A Referendum on Hope

If the next two days are anything like the last three, our country will have registered over 1 million new cases of Covid-19 in just five days. With a case fatality ratio of 1.2%, over 12,000 of these newly infected will die. It beggars belief that as with all these statistics, the real numbers are almost certainly larger.

Concomitantly, chilling stories of hospitals finding themselves overwhelmed with patients requiring admission abound. Social media is teeming with posts that ask for information about hospitals still able to admit patients requiring critical care and medication. Crematoriums in various parts of the country are now being operated round the clock, and some of their chimneys are melting. Widespread oxygen shortages are being reported. Against this miserable backdrop scored by the sirens of ambulances, the Maha Kumbh Mela in Haridwar proceeds as originally planned, with thousands of people congregating with no regard for physical distancing measures. Over 2,000 attendees have, in the last five days, tested positive for Covid-19. It has been decided, nevertheless, that the festival will continue until the end of the month since, in the words of Uttarakhand Chief Minister Tirath Singh Rawat, "faith in God will overcome the fear of the virus".

It is in this context that we wish to address an irritatingly pernicious attitude: that there is "no alternative" to the status quo, that the BJP was (in both 2014 and 2019) the only viable political party to back, and that the ferocity of the pandemic implies with mathematical certainty that cases would rise by so much and that so many people would die. This resignation has a hegemonic presence in the public imagination, and it must be unseated if we are to have any hope of even imagining a better future.

While the lion's share of the blame for the botched management of the present crisis no doubt goes to the central government, it is important to recognise a more systemic failure: the Indian healthcare system is shockingly deficient. Over the last decade, India has consistently spent only between 1.2-1.6% of its GDP on public health. There are widely acknowledged gaps in healthcare delivery and infrastructure, ranging from the aforementioned paucity of public funding, to the decades-long push towards privatisation and the retreat of the state from this critical sector of the economy, to simply not enough medical personnel, equipment, and beds; Anjali Chikersal writes in The Wire:

"There is only one government doctor for more than 11,500 people in India as opposed to one for every 1,000 as recommended by the WHO; only one government bed for about 2,000 people, medicines are in constant short supply, the private health sector is completely unaffordable, and whatever services are available are significantly skewed towards the benefit of the rich and the urban."

Most of all, it is significant that this state of affairs has for decades remained the result of a determination, renewed roughly every year, to keep things the way they are.

The most common iteration of the question of viable alternatives is to ask which political party to vote for in an upcoming election. However, there is another, more long-term view of the same question that is more profitable. Its formulation sees the question of alternatives not as beginning and ending in the present, but stemming from the past and growing into the future. It looks back at the history of independent India and asks: how did we get here?

With this more holistic view, it is easily seen that there have always been viable alternatives. At every step of the way, we could have made better choices. We could have chosen to invest more in public healthcare infrastructure. We could have resisted more vigorously the retreat of the state from the arena of public healthcare and fought back against its encroachment by private capital, the result of which has been poorer healthcare coverage largely restricted to urban areas and higher out-of-pocket costs. These preventive, socialist measures would have shored up our defenses against the Covid-19 pandemic. To pose the question of alternatives as solely a matter for the present, all the while ignoring the warning signs from the past, is myopic. It is significant that viable alternative courses of development were passed over.

Countless academics and policy experts have repeatedly highlighted the inadequacy of our public healthcare infrastructure, many doing so decades before the pandemic. It is significant that there were people around who advised the government against the course of action it took. They were ignored. As a result, we are today witnessing a hollowed-out, understaffed, and underfunded public healthcare system come apart at the seams. The contraction of public funding directed towards healthcare was a consequence of the Indian state's adoption of the neoliberal consensus, which in turn paved the way for privately managed healthcare --- inaccessible and unaffordable to most --- to take its place.

Indeed, countries with a more robust healthcare infrastructure and socialised medicine have objectively fared far better than countries with privately managed healthcare such as India and the USA. Their response has been more timely, their engagement with the crisis has been more comprehensive, scientific, and humane, and they have displayed a commendable internationalism. We have seen this in the striking examples of China, Vietnam, and Cuba.

It may be argued that the warning signs were ignored by political parties, and not the ordinary citizen. If we accept this as true --- that political parties did not act on the demands of their constituents, or worse, that they didn't think to improve public healthcare themselves --- we must necessarily conclude that our democracy hasn't been functional for some time now. We must conclude that it is lacking in the vitality needed to adequately respond to the present, and future crises. It is crucial we appreciate that this is a statement about our trajectory, and not merely our present state.

This pandemic, through which the Indian state is sleepwalking, is a referendum, not just on the question of the present administration's handling of the crisis, but on the economic principles that direct public policy. It is a crisis of neoliberal capitalism, and a referendum on hope. As Vijay Prashad wrote, "The virus has not destroyed society. Rather, a destroyed society has been confronted by a cruel virus." It bears repeating: a million new cases in just five days. Our only consolation in these trying times is that just as viable alternative futures existed in the past, they are not yet foreclosed upon, and we may awaken from this stupor, and push our country towards these more equitable, sustainable, and egalitarian futures.

Madhusudhan Raman is a theoretical physicist at the Tata Institute of Fundamental Research. The views expressed here are the author's own.

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