The public versus private debate is irrelevant because it has to be public because private cannot work in rural areas (first paragraphs) and now is the time to reform public because if it doesn't reform it will wither away because private will take market share and public will wither away (last paragraphs). Huh? Public private partnerships cannot be the main option because they only work in very specific conditions which don't exist all across India (first paragraphs), so we should reform the public sector all across India just like they did in the very specific conditions of Tamil Nadu (later paragraphs). Huh? It would seem when the path to success is uncertain (and you would think after 60 years of attempts and reforms, success at public sector production of clinic care has to be rated as at least "uncertain") trying multiple options is a good idea, so perhaps pursuing both a variety of public sector reforms and a variety of public-private partnerships aggressively is a good idea, as there are many overlaps in what one needs for public sector reform and public-private partnership--in fact a "single payer" insurance scheme can be provider neutral. That way when (or "if" if you prefer) public sector reforms fail there is an existing alternative to "business as usual."