On May 2, the total number of active Kovid cases in the country crossed 3.4 million. As of March 31, the number was at 5,80,387, an increase of approximately 488% over a one-month period. Unlike the first wave, middle-class people who were supposed to do well during this time were also heavily affected by the epidemic. Even the upper middle class and the rich are getting the feel of a real Indian system, or lack thereof.
As the 15th Finance Commission (FFC) pointed out in its report: “There are 11.54 lakh registered allopathic doctors in 2018 [and] 29.66 lakh nurses. “The ratio of doctors to our population is very low, at one doctor for every 1,511 people, against one for every 1,000 people recommended by the World Health Organization. Yet, India has one nurse for every 670 people.
As of June 2020, there are only 1.25 million allopathic doctors in India. As of December 2019, the number of nurses was approximately 3.26 million.
These are total numbers, and the situation varies in different parts of the country. There are 65,685 doctors in Kerala for a population of 35.6 million. Jharkhand has a population of 38.6 million, but there are only 6,837 doctors in the state. There are 130,698 doctors in Karnataka with a population of 67.6 million. By comparison, Gujarat has a population of 63.9 million with 69,746 doctors. There are 84,560 doctors in Uttar Pradesh with a population of 237.9 million. Clearly, there is great disparity when it comes to the availability of doctors. This also applies in the case of nurse availability.
There is a lot more to health infrastructure than just doctors and nurses, but a look at these data suggests that India’s medical infrastructure is weak and unevenly distributed. Even in 2020-21, the central and state governments spent only 1.8% of India’s gross domestic product (GDP) on health, up from 1.4-1.5% of GDP earlier.
The same is true of health, education, and other areas of life. This is known as the departure of economist Albert Hirschmann from the state; Those who can, stop. As Akhilesh Tilotia writes By looking glass: “They create parallel infrastructure at considerable private cost.”
This gate is about how people shape themselves in urban gated communities, making sure there are diesel generators to ensure power availability despite power cuts, sending their children to private schools, buying vehicles to turn around because there is no transport mark, and so on. Withdrawal also includes tax evasion. Taxes collected by our central government fell from a peak of 12.1% of GDP in 2007-08 to 10.6% in 2020-21.
Tilotia calls it the private expense of public failure because “citizens are looking for market-based ways to meet their needs” and have to pay lower taxes in the process.
The exit will also include the use of private health services, as what the government provides in most states is unreliable. The problem is that even private health services do not have the level to meet what the government cannot provide. And with the second wave of this epidemic it came to the screen.
How will it play out once we get out of the pandemic? One thing that is going to happen is that most of the great rich in India want to leave the country and go to places with better health systems and lower tax rates. In fact, according to Global Wealth Migration Review, New World Wealth, a wealthy intelligence agency, nearly 7,000 wealthy Indians or 2% of our high net worth people left the country in 2019. In fact, it’s more due to higher taxes here than our Ricky health system.
These revenues will intensify in the coming years, putting pressure on the total taxes levied by the government, with the vast majority of the country’s income tax being paid by very few. As the 15th Finance Commission report points out: “The number of taxpayers filing returns in AY 2018-19 is around 5.87 crore … 40.4% in the Nil tax bracket and another 52.8% in the tax-bracket” ₹1.5 lakhs. “Therefore, those in the top tax bracket pay more tax. And if some of them choose to leave the country, it means that the government will charge less tax.
In fact, most of our well-being will continue to live in the country. Being more active politically is one way for their lives to be easier. But given their number they are politically irrelevant.
So, the only option left for them is more and more self-care, and this means more and more people are trying to leave the state. In the short term, this means allocating more money to a health emergency. The immediate effect of this is that the pent-up consumption we saw after the first Kovid wave last year will not happen this time.
In the long run, gated communities can be expected to come to their own hospitals. It can soak up medical resources and put more pressure on our already weakened health infrastructure. No doubt, all of this would be very difficult to measure. But it will be a private expense for India’s public failure.