Health for all, or health for few?

The CMHIS and Ayushman Bharat schemes are big. They cover every person in Nagaland. That
is good. That is rare. A state with two million people now has a health safety net. On paper, it is a revolution. Ayushman Bharat was launched in 2018 by the Government of India. CMHIS followed in
Nagaland in 2022. The goal was simple: no one should go broke because they got sick. The schemes offer up to 5 lakh per family per year. In Nagaland, CMHIS expanded that to25 lakh for government employees and their dependents. The state partnered with insurance firms. Hospitals were empaneled. Cards were issued. The promise was made. But promises are not access.
In the hills, villagers fall sick. They stay home. They wait. They hope. A fever becomes a cough. A cough becomes blood. By the time they reach a hospital, it is too late. They cannot claim 10,000. They do not know how. They do not have the papers. They do not have the transport. They do not have the time. In the cities, it is different. An officer gets a diagnosis. He books a flight. He goes to Delhi or Mumbai. He uses the full25 lakh. The treatment is advanced. The case is terminal. The money is spent. The outcome is often the same.
This is not envy. It is a fact. The system works better for the few than for the many. That is not progress.
That is a warning. A disease caught early is cheap.
A disease caught late is a disaster. A woman with anemia needs iron. A man with diabetes needs a test. A child with a fever needs a bed.
These are not expensive. But they are far away. And so they are missed.
When we miss them, they grow. They become cancer. They become stroke. They become death. And then we spend lakhs. And then we mourn. This is not compassion. This is failure.
We must do better. We must bring care to the people. Not wait for the people to come to care. We must cap the spending per person. We must spread the benefit.
We must build clinics. We must train doctors. We must pay nurses. We must fix roads. We must send medicine. This is not charity. This is economics.
A rupee spent early saves ten later. A healthy worker earns. A healthy child learns. A healthy mother lives. This is how a poor state becomes strong. The policy is good. The intent is noble. But the design must change.
A few changes can shift the weight. From the top to the roots. From the last breath to the first cough. That is how we build a system.
That is how we serve the people. That is how we make health real.
Dr Kevilhounyü Linyü GIVF Nursing Home