16 SOCIAL SCIENTIST is not taken into account is an entirely arbitrary one. Thus, the basic exercise is full of methodological flaws. Not only is the methodology employed in demonstrating the great gains to be had from the pursuit of the Bank plan flawed, but in fact there is reason to believe that these gains may not be there; and this relates to an essential feature of structural adjustment. Such programmes begin by criticising the performance of the State sector, but the "dualism" institutionalised as a consequence cause the performance of the State sector to be actually even worse than had been the case to start with. Consider the case of health. The persons responsible for the public sector health effort would be a bunch of lower-paid (than in the private sector), disgruntled medical employees; since there would be neither any material incentives nor any "moral" incentives (concepts such as "working for the country", "serving the people" etc. having been abandoned as ludicrous sentiments in the new ambience of "market-friendliness"), they are likely also to have lower levels of competence, commitment and honesty. In other words, even in the so-called essential services the quality of the services would deteriorate, even if the quantity expands (and this quantitative expansion too would depend upon "foreign aid"), so that the gains claimed on the basis of the mere quantitative expansion would have turned out to be illusory. The health plan which seems attractive at first sight is in fact, to my mind, an effort to make the structural adjustment package, which is often criticised precisely on the grounds of its adverse effects on health and other social sectors, appear palatable. NOTES AND REFERENCES 1. I have discussed this issue in "International Capital Mobility and National Economic Policy: A Critique of India's Economic Reforms", Economic and Political Weekly, March 19, 1994, and also in "International Finance and the Problem of Effective Demand in Underdeveloped Countries'", paper presented to a colloquium in Paris, September 1994, mimea 2. Rather surprisingly this second issue does not appear to have been discussed much in the literature. While there is some discussion of the internal political economy compulsions which make third world economies go in for structural adjustment, the political economy of structural adjustment itself has received scant attention. Josef Steindl and Amit Bhaduri's "The Rise of Monetarism as a Social Doctrine", Thames Papers on Economic Activity, Autumn 1983, discusses the political economy of monetarism. C.P. Chandrashekhar's "The Macroeconomics of Imbalance and Adjustment" forthcoming in P. Patnaik (ed.). Macroeconomics (in the Themes in Indian Economics series of OUP, New Delhi) i& one of the few attempts at a political economy of such adjustment. ^ 3. Whatever sacrifice of consumption is made in such a case is made by the workers who yield the "forced savings"; but they are not the ones who acquire the wealth. See J.M. Keynes, A Treatise on Money Vol, 1: The Pure Theory of Money, Macmillan, London, 1930. 4. Rosa Luxemburg, The Accumulation of Capital (1913; Eng. Tr. RKP, London, 1951).