Purposeful negotiation
The author, building upon his contribution towards formulating health insurance scheme, managed to convince the PM on ‘insurance model’ of RSBY in national interest
Imet Narendra Modi for the first time around 20 years ago on June 7, 2002. He was then grappling with the post-godhra crisis as the Chief Minister of Gujarat. As Chairman, Agriculture and Processed Food Exports Development Authority (APEDA) in the Ministry of Commerce, Government of India, I was engaged in promoting the setting up of Agriexport Zones (AEZ). The idea was to take a comprehensive look at all the issues in the entire value chain of an agricultural product so as to promote exports of such selected products. We were looking at the value chain relating to Kesar Mango from Gujarat as it had enormous potential for exports though there were issues relating to grading, sorting, storage, packaging and transportation. The objective was to build protocols. All this was part of the MOU that was proposed to be signed with the state government where the respective roles of the Central and state agencies were defined.
The MOU was signed in the presence of Narendra Modi. There was hardly any conversation. He appeared pre-occupied. Interestingly, the video recording of this ceremony was used in the publicity material during the 2014 elections. NDA swept to power and Narendra Modi became the Prime Minister of the country. Many of my friends thought that I was close to Modi. I was not.
I superannuated in June, 2018. The last meeting with Narendra Modi happened a few months before this. The Prime Minister’s office called. The Principal Secretary to the PM wanted to talk. I was posted as Secretary, School Education and Literacy. However, the conversation we had did not relate to education.
“Anil, can you brief the Prime Minister on Health Insurance?” was his question. I could not fathom the context. Yes, I was involved in visualising, conceptualising, articulating, implementing, and evaluating arguably the largest health insurance scheme globally, Rashtriya Swasthya Bima Yojana (RSBY). This scheme had come to be recognised by the International Labour Organisation (ILO) and World Bank as one of the finest. But the scheme had fallen from grace as it was considered a scheme of the ‘previous’ government. Moreover, a Group of Secretaries, none of whom had any clue about the nuances of health insurance, had condemned the scheme that was subsequently starved for funds.
“Sir, but what have I to do with Health Insurance?” I asked, thoroughly puzzled.
“No, the Prime Minister is keen on providing health insurance (assurance as it was called) to the citizens of the country, and the Health Ministry has been trying to evolve a scheme. However, there hasn’t been a consensus”, he concluded.
The Group of Secretaries that had condemned and dumped RSBY had not suggested any alternative. They had soon discovered that it was easy to ‘destruct’ but challenging to ‘construct’. The officers
in the Health Ministry were struggling to develop a scheme to the PM’S liking and satisfaction even after three years of his announcement to provide health assurance to the masses.
“But sir, what is my locus standi to provide my inputs and suggestions to the PM on health insurance?” I countered.
The Principal Secretary had a ready answer, “There is a meeting scheduled for the review of certain proposals of the Health Ministry. We will line up a review of the Education Ministry as well. Hence, you will be present when the discussion on health insurance takes place. If the PM asks you about your views on the health insurance scheme, you can give your inputs.”
Some of the officers of the Health Ministry and NITI Aayog (National Institution for Transforming India) had taken inputs from me in the recent past while formulating the ‘new’ health insurance scheme that was primarily structured on the lines of RSBY. A very competent team in NITI Aayog, headed by one of its members, VK Paul, and comprising officers like Alok Kumar, who was wellversed in the nuances of health insurance, was working on it. The earlier attempts had failed, but this team had developed a new proposal to convince the PM about the scheme. I saw this as an opportunity to revive RSBY that had earned encomiums from World Bank and other international organisations but was discarded unceremoniously thereafter. The scheme had benefited hundreds of thousands of poor people. There were indeed some issues with the scheme, but then no scheme was perfect. So, I agreed to attend.
The meeting started late in the afternoon at 7, Race Course Road, the residence of the PM. Apart from a couple of ministers, there were a few officers as well. The Health Secretary made a presentation on the proposed health insurance scheme. Everyone was apprehensive about the PM’S response. I had been informed that he was unhappy on a few occasions when the scheme was presented to him. He disapproved of the Insurance model as he felt that the insurance companies would not take care of the interest of the poor and corner all the profits.
On this occasion, too, he did not appear to be very impressed. However, he turned towards me and remarked, “Anil, you have handled Health Insurance in the past; what is your comment?” I spoke for around 15 minutes, outlining the need for health insurance and the strengths of the proposed scheme. The PM listened very patiently. He appeared quite convinced with the rationale provided by me. He did ask a couple of questions (his yearning for details was amazing). Then a decision was taken in principle to go ahead with the scheme. He somehow came around to accept the insurance model of the scheme.
While coming out of the meeting a Joint Secretary at the PMO who was present at the meeting asked me, “Sir, how were you so blunt with the PM? Despite being aware that the PM didn’t like the insurance model, you still went ahead and spoke in defence of such a model”. My answer was simple, “I don’t expect anything from the PM, neither now nor after retirement. Hence, I conveyed to him what I thought was in the interest of the country. It didn’t really matter to me whether he liked it or not.”
This was my last interaction with Narendra Modi.
With excerpts from the writer’s recently released book, No More a Civil Servant.
Views expressed are personal
The PM initially disapproved the insurance model as he felt that insurance companies would not take care of the interests of the poor and corner all the profits instead