran into a different storm as both Toshiba and Westinghouse had major financial troubles last year. After a near-bankruptcy, Toshiba jettisoned Westinghouse for just $4.6 billion to a Canadian consortium a deal that is now expected to be cleared by the end of 2018.

 

  • With shifts in global politics, renewable energy technology, the U.S.’s commitment to India, and the supplier’s capacity and ability, it would be ridiculous if India remained steadfast to a deal envisaged a decade ago under very different circumstances.

 

  • There are various changes in the deal itself. Like the financial crisis was set off because Westinghouse went into major cost overruns, possibly worth more than $15 billion, in building four AP1000 reactors at two projects in the U.S., the same reactors as the ones meant for India. When work was halted on the Westinghouse projects in South Carolina, the construction was already five years over schedule.

 

  • India’s past record with Russian project puts the mean time to construct a reactor. This would mean that even if an India-U.S. techno-commercial contract is finally readied in 2019, and the ground breaking begins immediately, it may not see fruition until 2029, a good 20 years after the nuclear agreement was signed.

 

  • The changed US regime provided that the nuclear dollars have dimmed in comparison to the lucre of fossil fuels in America. In his State of the Union address Mr. Trump said that the U.S. has “ended the war on beautiful, clean coal,” and will now mine, export and push oil, gas, coal and shale trade into its foreign outreach.

 

  • India has already received a rude shock with the U.S. pulling out of the Paris climate change accord, and from Mr. Trump’s singling out India as a “leading polluter” during his announcement of that decision last year. This, after the Obama administration had browbeaten India into acceding to the Paris accord two months ahead of deadline, by promising to help India reduce its dependence on fossil fuels.

 

  • India’s own requirements from the India-U.S. civil nuclear deal have changed considerably. In May 2017, the Cabinet approved a $11 billion, 7,000 MW construction plan for 10 Indian-made pressurised heavy water reactors (PHWRs).

 

  • With existing constructions and the current capacity of 6,780 MW, India hopes to have 14,600 MW of nuclear power online by 2024. Even as it makes a push for indigenous nuclear power plants, the Department of Atomic Energy is also advocating PHWRs in more inland sites in Rajasthan, Haryana, Karnataka and Madhya Pradesh, with concerns about too many nuclear projects dotting the southern coastline which lies along tsunami and earthquake faultlines, as the U.S. and French projects are.

Way ahead

  • The shifts in the world nuclear industry must be studied closely before heading back into negotiations with new companies. Most nuclear companies globally are staring at major losses over their nuclear businesses. More countries now see nuclear power as a “base-load” option, to be kept as back-up for the unstable, but infinitely less costly and eco-friendly solar and hydroelectric power options.

 

  • As  the India-U.S. civil nuclear agreement for commercial projects, it was completed all those years ago, is now obsolete and reviving it will require a different template that takes into account India and the new global realities, the deal that was “done” is now dead.

 

Question – The India-U.S. civil nuclear agreement is obsolete. In reviving it, India must heed the new global realities. Analyse