Why (I've been asking myself) am I investing so much time and energy in supporting health care reform when I'm already on the best policy America has to offer? It seems so obvious to us on our side of the argument: we just plain need universal health care in this country. No one's healthy unless we're all healthy. That's a perfectly respectable spiritual as well as intellectual concept. But the right, the side which lays claim to "spiritual values," is once again shown to be empty and destructive.
Listening to Nandan Nilekani convinces me that those of us who are fighting for health care reform know instinctively -- in our gut as well as intellectually -- that America is on a slippery slope. That slope is greased by more than an iffy economy or (say) swine flu.
Nilekani is one of the most important people in India. He founded the successful company, Infosys, and has become involved in charting India's economic and social future. You can hear him talk and at the same place read a transcript of his belief that India will profit from a huge "demographic dividend" which will go a long way towards making that country a powerful and competitive nation. He's pretty clear about what makes a nation powerful.
As healthcare improves, as infant mortality goes down, fertility rates start dropping. And India is experiencing that. India is going to have a lot of young people with a demographic dividend for the next 30 years. What is unique about this demographic dividend is that India will be the only country in the world to have this demographic dividend. In other words, it will be the only young country in an aging world. And this is very important. At the same time if you peel away the demographic dividend in India there are actually two demographic curves. One is in the south and in the west of India, which is already going to be fully expensed by 2015 because in that part of the country, the fertility rate is almost equal to that of a West-European country. Then there is the whole northern India, which is going to be the bulk of the future demographic dividend. But a demographic dividend is only as good as the investment in your human capital. Only if the people have education, they have good health, they have infrastructure, they have roads to go to work, they have lights to
study at night -- only in those cases can you really get the benefit
of a demographic dividend.
Well, we still have the lights to study at night, but we're falling down badly on everything else -- most noticeably our "human capital" and the health care it receives doesn't receive. Oh, and I don't think many Americans "study at night," do you? When "study at night" is replaced by emailing what Glenn Beck had to say during the day, I think we're in real trouble.
Nilekani cites another factor in India's upsurge: democracy.
And finally, India has had the deepening of its democracy. When democracy came to India 60 years back it was an elite concept. It was a bunch of people who wanted to bring in democracy because they wanted to bring in the idea of universal voting and parliament and constitution and so forth. But today democracy has become a bottom-up process where everybody has realized the benefits of having a voice, the benefits of being in an open society. And therefore democracy has become embedded.
Improving health care for all and a vibrant, deepening democracy. Aren't those exactly the elements in American life which have gone missing?