Syndicate content

Add new comment

Submitted by Shanta on

Nachiket: Thanks for the thoughtful comments. I agree that we can make progress with better designed policies and institutions, such as pricing, independent regulators and separation of purchaser from provider. But if the underlying politics is dysfunctional, it is sometimes difficult to get these reforms implemented. Quite simply, people resist having to be more accountable than they are today (less politely, people don't like to lose their rents). If they are sufficiently organized, they can resist these reforms. Health insurance in Kenya was resisted by doctors. It's difficult to get truly independent water regulation in India (as a result, no city in India has 24x7 water). And the textbook example of purchaser-provider split is contract teachers. My sense is that all these reforms you propose are attempts to "trick" the people whose rents are going to be undermined into not noticing that this is the case. They are variants on "politician-proof public policy". They may still work, but you have to be lucky. Shanta