• Anup Kumar Srivastava

The Modi government has expanded insurance cards, digital platforms and centrally branded welfare programmes. But from a deeper test is whether ordinary Indians can obtain affordable treatment, dependable pensions, adequate nutrition and dignified income security. On that test, the record remains deeply troubling.

In today’s India, illness is not merely a medical emergency. For millions of families, it can become a financial catastrophe. A hospital admission may mean borrowing money, selling jewellery, postponing a child’s education or surrendering a season’s income. An elderly citizen may technically be covered by a pension scheme yet receive a central contribution of only ₹ 200 a month. A rural worker may possess a job card but not receive work when it is needed.

This is the gap between the Modi government’s publicity and the lived experience of social security.

Since 2014, the Union government has announced schemes on an impressive scale—Ayushman Bharat, Ayushman Arogya Mandirs, PM-Kisan, PM Garib Kalyan Anna Yojana and a growing architecture of digital benefit delivery. Some have provided genuine assistance and should not be dismissed. But a critical assessment must ask a harder question: have these schemes strengthened universal public services, or have they substituted branding and selective benefits for enforceable social rights?

From a public-health mission to an insurance model

The United Progressive Alliance inherited a weak public-health system, but it attempted to build a permanent institutional foundation. The National Rural Health Mission, launched in 2005, sought to strengthen rural health infrastructure, establish Indian Public Health Standards and provide accessible, affordable care to vulnerable communities. The government’s own health portal acknowledges that the mission created the framework for improving sub-centres, primary health centres, community health centres and district hospitals. The National Urban Health Mission was subsequently conceptualised in 2012, and both became part of the National Health Mission. (Ministry of Health and Family Welfare)

The UPA also enacted the National Food Security Act in 2013, converting subsidised food, children’s nutrition and maternity support into statutory entitlements. Section 4 of the law provides for a maternity benefit of not less than ₹ 6,000, apart from nutritional support during pregnancy and after childbirth. (India Code: National Food Security Act, 2013).

The Modi government’s flagship health intervention, Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana, took a different route. It offers eligible families insurance-funded hospital care, but insurance cannot replace functioning primary health centres, doctors, medicines, diagnostic facilities or disease prevention. A card is valuable only when a suitable hospital exists, accepts the patient and provides the entire treatment without imposing additional costs.

The government’s own data reveal the continuing weakness of the public system. Health Dynamics of India 2022–23 records major shortages and vacancies in rural health facilities, including doctors and specialists at community health centres. These shortages are particularly damaging because CHCs are supposed to provide the first level of specialist care outside district hospitals. (Ministry of Health and Family Welfare).

‘Ayushman Bharat’ itself has faced serious implementation problems. The Comptroller and Auditor General’s 2023 performance audit found that, as of November 2022, 7.87 crore beneficiary households had been registered—73 per cent of the original target of 10.74 crore households. The audit also identified deficiencies in beneficiary databases, hospital empanelment, claims management, monitoring and grievance redressal. CAG Performance Audit of PM-JAY.

This demonstrates the central weakness of the Modi model: public money increasingly finances episodes of hospitalisation, including treatment in private institutions, while the underlying public-health network remains understaffed. The result risks becoming publicly funded private care for selected procedures instead of comprehensive health care available to every citizen.

The unfinished promise of public spending

India’s public-health expenditure has historically been inadequate under governments of different parties. That fact should be admitted honestly. But after more than a decade in office, the Modi government cannot continue treating inherited weakness as an explanation.

The Economic Survey reported that combined Centre-state health expenditure rose from 1.2 per cent of GDP in 2014–15 to 1.5 per cent in 2019–20, with a higher pandemic-era budget estimate thereafter. This was an increase, but it remained modest compared with India’s enormous needs and the government’s own policy ambitions. (Economic Survey 2020–21).

There have also been measurable improvements. Government health expenditure increased as a share of total health expenditure, while household out-of-pocket expenditure declined from 64.2 per cent in 2013–14 to 47.1 per cent in 2019–20. Infant and maternal mortality also fell. These gains matter, and a credible opposition should acknowledge them. (Economic Survey 2023–24). However, these indicators do not establish that India has achieved affordable or universal care. Households were still directly financing nearly half of total health expenditure in 2019–20. National averages also conceal enormous differences between states, rural and urban regions, and richer and poorer citizens. Declining mortality is welcome, but it cannot excuse vacant medical posts, overcrowded hospitals or families forced toward expensive private treatment.

The accurate criticism, therefore, is not that every health indicator deteriorated after 2014. Public data do not support such a blanket claim. The stronger and more defensible charge is that the Modi government failed to use ten years of political dominance to build a sufficiently funded, universal and accountable public-health system.

Social security reduced to token payments

The condition of India’s elderly, widowed and disabled citizens exposes an even starker failure. Under the National Social Assistance Programme, the Union government’s contribution to the old-age pension for a person between 60 and 79 remains only ₹ 200 per month. Widows and eligible persons with severe disabilities generally receive a central contribution of ₹ 300, while ₹ 500 is provided in specified higher-age categories. These amounts are documented in the CAG’s national performance audit. (CAG audit of the National Social Assistance Programme).

In an era of rising food, medicine, cooking-gas and transport costs, ₹ 200 is not social security. It is administrative symbolism. The same audit found that NSAP reached an annual average of 2.83 crore beneficiaries through central assistance during 2017–21, with states and Union Territories covering additional beneficiaries from their own resources. But it also documented failures to update beneficiary databases, irregular payments, overpayments and short payments, delayed or non-monthly pensions, incomplete compliance with direct-benefit-transfer requirements, and weak monitoring and grievance systems. (CAG overview).

This is particularly revealing. State governments allocated substantially more additional assistance than the Centre during the audited period. The Union government has consequently transferred not only administrative responsibility but much of the financial burden of dignified pensions to states.

Maternity protection diluted

The National Food Security Act promised maternity benefits of at least ₹ 6,000. Yet the Pradhan Mantri Matru Vandana Yojana initially restricted its ₹ 5,000 benefit largely to the first living child, subject to conditions and documentation.

Implementation has also been uneven. A CAG examination in Andhra Pradesh found that, between 2017–18 and 2021–22, only 8.61 lakh of 18.19 lakh pregnant and lactating women covered by the audit population received the full PMMVY benefit.

This reflects a larger ideological retreat. The 2013 law approached maternity support as a right. The post-2014 framework narrowed it through eligibility rules, instalments and administrative conditions. A Congress critique should insist that pregnancy and wage loss are not matters for discretionary charity. Maternity protection must be universal for eligible women, simple to access and consistent with the statutory minimum.

Food security resting on an outdated population count

Free foodgrain has been one of the Modi government’s most important relief measures, particularly during and after the pandemic. It has protected millions of households and deserves recognition. But the programme still relies on coverage calculated from the 2011 Census. The Department of Food and Public Distribution states that the National Food Security Act’s ceiling remains 81.35 crore people, derived from the 2011 population, with approximately 80.67 crore covered as of October 2024.

India’s population has grown substantially since 2011. Keeping the ceiling tied to that census risks excluding millions who would be covered if the statutory rural and urban proportions were applied to an updated population. Free grain for existing ration-card holders is valuable, but it does not resolve exclusion from the beneficiary list. The irony is unmistakable: the Modi government advertises free grain as a new act of generosity, while implementing an entitlement created through the Congress-led National Food Security Act.

Employment security under pressure

MGNREGA, enacted under the UPA in 2005, established a legal guarantee of up to 100 days of rural wage employment on demand. It became indispensable during the COVID-19 crisis, demonstrating the lasting importance of the rights-based welfare architecture inherited by the Modi government.

Yet the official Economic Survey shows how far implementation remains from the statutory promise. Average employment per participating household was 50.9 days in 2018–19, 48.4 in 2019–20, 51.5 during the pandemic year of 2020–21 and 50.1 in 2021–22—roughly half the maximum guarantee. By 6 January 2023, the reported average for that financial year was only 40.7 days. (Economic Survey).

The programme’s survival is itself a tribute to the UPA’s legislative vision. But inadequate employment, wage delays and repeated funding controversies have weakened its ability to operate as a genuine demand-driven guarantee.

A different idea of government

The fundamental difference is philosophical. The Congress-led approach at its best—through MGNREGA, the National Food Security Act, the National Rural Health Mission and rights-based social legislation—sought to make the state directly responsible for basic capabilities and entitlements. Its implementation was imperfect, and corruption and administrative weakness cannot be ignored. But the direction was toward enforceable rights, decentralised institutions and public capacity.

The Modi government has preferred centralised branding, technology-driven targeting and schemes closely associated with the Prime Minister’s identity. Digital systems can reduce leakage and accelerate payments, but they can also exclude citizens whose biometrics fail, whose records contain errors or who lack the documents and connectivity required to navigate the system. India does not need another card, portal or slogan as a substitute for care. It needs adequately staffed public hospitals, free essential medicines and diagnostics, stronger primary care, universal maternity protection, inflation-linked pensions, updated food-security coverage and a fully funded employment guarantee.

The most serious indictment of the period since 2014 is therefore not that nothing improved. Some indicators did improve, and several schemes delivered real benefits. The indictment is that the government possessed the time, parliamentary strength and fiscal capacity to move India decisively toward universal social protection, but settled for a fragmented system in which eligibility is narrow, benefits are often inadequate and access depends too heavily on geography, paperwork and private providers.

A welfare state should not force citizens to prove their poverty repeatedly. Nor should health care begin only after a family reaches the hospital. Congress offered a credible alternative: social security as a right, public health as essential infrastructure, and dignity—not publicity—as the measure of government.

(The author is freelance writer and trainer, brings rich insights into the intersection of finance and economics through his research & writing with a strong background in business studies & corporate analysis.)