Retomando uma agenda racional, em 2023 - Felipe Salto (OESP)

 Feliz 2023!

Felipe Salto

01:03:55 | 06/07/2021 | Economia | O Estado de S. Paulo | Espaço Aberto | BR

Estamos em janeiro de 2023. O Brasil comemora a eleição do novo governo e o programa coeso apresentado para o País. Surge uma oportunidade real para retomarmos a tendência histórica de melhoria das condições sociais. Há espaço para discutir a ampliação da igualdade de oportunidades por meio do crescimento econômico e da atuação eficiente do Estado.

A redução da pobreza, o fortalecimento do Sistema Único de Saúde (SUS), a preservação da Amazônia, a reinserção do Brasil no mundo, a educação de qualidade para todos, o aumento dos investimentos, a garantia dos direitos humanos, a reforma do aparelho do Estado, a simplificação do sistema tributário e a responsabilidade com as contas públicas são as bases do novo discurso oficial.

O desafio é enorme em todas as áreas. A desigualdade social e a dinâmica medíocre de aumento do produto interno bruto (PIB) per capita precisam ser transpostas. Há muito por fazer.

Uma premissa central do governo eleito vem das ideias de John Rawls, importante filósofo falecido em 2002. Ele defendia a tese de que, sob um "véu de ignorância", as pessoas jamais desejariam políticas públicas concentradoras de renda, que excluíssem os setores menos favorecidos. A ideia é instigante: se você não soubesse em que família nasceria, com qual situação financeira, em que região geográfica, com quais capacidades biológicas, almejaria ter condições mínimas de igualdade.

Na mesma linha, o economista Amartya Sen, Prêmio Nobel de Economia, defende a chamada igualdade de oportunidades.

Sen mostra que para ter uma sociedade economicamente desenvolvida e socialmente justa o Estado precisa garantir o acesso equitativo às políticas públicas de educação, emprego, renda, saúde, etc.

No programa do governo eleito lê-se que o Brasil avançou muito com a Constituição cidadã, desde 1988. Os direitos sociais foram expandidos e tornaram-se obrigação do Estado, assim como a busca pela transparência e pela impessoalidade no processo orçamentário.

A promessa é resgatar esses princípios norteadores e elaborar políticas que lhes atendam de maneira eficiente.

Na economia, o programa mostra que o Brasil conquistou certo espaço na cena internacional nos anos 1990 e na primeira década dos 2000, e ampliou suas vantagens comparativas na exportação de produtos primários. No entanto, não superou, mesmo nos melhores momentos, o desafio de expandir permanentemente suas taxas de crescimento.

O governo eleito para comandar o País de 2023 a 2026 parece ter percebido que a saída para a economia passa por uma combinação de políticas.

De um lado, zelar pela responsabilidade fiscal, pelo equilíbrio da dívida pública em relação ao PIB, pela transparência no processo orçamentário, pela qualidade do gasto público e pela manutenção do controle inflacionário. De outro, abrir espaço orçamentário para políticas de incentivo â desde que bem desenhadas e avaliadas â em momentos de alto desemprego e elevada ociosidade na economia.

Também estão no plano de governo a abertura comercial, o aumento da competitividade e a busca de acordos que favoreçam o setor produtivo nacional.

O acordo entre o Mercosul e a União Europeia tem grandes chances de prosperar, finalmente, a partir do compromisso efetivo do Brasil com a preservação da Amazônia e de políticas ambientais responsáveis.

A reforma do Estado começa a ser discutida a sério: busca-se a eficiência na provisão de serviços públicos, a valorização da burocracia estatal e a adoção das práticas de gestão e de remuneração por resultados.

Preconiza-se a adoção de um sistema de avaliação de políticas públicas, com planos pilotos para testar novas ideias e evitar o desperdício de dinheiro público.

O plano de governo é acompanhado de estimativas para o espaço orçamentário nos próximos anos. Traz simulações para o ganho derivado da extinção de políticas ineficientes, a exemplo de certos incentivos tributários carregados por décadas nas contas públicas.

Contém, ainda, cálculo minucioso para uma proposta de reforma tributária com dois objetivos: simplificação e redução da regressividade.

Na área social, pretende-se ampliar o Bolsa Família por meio de programa de renda básica, mas unificando programas que deram pouco resultado e nunca foram avaliados a contento. Na educação, a ministra anunciada é experiente, conhece o setor como ninguém, tem ciência dos avanços do passado e apresentou uma lista de prioridades para sua pasta.

Na saúde, o programa proposto considera que a população brasileira está envelhecendo e a demanda por serviços do SUScrescerá. Abre-se espaço orçamentário para isso em três frentes: aumento de receitas, corte de gastos e realocação de recursos.

Parece um sonho, não é? Depois do horror, da incompetência, da falta de sensibilidade social das hostes oficiais, da crise pandêmica, do luto não vivido, do luto evitável, da tristeza geral destes anos, poderemos ter um novo horizonte. Convidoos a imaginar, desde já, o Brasil que queremos ter a partir de 2023. O futuro é logo ali!

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DIRETOR EXECUTIVO E RESPONSÁVEL PELA IMPLANTAÇÃO DA IFI.

AS OPINIÕES NÃO VINCULAM A INSTITUIÇÃO.

India: Sen e Bhagwati se opoem quanto aos caminhos do desenvolvimento (NYT)

MEMO FROM NEW DELHI

Rival Economists in Public Battle Over Cure for India’s Poverty

Mansi Thapliyal/Reuters

The role of the Indian government in programs like this one, in which a government-run school provides meals to the poor, is one area in which Amartya Sen and Jagdish Bhagwati disagree.

By GARDINER HARRIS

The New York Times, August 21, 2013

NEW DELHI — She is 7 years old, covered in dirt and spends her days asking for food from pedestrians and drivers in one of this city’s central business districts.

Her name is Rohini, and other than pleading for bread, she had little to say when asked about her life. Instead, she threaded her way through thick traffic to her mother, Kamlesh, who on a recent rainy day was carrying one of Rohini’s sisters, a toddler with a cloudy eye and a disturbingly quiet demeanor.

“We don’t have the money to send the kids to school,” Kamlesh said simply.

India’s inability to pull Kamlesh and hundreds of millions of others out of desperate poverty despite decades of robust economic growth has been one of history’s great governance failures and economic mysteries.

Does India simply need more time for growth to work its magic, or is there something fundamentally wrong with its formula? Do improvements in health and literacy create growth or simply derive from it? And would India’s people have better lives if the government focused on improving workers’ skills or on bettering investors’ opportunities?

Those are some of the questions behind an unusually nasty fight between two of this nation’s greatest economists. It is a fight that has echoes in poor countries across the globe.

The battle between Amartya Sen, a Nobel Prize winner and Harvard professor, and Jagdish Bhagwati, an eminent professor at Columbia University, has broken out just as India’s economy seems to be coming undone. The rupee has plunged to historical lows against the dollar, and extraordinary efforts by the government to stem the slide, including limits on investments abroad by Indian companies, appear to be having little effect. Growth has fallen to 5 percent annually, and Prime Minister Manmohan Singh recently admitted that it was unlikely to snap back soon. Foreign investors are turning away, and the nation’s stock market has recently swooned.

Into this combustible mix came Mr. Sen and Mr. Bhagwati.

A courtly man with a cackling laugh, Mr. Sen, 79, is one of India’s greatest living intellectuals. His speeches are thronged, his pronouncements make news and college students give him the kind of rock-star adulation that economists in the United States may never know.

Mr. Sen returned to India this summer to promote his new book, “An Uncertain Glory,” co-written with Jean Drèze. In an interview, he said that he had no idea that his book tour would make national political news or that he would be forced to defend himself against his old rival, Mr. Bhagwati.

After Mr. Sen made critical comments about an opposition politician, he was denounced by Hindu nationalists. But in an interview, he said that those who view him as sympathetic to the governing Indian National Congress Party have probably not read his book, which is a searing indictment of India’s present government and every previous one.

In the book, Mr. Sen argues that India, almost alone among emerging Asian nations, has failed to invest substantially in the health and welfare of its people. This failure could doom its economy and people, he says, because a country’s future growth depends just as much on its social infrastructure as its physical state.

India’s economy grew nearly 8 percent annually in the past 10 years, second only to China among major economies. This improved incomes for hundreds of millions and created a growing middle class that in recent years has thronged Delhi’s streets in protests about corruption and gang rapes. Meeting the growing expectations of this middle class has become a potent political issue.

But Mr. Sen argues that India’s growth has failed to translate into substantially better lives for hundreds of millions of others. He points out that countries like Bangladesh, which have grown far more slowly and have much lower income levels, have performed better on key indicators like life expectancy.

“Living conditions in the poorer half of India are not much better, if at all, than in the poorer half of Africa,” Mr. Sen wrote.

Indeed, nearly a third of all newborn deaths occur in India. One in three malnourished children are Indian, and rates of malnutrition are higher in India than in sub-Saharan Africa. Such facts serve as the core of Mr. Sen’s book, and they are the kind of realities that much of India’s elite have trouble even discussing, he wrote.

“Rapid economic growth has not achieved much on its own during the last 20 years or so to reduce India’s horrendous levels of child undernourishment or to enhance child immunization rates,” he wrote.

These problems are hardly addressed — some say even worsened — by miserable government nutrition, education and health care systems, but Mr. Sen’s prescription is to expand these compromised programs.

“There has been a kind of write-off of public institutions by this administration, and they think the only thing that works is business, so they think the more we put in the hands of business the better,” he said. “That’s a disastrous position to take.”

This argument is one that Mr. Bhagwati and his co-author on “Why Growth Matters,” Arvind Panagariya, denounce as not only mistaken but dangerous, since they view money spent on government programs as largely wasted.

Mr. Bhagwati, who is also 79, is one of the world’s great trade economists, but he has lived in the shadow of Mr. Sen’s Nobel for much of his professional life, and it clearly irks him. If his written criticism of Mr. Sen’s work is shrill, his verbal criticism is downright nasty.

“My impatience with him is that he is obfuscating things constantly,” Mr. Bhagwati said in one of his less incendiary descriptions.

To Mr. Bhagwati, India’s myriad problems have less to do with poor health and literacy than a poor investment climate. Give people jobs and money and they will invest in their own education and health, he said.

Mr. Bhagwati’s embrace of the private sector is widely shared in India. Only the poorest send their children to government schools and hospitals, and the central government now promotes public-private partnerships.

Some economists in India resolve the debate by saying that both have good ideas but go too far with them.

“Both guys are at the extremes of the spectrum,” said Ajay Shah, a professor at the National Institute of Public Finance and Policy in New Delhi. “We need to reinvest in some government programs and end others altogether.”

Hari Kumar contributed reporting.

Why India Trails China - Amartya Sen (NYT)

The New York Times, June 19, 2013

Why India Trails China

By AMARTYA SEN

CAMBRIDGE, Mass. — MODERN India is, in many ways, a success. Its claim to be the world’s largest democracy is not hollow. Its media is vibrant and free; Indians buy more newspapers every day than any other nation. Since independence in 1947, life expectancy at birth has more than doubled, to 66 years from 32, and per-capita income (adjusted for inflation) has grown fivefold. In recent decades, reforms pushed up the country’s once sluggish growth rate to around 8 percent per year, before it fell back a couple of percentage points over the last two years. For years, India’s economic growth rate ranked second among the world’s large economies, afterChina, which it has consistently trailed by at least one percentage point.

The hope that India might overtake China one day in economic growth now seems a distant one. But that comparison is not what should worry Indians most. The far greater gap between India and China is in the provision of essential public services — a failing that depresses living standards and is a persistent drag on growth.

Inequality is high in both countries, but China has done far more than India to raise life expectancy, expand general education and secure health care for its people. India has elite schools of varying degrees of excellence for the privileged, but among all Indians 7 or older, nearly one in every five males and one in every three females are illiterate. And most schools are of low quality; less than half the children can divide 20 by 5, even after four years of schooling.

India may be the world’s largest producer of generic medicine, but its health care system is an unregulated mess. The poor have to rely on low-quality — and sometimes exploitative — private medical care, because there isn’t enough decent public care. While China devotes 2.7 percent of its gross domestic product to government spending on health care, India allots 1.2 percent.

India’s underperformance can be traced to a failure to learn from the examples of so-called Asian economic development, in which rapid expansion of human capability is both a goal in itself and an integral element in achieving rapid growth. Japan pioneered that approach, starting after the Meiji Restoration in 1868, when it resolved to achieve a fully literate society within a few decades. As Kido Takayoshi, a leader of that reform, explained: “Our people are no different from the Americans or Europeans of today; it is all a matter of education or lack of education.” Through investments in education and health care, Japan simultaneously enhanced living standards and labor productivity — the government collaborating with the market.

Despite the catastrophe of Japan’s war years, the lessons of its development experience remained and were followed, in the postwar period, by South Korea, Taiwan, Singapore and other economies in East Asia. China, which during the Mao era made advances in land reform and basic education and health care, embarked on market reforms in the early 1980s; its huge success changed the shape of the world economy. India has paid inadequate attention to these lessons.

Is there a conundrum here that democratic India has done worse than China in educating its citizens and improving their health? Perhaps, but the puzzle need not be a brainteaser. Democratic participation, free expression and rule of law are largely realities in India, and still largely aspirations in China. India has not had a famine since independence, while China had the largest famine in recorded history, from 1958 to 1961, when Mao’s disastrous Great Leap Forward killed some 30 million people. Nevertheless, using democratic means to remedy endemic problems — chronic undernourishment, a disorganized medical system or dysfunctional school systems — demands sustained deliberation, political engagement, media coverage, popular pressure. In short, more democratic process, not less.

In China, decision making takes place at the top. The country’s leaders are skeptical, if not hostile, with regard to the value of multiparty democracy, but they have been strongly committed to eliminating hunger, illiteracy and medical neglect, and that is enormously to their credit.

There are inevitable fragilities in a nondemocratic system because mistakes are hard to correct. Dissent is dangerous. There is little recourse for victims of injustice. Edicts like the one-child policy can be very harsh. Still, China’s present leaders have used the basic approach of accelerating development by expanding human capability with great decisiveness and skill.

The case for combating debilitating inequality in India is not only a matter of social justice. Unlike India, China did not miss the huge lesson of Asian economic development, about the economic returns that come from bettering human lives, especially at the bottom of the socioeconomic pyramid. India’s growth and its earnings from exports have tended to depend narrowly on a few sectors, like information technology, pharmaceuticals and specialized auto parts, many of which rely on the role of highly trained personnel from the well-educated classes. For India to match China in its range of manufacturing capacity — its ability to produce gadgets of almost every kind, with increasing use of technology and better quality control — it needs a better-educated and healthier labor force at all levels of society. What it needs most is more knowledge and public discussion about the nature and the huge extent of inequality and its damaging consequences, including for economic growth.

Amartya Sen, a Nobel laureate, is a professor of economics and philosophy at Harvard. He is the author, with Jean Drèze, of “An Uncertain Glory: India and its Contradictions.”

China ou India: onde voce preferiria morar?

Eu, pessoalmente, em nenhum dos dois.
Existem vários motivos, mas apontaria apenas dois: gosto de livrarias com amplo estoque de livros de todas as origens, variedades, tipos de literatura, não apenas daquela onde alguém precisa dizer o que eu posso ou não ler; também gosto de sociedades sem nenhum tipo de divisão social, pelo menos quanto aos méritos, origens e filiações de algum tipo, sociedades abertas às oportunidades e aos talentos. Apenas isto...
Paulo Roberto de Almeida

Quality of Life: India vs. China
Amartya Sen
THE NEW YORK REVIEW OF BOOKS, MAY 12, 2011

1.
The steadily rising rate of economic growth in India has recently been around 8 percent per year (it is expected to be 9 percent this year), and there is much speculation about whether and when India may catch up with and surpass China’s over 10 percent growth rate. Despite the evident excitement that this subject seems to cause in India and abroad, it is surely rather silly to be obsessed about India’s overtaking China in the rate of growth of GNP, while not comparing India with China in other respects, like education, basic health, or life expectancy. Economic growth can, of course, be enormously helpful in advancing living standards and in battling poverty. But there is little cause for taking the growth of GNP to be an end in itself, rather than seeing it as an important means for achieving things we value.
It could, however, be asked why this distinction should make much difference, since economic growth does enhance our ability to improve living standards. The central point to appreciate here is that while economic growth is important for enhancing living conditions, its reach and impact depend greatly on what we do with the increased income. The relation between economic growth and the advancement of living standards depends on many factors, including economic and social inequality and, no less importantly, on what the government does with the public revenue that is generated by economic growth.
Some statistics about China and India, drawn mainly from the World Bank and the United Nations, are relevant here. Life expectancy at birth in China is 73.5 years; in India it is 64.4 years. The infant mortality rate is fifty per thousand in India, compared with just seventeen in China; the mortality rate for children under five is sixty-six per thousand for Indians and nineteen for the Chinese; and the maternal mortality rate is 230 per 100,000 live births in India and thirty-eight in China. The mean years of schooling in India were estimated to be 4.4 years, compared with 7.5 years in China. China’s adult literacy rate is 94 percent, compared with India’s 74 percent according to the preliminary tables of the 2011 census.
As a result of India’s effort to improve the schooling of girls, its literacy rate for women between the ages of fifteen and twenty-four has clearly risen; but that rate is still not much above 80 percent, whereas in China it is 99 percent. One of the serious failures of India is that a very substantial proportion of Indian children are, to varying degrees, undernourished (depending on the criteria used, the proportion can come close to half of all children), compared with a very small proportion in China. Only 66 percent of Indian children are immunized with triple vaccine (diphtheria/pertussis/tetanus), as opposed to 97 percent in China.
Comparing India with China according to such standards can be more useful for policy discussions in India than confining the comparison to GNP growth rates only. Those who are fearful that India’s growth performance would suffer if it paid more attention to “social objectives” such as education and health care should seriously consider that notwithstanding these “social” activities and achievements, China’s rate of GNP growth is still clearly higher than India’s.
2.
Higher GNP has certainly helped China to reduce various indicators of poverty and deprivation, and to expand different features of the quality of life. There is every reason to want to encourage sustainable economic growth in India in order to improve living standards today and in the future (including taking care of the environment in which we live). Sustainable economic growth is a very good thing in a way that “growth mania” is not.
GNP per capita is, however, not invariably a good predictor of valuable features of our lives, for those features depend also on other things that we do—or fail to do. Compare India with Bangladesh. In income, India has a huge lead over Bangladesh, with a GNP per capita of $1,170, compared with $590 in Bangladesh, in comparable units of purchasing power. This difference has expanded rapidly because of India’s faster rate of recent economic growth, and that, of course, is a point in India’s favor. India’s substantially higher rank than Bangladesh in the UNHuman Development Index (HDI) is largely due to this particular achievement. But we must ask how well India’s income advantage is reflected in other things that also matter. I fear the answer is: not well at all.
Life expectancy in Bangladesh is 66.9 years compared with India’s 64.4. The proportion of underweight children in Bangladesh (41.3 percent) is lower than in India (43.5), and its fertility rate (2.3) is also lower than India’s (2.7). Mean years of schooling amount to 4.8 years in Bangladesh compared with India’s 4.4 years. While India is ahead of Bangladesh in the male literacy rate for the age group between fifteen and twenty-four, the female rate in Bangladesh is higher than in India. Interestingly, the female literacy rate among young Bangladeshis is actually higher than the male rate, whereas young women still have substantially lower rates than young males in India. There is much evidence to suggest that Bangladesh’s current progress has a great deal to do with the role that liberated Bangladeshi women are beginning to play in the country.
What about health? The mortality rate of children under five is sixty-six per thousand in India compared with fifty-two in Bangladesh. In infant mortality, Bangladesh has a similar advantage: it is fifty per thousand in India and forty-one in Bangladesh. While 94 percent of Bangladeshi children are immunized withDPT vaccine, only 66 percent of Indian children are. In each of these respects, Bangladesh does better than India, despite having only half of India’s per capita income.
Of course, Bangladesh’s living conditions will benefit greatly from higher economic growth, particularly if the country uses it as a means of doing good things, rather than treating economic growth and high per capita income as ends in themselves. It is to the huge credit of Bangladesh that despite the adversity of low income it has been able to do so much so quickly; the imaginative activism of Bangladeshi NGOs (such as the Grameen Bank, the pioneering microcredit institution, and BRAC, a large-scale initiative aimed at removing poverty) as well as the committed public policies of the government have both contributed to the results. But higher income, including larger public resources, will obviously enhance Bangladesh’s ability to achieve better lives for its people.
3.
One of the positive things about economic growth is that it generates public resources that the government can devote to its priorities. In fact, public resources very often grow faster than the GNP. The gross tax revenue, for example, of the government of India (corrected for price rise) is now more than four times what it was just twenty years ago, in 1990–1991. This is a substantially bigger jump than the price-corrected GNP.
Expenditure on what is somewhat misleadingly called the “social sector”—health, education, nutrition, etc.—has certainly gone up in India. And yet India is still well behind China in many of these fields. For example, government expenditure on health care in China is nearly five times that in India. China does, of course, have a larger population and a higher per capita income than India, but even in relative terms, while the Chinese government spends nearly 2 percent of GDP (1.9 percent) on health care, the proportion is only a little above one percent (1.1 percent) in India.
One result of the relatively low allocation of funds to public health care in India is that large numbers of poor people across the country rely on private doctors, many of whom have little medical training. Since health is also a typical example of “asymmetric information,” in which the patients may know very little about what the doctors (or “supposed doctors”) are giving them, even the possibility of fraud and deceit is very large. In a study conducted by the Pratichi Trust—a public interest trust I set up in 1999—we found cases in which the ignorance of poor patients about their condition was exploited so as to make them pay for treatment they didn’t get. This is the result not only of shameful exploitation, but ultimately of the sheer unavailability of public health care in many parts of India. The benefit that we can expect to get from economic growth depends very much on how the public revenue generated by economic growth is expended.
4.
When we consider the impact of economic growth on people’s lives, comparisons favor China over India. However, there are many fields in which a comparison between China and India is not related to economic growth in any obvious way. Most Indians are strongly appreciative of the democratic structure of the country, including its many political parties, systematic free elections, uncensored media, free speech, and the independent standing of the judiciary, among other characteristics of a lively democracy. Those Indians who are critical of serious flaws in these arrangements (and I am certainly one of them) can also take account of what India has already achieved in sustaining democracy, in contrast to many other countries, including China.
Not only is access to the Internet and world opinion uncensored and unrestricted in India, a multitude of media present widely different points of view, often very critical of the government in office. India has a larger circulation of newspapers each day than any other country in the world. And the newspapers reflect contrasting political perspectives. Economic growth has helped—and this has certainly been a substantial gain—to expand the availability of radios and televisions across the country, including in rural areas, which very often are shared among many users. There are at least 360 independent television stations (and many are being established right now, judging from the licenses already issued) and their broadcasts reflect a remarkable variety of points of view. More than two hundred of these TV stations concentrate substantially or mainly on news, many of them around the clock. There is a sharp contrast here with the monolithic system of newscasting permitted by the state in China, with little variation of political perspectives on different channels.
Freedom of expression has its own value as a potentially important instrument for democratic politics, but also as something that people enjoy and treasure. Even the poorest parts of the population want to participate in social and political life, and in India they can do so. There is a contrast as well in the use of trial and punishment, including capital punishment. China often executes more people in a week than India has executed since independence in 1947. If our focus is on a comprehensive comparison of the quality of life in India and China, we have to look well beyond the traditional social indicators, and many of these comparisons are not to China’s advantage.
Could it be that India’s democratic system is somehow a barrier to using the benefits of economic growth in order to enhance health, education, and other social conditions? Clearly not, as I shall presently discuss. It is worth recalling that when India had a very low rate of economic growth, as was the case until the 1980s, a common argument was that democracy was hostile to fast economic growth. It was hard to convince those opposed to democracy that fast economic growth depends on an economic climate congenial to development rather than on fierce political control, and that a political system that protects democratic rights need not impede economic growth. That debate has now ended, not least because of the high economic growth rates of democratic India. We can now ask: How should we assess the alleged conflict between democracy and the use of the fruits of economic growth for social advancement?
5.
What a democratic system achieves depends greatly on which social conditions become political issues. Some conditions become politically important issues quickly, such as the calamity of a famine (thus famines tend not to occur at all when there is a functioning democracy), while other problems—less spectacular and less immediate—provide a much harder challenge. It is much more difficult to use democratic politics to remedy undernourishment that is not extreme, or persistent gender inequality, or the absence of regular medical care for all. Success or failure here depends on the range and vigor of democratic practice.1 In recent years Indian democracy has made considerable progress in dealing with some of these conditions, such as gender inequality, lack of schools, and widespread undernourishment. Public protests, court decisions, and the use of the recently passed “Right to Information” Act have had telling effects. But India still has a long way to go in remedying these conditions.
In China, by contrast, the process of decision-making depends largely on decisions made by the top Party leaders, with relatively little democratic pressure from below. The Chinese leaders, despite their skepticism about the values of multiparty democracy and personal and political liberty, are strongly committed to eliminating poverty, undernourishment, illiteracy, and lack of health care; and this has greatly helped in China’s advancement. There is, however, a serious fragility in any authoritarian system of governance, since there is little recourse or remedy when the government leaders alter their goals or suppress their failures.
The reality of that danger revealed itself in a catastrophic form in the Chinese famine of 1959–1962, which killed more than 30 million people, when there was no public pressure against the regime’s policies, as would have arisen in a functioning democracy. Mistakes in policy continued for three years while tens of millions died. To take another example, the economic reforms of 1979 greatly improved the working and efficiency of Chinese agriculture and industry; but the Chinese government also eliminated, at the same time, the entitlement of all to public medical care (which was often administered through the communes). Most people were then required to buy their own health insurance, drastically reducing the proportion of the population with guaranteed health care.
In a functioning democracy an established right to social assistance could not have been so easily—and so swiftly—dropped. The change sharply reduced the progress of longevity in China. Its large lead over India in life expectancy dwindled during the following two decades—falling from a fourteen-year lead to one of just seven years.
The Chinese authorities, however, eventually realized what had been lost, and from 2004 they rapidly started reintroducing the right to medical care. China now has a considerably higher proportion of people with guaranteed health care than does India. The gap in life expectancy in China’s favor has been rising again, and it is now around nine years; and the degree of coverage is clearly central to the difference.2 Whether India’s democratic political system can effectively remedy neglected public services such as health care is one of the most urgent questions facing the country.3
6.
For a minority of the Indian population—but still very large in actual numbers—economic growth alone has been very advantageous, since they are already comparatively privileged and need no social assistance to benefit from economic growth. The limited prosperity of recent years has helped to support a remarkable variety of lifestyles as well as globally acclaimed developments of Indian literature, music, cinema, theater, painting, and the culinary arts, among other cultural activities.
Yet an exaggerated concentration on the lives of the relatively prosperous, exacerbated by the Indian media, gives an unrealistically rosy picture of the lives of Indians in general. Since the fortunate group includes not only business leaders and the professional classes but also many of the country’s intellectuals, the story of unusual national advancement is widely and persistently heard. More worryingly, relatively privileged Indians can easily fall for the temptation to focus just on economic growth as a grand social benefactor for all.
Some critics of the huge social inequalities in India find something callous and uncouth in the self-centered lives and inward-looking preoccupations of a relatively prosperous minority. My primary concern, however, is that the illusions generated by those distorted perceptions of prosperity may prevent India from bringing social deprivations into political focus, which is essential for achieving what needs to be done for Indians at large through its democratic system. A fuller understanding of the real conditions of the mass of neglected Indians and what can be done to improve their lives through public policy should be a central issue in the politics of India.
This is exactly where the exclusive concentration on the rate of GNP growth has the most damaging effect. Economic growth can make a very large contribution to improving people’s lives; but single-minded emphasis on growth has limitations that need to be clearly understood.

Notes:
1. I have discussed this issue more fully in " How Is India Doing? ," The New York Review , December 16, 1982; in (jointly with Jean Drèze) Hunger and Public Action(Clarendon Press/Oxford University Press, 1989); and in Development as Freedom(Knopf, 1999).
2. I discuss this in "The Art of Medicine: Learning from Others," The Lancet , January 15, 2011.
3. I am grateful to Lincoln Chen, Jean Drèze, and A.K. Shiva Kumar for helpful discussion of this and related issues.