Policy as Experimentation Failing 'Forward' Towards Universal Health Coverage in India

The article starts with puzzlement about the optimism of a new generation of (Indian) policy-makers who believe that investing in digitally managed publicly funded health insurance (PFHI) schemes can dramatically improve health security in India, provide poor people with seamless access to high-quality hospital care and contribute significantly towards achieving universal health coverage. In view of persistent high social inequality and dissatis-faction with the chronically underfunded medical system, this optimistic vision appears as a curious utopia, not least because it survives multiple failures and heavy critique. Fine-grained ethnography shows that in practice the ambitious transformation of health finance, via the operation of national health insurances projects, was slow to be established and plagued by myriad technical and administrative frictions, and its impact on wellbeing and sustainabil-ity has been heavily contested. By zooming into the nitty-gritty of the laborious roll-out of a project with dramatically new features, this article illustrates that hope for transformation emerges less from successful implementation than from the determination to keep trying ??? seeking improvement through tweaking the system and reforming policy. Welfare in this iteration is an experimental engagement with future-making. As such, it does not promise effective management per se; rather, it demands investment in an uncertain journey, cobbled together by tinkering, adjusting, reforming and re-regulating.