Unhealthy move to the concurrent list

Unhealthy move to the concurrent list

Help states discharge their duty, instead.

The suggestion by a high-level group of the Fifteenth Finance Commission to make health a fundamental right and to move it to the concurrent list is ill-advised. It is neither necessary nor sufficient to guarantee the provision of accessible, affordable and adequate healthcare for all. Besides, right to health is, arguably, already provided for via the Constitution’s Article 21 that guarantees protection of life and liberty. Shifting ever more subjects from the states to the Centre would erode India’s federal nature and impair efficiency by abandoning the principle of subsidiarity, which holds that any task should be left to the level of government best placed to do it.

The Centre must, instead, trust cooperative federalism. It must direct its energies to designing policy that would help states deliver on their constitutional mandate to provide adequate, accessible and affordable healthcare for all. Access to central/external funds conditional on achieving health outcomes could serve as an incentive, complemented by other policy instruments. Health being a state subject does not preclude the Centre offering constructive support, as with agriculture or maintaining law and order. The NITI Aayog’s Health Index, financial assistance through the insurance-based programme Ayushman Bharat, improved regulatory environment for healthcare providers and medical education are examples of such support that can nudge states in the right direction. The Centre has onerous responsibilities of its own, for which it struggles to find resources. Taking more on to its plate would help neither the states nor the Centre discharge their constitutional obligations.

Clean drinking water, improved sanitation, protection wetlands and freshwater sources, enforcement of environmental norms for clean air and water — the Centre already does a fair bit for better health. The Centre devolves 42% of the taxes it collects to the states. The point is to encourage the states to do what they are supposed to do, while the Centre optimises use of its own resources, focusing on its obligations.