Use of the term Jihadist an example of electronic and print graffiti.
With the recent flurry of cases of young Muslim Americans who were allegedly planning to engage in Jihad, like the five young men from Virginia who were detained for questioning in Pakistan and other cases, there has been extensive use of the term Jihadist to describe these individuals. Electronic and print media use the term Jihadist with abandon many a time link it with the phrase Islamic terrorist. From reporters, “Recruits in jihadist training camps “ (Katharine Houreld, Associated Press), to politicians, “ground zero for Jihadist terrorist plots”, (U. S. Rep. Mark Kirk), to op-ed writers and commentary on the electronic media, “Whenever a jihadist volunteers for martyrdom” (Charles Krauthammer) everyone is in to using the term to mean an unreasonable, faith driven extremist, the so called dead-ender. The word Jihadist does not exist in Muslim lexicon. Jihad does.
The word Jihad, which has the letters JHD and the as its root, and its derivatives jahada and jaahada, appear numerous times in the Qur’an and are used to describe “Striving for God with the effort which is His right.” A literal translation of the word Jihad would be “struggle” but the phrase that would capture the spirit of the word would be “a noble struggle.”
For ordinary piety minded Muslims all through the ages, the concept of Jihad is quite straightforward, and can be illustrated by the following anecdote. Once when Muslim soldiers were returning from a military engagement, their commander made the statement that "We are going from a lesser Jihad to a greater Jihad". The soldiers were surprised, I suspect dismayed, and asked which military engagement they were headed for next. The commander replied that by "the greater Jihad" he meant Jihad or struggle against one's inner self (Nafs).
Jihad is to strive for the highest possible goals, struggle against injustice and practice self denial and self control to achieve moral purity. That is how Muslims understood the word and applied it in their personal, social, political and military lives.
There are Muslim apologists who argue that Jihad does not mean “Holy war.” They are right in the sense that it more accurately means “just war.” Violence is to be used in self defense, in a limited manner, and as the absolute last resort and with no loss or injury to innocent life. Nevertheless the history of Muslim rule is replete with examples of those who attempted to sanctify their wars of personal aggrandizement as wars for a noble cause by labeling them Jihad. A few even named their war departments as the “departments of Jihad.”
Those who consider Jihad as a "fight against the whole world", including other Muslims who do not subscribe to a group’s incoherent and exclusivist understanding of Islam, like the al-Qaeda, seriously misunderstand it; they corrupt the concept.
Those who have no use for it in public life and define it strictly as a way of improving self; they diminish the concept.
Then they are those who understand it as a difficult but noble struggle to be conducted with patience, wisdom and with peaceful means, these are most Muslims, they comprehend the proper concept.
This “jihad of the new age” is to fight for rights, justice and dignity in “the realm of ideas, media, and communication,” such as the internet, video, and satellite television is in essence activism. It may used to influence politics and policy, feed the hungry and provide health care for the needy or write a blog.
Those who use the terms Jihad and Jihadist in a derogatory fashion, divorced of its original meaning, its historical and theological context and all of its nuances are either ignorant or lazy or both. Some are bigoted and are indulging in Muslim bashing.
Javeed Akhter, a physician, is founding member of a Chicago based Muslim American think tank “The International Strategy and Policy Institute.”
Sunday, December 20, 2009
Saturday, November 28, 2009
An Attitude of Gratitude
Javeed Akhter
If we reflect upon it for a minute there is lots we all have to be thankful for. Much of it we take for granted; our life, health, children, knowledge and so on.
Islam strives to make people lose this complacency and be aware of their good fortunes. In the Qur'anic chapter titled Rahaman the flamboyant recurring refrain “and which of thy Lord’s favors will you deny?” is a direct allusion to the human flaw of taking things for granted.
Though not unique, the teaching that one should be thankful in every circumstance and strive to attain an attitude of gratitude, is central to Islamic way of thinking.
Gratitude may be expressed in many ways, like charity, and Sadaqa but above all by good deeds; by giving without expecting thanks in return.
A consequence of being thankful is optimism. It is an antidote to pessimism and depression.
Dr. Robert A. Emmons of the UC Davis has done interesting research on gratitude and its relation to happiness. Some of his findings were summarized in an op-ed in the Chicago Tribune recently. Those who kept gratitude journals and lists, felt better about their lives as a whole, and were more optimistic than those who recorded hassles or neutral life events. They were more likely to have made progress toward important personal goals (academic, interpersonal and health-based) over a two-month period compared with control groups. Young adult subjects self reported higher levels of positive states like enthusiasm, determination, attentiveness and energy. They were more likely to have helped someone with a personal problem or having offered emotional support to another.
In summary Emmons' research shows that inculcating and practicing gratitude resulted in higher reported levels of optimism, alertness, energy, enthusiasm and determination.
Salat, the Muslim prayer, is a gratitude exercise performed many times a day; sajada, prostration, is the ultimate symbol of gratitude.
Different stages of gratitude are recognized: The first level is gratitude for the favors one has received I life. A higher state is attained when one is grateful even if a wish is unfulfilled. Here one sees the blessing veiled in difficulty.
The Qur’anic verses from Fajr (89.15, 16) allude to both of these states; it considers both good and bad fortune as equal trials.
As for man, whenever his Lord tries him by honoring him, and is gracious unto him, he says: My Lord honors me. (15)
But whenever He tries him by straitening his means of life, he says: My Lord despises me. (16)
People who realize good fortune is as much of a trial as is difficulty and those who remain thankful, even in the face of hardship, have achieved an uncommon level of spirituality. They have attained the much coveted inner peace, the nirvana, the serenity of soul, the tranquility of heart that we all desire. The challenge is to remain content, even in adversity.
As a wise man once noted “A heart filled with thankfulness has no room for self-pity or despair.”
Sunday, November 15, 2009
The Fort Hood Tragedy:
Need for Patience.
A major tragedy, like the horrific violent act by Major Hasan, brings to the best and the worst in people.
Even before we learned any of the details of the incident or the bio of the killer politicians like Joseph Lieberman were calling it the greatest act of Islamic terrorism since 9/11. Lieberman, who is in charge of homeland security, plans to launch an investigation even though he has pre judged the conclusions. Lieberman is joined in his shrill rhetoric by many in the media and a slew of right wing pundits.
Experts tell us that an act like this is multi-factorial in origin. It is becoming increasingly clear that Major Hasan’s actions may have been partially because he either was mentally ill or snapped under the stress of his personal circumstances. There are indications that he was increasingly ambivalent in fighting other Muslims. But it is not clear how much he was motivated by religious zeal. If he was then he has clearly a wrong and twisted understanding of Islam.
It is reported that he became increasingly reclusive after his parent’s death. His supervisors during the residency program worried about his becoming “psychotic.” It is hard to understand why they did not demand a psych evaluation. But we still do not know all the details. We need to wait till the army’s investigation is complete. This is not to condone or justify his actions or turn him into a victim; it is to understand what happened and learn from it.
Even a psychiatrist may have an incipient mental illness that is exacerbated by the stress of his work. This may be especially true if the work involves dealing with human tragedy like PTSD ad infinitum. Others in the army in positions similar to Hasan should be examined for warning signs of stress.
Not uncommonly a sudden and swift breakdown is the first overt sign of a mental illness. All too frequently early symptoms of a mental illness may be misconstrued as personality trait of being introverted or having poor social skills. The person suffering from mental illness, almost invariably, does not recognize that he is in trouble. Often family or close friends may not pick up on clues of an impending breakdown. Major Hasan appears to be a man who had few friends and a meager social support network.
There are contradictory reports that Hasan was stereotyped and even harassed. It would not be surprising if some stereotyping goes on in large institution like the army. A question to be looked at carefully is how the armed forces deal with stereotyping of minority groups like women, blacks, gays, Muslims and others.
It is important that a professional and unbiased analysis of all the factors involved be carried out. The army appears to be doing just that. The investigation should not be tarnished by the grandstanding of politicians or Islamophobes.
The words of General George Casey Jr., the Army chief of staff, provide much needed dose of sanity and objectivity when he pointed out that Hasan may have just “snapped” and cautioned against speculation about the soldier’s faith might “cause a backlash against some of our Muslim soldiers.” General Casey pointed out correctly that “it would be a shame if our (army’s) diversity became a casualty as well” of the tragedy. Casey’s words are wise and apply to our civil society as well. We are a nation committed to the ideals of fairness, justice, tolerance and above all E pluribus ununm.
Javeed Akhter, a physician, is founding member of a Chicago based Muslim American think tank “The International Strategy and Policy Institute.”
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Saturday, October 31, 2009
Dalit Children forced to clean toilets at school.
Dalit Children forced to clean toilets at school.
Even hardened cynics would be shocked by the story reported in an English language Indian weekly Outlook that dalit children are routinely forced to clean toilets in schools in Gujarat. This was not an expose by the news weekly but an account of a conference held at Sabarmati Ashram founded by Gandhi. "The children were at the ashram to share their 'experiences' with a fact-finding panel, tales of being forced to clean toilets and mop floors in school, of horrific discrimination by their upper-caste schoolmates and teachers. They came to the podium in line, district by district, took the mike to tell their stories," said the report.
The story added that "All these kids work for a pittance, cleaning manure pits, dragging dead animals, helping their parents to sweep streets, mop floors, clear garbage, clean toilets. In schools they are forced to do this for free. In the evenings the children accompany their parents to collect leftovers from the homes their mothers work in. It's known as "baasi" or stale food."
A recent novel "A Fine Balance" by Rohinton Mistry weaves in the plight of the dalits in a compelling narrative not meant for the faint of heart. Relentless, graphic and depressingly matter of fact, Mistry's novel leaves the reader's emotions in tatters. The reality of these children in Gujarat's schools is even more emotionally wrenching. It appears to be wide spread and raises few if any eyebrows.
The caste system is the most severe indictment of traditional Hinduism, which otherwise has much humanism in it. I do not know how caste system can be rationalized leave alone justified. My Hindu acquaintances and friends I suspect are largely uncomfortable with this part of their faith.
This is not to say that other faiths in India do not practice discrimination based on caste. Eighty percent of Christians who are of dalit background complain of the higher Christian castes monopolizing the Church hierarchy. Muslim society in India is guilty of its own social ills. One reason for the revered reformer Ambedkar's conversion to Buddhism, and not Islam, as a way out of the dalit black hole was the discrimination by Muslims of a group amongst them, the so called Arzals. He criticized Muslims for sugarcoating their sectarian caste system with euphemisms like "brotherhood".
I have not been witness to caste based discrimination among Muslims. This may be because I have lived in an urban and not a rural environment. But I have seen pervasive 'servant' abuse in India that is really another form of class discrimination. Servants, many of them children, are not allowed to eat at the same table or sit at the same level. Sometimes I have seen waiters in restaurants verbally abused as are chauffeurs. Many as a result of years of discrimination have a painfully obsequious attitude toward those perceived as belonging to a higher class.
In spite of its many social ills it would be fair to state that Islam has done a better job at getting rid of stratification based on race and caste. Who among Muslims has not heard the statement in Prophet Muhammad's last speech when he said that we should stratify people not on the basis of race but their righteous behavior.
India needs to act forcefully and quickly to exorcise it's demon of the caste system. The laws are there but they need to be enforced. There are hopeful changes in the political arena as witnessed by the election of a dalit leader Mayawati as Chief Minister of the large and important state of Uttar Pradesh. Yet much more needs to be done.
India's hopes for reform lie in its strong English language press, which has good record as a watch dog, and a large intelligentsia with a growing tradition of standing up for human rights.
Javeed Akhter, a physician, is founding member of a Chicago based Muslim American think tank "The International Strategy and Policy Institute."
Sunday, October 11, 2009
Health Care Reform.
Reforming healthcare while ignoring the physicians.
If physicians, who after all drive healthcare, were asked how they would reform the system, they may come up with somewhat different set of proposals that are being debated.
High on the list would be stringent transformation of the health insurance industry, malpractice reform and reeducation of physicians in giving up defensive medicine in favor of practice based on evidence based guidelines. This would truly improve the health care system and arguably attain substantial cost savings.
Physicians would debunk the myth that US has the best health care system in the world that should be left alone. It is also not as bad as some statistics tend to show. US physicians are well trained, Hospitals are equipped with star wars technology, medical and surgical protocols are exemplary and followed by the rest of the world. If criteria like life expectancy, infant and child mortality and cost effective care are used as parameters US is lower than many developed countries. No Canadian or Brit or French would like to migrate to the US for health care; unless they could afford it.
The main problem our healthcare is the huge rich/poor, rural/urban and inner city/suburb divide. There are North side Hospitals in Chicago that are so well appointed they rival five star Hotels and others in the South side that look like they are in a poor country in a different continent. The healthcare system suffers from an ethical deficit not a dearth of god medicine. No system that leaves millions of its citizens unprotected can be called a good system
The insurance industry makeover must include simplifying rules reducing phone calls and paper work that accounts for 7% of healthcare expenses. Many physician practices have one or more associates devoting their time simply dealing with paper work generated by many and confusing rules. For hospitals this administrative load is exponentially greater. Avarice of insurance companies has resulted in a diabolically complex system with multiple and confusing plans.
There are in network and out of network options to consider (your favorite physician may be out of network and therefore out of reach) and pre authorization even for PPO plans is common place. Current insurance plans may accurately be described as schemes that have more to do with increasing corporate profit and less with providing health care.
The “pre existing condition” clause and loss of coverage when individuals move to a different job are other examples of egregious Insurance behavior that health care reform proposals aim to eliminate and are universally embraced by care givers and care receivers alike.
Insurance companies, if they wish to do business, should be mandated to offer a simple, economical, no questions asked, basic plan. This frill free plan would provide for catastrophic coverage, hospitalizations and routine preventive care. The premiums for this type of plan may be subsidized by the federal government. This along with expanded Medicare eligibility and appropriate funding of Medicaid would eliminate the need for the “Public Option.” Expanded coverage would result in timely health maintenance, fewer visits to emergency room with significant cost savings.
Malpractice reform is a necessity not a luxury. The current malpractice system is corrosive, penalizes the caregivers directly and the patients indirectly. It is common to hear in discussions among physicians phrases like “It is not indicated medically but for medico-legal reasons it would be prudent to run the test.” That is not good medicine. Physicians are not suggesting getting rid of malpractice system but making it fair and balanced. Freedom from the ever present terror of the malpractice suit would allow the physicians to practice medicine the way it should be.
At the very end of the speech on health care reform to the joint session of Congress President Obama mentioned the words physicians had been waiting eagerly to hear; “malpractice reform.” But the statements that followed left many scratching their heads in puzzlement as there were few specifics mentioned; “move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine.” It seemed like a gesture to appease rather than a commitment to do anything substantive.
President Obama remarked “I don't believe malpractice reform is a silver bullet” and added, “I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.” President Obama is right malpractice reform is not a silver bullet and may not result in much direct cost saving but it will result in an assurance to the care receivers that they may not be subjected to excessive tests and much needed peace of mind for the care givers. What is distressing is that the malpractice issue has been reduced to largely economic question when it is primarily a matter that affects physicians as humans with feelings and vulnerabilities. There is no other country in the world where physicians practice their craft under GREATER DURESS than in the US. People tend to forget that a malpractice suit not only threatens their livelihood and life savings but cause untold emotional stress. Many experienced physicians have retired early or moved from sates like Illinois to states like Indiana that have instituted reasonable malpractice reform that we can learn form and improve upon. President Obama may have talked to many doctors but has he listened to any?
As a part of reform physicians would be retrained to practicing Evidence Based Medicine, and not defensive medicine; this arguably would result in large cost savings. Educating physicians in moving away from defensive medicine that is partly driven by fear of a malpractice suit, partly bad habits inculcated over years and partly patient expectation of a perfect outcome is a cultural shift of seismic proportions.
But it can be done.
Increasingly carefully crafted evidence based guidelines are published by societies in the discipline. Physicians would argue evaluating their performance on practicing Evidence Based Medicine rather than outcomes alone as suggested by President Obama is a better option. Outcomes depend on many and complex variables and would be problematic to use as the only way of judging good care. Caregivers who take on patients with higher acuity and complexity may have lower outcomes. Physicians and hospitals may start screening for patients with lesser acuity. Another part of the education process would be encouraging patients to enquire about guidelines in place in a practice or hospital for managing a particular illness and how is their efficacy being assessed.
Americans are compassionate group and have an admirable history of caring for their neighbors and regardless of party affiliation. They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness; I know they will support a sensible and compassionate health care reform. But successful reform depends on listening to physician concerns.
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
If physicians, who after all drive healthcare, were asked how they would reform the system, they may come up with somewhat different set of proposals that are being debated.
High on the list would be stringent transformation of the health insurance industry, malpractice reform and reeducation of physicians in giving up defensive medicine in favor of practice based on evidence based guidelines. This would truly improve the health care system and arguably attain substantial cost savings.
Physicians would debunk the myth that US has the best health care system in the world that should be left alone. It is also not as bad as some statistics tend to show. US physicians are well trained, Hospitals are equipped with star wars technology, medical and surgical protocols are exemplary and followed by the rest of the world. If criteria like life expectancy, infant and child mortality and cost effective care are used as parameters US is lower than many developed countries. No Canadian or Brit or French would like to migrate to the US for health care; unless they could afford it.
The main problem our healthcare is the huge rich/poor, rural/urban and inner city/suburb divide. There are North side Hospitals in Chicago that are so well appointed they rival five star Hotels and others in the South side that look like they are in a poor country in a different continent. The healthcare system suffers from an ethical deficit not a dearth of god medicine. No system that leaves millions of its citizens unprotected can be called a good system
The insurance industry makeover must include simplifying rules reducing phone calls and paper work that accounts for 7% of healthcare expenses. Many physician practices have one or more associates devoting their time simply dealing with paper work generated by many and confusing rules. For hospitals this administrative load is exponentially greater. Avarice of insurance companies has resulted in a diabolically complex system with multiple and confusing plans.
There are in network and out of network options to consider (your favorite physician may be out of network and therefore out of reach) and pre authorization even for PPO plans is common place. Current insurance plans may accurately be described as schemes that have more to do with increasing corporate profit and less with providing health care.
The “pre existing condition” clause and loss of coverage when individuals move to a different job are other examples of egregious Insurance behavior that health care reform proposals aim to eliminate and are universally embraced by care givers and care receivers alike.
Insurance companies, if they wish to do business, should be mandated to offer a simple, economical, no questions asked, basic plan. This frill free plan would provide for catastrophic coverage, hospitalizations and routine preventive care. The premiums for this type of plan may be subsidized by the federal government. This along with expanded Medicare eligibility and appropriate funding of Medicaid would eliminate the need for the “Public Option.” Expanded coverage would result in timely health maintenance, fewer visits to emergency room with significant cost savings.
Malpractice reform is a necessity not a luxury. The current malpractice system is corrosive, penalizes the caregivers directly and the patients indirectly. It is common to hear in discussions among physicians phrases like “It is not indicated medically but for medico-legal reasons it would be prudent to run the test.” That is not good medicine. Physicians are not suggesting getting rid of malpractice system but making it fair and balanced. Freedom from the ever present terror of the malpractice suit would allow the physicians to practice medicine the way it should be.
At the very end of the speech on health care reform to the joint session of Congress President Obama mentioned the words physicians had been waiting eagerly to hear; “malpractice reform.” But the statements that followed left many scratching their heads in puzzlement as there were few specifics mentioned; “move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine.” It seemed like a gesture to appease rather than a commitment to do anything substantive.
President Obama remarked “I don't believe malpractice reform is a silver bullet” and added, “I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.” President Obama is right malpractice reform is not a silver bullet and may not result in much direct cost saving but it will result in an assurance to the care receivers that they may not be subjected to excessive tests and much needed peace of mind for the care givers. What is distressing is that the malpractice issue has been reduced to largely economic question when it is primarily a matter that affects physicians as humans with feelings and vulnerabilities. There is no other country in the world where physicians practice their craft under GREATER DURESS than in the US. People tend to forget that a malpractice suit not only threatens their livelihood and life savings but cause untold emotional stress. Many experienced physicians have retired early or moved from sates like Illinois to states like Indiana that have instituted reasonable malpractice reform that we can learn form and improve upon. President Obama may have talked to many doctors but has he listened to any?
As a part of reform physicians would be retrained to practicing Evidence Based Medicine, and not defensive medicine; this arguably would result in large cost savings. Educating physicians in moving away from defensive medicine that is partly driven by fear of a malpractice suit, partly bad habits inculcated over years and partly patient expectation of a perfect outcome is a cultural shift of seismic proportions.
But it can be done.
Increasingly carefully crafted evidence based guidelines are published by societies in the discipline. Physicians would argue evaluating their performance on practicing Evidence Based Medicine rather than outcomes alone as suggested by President Obama is a better option. Outcomes depend on many and complex variables and would be problematic to use as the only way of judging good care. Caregivers who take on patients with higher acuity and complexity may have lower outcomes. Physicians and hospitals may start screening for patients with lesser acuity. Another part of the education process would be encouraging patients to enquire about guidelines in place in a practice or hospital for managing a particular illness and how is their efficacy being assessed.
Americans are compassionate group and have an admirable history of caring for their neighbors and regardless of party affiliation. They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness; I know they will support a sensible and compassionate health care reform. But successful reform depends on listening to physician concerns.
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
Wednesday, September 30, 2009
euphemisms are for unethical acts: public option is a moral obligation.
The use of the euphemism “public option” has added to the confusion in the health care reform debate. Let us call it what it is; plan to cover the millions of uninsured and underinsured.
I include the large numbers of Medicaid recipients among the under insured. Because of poor reimbursement there are major swaths of the country, suburban and rural areas, where primary physicians do not accept Medicaid and an even a larger number who limit the number of these patients in their practices. These numbers are even higher among subspecialists and the problem of inability to get necessary subspecialist help has reached epidemic proportions.
Many others who have private insurance are partially covered because of the rampant abuse of the pre-existing clause by insurance companies. Still others because of job losses are on the way to join the ranks of the under insured and uninsured.
AT ITS VERY ESSENCE UNIVERSAL HEALTH CARE IS AN ETHICAL QUESTION. Do we as a society believe that health care is a basic human right that all of inhabitants of the US should have or do we consider it a luxury. Are we in line with the 12th century Muslim scholar al-Ghazali who asserted that “Profession of medicine is a duty on the society that some of its members can carry in lieu of the whole.” Or do we agree with John Mackey, CEO of Whole Foods who basically said “health care is a commodity that only the rich deserve.”
Americans are compassionate group of people with an admirable history of caring for their neighbors and regardless of party affiliation would support the idea that basic health care it is a right not a privilege. They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness. Most would agree that there should be basic, including catastrophic, coverage for all.
Let us also be honest that we cannot cover millions of new individuals and fund Medicaid and Medicare properly without spending money. Reform, including malpractice reform, may save substantial amounts but not enough for the new expenses. They would have to come from either new taxes, or redistribution of funds in the budget or both.
But if as a nation we agree with the basic goal of leaving no citizen behind in health care coverage then we can discuss the best option or options that are available to accomplish it. We would only be joining the Brits and Canadian and many others who already do so.
The choices include the government run insurance company, the “public option”, but who would want a new bureaucracy; look at all the bureaucracies we already have, look at the post office. Insurance companies could be mandated to offer a simple, economical basic plan for all comers. This would provide for catastrophic coverage, hospitalizations and routine preventive care. The premiums for this frill free plan may be subsidized. Another option, which the administration is already considering, would be to change the Medicare into a hybrid plan where some who qualify might buy into. Medicare has been around and its administrators have done a decent job administering healthcare compared to the private insurance companies; without question they like the private insurers need better oversight.
But the administration has to be honest and up front and President Obama should follow his own advice that we should speak in public what we say in private and stop using euphemisms that only confuse; that is the best antidote to the smear of socialism that the reform is being subjected to. What makes a nation great is not its wealth and might but its ideals and compassion; I believe we live in a great nation
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
I include the large numbers of Medicaid recipients among the under insured. Because of poor reimbursement there are major swaths of the country, suburban and rural areas, where primary physicians do not accept Medicaid and an even a larger number who limit the number of these patients in their practices. These numbers are even higher among subspecialists and the problem of inability to get necessary subspecialist help has reached epidemic proportions.
Many others who have private insurance are partially covered because of the rampant abuse of the pre-existing clause by insurance companies. Still others because of job losses are on the way to join the ranks of the under insured and uninsured.
AT ITS VERY ESSENCE UNIVERSAL HEALTH CARE IS AN ETHICAL QUESTION. Do we as a society believe that health care is a basic human right that all of inhabitants of the US should have or do we consider it a luxury. Are we in line with the 12th century Muslim scholar al-Ghazali who asserted that “Profession of medicine is a duty on the society that some of its members can carry in lieu of the whole.” Or do we agree with John Mackey, CEO of Whole Foods who basically said “health care is a commodity that only the rich deserve.”
Americans are compassionate group of people with an admirable history of caring for their neighbors and regardless of party affiliation would support the idea that basic health care it is a right not a privilege. They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness. Most would agree that there should be basic, including catastrophic, coverage for all.
Let us also be honest that we cannot cover millions of new individuals and fund Medicaid and Medicare properly without spending money. Reform, including malpractice reform, may save substantial amounts but not enough for the new expenses. They would have to come from either new taxes, or redistribution of funds in the budget or both.
But if as a nation we agree with the basic goal of leaving no citizen behind in health care coverage then we can discuss the best option or options that are available to accomplish it. We would only be joining the Brits and Canadian and many others who already do so.
The choices include the government run insurance company, the “public option”, but who would want a new bureaucracy; look at all the bureaucracies we already have, look at the post office. Insurance companies could be mandated to offer a simple, economical basic plan for all comers. This would provide for catastrophic coverage, hospitalizations and routine preventive care. The premiums for this frill free plan may be subsidized. Another option, which the administration is already considering, would be to change the Medicare into a hybrid plan where some who qualify might buy into. Medicare has been around and its administrators have done a decent job administering healthcare compared to the private insurance companies; without question they like the private insurers need better oversight.
But the administration has to be honest and up front and President Obama should follow his own advice that we should speak in public what we say in private and stop using euphemisms that only confuse; that is the best antidote to the smear of socialism that the reform is being subjected to. What makes a nation great is not its wealth and might but its ideals and compassion; I believe we live in a great nation
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
Ten Myths about health care reform debate.
Just as truth is the first casualty of war, in the debate on health care reform facts have become increasingly shrouded in the fog of partisan debate. Here is an attempt to separate ten myths from facts.
Myth #1. US has the best medical system in the world.
For those few who have the Cadillac Insurance plans this is indeed true. US physicians are very well trained, Hospitals are equipped with star wars technology, the procedures and medical and surgical protocols used here are followed by the rest of the world. But if health criteria like life expectancy, infant and child mortality and cost effective care are used as parameters US is lower than most developed countries. No Canadian or Brit would like to migrate to the US for better health care.
There are also huge rich/poor, rural/urban and inner city/suburb divides. In the Chicago area this North/South divide is both figuratively and literally true. There are North side Hospitals in Chicago that are so well appointed they rival five star Hotels and others in the South side of the city that look like they are in a poor country in a different continent. No system that leaves millions of its citizens unprotected can be called a good system
Myth #2. Folks who have private insurance love it and want to keep it.
That may have been true a few years ago but is no longer accurate. There is very little of the old hassle free commercial insurance left. The avarice of the insurance companies has resulted in a diabolically complex system that is currently in place with multiple and confusing plans like PPO, HMO, conventional commercial and POS tailored differently for individual physicians and PHOs. Co pays keep getting higher, there are in network and out of network options to consider (your favorite physician may be out of network and therefore out of reach) and pre authorization even for PPO insurance is common place. The “pre existing condition” clause and loss of coverage when individuals move to a different job are other examples of egregious Insurance behavior that the health care reform proposals may successfully eliminate.
Current insurance plans may accurately be described as schemes to increase corporate profit and less to do with providing health care. Patients and care givers alike spent hours trying to deal with the complexities of the system. Many physician practices have one or more associates devoting their time simply dealing with paper work generated by many and confusing rules. For hospitals this administrative load is exponentially greater. Patients have to jump through hoops of fire to get the insurance companies to pay up. There is a great need for simplifying the plans, making them uniform and putting in place oversight and tight controls. Reform proposals do not address this issue simplifying rules and reducing paper work.
Myth #3. There is a lot of fat in Medicare and Medicaid, which with reform will result in major savings.
Medicaid is poorly managed and highly underfunded. The reimbursement is so low that large numbers of primary care physicians do not accept Public Aid patients. The numbers of specialists who decline Public Aid recipients is even higher and has reached crisis proportions.
Medicare is riven with incompetence and graft and in theory can be reformed; no one has reformed it in years. The reimbursement to pharmaceutical firms for medications can be easily fixed with significant dollar savings. Similarly the payment to hospitals can be structured to provide mare cost effective care.
It would be better to take the administration of Medicaid and Medicare out of the hands of government bureaucrats and give to an independent agency with strong oversight.
Myth #4. Malpractice reform is not needed as it is a necessary protection for patients and does not affect the cost of care.
The current malpractice system is corrosive, penalizes the caregivers directly and the patients indirectly as it adds immense cost to the health care system. A popular medical website, visited by physicians to learn current management of illnesses, includes a section dealing with the medico-legal angle of the illness. It is common to hear in discussions among physicians phrases like “It is not indicated medically but for medico-legal reasons it would be prudent to run the test.” A direct effect of the current malpractice system is to force physicians to practice defensive medicine with its attendant cost.
People tend to forget that doctors are humans too and a malpractice suit not only threatens their livelihood and savings but causes serious emotional stress. Many experienced physicians have retired early or moved from sates like Illinois to states like Indiana that have instituted reasonable malpractice reform that we can learn from and improve upon.
Physicians are not suggesting getting rid of malpractice claims but making them fair and balanced. Malpractice reform would result in reduction in the practice of defensive medicine and excessive testing with large cost savings. Physicians need to be more transparent and police their own better. In a global sense tort reform is about restoring trust between patient and physician. Health care reform ignores this issue.
Myth #5. Americans are unwilling to pay extra for extending coverage to their uninsured fellow citizens.
Americans who are compassionate as a group have an admirable history of caring for their neighbors and regardless of party affiliation would support the idea that basic health care it is a right not a privilege. Although the 12th century Muslim scholar al-Ghazali is not well known, they would agree with his assertion that ““Profession of medicine is a duty on the society that some of its members can carry in lieu of the whole.” They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness. Most would also agree that there should be a safety net of catastrophic coverage for all.
Myth #6. AMA’s support implies physicians are lined up behind the plan.
Most physicians are not. AMA is apprehensive of the changes as they appear to be poorly thought out. They are supportive of the plan because they do not appear to look like they are hindering reform.
Myth #7. The “public option” is popular with many.
Most actually do not understand the logic behind the public option. They do not see much difference between the public option and other government run plans like Medicare and Medicaid and are afraid it might turn into another boondoggle. Physicians and Hospitals worry that it might be another way of driving down their reimbursements.
Myth #8. The plan will cost a trillion dollars over 10 years.
The history of health care insurance cost predictions tell us that it will end up costing a lot more.
Myth #9. Physicians and Hospitals should be evaluated and reimbursed based on outcomes.
Physicians would argue evaluating performance on practicing Evidence Based Medicine and not outcomes alone is a better option. The outcomes depend on many and complex variables and would be difficult to use as the only way of judging good care. Caregivers who take on patients with higher acuity and complexity may have lower outcomes. Consequently physicians and hospitals may start screening for patients with lesser acuity.
Myth #10. President Obama is attempting health care reform.
What is being attempted started out as health care reform but may now be described as a health insurance reform. A true health care reform would be holistic and attempt to change and not just insurance but attitudes toward health, like obesity, lack of physical exercise, self afflicted addictions like nicotine, drugs and alcohol and end of life issues. It would mean changing the health care attitudes of the care receiver as well as the care giver. The challenges of delivering health care to the inner city and rural areas depends not merely on availability of insurance but access to care, transportation, making primary care available, educating the families and patients on the importance of preventive care and doing outreach at home when necessary.
It is a change in attitudes that is critical to health care reform.
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
Myth #1. US has the best medical system in the world.
For those few who have the Cadillac Insurance plans this is indeed true. US physicians are very well trained, Hospitals are equipped with star wars technology, the procedures and medical and surgical protocols used here are followed by the rest of the world. But if health criteria like life expectancy, infant and child mortality and cost effective care are used as parameters US is lower than most developed countries. No Canadian or Brit would like to migrate to the US for better health care.
There are also huge rich/poor, rural/urban and inner city/suburb divides. In the Chicago area this North/South divide is both figuratively and literally true. There are North side Hospitals in Chicago that are so well appointed they rival five star Hotels and others in the South side of the city that look like they are in a poor country in a different continent. No system that leaves millions of its citizens unprotected can be called a good system
Myth #2. Folks who have private insurance love it and want to keep it.
That may have been true a few years ago but is no longer accurate. There is very little of the old hassle free commercial insurance left. The avarice of the insurance companies has resulted in a diabolically complex system that is currently in place with multiple and confusing plans like PPO, HMO, conventional commercial and POS tailored differently for individual physicians and PHOs. Co pays keep getting higher, there are in network and out of network options to consider (your favorite physician may be out of network and therefore out of reach) and pre authorization even for PPO insurance is common place. The “pre existing condition” clause and loss of coverage when individuals move to a different job are other examples of egregious Insurance behavior that the health care reform proposals may successfully eliminate.
Current insurance plans may accurately be described as schemes to increase corporate profit and less to do with providing health care. Patients and care givers alike spent hours trying to deal with the complexities of the system. Many physician practices have one or more associates devoting their time simply dealing with paper work generated by many and confusing rules. For hospitals this administrative load is exponentially greater. Patients have to jump through hoops of fire to get the insurance companies to pay up. There is a great need for simplifying the plans, making them uniform and putting in place oversight and tight controls. Reform proposals do not address this issue simplifying rules and reducing paper work.
Myth #3. There is a lot of fat in Medicare and Medicaid, which with reform will result in major savings.
Medicaid is poorly managed and highly underfunded. The reimbursement is so low that large numbers of primary care physicians do not accept Public Aid patients. The numbers of specialists who decline Public Aid recipients is even higher and has reached crisis proportions.
Medicare is riven with incompetence and graft and in theory can be reformed; no one has reformed it in years. The reimbursement to pharmaceutical firms for medications can be easily fixed with significant dollar savings. Similarly the payment to hospitals can be structured to provide mare cost effective care.
It would be better to take the administration of Medicaid and Medicare out of the hands of government bureaucrats and give to an independent agency with strong oversight.
Myth #4. Malpractice reform is not needed as it is a necessary protection for patients and does not affect the cost of care.
The current malpractice system is corrosive, penalizes the caregivers directly and the patients indirectly as it adds immense cost to the health care system. A popular medical website, visited by physicians to learn current management of illnesses, includes a section dealing with the medico-legal angle of the illness. It is common to hear in discussions among physicians phrases like “It is not indicated medically but for medico-legal reasons it would be prudent to run the test.” A direct effect of the current malpractice system is to force physicians to practice defensive medicine with its attendant cost.
People tend to forget that doctors are humans too and a malpractice suit not only threatens their livelihood and savings but causes serious emotional stress. Many experienced physicians have retired early or moved from sates like Illinois to states like Indiana that have instituted reasonable malpractice reform that we can learn from and improve upon.
Physicians are not suggesting getting rid of malpractice claims but making them fair and balanced. Malpractice reform would result in reduction in the practice of defensive medicine and excessive testing with large cost savings. Physicians need to be more transparent and police their own better. In a global sense tort reform is about restoring trust between patient and physician. Health care reform ignores this issue.
Myth #5. Americans are unwilling to pay extra for extending coverage to their uninsured fellow citizens.
Americans who are compassionate as a group have an admirable history of caring for their neighbors and regardless of party affiliation would support the idea that basic health care it is a right not a privilege. Although the 12th century Muslim scholar al-Ghazali is not well known, they would agree with his assertion that ““Profession of medicine is a duty on the society that some of its members can carry in lieu of the whole.” They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness. Most would also agree that there should be a safety net of catastrophic coverage for all.
Myth #6. AMA’s support implies physicians are lined up behind the plan.
Most physicians are not. AMA is apprehensive of the changes as they appear to be poorly thought out. They are supportive of the plan because they do not appear to look like they are hindering reform.
Myth #7. The “public option” is popular with many.
Most actually do not understand the logic behind the public option. They do not see much difference between the public option and other government run plans like Medicare and Medicaid and are afraid it might turn into another boondoggle. Physicians and Hospitals worry that it might be another way of driving down their reimbursements.
Myth #8. The plan will cost a trillion dollars over 10 years.
The history of health care insurance cost predictions tell us that it will end up costing a lot more.
Myth #9. Physicians and Hospitals should be evaluated and reimbursed based on outcomes.
Physicians would argue evaluating performance on practicing Evidence Based Medicine and not outcomes alone is a better option. The outcomes depend on many and complex variables and would be difficult to use as the only way of judging good care. Caregivers who take on patients with higher acuity and complexity may have lower outcomes. Consequently physicians and hospitals may start screening for patients with lesser acuity.
Myth #10. President Obama is attempting health care reform.
What is being attempted started out as health care reform but may now be described as a health insurance reform. A true health care reform would be holistic and attempt to change and not just insurance but attitudes toward health, like obesity, lack of physical exercise, self afflicted addictions like nicotine, drugs and alcohol and end of life issues. It would mean changing the health care attitudes of the care receiver as well as the care giver. The challenges of delivering health care to the inner city and rural areas depends not merely on availability of insurance but access to care, transportation, making primary care available, educating the families and patients on the importance of preventive care and doing outreach at home when necessary.
It is a change in attitudes that is critical to health care reform.
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
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