Why the state just doesn't care

Updated: Jun 15, 2020, 07:13 IST | Ajaz Ashraf | Mumbai

Although India's middle class, comprising mostly the upper castes, has a dominant voice, it did little to make the state prioritise public health because until COVID-19, the class never thought it'd need it

Doctors and staff at KEM Hospital attend to COVID-19 patients. Pic/Suresh Karkera
Doctors and staff at KEM Hospital attend to COVID-19 patients. Pic/Suresh Karkera

Ajaz AshrafThree disparate data points can be connected to explain the Indian state's indifference towards its citizens. One of these is the Madhya Pradesh government's survey, which shows that only 2.7 per cent of the 7.3 lakh migrant labourers who returned to the State during the lockdown belonged to the general, or upper, caste category. This suggests that upper-caste people left the State in smaller numbers as they did not suffer from acute deprivation; or if they did indeed migrate, their financial well-being did not make them pine for home in desperation.

The second data point pertains to India's public health spending, which is less than one per cent of its GDP, lower than Bhutan. This is why India, identified as a rising power, has a rickety health infrastructure, evident from media stories about the Coronavirus-infected having to run around in just about every city to secure a hospital bed. Their harrowing tales have aggravated the nation's panic disorder, which initially arose from the possibility of the Coronavirus turning a seemingly routine cough into a desperate gasp for air.

The third data point is from Delhi, where, on June 9, out of 9,179 beds reserved for COVID-19 patients, 4,250 were vacant. This figure underscores the failure of the public health infrastructure to inspire confidence in all, particularly the middle class, whose voice dominates whether in crises or normal times. Accustomed to visiting costly private hospitals, they think government health institutions are overcrowded, unhygienic, and lack in facilities and skills. Their imagining of the public medical space, even without experiencing it, is correct.

Yet the middle class is complicit in the state's low expenditure on public health. They have not used their control over the state to prioritise public health, largely because, until the advent of the Coronavirus, they knew they would not visit government hospitals for medical care. It is surely not a coincidence that Prime Minister Narendra Modi's idea of public health is to float the Ayushman Bharat Scheme, which provides a medical insurance cover to citizens. This will undoubtedly enable lakhs of citizens to access private medical facilities, but their gains will turn the state even more negligent of public health.

Now, return to the first data point to identify the social groups whom the shift to the insurance-based healthcare will adversely affect. Madhya Pradesh's army of distressed labourers overwhelmingly comprised Dalits and Other Backward Classes. Those who cannot survive for a week on their savings can depend only on the public health infrastructure for medical care. Yet their poor representation in the middle class — though growing because of the reservation policy — means they cannot influence the state to frame health policies to their advantage.

It is also possible that when members of subaltern castes enter the middle class, they feel compelled to adopt its cultural norm, for acceptability and furthering their careers. Perhaps this explains why so many policies of Modi, an OBC leader and self-avowedly chaiwalla, hit the vulnerable sections the most, from demonetisation to GST to lockdown. His insurance-based healthcare model is yet another pointer to the sway of the upper caste-dominated middle class over state policies.

The grip of this class over the state is historical. India's independence did not lead to a restructuring of power relations among social groups. It is an exaggeration to claim that only the "complexion of rulers" changed at the switch from British rule to Indian rule, as economist KT Shah sarcastically remarked in the Constituent Assembly, which was, unthinkingly, vesting tremendous powers in the executive.

Yet Shah was, in some ways, correct, as Gyan Prakash's Emergency Chronicles demonstrates. Not only was the Constitution largely based on the Government of India Act, 1935, most of the fundamental rights granted to citizens were also simultaneously circumscribed. Ambedkar's justification was that "because fundamental rights are the gift of the state it does not follow that the state cannot qualify them."

Nehru, Patel and Ambedkar backed the construction of a strong Indian state, which they thought was required to tide over the Partition trauma, the war over Kashmir, and to reconcile contradictory interests to work for the common good. Yet Somnath Lahiri's famous remark in the Constituent Assembly that "many of these fundamental rights had been framed from the point of view of a police constable" rings so true now. This is because the powers constitutionally vested in the state have become a weapon to silence those seeking to change the state's behaviour.

These powers are often aimed at protecting and promoting the interest of the middle class-upper caste, which largely keeps away from transformational politics. This has increasingly turned just about every protest into a sectional one. Agrarian movements fail to muster the support of other occupational groups; the fight of Muslims on citizenship issues degenerated into theirs alone, as was also the case with the 2018 protests of Dalits. Will the Coronavirus panic have taught the middle class to pressure the state to rebuild the health infrastructure? Fond hope, but whoever lost anything by hoping!

The writer is a senior journalist

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