The credit for this essay goes to Subhashish’s book - Caged Tiger. The book is so captivating that in the middle of the first chapter, in the middle of a crowded Cafe, I removed my earphones and screamed out loud - Sab Badal Dunga (will change everything). And at the time of my writing, I don’t think, I let my imaginations (sometimes emotions :)) drive my fingers. This is the final essay for myself and everyone. If you like this essay, please do two things - one mandatory (Please read Subhashish’s Book) and one optional (Share this essay).
And to start this essay, I need to play the role of a dad that I am happy to do! :) Quickly, Let’s get started…
I am too young to have kids (Not biologically :)), but let’s assume me and my seven years old daughter having conversations about the origin of the human species:
My seven years daughter: Daddy, Who are we, and Where did we come from?
Me (Giving her the simplest answer): First, I will add a disclaimer - Darling, based on our current understanding, and this might change in the future: there is a high probability that we humans have evolved from single-cell species in around 3.8 billion years.
Me (Extending my answer): And there is enough proof about the first intelligent humans around 20,000 years spread across the world from Africa.
Me (Extending my answer again): And all these variations you see are combinations of Nature and Nurture (Environment).
My seven years daughter (in excitement): Daddy, we all have come from the same cell?
My seven years daughter: Then, why do we have war among nations and humans hate each other?
Before I answer, let's time-travel 10,000 years in future: If we as a civilization survive, we will probably be a multi-planetary species - occupying multiple planets or even galaxies. And there will be majorly one key difference, the wars would probably be between the planets and galaxies rather than the individual nations from the same planet. We might observe Planetalism or Galaxyalism rather than Nationalism - it seems inevitable from the first principle. And in those moments, assume a conversation between 7years old Daughter and Father. Here we have to specify, the daughter is from the planet named (P2).
Seven years daughter: Daddy, where did we come from?
Father: We have come from the Planet named (P1)
Seven years daughter: No before that, where did people come from, at the beginning?
Father: Most of them say that humans originally inhabited from the single planetary system
Seven years daughter (in excitement): We all have come from only one place?
Father: Yes, and we even don’t know which one: Planet (P4), Planet (P5), Planet (P0) etc: Some people even think we all have come from the same place called Earth, Planet (P0).
Seven years daughter: So, everyone we know about, they also come from the same place - then why do we have war among Planets and people hate each other?
Can you spot the similarities between the last questions asked by my daughter in the present and the daughter from 10,000 years in the future? In fact, both questions are the same, just the difference between the time scale and the progress of human civilization. (If we survive)
The one thing we can confirm from the above conversation is that even after 10,000 years in the future, we will struggle to answer such basic questions, no?
Let me throw the ball in your court…
What do you think? If your daughter/son will ask you the above questions? What would be your answer? You can take your time: we shall have the answer to this question at the end of the essay.
We all know, thinking/visualising is the same as remembering. So, let’s visualize the timeline in terms of past, present, and future. So we can close our eyes and see the future in 10,000+ years.
The intersection of time and space in millions of years (a rough sketch) (Sometimes I wonder, what is the point of knowing all these if we humans are going to live just 80 or 90 years? I think the human life span should have been 200+ years, your thoughts?)
Till the time you are coming up with potential answers asked by your daughter, let’s move to the next part of this essay. I come from a village named Dasaut (I want to make it famous, lol), and for the initial 23 years of my life, I thought about our (me, my family, the entire population of the state) situations - limited opportunities, poorness, access of fundamentals etc. - was our fate and decided by the creators (if there is one). For a significant part of my life, I thought: the government, institutions, police, systems etc are equivalent to the creator. What can you expect from an irrational person fighting his own battle?
However, as I started understanding the world and understood our situations were not the by-products of fate or decided by the creator - it was/are decided by a handful of people. And then the kind of emotion (fire burning inside) you encounter is unexplainable. You feel like picking them from their hair and keep slapping them like Singham. But that will have zero impact, and I will also be thrown into Jail. People ask me sometime, how come you have so much Energy? I highlight my daily experiences (1,98,720 hours of unique experiences), but this part of my life has a lot to do with the Fire burning inside me. And when you understand a few things, you know, to bring the real impact and make our world a better place - you must have a few ingredients. And access to those ingredients is a massive amount of work and commitment. And in that process, you find almost no time to look at the other part of our society.
But then young Authors like Subhashish make it easier for fire-burning people like us to understand the complex structure of our institution and keep things in mind that are necessary apart from life's mission, in our case it is - Making Quality Healthcare affordable for the 1.2 billion Indians.
Now, we need to talk about Subhashish’s book - Caged Tiger. Frankly, Subhashish messaged me on LinkedIn and shared about his book, I told him, if he delivers a copy, I will read it and give my feedback. And people, I finished that book in 18 hours - one of the fastest read. And when I finished the book, I wanted to read more. Here is an interesting part: even though many portions of the book are the incidents I have encountered recently, I couldn’t simply skip those because explained from a different lens.
When I started this book, I was hooked because the book starts with the COVID-19 incident and, I remember writing an article on the same - a direct criticism of the government in the centre. And when I was in the middle of Chapter-1, I remember reading in the middle of this cafe at around 06:30 PM, I was so pumped up - I removed my earphone and screamed out loud - सब बदल दूंगा (Will Change Everything). Of course, a crowded music-running cafe means only a few folks heard my voice. But just after that scream, I laughed at myself because you know you have a limited time, and there is no way you can solve more than two big and complex problems that can impact billions of Indians. And the same neurons are responsible for remembering your past and thinking about your future - it will cost me nothing to let a few neurons think and store one line - Will change everything!
I think I must write at least one paragraph for the book - Caged Tiger.
To start with, there are a few factual errors, which might be publishing mistakes. And I disagreed on many points including where Subhashish used the word citizens. I strongly think this book is still the account of India’s top-5 to 10% of the population. Because the reality of the citizens is different for the bottom 90%. For example, when Subhashish argues - citizens are good on their own, and government should not control the social, political, and cultural parts. In our nation, 80% of the population is still irrational and when you go and ask them - out of two options (a. Do everything on your own and b. Being told to do things by the Government), 80% of the population will have the default answer as option-2.
He has also criticised regulators, however, In the past few years, many of the regulators have improved themselves massively by releasing consultation papers for the public, creating public dashboards, thinking about the rules from billion populations rather than the top-5 or 10% etc. I can’t talk about other regulators, but Healthcare regulators have displayed amazing transparency. And I think this is true for the Security regulators as well. They have improved massively in the past 12 to 16 months.
Subhashish highlighted the Government’s subsidies and one of the examples: Free Health Insurance for millions of Indians (I think it is PMJAY). The first thing, PMJAY is just the upgraded version of Rashtriya Swasthya Bima Yojana (RSBY) launched in 2008. And this was upgraded based on one of Niti Ayoog’s reports - Missing Middle. From the scale pov, this is the world’s largest state-sponsored Health Insurance. Anything with that massive scale, 700 million beneficiaries, and 100K+ partners will have a few negative stories. However, from the potential +ves pov and alignments - PMJAY has all the ingredients to make quality Healthcare affordable and accessible for everyone in the country. And I can write this with 80% confidence because I have been on the ground for the past ten months.
Let me list a few points of the PMJAY (Pradhan Mantri Jan Aarogya Yojna): which covers secondary and tertiary healthcare expenses of 700 million bottom Indians. Here is the opportunity it has created for startups like us to make Healthcare affordable for 1.2 billion:
PMJAY has become the zero-cost distribution channel for startups solving the problem of Healthcare for the bottom 90% of Indians.
The best method to educate anyone about Health Insurance is to let them see and experience impacts and usefulness in the action especially when Health Insurance is a Long-term, tangible product. And negative word of mouth has dominated the entire industry. We can see how the +ve word of mouth has been propagating from beneficiaries to the non-beneficiaries.
Out of 3.3 million providers, just 20,000 are part of the insurance umbrella, and 90% of these providers are concentrated in 5% of India’s geography. Can you expect someone to travel 1000+ KM to avail of the benefits? This means Health insurance penetration would be a dream if we are not increasing the number of providers under the umbrella to 100,000. And PMJAY has definitely increased the size of the provider's umbrella. Impact: Private players like us don’t have to spend time and money onboarding providers under the insurance umbrella.
None of these future/invisible (2nd and 3rd order) impacts will be visible to outsiders. I think this is a well thought of scheme with multi-order impact in mind.
Let me give you one example that might highlight the importance of such subsidies. A few days back, Kiran Manumdar shared an article titled: Mental Illness and Insurance: Moving from Awareness to Access. This article is written by Anisha Padukone.
It is mandatory for Payers to include Mental Illness in Claims according to the Mental Healthcare Act (MHC Act) 2017 (Summary of MHC Act 2017). But the same Act talks about the right to confidentiality of information relating to mental illness. And hence the Act implementation is supper difficult for payers and providers. Because payers or providers look out for the “Source of Truth” and in the absence of the “Source of Truth” it becomes a problem of subjectivity. Let’s say someone is coming to a Provides and saying this incident is due to Mental Illness, and the Provider is sending the claim form to Payers as Mental illness without the source of truth - it creates a massive loophole in the entire system. And hence super difficult for both - providers and Payers - to implement this in the real world because on one side: Act is asking payers and providers to include the Mental Illness in the part of the claim, and another hand asking to make it confidential - however providers must produce the source of truth to Payers to get their treatment expenses?
A report in The Lancet Psychiatry suggests that approximately 200 million Indians suffer from mental illness. And this number will be directly propositional to the progress of our societies. This means in the next ten years - the number would potentially double. And solving this problem using technology is super easy.
And this would have been impossible to think of without PMJAY - we have 500 million attached Health Records. Because humans can’t hide anything from their bodies. This means many human Health vitals take shape as someone gets affected by Mental illness. And believe me, following the technology-led solution, we can
Create a source of truth for payers
Keep Patient’s confidentiality intact
Patients will be treated like any other patients
I think we are just limited by three things:
a. The Laws of Physics (We have hacked that as well, lol)
b. The right technology, and
Otherwise, there is not a single problem that we can’t solve. And I wish I could have solved all!
Meanwhile, if you would like to see some of our other demos on the utilization of technology in solving complex problems, you can see that on our website: https://jilehealth.com
We should come back to the book- Caged Tiger:
Okay, to understand why everyone should read this book, let me list the highlights:
Subhashish has used the world’s best invention - History (Past)
He is not criticising anyone - his takes are super balanced
Apart from highlighting the loopholes in the current institutions based on deep research, he has also suggested potential solutions. And I loved some of the solutions, but at the same time, I disagreed with a few because those were from the top 10% population pov.
He has explained one of the world's most complex institutions probably in the easy-to-understand language. Reading this book to understand the structure of India’s outdated (mostly) institutions doesn’t demand pre-reading or being an expert.
It is time to figure out the answer to the questions asked by my daughter and daughter of future humans on Planet (P2).
So, if I have to answer my daughter’s question, it would be something like this:
Darling, even though we all have come from single-cell or the same place. And the current human form is complicated - it has billion of cells - this means our source of origin/place fails to control our decision: humans are controlled by their minds. And hence our decisions are driven by emotions. Most emotions are a synthesis of time (past) - that controls our decisions. So, no one can answer the exact root cause of why humans hate each other, why there are wars between the nations on the same planet or why there will be wars between planets in the future. But this is the reality - present and future.
And this will be the last line of my answer: Irrespective of the war or hate, a small % of humans with support from a significant % will be working towards bringing the changes that will keep making our world/galaxies a better place. That small % of humans will be solving one problem at a time, and among all this noise you will always have the option to be that small % of humans!
Meanwhile, what are your answers to your daughter/son of the above question?
Before we wrap up this essay, even though I am fully aware of my limitation to solving 1 or 2 big and complex problems that will have +ve impact on billions of Indians/non-Indians, let me be irritational, Naive and Scream out loud with just one modification - Ham Sab Badal Denge (हम सब बदल देंगे): Will Change Everything. In the Bihari dialect, we use Ham (हम) to represent I (Individual).
This is also a good time to wrap up this essay. Thanks for reading, and if you find it informative - please share this among your network.
I shall see you all the next week…
PS: the future conversations between daughter and father are inspired from the web series: Foundation