Who wants to become a doctor?
Evidently, not too many people, as this ToI report notes.

It takes ten years of sustained, punishing, high-risk training of the finest minds to make a trained specialist (obstetrician, surgeon, pathologist); fourteen if you want a 'super' specialist (cardiologist, brain surgeon). The results these days, despite the risk, can be quite impressive.
The only known 'de-risker' we know? The calibre and training of the mind-hand holding the scalpel.

About 15 years ago, Maharashtra created a new 'super-risk': a line of mantris and babus of the command-and-control dispensation, for whom doctors were slave labour.
Clever policies and incentives ensued: mandatory rural postings, endless exams, shifting universities, disappearance of teaching seats, and, of course, increasing reservations.

The finest minds have voted with their feet. Should we be surprised?

Slumdog and Slumbai

It had to happen again.

Some white guys threw a bone in the direction of something indian (i am referring to slumdog millionaire, the movie), and people went into raptures about how the west is 'waking up to india'.

Most people i spoke to called slumdog millionaire a "triumph of the spirit over hardship" or "the never say die mumbai spirit" or something similar and seemingly inspirational.

Friends and colleagues gushed about how the fellow in the movie rose despite the deprivations of the slums and having to dive into human faeces to win some international dole-fest.

Cliches and prejudices aside (brilliantly articulated here), they are to be expected, it is the misplaced joy of the average mumbaikar that is disturbing: not one person found the presence and the continued growth of slums troubling anymore.

Not one person.

The slum -- and the urban planning failure it represents -- is the pink elephant in the room nobody wants to talk about. Just like the pink elephant of islamic terrorism.

It is now part of us, never to be sought to be removed, merely to be accepted and taken in our stride.

However, this pattern of ignore and move on has been going on. For 60 years, year after year (or election after election) we the people of mumbai have consistently voted NOT to fix things, preferring the soporific of rice at 2 kgs (for the masses) or the "wonderful mumbai spirit" (for the chattering classes) to real, painstaking change.

Mumbai is now a city without a collective objective and a collective aspiration.
A city without a future.

Over at Shadow Warrior, Rajeev points out how this is also visible among hindus at the national level. Everyone has a plan for our decimation. We don't even know that we're being hunted.

Weekend musings: what Chanakya knew

A recent McKinsey report, based upon a study of schools all over the world made a very insightful finding:

The quality of an Educational System cannot exceed the quality of its Teachers

The report notes how students with similar intrinsics follow dramatically different life trajectories based upon the quality of teaching afforded.

Acharya Chanakya knew this over 3000 years ago. He noted the importance of teachers in individual development and, by direct translation, Nation building.
His beliefs were excellently paraphrased in the excellent TV serial from ~1990, which i only remember vaguely:

Shikshak koi saadharan vyakti nahi ho sakta, Dhana Nanda.
Prakruti uski god me khelti hai... main tumhaare raashtra ka pyaasa nahin.
Chaahe to main apna samraat swayam nirmaan karoonga.

Contextualised translation: A teacher is no ordinary man, Dhana nanda; he nurtures nature in his lap. I do not come to you with aspirations for personal power [but for the task of securing Bharat's borders]. If i choose, I can create my own Emperor [who can do the task of defending Bharat].
And he did.

But education in India today lies in ruins, its Chanakyas ideologically cleansed.
As a result, India's education system cannot create the next Chandragupta -- the Emperor who reunited a fragmenting Bharat.
Perhaps that is why we have to outsource the running of the nation to Italian waitresses.

Postscript: Visit YouTube for some truly evocative and inspiring clips from the same TV serial. Replace Magadha, Takshashila with modern names: Arunachal, Sikkim, Kashmir and the message is totally consistent.
We have forgotten our own history, and we're putting ourselves at significant risk of it repeating itself.
Post-Postscript: If any reader has the link to that sequence on YouTube or elsewhere, can you please let me know?

Becoming literate more expensive than becoming a doctor?

India's Education tragedy continues.

Families in India have to spend a considerable amount on the primary school education of their children, making the fundamental right to basic education a distant dream, according to a recent UNESCO report. In contrast, university education remains subsidised and costs just half of the primary school spending.

Take a deep breath, and read that again: going to School is twice as expensive as going to University. This when a University education can pay for itself (by making you qualified for more skileld jobs)and hence be rendered as a fee-for-service.

And Arjun Singh wants to continue meddling with the IITs and the IIMs.
Of course, we all know why -- seats at these schools are a powerful tool for political patronage.

In contrast, making functional primary education requires real work -- as you need to create millions of them to educate the hundreds of millions of Indian Children.

When the Government, despite focusing on Uiversities like a hawk, has still failed to create enough capacity, can it, by any stretch of imagination, ever provide enough Primary Education?

Education in India is the largest remaining bastion of the License Raj, propped up by rabidly discriminatory laws like Article 30 and surrounded by an impressive ring of lies, half truths and emotionally wrenching but factually empty statements (Private education will be too expensive. Education is too important to be given to the rapacious private sector. Private companies will fleece the poor etc. etc.).

This bastion must fall, for India to get anywhere. Otherwise, no amount of hand-wringing, staring at the demographic bulge, exhorting Indian businesses and companies or calling for innovation is going to help.

I despair.

Prime Minister's Independence Day Address -- Part 3

Economic Development [Continued from previous post]

This Government believes that the role of Government in economic activity is not that of a principal industry player or provider, because Government has neither the expertise, nor the capacity to run each and every sector.
Instead, the Government's role in this area should principally be safeguarding the interest of the single largest community -- consumers.

Hence, my Government, over the next 5 years, and in particular, over the next 100 days will begin the process of relinquishing Government control and management of several such companies while establishing strong regulatory mechanisms -- such as self-funded independent regulators.

Depending upon the scale of the Government-owned enterprise in question, small assets (those below 1 billion dollars in value) will be put under public ownership on our capital markets directly.

The divestment of larger companies will be overseen by Special Purpose Vehicles (SPVs) that will oversee the gradual transfer of management and assets to professional management. Some of these companies include National airlines, state-owned metal and mining companies and entities like the Food Corporation of India.
In line with our overall economic thinking, we believe that while the services of these companies are important (e.g. FCI provides basic rations to our poorest citizens), Government can not and should not be running them as monopolies. Hence, some of these companies, will not be sold en bloc but as de-merged agencies that will have to compete for resources (e.g. such as food vouchers).

Finally, even as the Government reduces its role in running enterprises, some enterprises operate in sectors of vital strategic importance. These include companies in sectors associated with natural resources (water, minerals) and energy (e.g. oil and gas) and with some critical national installations (e.g. Ports).

We believe that like in other sectors, daily management of these companies should not be a concern of the Government, but, given their strategic importance, Government should continue to own them in significant measure.

To ensure strong strategic management of these companies, ownership of these companies will be divested from their parent ministries and transferred to a holding company that is responsible for the management of these entities. We believe this separation of company ownership from the regulating ministry is essential to establish an 'arms length' relationship. This is to ensure that no player gets privileged access, ensuring a level playing field.

These holding companies will be placed under the direct management of Bharat Uday -- a Sovereign Strategic fund that will own these government assets. Bharat Uday will be staffed with the best and brightest Indians who will be tasked with professionalising the management of these companies to ensure that they compete with the best companies in the nation while earning the Government top-quartile returns. Returns from companies owned by Bharat Uday will be utilised to further strategic interests by investing in vital assets worldwide -- such as oil and gas reserves.
To ensure Bharat Uday meets its strategic objectives, it will be accountable directly to the Prime Minister and the Cabinet. We believe such a construct will add an altogether new dimension to India's National Interest -- that of Strategic Security earned by Economic power, in addition to military power.


Social Reforms

Finally, my Government will extend its philosophy of establishing clear roles for Government (regulator, provider or financier) to the Social Sector.
We believe that in the Social sector, the role of Government is exclusively as a regulator that establishes a fair and level playing field for all citizens -- irrespective of their differences.
To that end, my Government will focus on reforming or, in some cases, altogether eliminating rules and laws that create distortions, driving wedges between peoples.

It is my belief that initiatives designed to address perceived deficiencies or weaknesses of communities or sectors of society by providing selective benefits against these perceived deficiencies have only succeeded in highlighting these deficiencies, driving a wedge among communities.

For instance, laws such as Article 30 -- expressly discriminate against Hindus by disallowing Hindu organisations from running Schools and Colleges, simply because they are a majority.
This has effectively made Hindus a disadvantaged community, dependent upon Schools operated by other communities for their education. In addition to being discriminatory, such policies artificially reduce the number of schools in our nation.

However, merely removing discrimination is not enough: government must also actively enforce fairness and justice.
Hence, even as social services are given additional freedom, they will now be expected to conform to regulation. Just as our companies must meet norms of probity and accountability, so must our social sector. To that end, a social sector regulator will be established to ensure that all Social organisations -- NGOs, Religious institutions of all denominations and not-for-profit institutions will be required to declare their accounts and activities to the public, in a prescribed format.
This is particularly important, given alarming evidence of the involvement of several NGOs and religious institutions in activities detrimental to India's -- and her citizens' -- welfare and security.

These are our priorities for the next five years: security, education, healthcare, economic development and social sector reform.

In conclusion, India embarks on another illustrious year in her dramatic 6,000 year history. All the Indians I have spoken to in the past few months have been clear that they want this year to be different. A year when we shall promise to our children -- and their children -- an India of unparalleled security, prosperity and opportunity.
Making that difference -- and delivering on that promise -- is a massive challenge. It is now upto us all to deliver.

Jai Hind.

[Concluded]

Prime Minister's Independence Day Address -- Part 2

Education

Reforms in Education constitute the third focus for my Government.

Analysis of Government spending in education reveals a startling fact: expenditure on higher education (medical, technical, engineering and managerial development) is orders of magnitude higher than on primary education.

This is an unsustainable and unacceptable distortion. Insufficient investment in primary education implies that a significant fraction of Indians are not provided the opportunity to earn even a high-school certificate.
Overspending on higher education -- while neglecting primary education -- is perhaps the single-largest mistake we have made in perpetuating discrimination within India.

Insufficient investment in Primary Education (and, I may add, Primary Health) also means non-competitive and anti-merit steps such as quotas and reservations need to be taken to provide symptomatic relief for this underlying flaw.

Finally, international evidence has demonstrated that government subsidisation and control over higher education is largely unnecessary. This is because higher education is usually self funding since degrees typically translate directly into employment opportunities. This has also been proven in India, where private colleges, despite working in a highly restrictive environment, have created tremendous value. They have conferred degrees on lakhs of engineers, doctors and professionals who are now in a position to compete for -- and win -- global opportunities.

Against this background, my Government's Education reform agenda has two simple objectives: universal Primary Education, and a liberalised, competitive higher education sector.

We plan to treble investment in Primary Education -- buttressed by "Education vouchers" similar to healthcare vouchers -- to ensure universal primary education becomes a reality.
Even as investments in Primary Education are increased, the mode of delivery will also be revamped. Special Purpose Vehicles (SPVs) managed by educational professionals will be formed, under strict performance-payment contracts to ensure that Education is actually being delivered.

In conjunction, the Government will begin the slow divestment of higher educational facilities. Key institutions like the IITs, IIMs, Medical Schools and other higher educational institutes will be transferred to autonomous Trusts, with complete authority -- and responsibility -- for maintaining standards and remaining fiscally viable.
Liberalising the rules to allow private institutions, along with fiscal reforms to facilitate funding of higher education will ensure fee levels remain competitive -- and educational supplies flex to match changes in market demands for talent and skills.

To ensure that quality is maintained in a multi-provider environment, robust regulation is also required. A Primary Education regulator shall be formed to monitor the performance of the SPVs referred to earlier. Existing higher educational regulators (e.g. the UGC) will be vested with higher executive authorities to effectively regulate (as distinct from control) a more diverse higher education provider base.

We believe that, for a nation with a unique dempgraphic like india, a "students' market" that provides skills ased upon job seekers' needs -- rather than an "educators' market" which provides skills based upon suppliers' ability to provide -- is preferred.

Economic Performance
The robust economic growth shown by Indian enterprises since Prime Minister Narasimha Rao initiated liberalisation in 1991 is one of the major success stories of post-independence India.
This growth has weathered several storms -- recessions, boom-bust cycles and global crises. Even as Indian companies have made record profits, acquired global companies and expanded, domestic consumption of virtually all goods (commodities, services, retail) has increased strongly across all sectors -- demonstrating that Indian enterprise is second to none in value creation.

Given this stellar track record in value creation, my government believes that this responsibility should be left to the Indian private sector. The role of the government here should be restricted to regulating the system and preventing distortions.

This will free up government resources and expertise to focus on creating value in areas where the private sector is unable or not suited to value creation -- such as law and order, healthcare and education.

[to be continued]

Prime Minister's Independence Day Address -- an agenda for reform Part 1

PRESS RELEASE
15 August 20xx


In a significant break from tradition, the Prime Minister delivered the Independence day Address to the Nation while standing outside Parliament, in contrast to the usual heavily barricaded Ref Fort ramparts.

Excerpts from his speech:

"My dear countrymen. This day marks the xxth anniversary of India's political independence from over 300 years of Imperial occupation.
Every Independence day is a time for reflection -- of past successes and failures and of future opportunities.
Too many independence days have been spent thinking of the past, and of missed opportunities.
I believe, starting this Independence Day, India and Indians should spend more time thinking about their future.
Keeping that in mind, I spent a significant period of my first 30 days in office meeting over a thousand Indians, from all walks of life, from all parts of India.

Despite their incredible diversity, what struck me was how similar their aspirations for India were: Virtually all aspired to see, in their lifetimes, an India that is safe, powerful, prosperous and dynamic; an India that guarantees the safety and security of all her peoples.

As your Prime Minister, that message is especially pertinent : my people are demanding actions from me and my Government that take concrete steps in setting India in this direction.
And we are required to deliver -- in five years.

On the occasion of this 15th August -- my government's first 15th August -- i will unveil our "first 100 day plan". Reflecting the urgency of expectations, this plan is time-bound -- a response to a clearly articulated expectation of tomorrow's India.

This 100-Day Plan is clearly focused on fundamental reforms and improvements in five core sectors that underlie people's aspirations for a safe, dynamic and wealthy and caring India.
These sectors are: Law and Order (internal and external), Healthcare, Education, Economic performance and Social reforms.

Even as we have focused on these five core sectors, my Cabinet colleagues have debated extensively what the role of Government in each of these areas should be. We believe that in any sector, the Government can play three separate roles: the role of a regulator (that sets and enforces laws), of a provider (an entity that renders a service) or of financer (pays for the service in question, but does not necessarily provide the service itself).

My government has established a clear point of view on the Government's role in each of these sectors.
The objective of the "100 day plan" is to set in motion fundamental reforms in each of these sectors. I shall outline my vision for reform in each of these sectors one by one, beginning with probably the most important: Law and Order.

Law and Order
Ensuring the security of peoples is the first and fundamental role of any Government. Unfortunately, over the past decades, this area has been systematically ignored.
This is an oversight that must be corrected; for, unlike in the other sectors, the role of the Government here is that of regulator financier and provider -- all in one. Failure in this sector is thus entirely ascribable to a Government failure.

Our first priority then in Law and Order will be to raise the funding of elements of our internal and external law and order mechanisms. Resources are needed to raise the service levels of our Courts (that have over 22 million cases pending), our understaffed Police services and our Armed Forces -- to minimise this risk of failure.

In addition to augmenting resources, structural reforms are also necessary to ensure that Lew and Order are always upheld. My government is working to create a reform blueprint to completely insulate Law Enforcement from political influence. This is necessary to ensure that the fundamental right of all citizens to a safe living environment is never held hostage to political and vested interests. It is my belief that with the implementation of these reforms, every perpetrator -- irrespective of class, religion, creed or nationality, will be brought to justice effectively and quickly. A crime punished is ten crimes averted.


Healthcare
Ensuring the mental and physical health of all 1.2 Billion Indians is the bedrock of a strong society.
Healthcare is a top priority for this government since in the next 5 years, this country will have over 300 million children below 15 and over 200 million people over 65 -- both of whom have significant healthcare needs.

The first reform my Government plans to make is to shift the burden of payment for healthcare from the user to the provider.
In our present healthcare system, the government funds hospitals and providers -- irrespective of the quality of care they provide or whether they provide care at all. In this system, citizens end up paying healthcare expenses from their own pockets -- a system that, in nation after nation, has proved to be inequitable and inefficient.
In contrast, the healthcare payment system being devised by my government will provide citizens with cash equivalents that they can redeem in exchange of healthcare services. Hospitals and doctors will be paid on the basis of healthcare cash equivalents they accumulate.
This will significantly increase the efficiency of the system by ensuring that costs are incurred only for services rendered, while also providing users -- especially the poor -- with a real choice in healthcare. A special ring-fenced fund will be established for administering this service to the poor.

The second major reform in health care is around quality management: its important for the Government to ensure that only those health facilities that meet stringent quality, service, hygiene and competence criteria are allowed to operate.
To that end, strong professionally run regulator institutions will be established in the next 5 years to monitor healthcare education, hospitals and patient safety.

[to be continued]

How Sarkari "enterprises" destroy value

Air India has bought 2 Boeing 777s that can fly direct to New York.
But the inaugural flight has gone empty.

Even as Union Civil Aviation Minister Praful Patel flagged off Air India’s inaugural non-stop flight to New York amid much fanfare early on Wednesday, the flag carrier’s top brass mulled over the near-empty Boeing 777-200LR that pushed back from Mumbai’s Chhatrapati Shivaji International Airport at 12:45 am.
For onboard the “historic” flight were a meagre 80-odd passengers—including a dozen freeloaders [emphasis added] —as against the 238 seats available. Or a paltry 33 per cent load. What’s worse: things don’t appear much better for the first fortnight either.

In an era of free(er) skies, will anyone really fly Air India? I had the misfortune of flying them once and was appalled, really appalled at the planes and the (total lack of) service.

Despite this,

Air India had opened bookings with fares over 30 per cent higher than the industry average on the sector, which were later brought at par, because of slow bookings.

So, not only does the airline offer pathetic services, it also charges more than its competitors! That's rich!!

Inquiring taxpayers (like myself) want to know where the money goes, and why the all-knowing Government of India continues to squander my taxes on funding this -- and other -- white elephants.

Medical Education in Maharashtra – 2

A path to resolution.

Now that the stewards of state (of “commanding heights” fame) have completely botched things, how do we reform? Where do we begin? What do we do?

To answer that question, it may be useful to remember the Cheshire Cat from Alice in Wonderland, “[what you need to do] depends a good deal on where you want to go.”

To understand what we need to do, we need to have a suitable vision of where we want to go. We may, for instance, want to “Establish a system to produce world-class physicians and health care leaders to meet Maharashtra’s and India’s demand for talent, while creating economic value via high-quality patient care, research and accelerated job creation.”

Translated into plain English, this means more and better hospitals -- say three times as many, with vastly improved teaching skills and capabilities that directly meet India’s healthcare needs.

It is tempting – but wrong – to conclude that all it will take is more money. If that were the case, the thousands of crores of taxpayer money the government has spent in shoring up Air India and Indian Airlines again and again would not have been as completely wasted as they have been.

No – it’s not more money that is required. What is required is an entirely new system for channelling cash, most of it from private pockets, to create an all new educational system.

There are three big changes the government must drive to make this happen:

1.Create competition in the delivery of medical education by liberalising norms governing setting up of medical institutions

The only way we can have more medical schools is, well, by allowing more people to start medical schools.

Transparent, simple yet stringent norms should be established – and anyone meeting those norms should be allowed to start a medical school. The norms could well cover requirements such as financial stability, experience in running medical schools – perhaps even globally. This is a good way of getting schools like Harvard and Hopkins interested. Incidentally, Singapore adopted a similar strategy to attract Insead Business School and Duke Medical School to Singapore.

Going beyond the school itself, medical institutions should be allowed to select the university with which they choose to be affiliated. Ergo Medicine programs should be repatriated to their parent universities, completely reversing the current trend for sameness. Creating competition – where universities strive to be affiliated to the best schools – is a far more powerful means of creating quality than by obsessing over standardising curricula across the state.

2. Create payment security in Education to attract the best medical schools

While (1) will grab the interest of leading healthcare educational institutions, it is unlikely to keep them from having bouts of attention deficit. To make sure the Harvards of the world come – and stay – the Government will need to assure them of a good return on their investment.

Discussing “returns on investment” in education is typically considered inapplicable – heretical even.

I disagree.

An education – in particular, a degree from a reputed college – is highly monetisable. When an average IIM-A student gets a starting salary worth 10 lakh, the market deems the worth of that “student+degree” combination to be worth at least as much. So, if an IIM-A student is charged Rs. 5 for a degree, s/he should not really be bothered – s/he will still be, economically speaking, better off.

So, in a nutshell, the government must give full freedom to medical schools to charge market rates for their fees.

And, instead of controlling fees, mechanisms should be established whereby the poorest of the poor have access to the capital required to fund this education. A cornucopia of solutions – from student loans to vouchers as suggested by Friedman – are possible. The government can, in fact, “fund” the education of students from whichever caste/creed/demographic/electorally useful group of people it wishes to pamper by directly paying the school the full cost of their education.

Such a move will have an altogether salubrious effect on the schools themselves. Forced with having to compete for the student’s rupee, colleges will have to offer better facilities, higher teaching standards and resources to attract students and value –added services – like career counselling and placements. The motivation for becoming distinctive will also incentivise them to establish tie-ups and alliances for research and development.

Existing shackles that prevent these relationships from emerging should also be removed.

3. Ensure public safety by establishing an independent regulatory authority.

While (1) and (2) may be adequate in other sectors, it is certainly not enough in medical education. After all, is it safe to leave the licensing of physician to a bunch of colleges that is interested in a 100% pass rate?

This is a legitimate concern, but effectively solved by establishing an independent regulator.

In the United States for instance, all physicians – even those from the best schools –must pass stringent licensing examinations administered by an independent licensing authority.

India too has successfully established ombuds and regulators such as the TRAI, indicating the viability of the concept. This regulator should be kept independent of the government (which means the Ramadoss or Grand poobah of the time should not be allowed to meddle in its operations). It should also be made financially secure by providing it with ring-fenced government funding and “licensing fees” collected from students and medicall colleges.

This independence and financial stability is crucial to staff the regulator with high quality experts – and not some spineless lackeys beholden to the present Minister.

Details about how we can make this regulator – indeed any institution – at arms length from political vicissitudes is matter enough for a separate post.

So there we have it – a framework to pull Maharashtra back from its state of self-inflicted medical decline and place it firmly onto a growth trajectory.

Of course, several operational issues remain unanswered – such as how do we ensure that these medical colleges have the right kind of teaching hospitals available? This one is easy: allow hospitals to forge alliances with existing hospitals to upgrade them into teaching institutions. Give incentives for adopting and transforming poorly run government hospitals and so on.

Some questions are harder – such as how do we get the best here? How many medical schools are enough? How expensive is too much?

They are all valid and important.

However they are also amenable for resolution under the umbrella framework of the three shifts listed above: competition, payment security and outcome regulation.

So, why have we not started as yet?

Unfortunately, like most changes – this change too has to start from the government. Babus have to go from thinking of themselves as thekedaars and maay-baaps of the sector to facilitators and nurturers.

They have to realise that this sector is too important to be held ransom to their petty egos.

Alas, the recent fracas with Ramadoss and the AIIMS demonstrated how far the sarkar is from this realisation.

Einstein had once said that a problem can only be solved at a level of consciousness higher than at which it was caused.

Our netas and babus need to raise their levels of consciousness pretty significantly to embrace such radical change.

Cold comfort, that we need to wait for our Netas and Babus to think differently.

Perhaps they should begin their journey by reading Alice in Wonderland.

Medical Education in Maharashtra - 1

Creating a robust Medical Education is a strategic imperative for India – healthcare is a critical sector of the economy in any nation. In a growing nation like India – with an absolute deficit of doctors, -- establishing a robust "pipeline" of medical talent is a critical element of development. After all, you cannot create economic surplus if you're sick.

Stewards of state are therefore expected to create an environment where talent is allowed to nurture and bloom.

Sadly, stewards of state in India -- and in Maharashtra in particular -- have done exceedingly well at destroying talent by establishing a deadening centralised license raj.

This is the story of what has happened in Maharashtra -- and what to expect as a result.

To begin with, starting a medical college in India is tough. You have to jump through multiple governmental hoops to get a green signal: from the number of beds you have/need, to the sizes of lecture rooms... even the fees you can charge!

However, the government worries very little about what quality of doctors you produce (in stark contrast, virtually all nations tightly regulate the quality of doctors produced; important, since a drop in educational standards can directly cost human lives).

As a result, many freshly graduated doctors in India are, to put it midly, incompetent. I had colleagues in my class who could not read a chest X-ray. This in a country where the first, second and third diagnosis for chronic cough is tuberculosis, tuberculosis and tuberculosis.

As a result, even after nearly 6 years of schooling, employment opportunities for a Doctor are slim (in stark contrast to graduates from engineering or management colleges).

No one comes to medical schools in India to recruit the next generation of Naresh Trehans or Nitu Mandkes: the cost associated with separating the wheat from the chaff is just not worth it. The best hospitals, in fact, simply do not entertain candidates until they earn credentials overseas – a simpler way (but more effective, at least from the Hospital’s perspective) of ensuring quality of supply.

Despite these flaws, the system was getting by: many doctors were starting out on their own, others were earning overseas qualifications and either returning or emigrating.

Somewhat predictably, the Maharashtra government began facing a crippling shortage of medical officers -- particularly in her rural areas.

Instead of freeing up the supply of doctors to address this shortage, the Government actually strengthened its stranglehold over supply and brough every aspect of medical education under direct governmental control.

All students were forced into mandatory rural service (girls from my class have served their bonds in Gadchiroli – a naxal infested area). Bonds were signed to make sure no student ‘slipped the dragnet’. Since the government could not "afford" to pay her resident doctors (doctors in teaching hospitals working to earn their MD/MS degrees), salaries were reduced. In fact, several resident doctors working to earn their DNB, do so gratis! Imagine a 27 year, unpaid neurosurgery resident!

Education delivery was next. Medicine programs that had run for perhaps longer than a 100 years at Mumbai and Pune University (among others) were dismantled and centralised to a no-name university operating out of a shed in Nasik. Centralised because the state found it easier to control one puppet university, Nasik because that was the health minister’s constituency.

To complete the picture, private medical schools in Maharasthra were also told by the government whom they must admit and what fees to charge!

As respected programs were demolished and replaced with an unknown and unwanted one, examination standards dropped; the new degree was even invalid internationally for several years. Doctors’ employability levels dropped further.

The result has been predictable. Lines to join medical school have been getting thinner. Growth in seats has stalled -- not one medical seat has been added in Mumbai in the past decade. Those already stuck in the system are leaving: fully half my graduating class has either migrated overseas, moved out of the clinical sciences or both.

Over a short span of ten years, vibrancy in medical education in Maharashtra was decimated, replaced by a deadening License Raj. A Raj of unmet demand, insufficient supply and poor quality.

But the divine law of supply and demand -- hated by the dirigiste state -- has caught up with Maharashtra. Over the next 20 years, Maharashtra will face a catastrophic shortage of medical doctors. This shortage will hit where it hurts most: public healthcare.

This catastrophe will not be easy to fix: it takes years to create a medical college of any standing (infrastructure, teachers, a working hospital) and nearly a decade to make a doctor (longer, if you include complex specialities).

By acting cynically to perpetuate their personal control over the sector, Maharashtra’s political leaders have virtually wiped out an entire generation of physicians, exposing her citizens to medical risk of institutional proportions.

They must be tried for criminal malpractice.

And yet, it is possible for Maharashtra to reverse the decay; i shall cover the topic in a separate post.

First you screw them...

... then you give them sops.
Classic maay-baap sarkar behaviour: choke off all sources of income to reduce to penury.
Then save from penury -- but only just -- by starting a life-support drip.
Control the pace of the drip to ensure that income is never infused fast enough for the patient to recover and walk off.

When will the UPA idiots learn?
The solution to Agriculture, as elsewhere, is simple:

1. Establish a water and electricity policy -- including private transmission and distribution to ensure farmers have the "raw materials" to grow and transport food (a lot of food perishes because our cold chains are poor -- because we dont even have 100% electricity). Buttress with a buildout of roads (remember the NDA's golden quadrilateral?)

2. Get out of the way -- dismantle controlled price regimes and allow farmers to produce what the market needs -- and sell directly to consumers.

Reforms -- a means to an end

It’s been 30 months since I moved from the United States back to Mumbai to start my first real job. So it was with much excitement that I was looking forward to visiting the United States again.

The America I left in 2003 was swaggering and strutting, buoyed by the confidence of a rebounding post 9-11 economy (concerns about being "Bangalored" notwithstanding). It was also the America that had, with impressively little effort, pulverized the Taliban that had successfully kept the Soviet war machine busy for over a decade.

Against that memory, America 2007 felt palpably different to me. The swagger had given way to a shuffle –The war on terror in Afghanistan still lingered and continued to add to the body count. Worse, the invasion in Iraq had gone horribly wrong, costing billions and killing thousands of troops. Scanners, metal detectors, x-ray machines and ID checks were everywhere, constant reminders of the here-and-now nature of terrorism.

America had also suffered multiple domestic body blows. Katrina had severely shattered America’s confidence. As New Orleans plunged into sub-saharan African style anarchy, the world saw the soft underbelly of the sole superpower.

America’s vaunted healthcare system also seemed to be misfiring – with medicare bankruptcy within the next 10 years a real possibility.

Was this it, then? The beginning of end of the American century? The end of Pax Americana as we know it?

My guess is probably not – for while the damage was visible, what was also starting to show was an acceptance of the problem and a resurfacing of the “we shall overcome” spirit.

A store clerk in LA quipped to me that “The climate is changing, we’ve done something wrong and it aint what it used to be.” Another man noted how in his home town in Colorado, they had snow in February for the first time in over years.And it was not merely in words – for the first time I was seeing words like hybrids, low emissions, green housing and sustainable buildings in American newspapers. In general, the focus had shifted from an analysis of what is broken to what is needed to fix it. On healthcare too, the debate was rapidly shifting to systematically controlling costs and ensuring coverage. America seemed to be waking up and smelling the coffee.

I had noted this behaviour during my days in Boston in 2001-2003. Those were the days when Americans were afraid of being "Bangalored" -- their jobs vacuum cleaned to Indian shores. I remember Wipro’s Azim Premji having to take some tough questions at MIT in late 2003 (he dispatched them with panache).

The breast beating lasted all of a few weeks. The American people accepted it, hunkered down and began reskilling to live in an outsourceable world.

And then it struck me. America -- and Americans are a resilient lot.

They see change -- and adapting to it -- as a pre-requisite for continued prosperity and growth. For instance, America has taken to green technology not because it is "good for mother earth" but because sustainable energy usage is vital if America has to continue to enjoy economic growth and security.

It is this resilience, this willingness to change to reach a higher goal that has made America a leader among nations.

So what does all of this mean for a resurgent India?

Should a nation that is only just learning to sprint slow down to a shuffle again, as she was shuffling under the weight of the Nehruvian Penalty*?

Hardly. Like America, India too needs to realise that reforms are necessary to ensure future prosperity and security. There are plenty of "bumps" in the road India has chosen -- bumps that can prevent india from getting into her stride. It is in her best interest, therefore to remove these bumps.

One of the biggest bumps facing India are her dismal education system. If India has to leverage her much touted “demographic advantage” over China and continue growing for the next 50 years – her education system needs to be nursed to fitness pronto.

Murli Manohar Joshi may have missed the point by asking for IIM fees to be dropped, but Arjun Singh’s "Mandal 2" crusade and re-establishment of an educational license-raj, with the government as lord and master, can potentially nuke it to the dark ages.

To fix this problem, Indian education needs radical surgery. As a first step, we should shutter (ideally nuke) the Ministry of Human Resources. Second, we should liberalise education delivery and allow any player -- private, public or charitable -- to start educational institutes. Finally, to ensure standards are met and enforced, an independent regulator should be established. This regulator should be staffed by experts (not babus), and may be funded by levying nominal charges from all institutes and users to ensure impartiality. A supporting framework to finance education for the 'meritorious poor' will also be required to ensure that no one is left behind.

In addition to fixing the system, the content our system imparts needs to be reformed as well. Education needs to be freed from the clutches of the 4Ms (Marxists, Mullahs, Missionaries and Macaulay-followers). Issues like Article 30 of the Indian Constitution that exclude Hindus also need to be scrapped. All that is another story, for another entry.

Such educational reforms will not come without pain -- Indians have grown used to the concept of "nearly-free" education paid for by someone else's money. Migrating to a system where you have to pay for the education you get is not likely to be an easy transition. The biggest opposition is not likely to come from the sadharan Indian -- he already pays for sundry coaching classes and "donations". It is likely to come from the Marxists and the JNU types.

They should be ignored.

In sum, if India wants to become prosperous, she needs educated professionals. Paying for making those professionals is a key means to that end. Like the Americans say, there aint no free lunch!

With India going through ebullient times, then, reforms need to be hotfooted (not backpedalled as MMS and co. are doing) – the pain will be easier to bear.

And seriously, good times or bad, will anyone really miss Arjun Singh?

***

* Incorrectly known as the “Hindu rate of growth”. India's poor rate of growth from independence to the 80s is attributable to Nehru and his policies, neither of which were Hindu. The term is © Shadow Warrior; see rajeev2004.blogspot.com for more.

Man for all seasons -- Manmohan Singh (1)

Celebrating the achievements of PM (Dr.) Manmohan Singh

In early 2004, India heaved a collective sigh of relief. The people had spoken, and had shown the communal BJP-led NDA alliance the door.

Gone was the weak kneed Vajpayee (of the infamous Kargil debacle, and the famous Kandhar and bus trip successes), to be replaced by the strong and dynamic Manmohan Singh -- the man who unleashed liberalisation in india in 1991 (no, PV Narasimha Rao had nothing to do with it).

With India back in the hands of a man of integrity, vision and a clear roadmap for development (much like Nehru was), rapid development, elimination of all ills, culminating in superpower status are obvious outcomes. With India on her way to becoming a superpower by ... err sometime in the future (but don't worry, it will all happen very soon), many of her recent achievements have been ignored. This series of small essays is my attempt at filling that void.

Does Manmohan Singh deserve all the credit?

Success, as they say, has many fathers. Failure is an orphan.

So it is with Dr. Singh's successes.

Many have sprung from the woodwork to claim credit for our PM’s success. Some say… “aah it was the communists that forced ... err encouraged... him to do that”, or “Sonia madame must have said so” or “this is the peril of a coalition”.

This is blatantly unfair, for at least two reasons:

First: Manmohan Singh is the Prime Minster of India. This isn’t some badly run business we’re talking about: this is the Government of India, a well run ship with a clear strategy. Further, these are not petty gains but dramatic victories. In a well run organisation, none of these can happen without strong leadership.

Second: It is unfair to blame leaders for failures but look elsewhere to celebrate success. If Bush gets the blame for having trigger happy deputies (e.g. Rumsfeld?), Manmohan Singh must get credit for the achievements of his team.

This set of essays begins with foreign policy, where arguably, the successes have been most spectacular (though his achievements in the field of minority development, educational excellence may be considered equally dramatic).

First fix your neighbours: Successes in Foreign Policy

No single area captures the statesmanship of Our Prime Minister like his achievements in the field of Foreign Affairs. In particular, his handling of Pakistan, the United States of America and of China are worthy of celebration.

Highly successful sale of Indian security interests to Pakistan

Since being appointed PM (he was never elected, but what do people know about leadership?) Dr. Singh has superlatively handled our nasty neighbor, Pakistan. In his own inimitable style he has successfully cowed them into submission with the clever use of Independent India’s oldest weapons – unilateral concessions and kid gloves. The result of this has been spectacular: Pakistan’s largest domestic produce – international terrorism – is now flourishing and is being exported all over the world.

But we are getting ahead of ourselves here. So we will start from the beginning.

As a first gesture, on coming to power, Dr. Singh immediately scuttled POTA (Prevention of Terrorist Activities Act). POTA was a draconian legislation that had allegedly offended the human rights of several terrorists. Some say this was at the behest of the Leftists, Madame Sonia, others; but the rightful credit must go to the man in charge.

Dr. Singh then established a most innovative solution for reducing terror: forming a joint terrorism reduction network with Pakistan. Under this arrangement, India (the 'customer' of terrorism) will share evidence of terror activities with Pakistan (her supplier) . This knowledge sharing mechanisms will allow Pakistan to study evidence from successful and unsuccessful terrorist attacks, enabling key producers like the Pakistan army, the ISI and NGTO's (Non-Government Terrorist Organisations) to get a clear picture of why some attacks worked and others failed.

They will see for example, how foolish terrorists left behind evidence trails that allowed Indian police to trace them back to Pakistan. This information can then be used to refine the next wave of terror attacks, to wipe out innocent Indians more efficiently. This move will dramatically accelerate the development of Pakistan’s terrorism infrastructure; early results have been encouraging (vide infra).

Manmohan has ensured that these efforts for efficiency are not hampered by Indian red tape and bottlenecks that habitually obstruct economic activity. Several jobs are actively being created in India’s burgeoning activist industry to pressurise war-mongers like the Supreme Court, the President and the Police to cease and desist. The masterful clearance of Afzal Guru is iconic of this new thrust for efficiency. So, the more Afzal Gurus Pakistan can produce, the more India will allow them to prosper!

With this masterstroke, painted across a global canvas (India, Havana, elsewhere), Manmohan has bested Chamberlain in negotiating “peace in our lifetimes”, against a remarkably hostile enemy.

Given the time constraints, Dr. Singh had to move quickly, ignoring Parliament in the process. Which is fine: after all, decisive leadership never works on consensus!

See the following references for more details:

“Annual reports” on the robust growth of terrorism:

An encouraging 2004:

http://www.expressindia.com/fullstory.php?newsid=32957

A better 2005:

http://www.expressindia.com/fullstory.php?newsid=52485

A spectacular 2006:

http://www.expressindia.com/messages.php?newsid=75101

Pakistan can no longer conceal her glee and for the first time admits that this is a key business!

Man of action:

PM ignores prejudiced Police briefings (what do our Cops know? They’re lazy, corrupt and communal)

http://www.expressindia.com/fullstory.php?newsid=74764&headline=7/11~Probe:~

Instead of indulging in this nonsense, the Mumbai police should think creatively and establish a joint “crime reduction commission”. Imagine how powerful that would be: the men in khaki and the sundry dons of Mumbai sitting across the table defeating crime! Alas our cops know nothing, and are lazy, corrupt and communal.

Making it happen in Havana: Manmohan’s masterstroke -- declaring Pakistan a victim of terrorism! The Poor things!

http://www.outlookindia.com/full.asp?fodname=20060925&fname=parthasarathy&sid=1

http://ia.rediff.com/news/2006/sep/18raman1.htm?q=np&file=.htm

Coming next: Towards a nuclear and bright India

If the masterly handling of Pakistan has demonstrated our Prime Minister’s intellect, the winning of the nuclear deal with America will demonstrate his thirst for success.

I will post this article over the next few days.