May 5, 2021, 8:26 AM
Ruchir Sharma is the author of the upcoming ‘10 Rules of Successful Nations’
Those of us who see these as dark times for Indian democracy can take heart from the recent elections, not only because of the way regional parties stood up to the Centre’s ruling party machine but also because of the highly unusual nature of their win in the key battleground state.
In surviving the BJP onslaught in West Bengal, Mamata Banerjee also beat overwhelming odds. She became only the 10th CM to win a third term in more than 200 major state elections held since the mid-1970s when India became a true multi-party democracy. BJP had many advantages – from voter hostility towards a long-serving incumbent to the brute power of its heavily financed machinery – but still fell short.
India’s problem right now is not a broken democracy, it is a broken state. In the late phases of the balloting in West Bengal, BJP lost more momentum as the pandemic started spinning out of control. This turn is likely explained at least in part by growing popular anger at the central government’s handling of the rising caseload.
In recent weeks India has suffered one of the biggest surges of any country so far. Cases rose roughly twelvefold, according to official figures, and the real toll may be considerably higher. A crisis of this magnitude would stress even the world’s best healthcare system. In India, it has exposed pre-existing frailty – a broken state.
A few developed countries, such as France and Italy, also suffered rapid second waves but managed to lower death rates from the first wave. Their health systems had readied for the shock. In India, the second wave has brought with it scenes of devastation reminiscent of the dark ages.
When I watch overwhelmed hospitals turning away patients at the gates, leaving them to die at home or suffer in the streets, I am haunted by thoughts of my grandfather. He died of a heart attack under similar circumstances, turned away from a public hospital in Uttar Pradesh, where there was no doctor on night duty and an orderly tried but failed to install a pacemaker. That was 1993. India’s underlying tragedy is how little progress has been made since.
Among the world’s 25 biggest emerging markets, India ranks last for the number of hospital beds per 1,000 citizens, fifth from last for doctors, fourth from last for nurses and midwives. Even if you drop richer emerging markets and compare India to other large countries with per capita incomes between $1,000 and $5,000 – which includes Pakistan and Bangladesh – India still looks mediocre on these basic healthcare measures.
Government spending generally rises as a share of the economy as countries grow richer. India’s government spends the equivalent of about 30% of GDP, which is roughly in line with other nations in its income class. So the problem is not the size of India’s state, but how it spends.
When Modi brought BJP to office in 2014, he mocked the welfare populism of his predecessors. Yet soon he was vying with them in his promises of generous freebies, from gas to food and pucca homes. Today, welfare spending accounts for 9% of GDP – far higher than the miracle economies India would like to emulate, like South Korea and Taiwan, when they were at similar levels of development.
The government has meanwhile done little to modernise the basic structure of India’s state, which harks back to British rule. Many of India’s laws, and the structure of its federal ministries, including home and finance, dating back to the late 1800s. The corruption in public works that author Munshi Premchand was vividly described in his novels a century ago has yet to abate.
Our healthcare system was supposed to be revamped along lines described by the Bhore commission of the 1940s, but its comprehensive blueprint for hospitals and clinics throughout the country has yet to be realised. Instead, we have the sad reality of underfunded clinics, featuring operating rooms without surgeons, x-ray machines without radiologists. Some have beds without nurses, others have nurses without beds to attend. Economists who say India needs to spend more often have little to say about how badly our resources are currently deployed.
It is no surprise this unfinished and uncoordinated health system would falter in the face of a global pandemic. What was promised was “minimum government, maximum governance, but rather than reforming India’s outdated state, power has been centralised to a greater degree than in a long time.
The PM set himself up as the nation’s saviour, who would solve its every problem. But it was a tall order, even a Formula 1 driver would not have made much progress in an Ambassador. The reality is that BJP can no longer claim to offer a superior model of governance, and that reality is starting to catch up to it at the polls.
The good news is that private groups, as they have before, are rushing in to provide what the government does not. Expats are sending money and medical resources from abroad. Residential associations are providing whatever assistance they can muster to ailing neighbours. So far, the Indian stock market has barely flinched over the rising death toll, perhaps reflecting a collective intuition that India will survive this crisis too despite its broken state.