"I have always dreamed," he mouthed, fiercely, "of a band of men absolute in their resolve to discard all scruples in the choice of means, strong enough to give themselves frankly the name of destroyers, and free from the taint of resigned pessimism which rots the world. No pity for anything on earth, including themselves, and death enlisted for good and all in the service of humanity." - Joseph Conrad, The Secret Agent
Recently, the terrorist attacks around the world and the concurrent reading of "Holy War, Inc." by Peter Bergen (which in my opinion is quite unequivocally the most detailed, vivid read of the Taliban and Osama bin Laden without overdoing conjecture and personal thought) have got the gears in my head turning. Delving into the psyches of America's most wanted men has lately become an obsession of mine in attempts to dig up accurate accounts of what drives terrorist motives and what can be done to stop the seemingly endless bloodshed. My recent learnings have been disconcerting, to say the least.
Prior to the 9/11 attacks, there was a widely distributed video floating around the Middle East. This video is flooded with hints of inevitability of terrorist attacks in the near future on American soil. On September 9th, the New York times web edition posted a story about this video; this post was later retracted and little response was shown by government officials or intelligence. Two days later, the unthinkable happened. In May of 1998, bin Laden held a press conference in Afghanistan where he briefed the media of 'good news arriving in a few weeks,' and a 'black day for America.' Nine weeks later, the Kenyan embassies were bombed. The more I read, the more it seems that these attacks have subtle signals prior to their execution.
What I have recently learned to reluctantly accept is that we are battling an ideology. What upsets me is that my realization shows stark contrast to others, who believe we are fighting religious beliefs. Ardent Hindus attest that they have battled Islam for most of their natural lives and that Muslims are not to be trusted, under any circumstances. Some have even gone as far as to suggest that the 7 million Muslims residing in this country be chastised and controlled in a manner resembling Japanese internment camps of World War II, after the Pearl Harbor attacks. Believers of this antedeluvian school of thought outrage me, yet their is little I can do to assuage them otherwise. In response, I attempt to explain that this is not Islam nor is it the preachings of the Koran. My interpretation of these events can be best described as the work of extreme fundamentalists who have subsided the true values of Islam and support another ideology that condones jihad to exalt "God's word" and drive away Americans from Islamic nations. The restoration of the Khalifa, or caliphate, is the the primary motive of Bin Laden's work. In essence, martyrs in Allah's name will be taken to paradise and they saw themselves as shuhadaa, their attacks as a symbol of worship.
How do you fight an ideology? It is not a typical war of attrition. The terrorist network is so technologically expansive that after 9/11, the head of the NSA claimed that their technology was more advanced than that of the U.S. government. Scary. They communicate through encrypted emails on IMacs, satellite phones and the written word. They have "offices" (much like a well-established organization) all over the world. Ironic: the use of our own technology to inflict damage on us. Their members are not only limited to Middle-Eastern countries, but also that of France, Britain and even most recently the United States (with the recent capture of an American training in Afghanistan's camps). They are for the most part well-educated, financially successful individuals. How do you control something with that kind of network and power? Can or should you control it? Maybe control is what started this entire thing.
Lastly, what gets me the most is the impact it is having on our day-to-day life. It is almost commonplace to awake to the pictures of terrorist attacks blemishing the covers of our newspapers. Hitting us where it hurts most: disrupting our lifestyle. If they take that, then we have nothing. I don't want to have to relinquish my liberties in order to feel that I am safe. If I want to go to Egypt, I shouldn't have to think twice. If anything, I won't let them take that from me.
There's plenty more ranting, but no resolution.
Ipod: m83 - Lower your eyelids to die with the sun
So recently my rantings have all stemmed from the healthcare arena, probably because 12 of my 24 hours in a day is spent engrossed in the field and I'm constantly trying to figure out how a healthcare system that devotes 15% of its GDP can be running so amuck with inadequacy and inefficacy. My most recent encounter with the system came yesterday.
To attend graduate school, I have to fill out a stupid health services form for Cornell, essentially a vaccination report, and have it notarized by a doctor. My dad referred me to a local physician, so I paid him a visit. After some dimwitted banter with the service representative at the front desk, she bombarded me with the bill for my simple physical exam. $135. The physician didn't even examine me, and actually asked that I fill out the forms (in fact, he implored that I should fill these forms out and he could just sign them). A simple eye exam, heart check and albuterol prescription later, I was given a 2" x 2" credit card receipt. It's not only the pointlessness of the physical, but how I am lacking insurance at this point in time (I'm caught in this 'limbo' period of moving from one school to another, neither of which will insure me until the fall). "Have a nice day!" I scowled at the patients rep and exited the building.
After my bout with what can only be described as extortion and highway robbery, I pondered how these private practice doctors can sleep at night. It wasn't so much that I was charged this amount (at least I could afford it), but how do the 43 million Americans without health insurance (many of whom are under the poverty line) afford it? Sad fact: 80% of the uninsured are working families whose companies do not provide coverage.
In 2003, the average cost of the health insurance premium in this country was about $3400 for single coverage, $9100 for family coverage. Unfortunately, employers (and this is if you're covered) only will pay for about 75% of that cost (80 % if you're family covered). This is not an efficient system; one that erodes coverage and doesn't expand? After my short stint in Chicago working for an advocacy firm for national health insurance, I'm still convinced that legislation efforts pushed by people like Kucinich would fail in the eyes of a capitalist healthcare machine like the U.S. I am also not a believer in socialist medicine. So I'm constantly boggled by how other countries (like Germany) have masterfully handled healthcare costs and why we constantly face the prospect of escalating costs. There are a multitude of reasons, primarily that (at least in Germany) their government legislation imposes strict limits on hospital expenditures and the number of medical practitioners allowed to prescribe (the pharmaceuticals industry kills us in this country). There are over 400 options for state-provided plans for patients and the government regulates the fees. The government also regulates the three different private health insurance plans in the country. Needless to say, our government could learn a lot and still has a long way to go. I'm working on it. Trent, this is where our non-profit system comes in.
Now, an unanswerable question that struck me yesterday. Within the next two weeks, JCAHO (the joint commission of accredited hospitals) will be performing a rather rigid investigation and inspection of the hospital and will grant a pass or fail rating. This JCAHO standard is the stamp of approval for all hospitals in the country, so it's a stressful time and an important test. After conversing with the associate director, he commented that it is becoming increasingly difficult to direct or establish leadership within a civil service system where the employees are aware of their power. Simply put, it's difficult to get into the government, but very difficult to get fired. This especially holds true for those who've put in more than 15 years in the government. They are simply not afraid of authority. Not that they should be, but from a leadership perspective, it's hard to "sell" your ideas to the unmotivated who watch each tick of the clock, eager to leave for the day. My question is: how do you lead? How do you create and exude motivation? If only there was an A-team for the government. This holds true in private practice as well, although there is more leadership by fear rather than motivation at that level. While I'm here, I'd like to develop an effective concept for leadership that holds true at all levels, and I'd like to apply it and reform it throughout the years. In my mind, this is the question that I struggle with and begs to be answered each and every day.
The fourth of July weekend was spent not in New York city, as I had preferred, but in Toronto celebrating a family reunion. No booze cruise for me. Instead, picture a housefull of Chatterjees, Mukherjees and Banerjees. It boggles the mind. It was a festive weekend and it really was great to see everyone again. An interesting highlight of the weekend was a possible venture my cousin and I may be undertaking in the near future. We got into a long discussion about the potential within our family and how we'd like to extend our family's legacy by creating something that withstands the gates of time. I would not only like to utilize my time and energy to its fullest while I'm here, but make sure that those efforts are not forgotten and are maximized for years to come. With this in mind, my cousin has always had the dream of opening a nonprofit hospital with the vision of serving children or the elderly. Within our family, we have the capital, the brainpower and the diligence to carry out that mission. Since my background will be in healthcare administration, my cousin and I were talking it over and it's definitely something we foresee happening in the near future. Currently, we are deciding over location. Possibilities are Boston or New York City. More details to come as they are being processed.
Since the trip, I've been spending a significant amount of time at my internship at the Veteran's hospital. This is a particularly good time to be working there seeing as that there are heavy inspections going on and that I'll really get an inside-look into the hospital system at an administrative level. I'm working on a interesting policy amendment right now dealing with veterans and a no-show policy. Meaning, why veterans postpone their visit to a physician and under what circumstances should care not be granted. It's a precarious situation because it's difficult to set restrictions on those who desparately need care, but are not seeing a physician for one reason or another. Perhaps my most eye-opening experience thus far was taking a walk through 4C, otherwise known as the psychiatric ward. This is a confined, guarded facility that is restricted to visitors. When the first inspection team came to visit, I got the chance to tour the psychiatric facilities with them. It was shocking to see how some veterans had spent 10-15 years attempting to recuperate in this facility, completely overwhelmed by recurring symptoms of shock and awe, post-traumatic stress disorder, and suicidal tendencies. What really hit me is what kind of effect war had on them. I've had several conversations with veterans who've seen and endured things that I can only have nightmares about. And when they return to this country after giving their lives for us, nothing is more distressing than seeing them in the waiting room waiting for immediate care. There will be a higher influx of patients arriving, given the current situations in Iraq and Afghanistan. The hospital is already working at capacity, and with longer lengths-of-stay and wait-times, understaffed facilities and increasing demands of care, the hospital looks like it could entire dire straits. Sadly, the Veterans's Administration that I currently work at is far better off than most veteran medical centers across the country.
It's necessary for me to have this experience so that I can not only more clearly define my career objectives, but also establish my own mission statement. Granted, right now I have broadly defined goals, but they are constantly redefining themselves through immersing myself in the broad spectrum of experiences I have. I've gone from an HMO to a grassroots organization to a policy forum to the highest level of health systems management at the government to a veteran's hospital administration. I think the next necessary experience is understanding healthcare at the global level. I was offered a position at the World Health Organization last year, but turned it down to be in DC. Next year, I may find myself in Geneva.
