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Daily Editorials

A National Health Service in India


  • The current surge in COVID-19 infections has exposed problems amounting to near-chaos throughout Indian healthcare.

Coordinating measures to tackle COVID:

  • While those involved in the clinical response are clearly doing their often-desperate best — care staff are at high risk of contracting COVID-19.

  • The Central and State governments are now coordinating measures within and across their respective jurisdictions.

  • For example, the railways are running special trains carrying oxygen supplies.

  • The military is also involved in supply chains.

  • The Karnataka government has ordered private hospitals above a certain size to reserve 75% of their beds for COVID-19 patients who will be paid for under a public scheme.  

  • The Supreme Court has, suo motu, called for a national plan to deliver oxygen and vaccines.

    • Though Supreme Court’s call for a national supply plan has been publicly criticised in the political sphere.

Issues in Current Health System / Need of National Health Service:

  • India’s fragmented, often corrupt, urban-centred, elite-focused and wretchedly underfunded health infrastructure centres can look like no more than an accidental collection of institutions, staff, and services.

  • GDP on Health: India’s public spending on health is set to double in the 2021-22 financial year, but that is from a figure that has long been only a little over 1% of GDP.

  • Doctor-population ratio: In certain rural areas, the doctor-population ratio is over 1:40,000.

  • Huge Population: India’s healthcare providers, however, have the task of serving 1.4 billion people.

  • Medical expenses: It constitute the major reason for personal debt in India.

  • Episodic afflictions: Whether the causes are episodic afflictions or by environmental conditions which none can escape, such as air pollution.

    • Lancet Report says this accounted for 1.7 million deaths in India in 2019.

    • The annual business cost of air pollution is currently estimated at $95 billion, which is about 3% of India's GDP).

Merits of NHS:

  • Joseph Bhore Proposal: In 1946, the Civil Servant Sir Joseph Bhore submitted to the then government a detailed proposal for a national health service broadly modelled on the British National Health Service.

  • He went further by recommending that preventive and curative medicine be integrated at all levels.

  • Need in Britain: The fact of the Second World War, in the darkest hours of which a plan was prepared to transform Britain into a post-war social democracy with a comprehensive welfare state and a universal free public health service, may therefore have been catalytic rather than decisive in the creation of the NHS.

  • Mighty achievement: The result is a mighty achievement in public policy, politics, and the provision of top-class universal healthcare, including training, research, and changing engagement with the public as society changes.

  • Funding: The service is funded entirely from general taxation. The budget includes payment to general practitioners, most of whom remain private providers but are paid by the state for treating NHS patients.

  • No Charge: Items listed in general practitioners’ prescriptions incur no or neglibile charges in Britain.

  • Free Treatment: All hospital treatment and medicines are free, as are outpatient and follow-up appointments.

  • Cost Burden: The British public share the costs through their taxes, and almost without exception receive treatment solely according to their clinical needs.

  • Employment: With about 1.1 million staff, the NHS is the largest employer in the U.K.

  • GDP Share: Its current budget is about 7.6% of GDP, but despite its size and scale, it provides highly localised access to care.

Problems in the NHS

  • Among them are largely unintended inequalities in the time and attention given to patients of different social classes

  • Huge and frequent reorganisations imposed by Central government

  • Often ideologically driven underfunding.

Suggestions and Way Forward:

Burning Issue] India's Ailing Health Sector and Coronavirus – Civilsdaily

  • Unreserved support: Many senior hospital consultants who were opposed to a public health service when the NHS started have declared unreserved support for it in national conference resolution.

  • Most loved institution: An authority on the NHS has said that it is the most loved and trusted institution in the country and is held in even higher regard than the monarchy.

  • Serious health crisis: India now faces a very serious health crisis, possibly the worst since Independence.

  • The precise structure envisaged by Joseph Bhore may need some adaptation for today’s society and conditions.

  • But dealing effectively with the pandemic may itself require the urgent creation of an Indian National Health Service.

SOURCE: The Hindu

The SC ruling on identifying backward classes


  • Supreme Court held by 3:2 Majority, States Have No Power To 'Identify' Socially & Educationally Backward Classes after 102nd Constitution Amendment.

Maratha reservation Case:

Supreme Court sets aside law on Maratha reservation | Hindustan Times

  • In the judgment that declared the Maratha reservation unconstitutional, a Constitution Bench of the Supreme Court dealt with another issue.

  • By a 3:2 majority, it ruled that after the passage of the 102nd Constitution Amendment Act in 2018, the States do not have any power to identify ‘socially and educationally backward’ (SEBC) classes.

  • Union government: It argued that it was never its intention to deprive State governments of their power to identify SEBCs.

  • But the Court interpreted the bare text of the Amendment to the effect that only the President can publish a list of backward classes in relation to each State and that only Parliament can make inclusions or exclusions in it.

What does the 102nd Amendment say?

  • Constitutionalisation of NCBC: The Amendment established a National Commission for Backward Classes by adding Article 338B to the Constitution.

  • Function of NCBCs: The five-member Commission was tasked with:

    • Monitoring safeguards provided for socially and educationally backward classes,

    • Giving advice on their socio-economic development,

    • Inquiring into complaints and making recommendations.

  • Consultation with NCBCs: Significantly, it was laid down that the Centre and the States shall consult the Commission on all policy matters concerning the SEBCs.

  • President’s power to Notify SEBCs: The Amendment also added Article 342A, under which the President shall notify a list of SEBCs.

    • In relation to each State and Union Territory

    • In consultation with Governors of the respective States.

  • Parliament Power to amend: Once this ‘Central List’ is notified, only Parliament could make inclusions or exclusions in the list by law.

  • Definition of SEBC: A definition of ‘SEBCs’ was added to the Constitution — ‘SEBC’ means “such backward classes as are so deemed under Article 342A for the purposes of this Constitution”.

Why did this Amendment come up for judicial interpretation?

  • The reservation for the Maratha community was challenged in the Bombay High Court on various grounds.

  • One of the grounds was that the Act creating the Maratha quota through a new category called ‘SEBC’ was unconstitutional.

    • Because after the introduction of the 102nd Amendment,

    • The State legislature had no power to identify any new backward class.

  • Separately, a writ petition was also filed in the Supreme Court questioning the validity of the Amendment as it violated the federal structure and deprived the States of their powers.

    • In this context, the court had to examine the validity of the Amendment.

What were the rival contentions?

  • Role in identifying SEBC: The crux of the issue was whether the State government’s role in identifying backward classes had been denuded by the Amendment.

  • Parliament’s intent: The Union government said Parliament’s intent was only to create a Central List that would be applied only in the Central government and its institutions.

  • State Lists: It had nothing to do with the State Lists of backward classes or the State governments’ powers to declare a community backward.

  • Central Government: Those who questioned it contended that the effect of the Amendment was that only the President, or the Union government.

    • It was authorised to make a list in relation to each State, and thereafter, any change in it would be made only by Parliament.

How did the Supreme Court reach these conclusions?

  • Literal interpretation: Judges adopted a literal interpretation of the 102nd Amendment, holding that there was no ambiguity in its drafting that warranted a “purposive interpretation”.

  • Judges cited three main reasons.

  • One, the text was clear that the President alone could notify the list, and subsequent changes could be made only by Parliament by law.

  • Two, the text was identical to the provisions governing the NCSCs and NCSTs and the procedure to identify SCs was exactly the same.

    • It led to the conclusion that Parliament intended to “replicate” the same process for backward classes, too.

  • Third, a definition clause was added to the effect that only a class found in the list notified by the President under Article 342A was an SEBC.

  • Further, the definition was for “the purposes of the Constitution”, which meant that it was to apply to the Constitution as a whole, including Article 15(4) and Article 16(4),

    • Which enable special provisions for backward classes

    • Including reservation in public services, and are also implemented by the States.

  • Rajya Sabha Select Committee: The Supreme Court’s judgment also drew on deliberations before a Rajya Sabha Select Committee.

    • Which showed that the Centre had rejected suggestions from members who demanded that a specific clause be added.

    • Saying that States would continue to have the power to identify SEBCs.

  • SC accepted the Union government’s position that it was never its intention to deprive the States of their powers.

  • They held that the ‘Central List’ was only for use by the Centre in reservations for jobs and institutions under the Union government, and will not apply to States.

What next?

  • The Supreme Court has directed the Centre to notify the list of SEBCs for each State and Union territory, and until it is done, the present State Lists may continue to be in use.

  • The Centre may either comply with this or seek to further amend the Constitution to clarify the position that the 102nd Amendment was not intended to denude the States of their power to identify SEBCs.

SOURCE: The Hindu