Gregory P. Marchildon, Tommy Douglas and the Quest for Medicare in Canada. Toronto: University of Toronto Press, 2024. 728 pages.

Greg Marchildon has written the definitive 700-page book on Tommy Douglas’s political career and the political conflicts surrounding Canada’s “single-payer” health insurance system. If you are inclined to read it, it helps if, first, you know about the Social Gospel tradition (for example, J.S. Woodsworth and Stanley Knowles); second, you are interested in 20th-century Canadian and Saskatchewan politics; and third, you have been engaged in managing a single-payer insurance system and/or multidiscipline community primary care clinics.

I qualify. Long ago, I was a Saskatchewan MLA and briefly served as legislative secretary to the health minister, Walter Smishek, who figures prominently in Marchildon’s book. For three decades I have assumed various board responsibilities for a multidiscipline primary care clinic in East Vancouver.

The rise of Tommy Douglas

Marchildon begins with a detailed biographical account of Tommy’s early years, introducing aspects of his family. He was born in Scotland in 1904 to a devout Protestant family. The family emigrated to Canada in 1912 and settled in Winnipeg. The key to understanding Tommy’s political career is the severe tuberculosis infection he suffered in one of his knees. He received high-quality care, thanks to a young surgeon at the University of Manitoba hospital in Winnipeg. By chance, this surgeon came across Tommy’s case in a general ward and performed, pro bono, a complicated procedure that saved his leg from amputation.

Two decades later, Tommy shifted his career from Baptist preacher to politician as a major leader of the Co-operative Commonwealth Federation (CCF), predecessor of the NDP. In the 1935 federal election, he ran successfully in Weyburn, a town in southeastern Saskatchewan, and was one of seven CCF candidates elected. In 1942 he became leader of the Saskatchewan CCF, and in the June 1944 provincial election the CCF won an overwhelming victory. As Premier, he kept the health portfolio for himself.

Tommy’s political rhetoric was in the populist tradition of both the Canadian Prairies and the Great Plains U.S. states. In small towns or a CCF conference, his typical speech started with a few jokes at the expense of the Canadian Pacific Railway or bank owners in Montreal and Toronto. My favourite among his 1940s-era jokes is based on cream separators. A farmer pours fresh milk into a separator; a worker turns the handle. A banker has his mouth on the cream spout; the farmer sells the skim milk. From time to time, bloated bankers want no more cream. They call for an economic depression: workers are laid off and farm prices collapse. In due course, bankers repeat the cycle. Another standard joke concerns the farmer who buys hammers in the town hardware store. The farmer buys the first hammer for $1.25, goes outside and sells it for $1 to anyone passing. He goes back into the store, buys a second hammer and again sells it for $1. When the hardware employee sees the farmer repeat this money-losing exercise a third time, he asks the farmer why. “It’s better than raising wheat,” the farmer replies. After the jokes, he praises farmers for doing God’s work by raising wheat and feeding the world. Finally, he speaks about socialist solutions – often health insurance – to current problems.

Unlike most rhetorically skilled Prairie politicians – such as John Diefenbaker, who became Prime Minister in the 1950s, and William Aberhart, Social Credit Alberta Premier in the 1930s – Tommy relied on progressive professionals once he became Premier. He made amends for sending Japanese Canadians to internment camps of during World War II by inviting a dozen well-educated Japanese Canadians to live in Regina. The best known among them, Tommy Shoyama, led the provincial economic planning board. After the CCF defeat in 1964, Shoyama moved to Ottawa and finished his career as federal deputy minister of finance. Al Johnson, a farm boy from rural Saskatchewan, served as provincial deputy minister of finance over much of Douglas’s reign and completed a Harvard PhD in public administration. Post-1964, he became assistant deputy federal finance minister, then headed the CBC. He played an important role in composing the 1984 Canada Health Act, which legislated the five principles of Canadian medicare, as well as in expanding equalization transfers to the provinces.

In the middle of World War II, William Beveridge, a U.K. economist, published a postwar welfare state agenda (Social Insurance and Allied Services). Leonard Marsh, a student of Beveridge’s, wrote a Canadian equivalent. Both reports figured in postwar policy debates, and high on the list of goals was universal health insurance. Under Clement Attlee’s postwar Labour government in the U.K., the most important social policy achieved was a universal single-payer medical insurance system with no payments at point of service. Implementation of the National Health System began in 1948. Tommy hoped to implement a similar comprehensive medical insurance program in Canada before his second election, in 1948.

Marchildon undertook detailed archival research on the disappointing postwar conferences of the prime minister and premiers. Ottawa and most of the premiers balked at the administrative complexity and cost of major welfare state programs, the most costly being universal medical insurance. One reason why Saskatchewan successfully led Canadian health insurance, as opposed to other provinces or the federal government, is the failure of Canadians to elect a CCF government anywhere else.

After World War II, there was a large supply of progressive professionals and limited demand for their ideas. If they wanted to stay in Canada and do something – as opposed to writing articles and books in universities – reform-minded professionals had to leave Toronto, Ottawa or Montreal and move to Regina, a small city with minus-40-degree winters “in the middle of nowhere.” Despite these drawbacks, many accepted Tommy’s invitations.

Tommy tried to persuade Ottawa and the provinces to share the cost of a national single-payer medical insurance scheme. Ottawa and the largest provinces, Ontario and Quebec, flatly refused. Finally, Tommy narrowed his initial goal to a single-payer hospital insurance plan to be in place in Saskatchewan by 1947, well before the second provincial election. Fortunately, Tommy had the backup of a dozen ideologically dedicated physicians and administrators. Marchildon describes their respective roles.

Dr. Mindel Sheps, a young doctor from Winnipeg, and her husband Cecil worked day and night to inspire rural municipal leaders, design necessary regulations and contend with consistent opposition by senior physicians leading the College of Physicians and Surgeons (CPS). From the beginning in the 1940s to the intense conflict in the 1960s, the CPS argued that the majority in the province paid insurance premiums and already had some form of health insurance; all that was needed was a means-tested subsidy for the poor. Despite CPS opposition, the Saskatchewan hospital insurance plan, initiated in January 1947, turned out to be a well-managed program that required no payment at time of service. Successful introduction of hospital insurance was an important factor in the CCF’s second provincial victory.

The introduction of medicare and the doctors’ strike

Sixteen years after 1944, Tommy faced his fifth and what would almost certainly be his last provincial election. He made the 1960 election campaign a referendum on comprehensive medical insurance. After winning the election, he turned to the administrative complexities. He assumed that, as in the earlier hospital insurance conflict, the provincial physicians would ultimately accept a single-payer system, with some compromises. Tommy was naive about the intense opposition of the CPS. In addition, he succumbed to pressure from David Lewis, the foremost advocate for transforming the rural-based CCF into an equivalent of the U.K. Labour Party, to become the first leader of the federal New Democratic Party.

Tommy resigned as premier in late 1961 to take on the federal NDP leadership. The Saskatchewan CCF-NDP selected Woodrow Lloyd as Tommy’s successor. Woodrow was one of nine children in a farm family in southwest Saskatchewan. The family could not afford university; instead, Woodrow became a teacher in Biggar, a small town near Saskatoon. (Passing by the town’s large sign on the highway, drivers read, “New York is big; this is Biggar.”) Tommy realized Woodrow’s political sophistication and insisted he run in the 1944 election. From 1944 until he became Premier, Woodrow served as education minister, and did for rural schools what Tommy did for the provincial health system.

During the first half of 1962, it looked as if comprehensive medical insurance might collapse. With financial support from the Canadian Medical Association, the CPS mounted an effective antisocialist, antimedicare campaign. The Liberal official opposition in the legislature was led by Ross Thatcher, a CCF MP who had become an apostate. Further complicating the conflict, the provincial health minister resigned, crossed the floor to join the provincial Liberals, and supported the CPS campaign. The CPS endorsed Keep Our Doctors, a citizens’ society campaigning for withdrawal of the medicare legislation. KOD organized public meetings around the province, culminating in a large demonstration in front of the provincial legislature in early July.

In the midst of the growing polarization, a federal general election took place on June 18. Tommy ran as the Regina CCF-NDP candidate (the Saskatchewan NDP members were reluctant to drop their “CCF” acronym). In the election, the Conservative MP won reelection, with double Tommy’s vote.

The provincial medical insurance program came into effect on July 1, 1962. The same day, the CPS triggered a doctors’ strike. Woodrow Lloyd was one of the major actors in the 1962 drama – as was Allan Blakeney, who became health minister in mid-1962 (and Premier in 1971). More than a hundred U.K. doctors were invited to Saskatchewan to provide at least minimum primary care. Woodrow invited Lord Taylor, a Labour member of the House of Lords, to serve as mediator during the strike. After ten days of shuttle diplomacy between the cabinet and the CPS offices, Taylor successfully negotiated a workable compromise that maintained the single-payer principle. (Taylor refused payment for his task – except for a government-paid week fishing in northern Saskatchewan lakes.)

Woodrow lacked Tommy’s rhetorical skills and lost the 1964 election to Ross Thatcher. Fortunately, both Lloyd and Blakeney were exceptionally competent administrators. They introduced the complex insurance plan in the midst of political polarization and a doctors’ strike. Two years after introduction, public opinion in Saskatchewan had switched. Universal medicare was too popular for Ross Thatcher to cancel.

In 1964, I was a naive young summer employee in the provincial planning board. Thatcher, the new Premier, shook hands with us. The new cabinet mistrusted civil servants, some of whom were using government cars for personal use. I wrote the memo to cabinet with the solution: all government cars would henceforth have a licence plate number preceded by “G,” which would shame civil servants tempted to abuse use government cars.

In 1968, I came to know Woodrow Lloyd as a friend. He was concerned about the Saskatchewan CCF-NDP. Would there be a generational renewal? Would the party collapse, as was the fate of most populist parties in the U.S. plains and Canadian Prairies? That summer, Woodrow trekked to Chicago to attend the conflict-ridden Democratic convention. He empathized with Hubert Humphrey’s Farmer-Labour party and wanted to discuss with Humphrey why he was willing to lead the Democrats in pursuing the French colonial Vietnam war.

Woodrow wanted me to enter politics. I did so. Sandy Nicholson, one of the last Social Gospel CCF-NDP members of the legislature, held a Saskatoon riding. He retired in 1970, and I won the nomination to succeed him. One day, Sandy took me to northeast Saskatchewan where he had campaigned in the 1930s. He recalled his youth, campaigning in winter by horse-drawn cabins on sleighs. My wife was not impressed. I was a one-term MLA: elected in 1971, defeated in 1975.

Marchildon devotes the last third of his book to post-1963 politics in Ottawa and other provinces. During Lester Pearson’s reign as Prime Minister, 1963 to 1968, he and his cabinet colleagues introduced major programs: the Canada/Quebec Pension Plan, the Guaranteed Income Supplement and a national copy of Saskatchewan’s single-payer medical insurance. Al Johnson and Tommy Shoyama had their fingerprints on all the program designs and funding. Not surprisingly, cabinet ministers disagreed – and the CMA lobbied against a single-payer system.

Tommy resigned his NDP leadership in 1971 and was succeeded by David Lewis. Douglas remained an MP until the 1979 election. In his final decade, he consistently pressured the government to entrench principles for medicare. He died in 1986, having lived to see enacted the five principles of the Canada Health Act.

Bilateral monopoly

 A theme throughout Marchildon’s history is physicians’ organized opposition to single-payer medical insurance – from Saskatchewan hospital insurance in the 1940s through the 1962 doctors’ strike to the Canadian Medical Association’s adoption of “extra billing” until enactment of the 1984 Canada Health Act.

Marchildon documents in great detail examples of “bilateral monopoly” (economists’ jargon). If the suppliers of a good or service have the ability to limit market supply and sell at high prices, and agents of the purchasers are similarly well organized to limit their collective willingness to pay, the outcome is unpredictable.

Individually, physicians are largely well-intentioned suppliers of quality health care. Collectively, they exercise a monopoly: they organize themselves into very powerful associations at the provincial and national levels. Provincial governments have monopsony power: the ability to control the number of practising physicians. They have taxpayers’ money with which to hire health care providers and determine their number and remuneration.

In Canada, the most dramatic illustration of bilateral monopoly was the 1960–62 conflict in Saskatchewan. The outcome of that battle enabled Canada to develop a single-payer insurance system. Despite Canadian Medical Association lobbying, Lester Pearson’s cabinet in the late 1960s extended the Saskatchewan system to all provinces.

By the 1990s, I was neither a naive summer employee in Regina nor a radical graduate student. Saskatchewan is a small province, and I was part of the CCF-NDP provincial “family.” In the 1991 election, NDP leader Roy Romanow defeated Grant Devine, the academic economist who had become Conservative Premier in the 1980s. To the shame of academic economists, Devine sold Saskatchewan crown corporations and created the largest debt relative to provincial GDP. By 1991, Allan Blakeney was in retirement, but he exercised considerable influence behind the scenes. I recall his conclusion that Romanow might well be a one-term premier because his first obligation was to “clean up the Devine financial mess.” Blakeney was wrong: Romanow remained Premier into the new century.

In the mid-1990s, after two decades of continuous deficits at both provincial and federal levels, Canada had a debt/GDP ratio above 100 per cent. It is ironic that the first province to balance its budget in the 1990s was Saskatchewan under the fiscally prudent CCF-NDP. Romanow increased taxes and cut spending. The province exercised its monopsony power by closing more than 50 small rural hospitals.

The federal Liberals under Jean Chrétien were a shoo-in to win the 1993 election. They prepared a “Red Book” campaign document which promised to continue expansion of federal spending. Chrétien’s senior Finance Department officials warned that, if Ottawa honoured the Red Book promises, the Canadian dollar would collapse as had the Mexican peso. Chrétien threw away the Red Book. The 1995 federal budget reduced transfers to provinces, trimmed employment insurance benefits, doubled Canada/Quebec Pension “contributions” and increased federal income tax rates. The premiers, obliged to cut spending and increase provincial taxes, blamed Ottawa. There followed a round of bilateral monopoly conflicts. On one side, physicians’ associations, nurses’ unions and public sector unions damned their respective provincial governments, three of them led by the NDP. On the other side were provincial finance departments.

Not surprisingly, given fiscal conflicts in the 1990s, provincial governments are avoiding further bilateral monopoly conflicts this decade. In the health sector, provinces have allowed physicians’ associations a too-expansive role. I have abandoned radical rhetoric and wound up using policy wonk prose on behalf of preserving single-payer health insurance. For anyone interested, I have recently written a C.D. Howe Institute critique of physicians’ policy dominance. Here are several pieces of circumstantial evidence that link the power of physicians’ associations to the present political crisis of lack of adequate primary care providers:

• Canadian physicians have reduced average weekly hours of work since 1990. Legitimately, young physicians want a better work/family ratio than the physicians they are replacing. Their associations have been able nonetheless to maintain stable inflation-adjusted remuneration.
• Normalized, Canadian general practitioners (GPs) in 2021 are at the 70th per cent rank among family physicians in OECD member countries; specialist physicians are at the 79th per cent rank.
• Canada’s ratio of practising physicians per thousand population is low. The OECD average in 2021 was 3.6 per thousand; Canada’s ratio, at 2.8 per thousand, was well below the average.
• In all countries, the ratio of physicians per thousand population is higher in urban than in rural regions. The Canadian urban/rural ratio is much higher than the OECD average, an indication of inadequate provision of rural health care.

The inadequate supply of primary care provision came to a boil during the COVID-19 pandemic. Every two years, the OECD surveys national respondents’ satisfaction with availability of quality health care. In 2019, 78 per cent of Canadians responded that they were satisfied with access to quality care, well above the OECD average. In the same survey conducted in 2021, the Canadian score was 56 per cent, a decline of 22 percentage points; the OECD average fell only four percentage points in the same period, from 71 to 67 per cent.

The major proposals of physicians’ associations are to train more GPs, build new medical colleges and, to some extent, certify more foreign-trained doctors. To date, the provinces have acquiesced. A partial solution to give governments more ability to challenge physicians’ associations is a massive expansion of nurse practitioners. All rigorous evaluations undertaken over the last quarter-century have concluded that nurse practitioners deliver ambulatory primary care as well as do family physicians. Provincial limited scope of practice is not the problem. Scope for nurse practitioners is nearly as broad as it is for general-practice physicians.

Ashoka Mody, India is Broken: A People Betrayed, Independence to Today. Palo Alto, CA: Stanford University Press, 2023. 528 pages. Deepti Kapoor, Age of Vice. New York: Riverhead Books, 2023. 548 pages. Ram Gopal Varma (director), Sarkar 3 (film).

Ashoka Mody is an economist, currently a faculty member at Princeton University. He has written a history of India’s politics and economic development over 75 years, from independence in 1947 to the management of COVID in 2020–22. Given his career – he spent over a decade at the World Bank, followed by nearly two decades as a senior official at the International Monetary Fund (IMF) – the reader might expect his book to employ the cautious style of international agencies such as the IMF. Admittedly, Mody discusses exchange rate policies, tax policies, income distribution, poverty rates and such. Neither the Bank nor the IMF would ever publish this book. Mody’s goal is to damn the priorities of Indian politicians, from Jawaharlal Nehru to Narendra Modi. Numerous academic colleagues (Indian, American and British) have reviewed the manuscript and provided implicit support for Mody’s prosecution.

Some academics, graduate students and motivated general readers will read Mody’s book. Its audience will probably be small. Those not willing to read a lengthy academic book can get a feel of Indian politics via “realist” authors and movie directors – such as Salman Rushdie’s Midnight’s Children, Aravind Adiga’s The White Tiger, the film Slumdog Millionaire (based on Vikas Swarup’s Q & A) and Ram Gopal Varma’s “Godfather” Sarkar films. Deepti Kapoor’s Age of Vice is a new novel with themes that overlap with Mody’s: unacceptably large income inequality; unacceptable corruption in government and business, much of it in construction and real estate; elite capture of state-level governments; and blurring of the distinction between corrupt politicians and corrupt businessmen. Her novel may not be as complex as Salman Rushdie’s, but it is a good read.

Mody’s two accusations

Mody’s first accusation is that, from the beginning, Nehru and most – albeit not all – Congress leaders failed to prioritize provision of universal quality services such as primary health care and, above all, basic education. Nehru was enamoured of large-scale infrastructure and industrial projects such as steel mills. He described himself as a socialist, but he avoided the complex administrative details required to establish school systems able to provide universal literacy and numeracy.

The second is that, after Nehru, no prime minister has given priority to containing corruption. Indira Gandhi abandoned her father’s discomfort with corruption. She described it as a “global phenomenon,” making no distinction between Scandinavia and India. Over the following decades, Mody argues, corruption expanded and has become deeply embedded in the conventions of India’s public services. The potential for democratic accountability to rectify matters has more or less disappeared.

By prioritizing Hindu nationalism (Hindutva) and dismissing Mahatma Gandhi’s insistence on religious tolerance, Narendra Modi has eliminated the possibility of a major political party campaigning successfully on a platform reversing the political rot dating back to Indira Gandhi. Among many items of evidence, Mody notes the rise in the share of members of parliament (Lok Sabha) with pending criminal cases: from 24 per cent in 2004 (Congress government led by Manmohan Singh) to more than 40 per cent in 2019 (BJP government led by Modi).

Mody’s conclusion, echoing Kapoor: India is broken.

Basic education failure in South Asia and the Sri Lanka exception

Mody devotes a chapter to Rabindranath Tagore. Tagore is known as a poet and novelist, but he was also a passionate advocate of universal public education: “In my view the imposing tower of misery which today rests on the heart of India has its sole foundation in the absence of education. Caste divisions, religious conflicts, aversion to work, precarious economic conditions – all centre on this single factor.”¹ Tagore travelled widely; he examined public school systems in many countries. As mentor to Nehru, he (unsuccessfully) recommended that an independent India pursue the education strategies of countries such as the Soviet Union, Japan and Sri Lanka.

Akin to Canada in the mid-19th century, by the 1930s governments in the provinces of the British raj controlled domestic policy. Unlike the rest of the subcontinent, the leading politicians in Colombo prioritized universal basic education in the decades prior to Sri Lanka’s gaining sovereignty in 1948. The education minister, C.W.W. Kannangara, played a powerful role in cabinet debates over priorities. He and Tagore offered mutual support on the importance of education. By the time Kannangara retired from politics in 1947, Sri Lanka had an adult literacy rate of about 65 per cent, four times the rate elsewhere in the subcontinent. Tagore died in 1941. Had he lived past 1947, he would have been deeply disappointed.

Mody thanks his 96-year-old father for providing help on the early chapters dealing with the politics of Nehru’s reign. Presumably, this passage reflects both his and his father’s conclusion:

The government persisted in dedicating insufficient funds to primary education and spending those scarce education funds on higher education. Thus, India acquired a lopsided education system that did not serve the people and created the incentives among students for acquiring degree certificates rather than acquiring education. Corruption infiltrated the administration, especially, of colleges and universities.

Convincing evidence exists to confirm the conclusion of Mody and his father that, since 1947, India has continued to suffer a “lopsided education system.” Tagore’s “imposing tower” of illiteracy has shrunk over the last 75 years, but the majority of Indian children remain illiterate. The first five-year plan (1951–56) promised that all children aged 6–11 would achieve, within a decade, at least universal primary education and hence basic literacy and numeracy. Six decades later, in 2009, the Congress government enacted the Right to Education Act, which specified universal education to age 14. At the central and state levels, governments spent money on better school facilities but made no progress on reducing corruption in hiring and posting of teachers, decentralizing administration and increasing teacher supervision. Overall, student outcomes have not improved.

The only credible assessment of primary education outcomes across rural India is very large in-home surveys organized every two years by Pratham, a large NGO. The two key results of these surveys are the ability of Grade 5 students (the final primary grade in South Asia) to read a short story at a Grade 2 level and successfully divide a three-digit by a one-digit number. In the 2018 survey, the most recent pre-COVID, on average 50 per cent of more than 500,000 children surveyed could read the story; 28 per cent could do the division. Admittedly, the variance across Indian states is large.²

A new piece of evidence is the World Bank’s learning poverty statistic, a heroic attempt to compare basic literacy rates across countries in the cohort of children expected to be in upper-level primary grades. In India, the 2022 learning poverty rate (proportion of children between the ages of 10 and 14 who can’t read a Grade 2 story) is 56 per cent. That is, only 44 per cent of children in that age range can read at a Grade 2 level. The comparable rate in Bangladesh is 42 per cent able to read, in Pakistan 25 per cent. By contrast, 85 per cent of Sri Lankan children can read, at least at the Grade 2 level.

Failure to control corruption

The World Bank defines corruption as “the extent to which public power is exercised for private gain, including both petty and grand forms of corruption, as well as ‘capture of the state’ by elites and private interests.”³ Those engaged in corruption have an incentive not to divulge their illegal activity. Hence, measuring corruption is open to much debate. One respected measure of corruption at the national level is Transparency International’s annual Corruption Perception Index. In 2022, of 147 countries ranked top to bottom, India ranked 85th. Incidentally, the corruption in other South Asian countries is worse. Bangladesh ranked 147th, Pakistan ranked 140th, Nepal ranked 104th and Sri Lanka ranked 101st.⁴

Here is Mody’s abstract to Chapter 22 (“Modi Breaks India’s Fractured Democracy”):

A democracy works for the people when it provides public goods that help everyone enhance their own well-being. By that test, Indian democracy definitively betrayed its people. When Narendra Modi became prime minister , Indians suffered from poor quality education and health services, cities were chaotic, the judicial system worked only for some, and rampant environmental pollution was depleting the inheritance of India’s children. The centrality of construction as a growth driver was contributing to corruption and the injection of criminals in politics; this was true for even progressive states such as Tamil Nadu. With Modi’s ascent, an intolerant Hindutva became an added impediment to democracy. Modi’s initiatives to provide more toilets and gas stoves helped but made no dent in the broader lack of public goods. The 2019 election brought election spending, legislators facing criminal charges, and Hindutva to a new crescendo, sending Indian democracy into possibly irreversible decline.

Mody provides a critique of Indian business elites, politicians (in all major parties) and the judiciary. At time of writing (February 2023), it appears that Gautam Adani, head of a conglomerate with headquarters in Gujarat (Modi’s home state), has manipulated financial accounts. The result is a halving of Adani’s known corporate share values, previously $200 billion USD. The Economist’s summary of recent events is consistent with Mody’s:

The Modi years have in many ways eroded India’s checks and balances. His government has steadily undermined the independence of the courts and the police. The media are mostly too cowed to investigate the mighty as they once did. Few Indian newspapers would have touched a story about Mr Adani had an American firm not asked the tough questions first. Mr Adani himself recently bought NDTV, a news channel that was once critical of the government but is now supine.⁵

South Asia’s “realists”

Kapoor’s novel is partially an autobiography. Neda, a central character in the novel, is an investigative journalist for a Delhi newspaper. Kapoor was a journalist while in her 20s. She admits to participating in the dissolute lifestyle of Delhi’s young and rich. The second central character, Sunny Wadia, is the dilettante son of the powerful though thoroughly corrupt and brutal patriarch of the Wadia construction firm. The third is Ajay, son of an impoverished single mother whose husband has been killed by a neighbouring farmer. Ajay’s mother sells him to a trafficker of child servants and prostitutes. Ajay ultimately becomes Sunny’s personal assistant.

At times in the novel, Kapoor assumes the role of journalist and describes the tactics whereby the Wadia firm displaces slum dwellers in Delhi and buys up land titles of farmers with small holdings in the city’s outskirts. There is a corrupt beneficial link between the Wadia corporation and the chief minister of Uttar Pradesh. I don’t want to spoil the climax. Reviewers in the New York Times and the Guardian refer to Mario Puzo’s Godfather as a precedent.⁶ Both novels are based on the complex codependence of organized criminals and senior politicians. There are other literary precedents to note.

Kapoor has obviously been inspired, in terms of plot, by Adiga’s White Tiger, a brilliant satire and winner of the 2008 Booker prize. Adiga’s equivalent of Ajay is Balram, a very smart, very ruthless peasant from Bihar. He rises in status to become the driver for Mr. Ashok, owner of a coal mine. To get the permit for a new mine, Mr. Ashok must pay a very large bribe to the relevant cabinet minister in Delhi. As he drives his employer to the minister’s apartment, he slits Mr. Ashok’s throat and disappears with the duffel bag stuffed with cash. This provides Balram with the necessary financing to become a successful entrepreneur in Bangalore. The novel is written as a series of letters to the prime minister of China who is about to visit Bangalore and witness India’s high-tech developments there. Balram wants the Chinese guest to learn about the actual manner of conducting business in India, not the Potemkin village version prepared by political elites.

Much as Balzac, Dickens, Dostoyevsky and Gogol described the indefensible extremes of wealth, poverty and corruption in 19th-century Europe, Kapoor and Adiga are two of many realist novelists who describe the contemporary shape of Indian society. To these two can be added their Pakistani equivalents, Mohsin Hamid and Mohammed Hanif.

A link from Dickens to contemporary South Asian writers is Slumdog Millionaire, a film loosely based on Vikas Swarup’s novel Q & A that won the 2009 Oscar as best film of the year. The actors were all Indian; the director, Danny Boyle, was British. The equivalent of Fagin in Oliver Twist could be the thugs who recruit street children on a Mumbai garbage dump, blind them and set them up as productive beggars. The Mumbai Oliver and a young girl escape the clutches of Mumbai’s Fagins. He becomes a chawallah (tea seller), working for a television company that runs a popular quiz show; she becomes a prostitute. By good luck, Oliver finds a benefactor; by good luck, the chawallah becomes a quiz contestant and wins a million rupees. He elopes with the girl, who is liberated from a brothel. The ending is a Bollywood song and dance.

Ram Gopal Varma has, in the manner of Francis Ford Coppola, directed several “Godfather” Bollywood movies. He freely acknowledges his inspiration from Coppola and Puzo.⁷ His most recent Sarkar was released in 2017. Varma is here testing the limit of free expression in Modi’s India. Sarkar is a Mumbai don, the equivalent of Brando’s aging mafia don. The film introduces corrupt businessmen, corrupt politicians and corrupt police, as well as the role of vigilante justice. In Godfather II, the opening scene is an old man appealing to the don to revenge the rape of his daughter by beating up the rapist. In a similar scene in Sarkar, Sarkar’s lieutenants murder the rapist as he steps out of an expensive car parked at the entrance to a five-star hotel. As Al Pacino succeeds the old don, Sarkar’s “good son” agonizes over his family obligations. Ultimately, he sacrifices a peaceful domestic life in America with his fiancée and, instead, continues Sarkar’s tradition of vigilante justice.

The defence

Mody’s book is the prosecutor’s case against Indian elites. However, there is a defence case to be made. The defence is in the bullet points, with the prosecutor’s response in italics:

• The share of the population living below the “low” income country poverty threshold of $2.15 USD per person per day⁸ has dramatically declined since 1947. It is now only 10 per cent. The World Bank classifies India as “lower-middle” income with a recommended poverty threshold of $3.65 USD per person per day. With this somewhat higher threshold, 45 per cent of Indians are poor.
• India has had an impressive rate of per capita GDP increases since the turn of the century. The average annual increase from 2000 to 2019, the last year prior to COVID, was over 5 per cent, not as high as China but well above the increase among nearly all other “lower-middle” income countries. Despite embedded corruption and grossly inadequate public services, India illustrates that a country can achieve impressive growth rates. There is a ceiling to per capita GDP of “low middle” income countries with lamentable social services and high corruption. All “upper middle” income countries, such as China and Malaysia, deliver tolerably good education and health services.
• Over the last 50 years, Indian life expectancy at birth has risen from about 50 to 70. The life expectancies at birth for both Sri Lanka and China are higher.
• If we compare India 75 years after independence to, say, Britain 75 years after the publication of Adam Smith’s Wealth of Nations, we should discuss the Great Exhibition of 1851. It was an overly self-satisfied celebration of the British economy. It took another century before Clement Atlee, Labour Prime Minister following World War II, created adequate universal social services in the U.K. This is a legitimate argument against the British, but in post-1947 India everyone expected better than Britain in 1851.
• Mody elaborates on the role of corruption in destroying the environment of the subcontinent. For example, the air in India’s megacities is undeniably dangerous to human health, but probably no worse than the air in London as described by Dickens in Bleak House (published in 1853). Given rising temperatures and sea levels, we cannot wait for a century before Indian elites assume social responsibilities.

These are five credible qualifications but, were I the judge, I would still endorse Mody, the prosecutor.

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