The latest Sample Registration System data should worry every policymaker. In 2024, nearly half of all recorded deaths in India occurred without medical attention from a trained professional. This is up from 18 per cent in 2020. The proportion was even higher in rural India, and in states, such as Bihar, it was close to two-thirds. These are not merely mortality statistics. They are a measure of how far formal healthcare remains from the lives of ordinary Indians.

This is the background against which we must examine the Employees’ State Insurance Corporation, or ESIC. There is growing discussion about reforming it. Reform is overdue. But reform must not become a coded word for privatisation, outsourcing or handing over a valuable social security institution to private insurers and hospital chains.

The ESIC is often misunderstood as just another health insurance scheme. It is much more than that. It is a social insurance system for low-income workers in the formal economy. It combines medical care with income protection. It covers sickness, maternity, disability, workplace injury, dependants’ benefit, unemployment support, and lifelong pension in cases of permanent disablement. For a worker earning Rs 15,000 a month, the total annual contribution is about Rs 7,200, split between the employer and the employee. For that, the worker and family receive medical care without monetary ceilings, plus cash benefits that no ordinary private insurance product provides.

This matters not only for social justice, but also for India’s industrial future. India is among the world’s largest manufacturing economies, yet workplace injuries remain seriously under-reported and under-addressed. A well-functioning ESIC system that ensures quick treatment, wage compensation, rehabilitation, and disability support prevents injured workers from falling into poverty. It also helps them return to productive work sooner. Worker health is productive capital. The ESIC........

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