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Background paper prepared as a contribution to the Muslim statement before the US Congress on the healthcare debate by Professor Omar Hasan Kasule MB ChB (MUK), MPH (Harvard), DrPH (Harvard) September 15th 2009.
Statistics proving disparities in healthcare access and quality are not enough to motivate reform if the society as whole lacks the political will to act as a result of paralysis of 4 inter-dependent institutions needed in a healthy society: faith, brotherhood, mutual social help, and economic equity. All these 4 Islamic institutions are the same as basic and old American values whose recent decline is partially to be blamed for the healthcare crisis. The debate on healthcare cannot be confined to technical aspects of insurance coverage and availability of services because Disparities in healthcare access is just one manifestation among several forms of social inequity. There is a need to address fundamental issues of economic strength and economic justice.
Faith (iman) in one Creator-God is the basis for universal human brotherhood (ukhuwwat insaniyyat) and mutual social help (takaful ijtimae) both of which cannot be realized in practice without a strong and equitable income system (nidhaam maali). Universal human brotherhood[1] implies love, and caring for others, assisting the downtrodden (mus'adat al madhluumiin)[2], relieving needs (qadhau al haajaat)[3], and taking care of the weak (al ínaayat bi al dahuáfaa)[4]. Mutual social support starts in the family with caring for the young, the elderly (birr al waalidayn)[5], and relatives (Ittau al quruba)[6]. It extends to the general community in which members are like a building supporting one another (buniyaan yashuddu baádhuhu ba'dhan)[7]. The community is one physiological entity that suffers if any organ is afflicted (ka mathali al jasad al waahid idha ishtaka minhu udhu tadaaa lahu saairu al jasad bi al sahari wa al humma). Members of the community love for other what they love for themselves.[8] They relieve the stress of others[9]. They are kind to one another (marhamat)[10] and they know the rights of the needy (haqq al sail wa al mahruum)[11]. Special attention is given to weak groups that have a right to assistance such as orphans and widows (haqq al dhaifain al yatiim wa al mar at)[12] who have to be fed and clothed[13] [14] as well as the poor who also need feeding[15] [16] and clothing[17]. Giving is encouraged in all good causes (infaaq al maal fi al khair)[18]: to the relatives (infaaq ala dhi al qurba)[19], the orphans (infaaq ala al yatiim)[20], the poor (infaq ala al masakiin)[21]. Poverty can be relieved by zakat, a special tax taken from the rich to be given to the poor[22] (‘ilaaj al faqr bi al zakat)[23]
We cannot talk about healthcare reform separate from the economic system. Basically those who fall through the healthcare safety net are those who are economically disadvantaged. Economic self-sufficiency (kasab al rajul min ‘amal yadihi)[24] is a major social goal for each citizen. If every able bodied person were fully employed with a reasonable wage we would have gone far in solving the healthcare problem because job-based insurance would cover the worker and his / her family. The worker may have extra income to help pay for health coverage for parents and other relatives. For those incapable of supporting themselves, society would through either direct taxation or through charitable contributions provide for their health coverage. This leads us to talk about the economic system.
The ability of society to provide the needed safety net depends on the strength of its economic performance. Basic human sustenance such as food, water, medical care, shelter as a bounty (rizq) from the Creator God which is expansive and there in totality enough for everybody (bastat fi al rizq)[25] but mal-distribution may result in some being paupers or needy. Income differences among people are natural (tafaut al rizq bayna al khalq)[26] the only problem is when those differences are excessive or are created by systematic discrimination that perpetuates the differences. Lack of differences in wealth would eliminate the incentive to work and self-improvement because basically wealth is obtained as a reward for work (al maal ka ajr)[27].
The crux of the healthcare debate in America today is whether the wealthier members of society, in the spirit of universal brotherhood (ukhuwwat) and mutual social support (takaful), are willing to part with part of their wealth to support healthcare for the disadvantaged members of society. The way America concludes this debate will be an accurate barometer of its moral responsibility.
Beyond solving the healthcare problem we need to look beyond to its main cause: economic disparities and evolve a long-term solution.
[1] (p81 3:156, 3:168, 7:65, 7:73, 7:85, 11:50, 11:61, 11:84, 26:102, 26:124, 26:147, 26:161, 27:45, 29:36, 33:18, 46:21, 50:13)
[2] (nisa 73, anfal 72)
[3] (ma’uun 4-7, haaqat 33-34)
[4] (dhuha 9-10, kahaf 28)
[5] (an’am:151-152)
[6] (isra 22-38)
[7] (Bukhari and Muslim)
[8] (Bukhari and Muslim)
[9] (Muslim)
[10] (balad:11-18)
[11] (ma’arij:19-35)
[12] (KS579 Ahmad 2:439)
[13] (KS579 Muslim K53 H42, Abudaud K40 B120, 121, Tirmidhi K25 B14., 44, Ibn Majah K33 B6, Ahmad 2:375, Ahmad 4:344, Ahmad 5:29, 250, 265, 333, Tayalisi H1322)
[14] (p999 4:5)
[15] (KS511 Bukhari K27 B5, 6, 7, 8, K64 B35, K76 B16, Muslim K15 H80, 81, 82, 83, 84, 85, 86, Abudaud K11 B42, Tirmidhi K44 S2 H20, 21, Tirmidhi K44 S58 H1, Nisai K24 B94, Ibn Majah K25 B84, Muwatta K20 B237, 238, 239)
[16] (KS511 Bukhari K30 )
[17] (p999 5:89)
[18] (p1058-9 2:3, 2:177, 2:195, 2:245, 2:261-262, 2:265, 2:270-274, 3:134, 4:39, 8:3, 9:34, 9:99, 9:103, 22:35, 24:33, 28:54, 32:16, 34:39, 51:19, 57:7, 57:10-11, 57:18, 59:9, 63:10, 64:16-17, 90:14, 92:5-7, 92:18)
[19] ( )
[20] ( )
[21] ( )
[22] (KS261 Bukhari K24 B1,18,63, Abudaud K9 B39, Tirmidhi K5 B21, Ibn Sa’ad J4 Q2 p76)
[23] (p904-905 2:83, 2:177, 2:184, ?3:315, 2:271-273, 4:6, 4:8, 4:36, 5:89, 5:95, 8:41, 9:60, 17:26, 18:79, 22:28, 22:36, 24:22, 30:38, 51:19, 58:4, 59:7-8, 69:34, 70:24-25, 74:44, 76:8, 89:18, 90:14-16, 93:8, 93:10, 107:3)
[24] (KS248 Bukhari K34 B15, K42 B13, Nisai K44 B1, Ibn Majah K12 B1, Darimi K18 B9)
[25] (p192 5:64, 17:30, 27:82, 29:62, 30:37, 34:36, 34:39, 39:52, 42:12, 42:27)
[26] (p 498 2:212, 3:27, 13:26, 16:71, 17:30, 24:38, 28:82, 30:37, 34:36, 34:39, 39:52, 42:12, 42:27, 43:32, 65:7, 89:15-16)
[27] (p1062 11:29, 23:72)