The two nation theory

Back in the early 1940s, when the cause of Indian independence was gaining strength, the "Two Nation Theory" was proposed. The premise of the theory was simple and succinct -- the Hindus and Muslims living in the then British India were always segregated communities and thus Muslim-majority enclaves must be formed if the otherwise minority is to survive the inevitable massacre at the hands of the Hindus.

The upshot of this theory and the Indian independence in 1947 was that the British India was split into 3 contiguous landmass - India, West Pakistan (now Pakistan) and East Pakistan (now Bangladesh). The ensuing confusion, lawlessness and general chaos led to the death of 1 million (or more) in various riots as well as atrocities committed on the various refugee groups. Large amounts of property was summarily destroyed in an orgy of wanton destruction. Amongst the more gruesome activities, entire train-loads of refugees were massacred.

I am writing to show you how this theory was patently wrong then and how it is being undermined today.

Firstly, the Hindus and Muslims were not as segregated as the theory suggested. Most Muslims in India were not imports but converts. Many handicrafts in India were the exclusive province of one sub-sub-sub-caste confined to a small geographical location. When such groups decided to convert (at various times), that skill went over the Muslim side but the demand remained where it always did. For example, Varanasi is full of Muslim weavers who make very exquisite sarees that are traditionally worn by Hindu women. Many of the decorations for temples are Muslim-made as well. Muslim also had no problem borrowing money from Hindu moneylenders.

Another hotspot of Hindu-Muslim interaction is Muradabad where various brass, silver (and these days silverplated) items are made. Most of the artisans are Muslim but the consumption is universal. This city is responsible for exports worth $1 Billion a year!

These Hindu-Muslim links were not only economic in nature but also spiritual. Kabir was a famous spiritualist who rejected the Hindu-Muslim divide and till date has followers in both religions. But he is only one of many hundred spiritualists that are revered by followers of both religions. And while rare, Hindus and Muslims have married across the religion line as well with many Moghul kings (all Muslim) marrying Rajput princesses (all Hindus) in an attempt to shore up their kingdom.

While mass conversions (usually Hindu to Muslim) were common while various Muslim dynasties ruled over India and made Hindus pay more taxes, many families saw only some of the members convert to Islam. Such "split families" are common across India. So, the notion that there is no interaction and no common community of Hindus and Muslims comes under a cloud.

Even back in 1940s, it was obvious to many that the two-nation theory was nothing less than bunkum. Unfortunately, this theory grew legs so long and large that 1947 was etched into the brains of many refugees as they tried to move to either Pakistan or India. Surprisingly, at the end of the partition, there were more Muslims in India than in Pakistan. Sri Prakasa related an interesting story that happened when he was the Indian High Commissioner (aka Ambassador) to Pakistan. Some Muslims appeared at his office demanding help to go back "home" to Varanasi (which is in India), Sri Prakasa's hometown. When he replied that Pakistan was their home after the partition, these men grew very agitated. The initial fiction of two-nation theory did not survive the bout with reality and these men realized that their lives were intertwined with Varanasi and not Lahore!

Within 20 years of partition, the residents of then East Pakistan felt supressed under the rule of West Pakistan and in 1971, they separated to form Bangladesh. They felt that while West Pakistan was also a Muslim-majority state, their Bengali culture was a bigger defining attribute than their religion!

Sadly, the three counties still suffer from grinding poverty in many parts. Yet their fears have led to massive investments in the military and wars. Parvez Musharraf, the current dictator of Pakistan, was a little boy at the time of partition and many of his family members were massacred as they moved from India to Pakistan. At that time itself, he pledged to become a member of the military and protect his family. Unfortunately, too many people are more interested in "protecting" than in realizing that such suspicion is not helping matters one bit. These three countries are tied together by history and geography. The sooner they realize that they need to co-operate to improve their own lots, the sooner this festering wound can start to heal.

American Healthcare

American healthcare has lately been in the news quite often. Why? Well, for one, people are feeling the pinch of rising costs of healthcare. For those with insurance, co-pay and deductibles are going up while the insurance rates are also going up. Many employers are no longer provideing free health insurance, expecting the employees to pony up anywhere from 10% to 50% of the premium. For those without insurance, life is full of stress because of the amazingly high costs of medicines and doctor visits, not to mention surgical procedures. Employers too are feeling the heat from insurance companies as they attempt to trim costs, especially towards retiree healthcare.

Many Americans are coming up with clever methods to reduce their costs. Many in the northern states are visiting Canada for a weekend of fun and a bagful of medication for their chronic conditions, from diabetes supplies to heart pills. Many others are going on medical-tourism, getting elective and not-so-elective surgeries done in Poland, India, China, Thailand and Mexico. All these developments beg the question - Is our system broken?

Critics of the American system of healthcare often point out that Americans spend far more money than any other developed nation without the commensurate benefit in the form of higher life expectancy and better quality of health. Is it a fair statistic? As tempting as these statistics might be, I don't think that they are fair. Life expectancy is a complex measure derived from a lifetime of choices and decisions. We Americans lead, by and large, sedentary lives and are exposed to far more mental stresses than most other people. While medicine definitely has a role to play, life expectancy is more about lifestyle choices than medicine.

The supporters of our system of healthcare are quick to point out that Americans lead in innovations in medicine, surgery, therapy and if you were to be involved in a major accident, your survival is best in the US. All of this might be true but it still does not answer the fundamental question - Is our mechanism for healthcare delivery broken?

The American system has evolved over many decades, with many features and nuances that are unique to this country. The American psyche is quite allergic to government-run and government-mandated systems even though we interact with them on a daily, even hourly basis. Our electricity, gas, water, cable-TV, sewage, garbage collection and roads are all either supplied directly by the federal, state or local government or through government-sanctioned monopolies. The healthcare system also has a veneer of private enterprise even though many of the hospitals are funded by state or local governments and most hospitals are run with federal monies. In addition, many millions get health insurance from Medicare or Medicaid, both federal government programs.

My personal frustration with the healthcare system is the un-needed complexity and disincentives built into the system. For example, each health insurance company (and there are hundreds of them) has their own codes and forms for the doctor to fill out for reimbursement. Because of this lack of uniformity, errors in billing are common and require quite a bit of extra work on part of the doctors, nurses and ancillary staff. In addition, each health insurance plan has its own list of covered services which is another minefield that the medical staff, not to mention the patient, has to negotiate. The upshot is that payments take a long time, require many iterations of attention from the insurance company, the provider and the patient and in general waste a lot of productive hours, which get paid out of the higher medical costs.

The disincentives are even worse. Most insurance plans allocate a fixed amount of money for each patient to pay the providers for regular care. As the providers have an incentive to do the least amount of tests and spend the least amount of time and thus save money, the real loser is the patient and his/her health! Insurance companies pay large sums for treating diseases such as cancer but prevention takes a backseat. Many insurance plans don't even cover vaccinations!

What can we do to improve the situation?

Well, there are a lot of things that we can do. We can definitely try to compel the health insurance companies to get together and unify their codes and forms. This would reduce inadvertant billing errors which eat up a lot of time, effort, money and energy.

But, a bigger issue is, what is the society's response to the healthcare situation in the big picture? General Motors has been in the news lately for its very high healthcare costs that are helping it shrink. Toyota overtook GM as the world's largest automaker. Are the American companies and the American society going to go that way?

So, dear reader, ponder on the questions while I try to formulate how a single-payer system can be to our benefit.

Laws and loopholes

Let me tell you a story. Long time back in India, there was a king who was a devout follower of Brahma (one of the original Gods in Hinduism, along with Vishnu and Shiva; rest are avatars of these three). The king once prayed to Brahma for such a long time that Brahma appeared in front of him and asked him what he wanted. The king said "I want to be immortal". Brahma said "Sorry, but that is not possible. Only Gods can be immortal. You are a human being. I can grant you long life but not immortality". Hearing this, the king though long and hard and said "Okay. I would like that neither man nor beast can kill me". Brahma said "Ok".
"I cannot be killed during the day or night."
"Ok."
"I cannot be killed indoors or outdoors."
"Ok."
"Neither on ground nor in the air." (As you can see, he was anticipating air travel)
"Ok."
"Neither by missile nor by melee weapon." (In Sanskrit, there are two words for weapons - astra and shastra - differentiated by whether they are held while in use, such as a dagger, or thrown to use, such as darts)
"Ok."

The king was happy. But soon, he became cruel and started abusing his populace. And given the boon of near-immortality, he was simply unbeatable. When things came to a boil, Vishnu decided that he had to do something (Vishnu's role in Hindu mythology is quite central. His job is to keep the world in order by periodically restoring the balance between good and evil).

So, Vishnu came on earth in the avatar of Narasimha, a man-lion hybrid (Nara = man + Simha/Singha = lion). He grabbed the king and went and sat in the courtyard and lay the king on his lap such that no part of the king was touching the ground and at dusk, ripped the king apart with his long fingernails. Thus the king was killed by neither man nor beast, neither indoors nor outdoors, neither on ground nor in the air, neither during the day nor during the night and finally neither by held nor thrown weapon.

So, as you can see, the king might have figured out a loophole to become immortal, but Vishnu figured out a loophole within that.

The take-home lesson that I see in this story is that the more complicated the law, the easier it is to find loopholes. Therefore, I would like to see laws written in simple language. Our tax laws are as clear as mud and often we see people take advantage of loopholes. Then there are other laws that are so complicated that people don't even know when they are violating them. We should make laws simple to read and understand.

Something to ponder...