Viji Sundaram

Doctors Agree With Sanders on Universal Health Care

Presidential hopefuls have their own ideas on what to do with the Affordable Care Act (ACA), President Obama’s signature legislation, when they move into the White House.

Sen. Bernie Sanders thinks it should be replaced with a single-payer health plan of the kind Europe and Canada have. This federally administered universal health care program would eliminate copays and deductibles. There’s currently a move afoot in Colorado to have such a plan.

Secretary Hillary Clinton would like to keep the ACA, with a few fixes.

Donald Trump says he will uproot the ACA, get Congress to allow the sale of health insurance across state lines and allow individuals to take tax deductions for insurance premium payments. But that would not help low-income Americans because they do not pay much in income taxes.

This week, the American Journal of Public Health carried a proposal by a working group of more than 2,000 physicians nationwide titled: Moving Forward from the Affordable Care Act to a Single-Payer system. The physicans warn that the risks of continuing the ACA will leave millions uninsured indefinitely.

NAM health editor Viji Sundaram interviewed Dr. Adam Gaffney, a co-chair of the working group.

Viji Sundaram: Your proposal calls for a single-payer health care plan for the United States. Obamacare has helped 16.9 million people become newly insured. Would it not be less disruptive to expand the provisions in the ACA instead of repealing the law and replacing it?

Dr. Adam Gaffney: The U.S. health system is highly disruptive as things stand now. You’re liable to lose your insurance at any time—for instance, if you change your job or get divorced. Similarly, those purchasing plans on the “marketplaces” may find that they can keep down premium increases by changing plans on an annual basis. Every time your insurance plan changes, you may need to change all of your doctors and hospitals in order to stay “in network.” This is enormously disruptive to people’s health care. In contrast, in a single-payer system, everyone has free choice of doctors and hospitals. 

VS: Your proposal promises health coverage for all. Does this include undocumented U.S. residents?

AG: Yes, it would. The single-payer national health program we envision would include everyone regardless of country of origin, including undocumented residents. If we believe that health care is truly a human right, then this is the right thing to do. At the same time, it is also financially achievable. Immigrants, on average, have lower health care spending as compared to those born in the United States. One study demonstrated that immigrants actually pay more into Medicare than what they use in terms of health care. Everyone would be included in the national health program we envision.

VS: Why do you think there would be no additional government spending if the United States has a single-payer health care plan? Countries such as Canada and the England run their national health program on the backs of taxpayers. Will that happen in the United States as well? Can it be done without raising taxes?

AG: There would be additional government spending with a single-payer plan, but this would be offset by the elimination of spending by individuals and employers on premiums, co-payments, and deductibles. We can expand coverage to everyone in the country and eliminate co-payments and deductibles, and at the same time keep overall current health care spending roughly unchanged.

VS: Some providers criticize single-payer plan as one that will force them to contract with the one payer available. Currently, providers have some choice of insurers. They can even opt out of Medicare and Medicaid. 

AG: There are many benefits for practices to have to contract with only one payer: it’s much simpler and is less costly from an administrative perspective.

VS: How would you respond to the criticism of the single payer program as having the capacity to get doctors to sign in with fairly attractive reimbursement rates, but once in, those rates can come down, leaving providers helpless? 

AG: Because the vast majority of the nation’s doctors would participate in the national health program, there would be a powerful lobby fighting to ensure that reimbursements remain fair.

VS: In countries that have a single-payer health care system, there seems to be a long waiting period before a patient can see a doctor. How can we keep that from happening in this country?

AG: The problem of waiting times for care in other nations is often exaggerated. Moreover, where there are excessive waiting times for elective procedures, it is often due to underinvestment. We spend much more than other countries on health care, and have the resources to ensure that waiting times for elective procedures are reasonable. It’s also worth noting that we have waiting times in the United States also, though they are not as visible. Indeed, if you have the wrong insurance plan [currently], the waiting time for some providers may, so to speak, be infinite.

VS: The UK allows people to be in both the national health plan as well as subscribe to a private insurance plan, which they can fall back on for expedited care. But your plan calls for an end to commercial insurance.

AG: First, if providers must bill and contend with multiple different insurance plans, we lose the efficiency savings that come with a single universal system. Second, if we give the rich preferential access to superior and expedited care while relegating everyone else to an inferior tier, we make a mockery of the idea of an equal right to health care. Third, the best way to ensure that the quality of health care is superb is having everybody—whether rich or poor—in the same system together.

VS: Medicaid and Medicare depend on the cost shift from private payers. Some providers say the only way doctors are willing to get into the Medicare network is because they get higher payment from commercial insurers.

AG: Doctors would continue to do well under a Medicare-for-All system. The transition to a single-payer system would eliminate the need to bill and contend with a multiplicity of payers, producing substantial savings for practices (and hospitals). 

VS: How much could the United States save by switching to a single-payer health plan? What does it currently spend?

AG: It is estimated that upwards of $400 billion a year could be saved from reduced spending on administration and billing that would occur through the transition to a single-payer plan. Additional money could be saved when the national health program enters into direct negotiations with pharmaceutical companies over drug prices. These savings could then be used to cover everybody in the country, while at the same time eliminating copayments and deductibles. Overall health care spending, at the end of the day, would be approximately the same as it is now, but nobody would ever again have to worry about losing insurance, about paying a big deductible if they got sick, or about not having access to the doctor or hospital of their choose. 

Cavities, Cavities, in Kids' Mouths - and Not an Affordable Dentist to Be Found

Farmworker Maria Flores’s face breaks into a broad smile when she is told that soon her 14-year-old Mexico-born daughter, Ana, will be eligible for the state’s full-scope Medi-Cal program, under the Health For All Kids program set to launch May 16. 

Most importantly for Flores it will mean the teenager can soon have much-needed dental care.

“Every time we take her to the dentist we have to pay from our pocket and we really can’t afford it,” Flores, an undocumented, fruit packaging plant worker here says in her native Mixteco through an interpreter. “It’s hard to pay because we make so little.” 

Flores’ emphasis on dental care is echoed by four out of the five farmworker women—almost all undocumented—interviewed on a recent Saturday afternoon gathering at a local elementary school organized by the Oxnard-based Mixteco Indigena Community Organizing Project (MICOP).

Farther north, in the farming community of Reedley outside of Fresno, mothers attending an ESL class for parents at the Jefferson Elementary School say the same thing. And at a day laborer center in Hayward, Calif., parents say they would be willing to set aside their fears over outing themselves as undocumented if their children would become eligible for dental care via Medi-Cal. Medi-Cal is California’s name for Medicaid, the health insurance program for low-income people.

Eligibility Vs. Access

But eligibility for dental care and access to dentists are two separate issues. 

Assemblymember Jim Wood, D-Healdsburg, who was once a Denti-Cal (the dental arm of Medi-Cal) provider, says: “Beneficiaries are often frustrated to find out that having insurance coverage does not equate to easy access to care.” 

A scathing report out recently by the Little Hoover Commission (LHC), an independent oversight state agency, blasted the Denti-Cal program as being “dysfunctional” and having too few dentists in its network. 

“In California, we have kids’ teeth rotting out of their heads,” LHC Chairman Pedro Nava is quoted in a news report as saying.

Nava said that because of its “dreadful” low reimbursement rate—35 percent of the national average of $61.96 per patient, a rate that has not been raised since 2000—California dentists want nothing to do with Denti-Cal, making it virtually impossible for the more than 13 million current Medi-Cal enrollees, including 5 million children, having few places to use their coverage. 

In 11 of California’s 58 counties, there are no Denti-Cal providers at all, or no providers willing to accept new patients, according to a 2014 state audit. In Ventura County, for example where Flores and her family live, 53,000 kids are enrolled in Denti-Cal, but only 86 dentists accept it. Alpine County does not have a single dentist and in Imperial County, there is only one dentist for every 4,166 people, according to a UCLA Center for Health Policy Research report.

The Hoover report says the blame for Denti-Cal’s shortcomings could be shared by the state Department of Health Care Services—the agency that runs the program—the legislature and the Governor’s office. Decades of neglect and strategic misdirection have caused the Denti-Cal program to deny hundreds of thousands of people the oral health care they need.

Assemblymember Wood says “the legislature has made it clear through multiple hearings that restoring Denti-Cal rates [to pre-recession rates] should be made a priority. Unfortunately, so far it has not been a priority for the administration and the Governor.”

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California Bill Would Fund Trauma and Mental Health Services for Students

California schools will once again be able to offer mental health programs for students in kindergarten and grades one to three who are struggling with anxiety and other trauma or stress related symptoms, if a bill introduced in the legislature [last month] passes.

AB 1644 was introduced by Assemblymember Rob Bonta (D-Oakland) and is co-sponsored by Children Now, a statewide youth advocacy organization headquartered in Oakland, and by state Attorney General Kamala Harris.

“The evidence is clear that when we don’t intervene, many children are more likely to be either victims or perpetrators of crimes,” Harris said in a statement.

“We view early childhood trauma as a public health crisis,” noted Ben Rubin, senior associate of neurodevelopment and health with Children Now. He said adverse childhood experiences (ACE) lead to long-term mental and medical health effects.

Bonta’s bill would restore funding for mental health services that were once offered on 464 school sites around California under the state’s Early Mental Health Intervention (EMHI) program launched in 1992. The state gave matching funds to schools that provided intervention programs. AB 1644 is estimated to cost the state about $1 million a year.

In 2012, the state defunded the program, citing budgetary reasons. Research showed that 79 percent of the children who received those services improved their behavioral and social skills.

According to a Kidsdata.org study, more than half of all California elementary school staff reported that mental health is a problem at their school. And just over 70 percent of the state’s elementary school teachers say that their school “emphasizes helping students with emotional or behavioral problems.”

Early childhood mental health advocates say the teacher training and funding isn’t adequate to support young students who are experiencing symptoms resulting from stress and trauma. In its 2016 California Children’s Report Card, Children Now gave the state a D minus when it comes to spending on assessing and treating children who have mental health challenges.

The Children Now report warns that if kids struggling with mental health disorders don’t get the treatment they need, they are more likely to be hospitalized, drop out of school and become “involved with the justice system.” The report also says that only 40 percent of children under the age of six with mental health issues get the support they need.

California has the highest student-to-counselor ratio in the nation, with an average of 1,016 K-12 students per counselor, according to EdSource. The American School Counselor Association recommends a ratio of 250 to one.

The question of a school's responsibility to provide services to students suffering ACE related trauma is at the core of a lawsuit filed against the Compton Unified School District in Los Angeles. Five students and three teachers there have sued the district for allegedly failing to provide adequate training and resources for coping with trauma. The CUSD, the plaintiffs say in the federal lawsuit filed last year, is setting them up for academic failure.

Robert Hull, a school psychologist in Prince George’s County in Maryland, who has extensively researched the impact of complex trauma on childhood development, observed: “There’s a huge number of children walking into kindergarten with trauma. They’re just sitting in the classroom trying to make it through the day, not profiting from the instruction, however good it may be.”

By providing them early intervention, he said, “you are moving them from a survival mode into a learning mode.”

Bonta’s bill would establish a four-year pilot program in schools that are serving students who have experienced high levels of childhood trauma and adversity, expand the EMHI program to include younger children, and provide regional trainings and support to schools on mental health and trauma.

Why Are U.S. Farmers Still Using a Pesticide That Has Killed Many People Around the World?

On a cool November day in 2009, farmworker Jovita Alfau was transplanting hibiscus as she’d been instructed in a section of Power Bloom Farms and Growers nursery in Homestead, Florida.

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What It Means For Your Health When Your State Refuses to Expand Medicaid

Even though the Affordable Care Act (ACA) has helped millions of people get health insurance, quality health care is still out of reach for a large number of people of color, low-income families and those with language barriers. The high cost of insurance premiums and co-pays was the main reason cited for those who remain uninsured. The complexity of the enrollment process was also a deterrent.

Those were some of the findings in a report released Thursday by the Alliance for a Just Society (AJS) that interviewed 1,200 low-income people in 10 states, including California.

The report indicated that people who were hurting the most were those living in states that had not expanded Medicaid.

As the ACA was being rolled out, states were given the option of whether or not to expand their Medicaid program. Twenty-two states have chosen not to. The expansion allowed people whose income fell below 138 percent of the federal poverty level (about $16,000 for an individual and $33,000 for a family of four) -- up from the earlier requirement of 133 percent -- to enroll. It also removed the asset cap and the requirement that individuals had to have a child in order to qualify for Medicaid.

Nearly 60 percent of African Americans and 40 percent of Latinos live in states that have not expanded Medicaid.

A total of 2.2 million people have been denied access to health care because nearly half the states have chosen not to expand Medicaid, noted Gary Delgado, the report’s author. Nearly half of the respondents said they live with a chronic health condition, while 16.5 percent of Latinos, 18.7 percent of African Americans, 20.9 percent of whites and 22.2 percent of people who identified as mixed race reported living with two or more chronic conditions.

In Mississippi, a state that refused to expand Medicaid, there is a high incidence of infant mortality and diabetes among immigrant workers, said panelist Antron McKay-West of Upgrade Mississippi. Not all homes have Internet access so they can’t enroll online.

At 33 percent, Latino respondents had the lowest percentage of email addresses, followed by African Americans at 50 percent.

During Open Enrollment time, many people in Mississippi were told to “go the library and use the Internet.”

“In the neighborhood where I grew up, the library is 15 miles away,” McKay-West said.

A very small percentage (8.5 percent) of survey respondents said they had to travel about an hour to see their health care provider. But the percentage of Native American respondents (26.3 percent) was almost three times that of any other group.

Delgado, who is a visiting scholar at the Institute of Social Change at the University of California at Berkeley, said that for the ACA to be successful, the program needs to be retooled in such a way that it makes it easier for communities that have historically been left out of the American health care system to be included in it. The ACA has not addressed health care disparities – something it said it would do -- making it a “valiant attempt to build a new house with old bricks,” he said.
 

15 Calif. School Districts Begin Serving Locally Grown Foods to Students

SAN FRANCISCO -- Last week, 15 school districts across California began serving their students school lunches made from foods grown in California and prepared freshly just for them.

“We are going beyond the Healthy Hunger-Free Kids Act,” said Jennifer LeBarre, executive director of the Oakland Unified School District’s (OUSD) Nutrition Services. President Obama signed it into law by in 2010 and it was championed by his wife, Michelle Obama.

Actually, OUSD rolled out the “California Thursdays” school lunch program one year ago, and its success encouraged other school districts to emulate it. Aside from such large urban school districts as Los Angeles, Oakland, Riverside and San Diego, California Thursdays has also begun in rural school districts such as Alvord, Hemet and Coachella.

Planners of the program initially decided to offer locally grown food just once a month – “a bite-sized implementation strategy” as Chris Smith, program and resource director with the Berkeley-based Center for Ecoliteracy put it. Then they decided to do it one day a week, randomly picking the day, Thursday, and calling the program California Thursdays.

“Thursday just seemed the right day,” Smith said, adding: “The name stuck.”

LeBarre said that even though California schools launched the healthy meals school lunch program two years ago, not all school districts served foods grown locally and many served processed foods. Some of the foods were grown as far away as in South America and shipped to China for processing. Schools microwaved the frozen prepared foods and served them to children.

The recipes for "California Thursdays" meals have been student-tested and options include fresh chicken fajita bowls, Asian noodles with Bok Choy, and pasta penne with chorizo and kale.

“Whenever we serve fresh, locally grown food to children with these recipes, they devour it,” said Zenobia Barlow, executive director of the Center for Ecoliteracy.

Planners saw that the program, aside from helping children stay healthy and thereby help improve their academic performance, made good economic sense. They say that every $1 spent on local food fosters $1.86 in local economic activity. Every job created in the production of local food also leads to an addition of two or more new jobs within the community, according to a press release put out by the Center for Ecoliteracy.

“The California Thursdays program will help the local economy and the environment,” LeBarre said.
If the program is successful, this could become a regular part of menus for students across the state, and also every day of the week. Even as it is, some school districts serve fresh locally grown food more than one day a week, Smith said.

The California Department of Food and Agriculture’s Specialty Cross Block Grant Program, The California Endowment, TomKat Charitable Trust, U.S. Department of Agriculture and the Center for Ecoliteracy provided free tool kits to California school districts “to put together the resources” needed to launch California Thursdays, Smith said.

Mental Health Patients Will No Longer Be Discriminated Against Under ACA

Like most severely mentally ill patients, 23-year-old Daniel Padilla doesn’t see himself as that.

The insurance companies that cover him – Medi-Cal (California’s name for Medicaid, the federal-state-funded insurance for low-income and disabled people) and United Health Insurance -- don’t see the schizophrenia he was diagnosed with at age 19, as deserving the same benefits as someone with a medical condition.

His father, Benito, must go after the insurers month after month to get them to pay Padilla’s psychiatrist to keep his schizophrenia under control.

“The insurers approve three visits and then they put you through hell,” asserted San Diego-based psychiatrist Dr. Rodrigo A. Muñoz, who has been treating Padilla all along.

“Insurers discriminate against people who are mentally ill,” Muñoz said.

But that’s all going to change soon. When the historic Affordable Care Act fully unrolls on Jan. 1, 2014, it will require insurers to offer mental health care benefits equal to physical health benefits. In other words, a disorder in the brain will be treated no differently than one in the kidney, Muñoz said.

Not just people with mental disorders, but those with substance use disorders have encountered penny-pinching annual and lifetime caps on coverage, higher deductibles, or simply no coverage at all.

Federal Parity Law

The blatantly discriminatory practices by health insurance companies prompted Congress in 2008 to pass the Mental Health Parity and Addiction Equity Act (MHPAEA), which mandated that psychiatric illness be covered just the same as other medical illnesses. It required insurers to offer the same annual and lifetime dollar limits for mental health care as for medical and surgical care.

But the law applies only to larger employers – those with 50 or more workers – that offered a health plan that covered mental health and substance abuse. Smaller employers, as well as people who buy their own insurance, are excluded from the benefits of the law.

“Smaller employers have resisted changing the law, saying they will go broke” if they had to include mental health coverage in their health care plans, Muñoz pointed out.

The ACA has extended the MHPAEA provisions to state insurance exchanges, known as Covered California in this state. This would require policies purchased by smaller employers and individuals through the exchange, as well as those purchased outside of it, to be MHPAEA-compliant.

Had the MHPAEA mandated universal psychiatric benefits when it was created, insurers like Padilla’s would not have been able to discriminate between the treatment of psychiatric and non-psychiatric medical illnesses, he said.

Only a Fraction of the Mentally Ill Get Treatment

Dr. Clayton Chau, who practices psychiatry in Orange County, Calif., said that because of the discrimination factor, poor access to care and inadequate insurance coverage, only a fraction of those with mental illness get treatment.

A report by the Surgeon General indicates that one in four Americans has a diagnosable mental illness at any given time. National and international studies show that 1 percent of the general population has schizophrenia, an illness that is treatable, though not curable. Surveys, including those done by the National Institutes of Mental Health, show that only about 50 percent of Americans seek psychiatric treatment.

According to Randall Hagar, director of government relations with the California Psychiatric Association, a state mental health parity bill signed by Gov. Davis in 2000 required insurers to cover the diagnosis and treatment of a range of mental illnesses under “the same terms and conditions applied to other medical conditions.” The intent of the law was to eliminate the disparity in co-pays and higher deductibles.

In the opinion of many advocates, Hagar observed, the law is “routinely violated by plans and insurers, and enforcement is generally weak.”

That prompted Sen. Jim Beall, D-Campbell, to try five times to give more teeth to federal and state mental health parity laws. Beall’s first four bills were vetoed by Gov. Schwarzenegger, and his most recent bill (SB22) didn’t even make it out of committee.

What the Health Care Law Will Do

Under the ACA, aka Obamacare, health insurers are forbidden from excluding people with pre-existing illness from medical coverage. By definition, Americans with a mental illness have a pre-existing disorder, and up until now, private health insurers have denied with impunity coverage to those with pre-existing conditions.

California has added a mental health component to its expanded Medi-Cal program, under ACA, to ensure that its Medi-Cal population with mental disabilities receives more comprehensive mental health benefits, starting Jan. 1, 2014.

The current mental health component of Medi-Cal “is limited in terms of the number of providers and the number of services” it offers, Chau said.

Older people with mental illness will also benefit from the ACA because the law will close the notorious “donut hole,” allowing the Medicare population to not have a break in medication.

Padilla, who’s currently working for his GED, has been able to stay on his father’s insurance because of his age. A provision in the ACA allows children under 26 to remain on a parent’s insurance plan.

Muñoz is relieved that the ACA will help patients like Padilla access the care they so badly need. The removal of lifetime caps by insurance companies will enable mentally ill patients to access care before turning to suicidal thoughts, becoming violent or ending up homeless, he said.

Electric Bras and Condoms With Teeth? The Misguided Efforts to Stop Rape

Editor’s Note: Modern technology has brought us a new kind of rape whistle – an electrified bra that shocks anyone who touches it and sends out a GPS signal to police. But the invention is just as ludicrous as its predecessor -- and once again puts the impetus of preventing rape on women, instead of where it belongs: the education of men and boys. 

A group of female engineering students in India have unveiled a new electrified bra to protect women from getting raped. The bra, according to reports, not only shocks the attacker the moment its pressure sensors get activated; its built-in GPS also alerts police and the victim’s parents to the location where the attack is taking place. The designers of the bra, which is called Society Harnessing Equipment, or SHE for short, eventually hope to connect it with smart phones via Bluetooth and infrared technology.

I am sure the female engineering students in Chennai who designed this piece of lingerie did it with the best of intentions, following the national uproar that was generated by the rape and murder of a young woman on a bus in Delhi last December, and several other well-publicized rapes that have occurred in the country since then. (Not to mention around the world -- just this week in Brazil, an American tourist was gang raped for six hours on a mini bus in Rio de Janeiro.)

The fact that the engineers felt it necessary to design such a bra shows that Indian women have little faith in the sweeping rape law the Indian government passed last month to protect women against sexual violence. India has never had trouble enacting laws, just enforcing them. And as every Indian knows, any law can be bypassed by greasing the right person’s palm. Why should the rape law be any different?

And how can you blame women for not expecting much from the law? The practice of dowry (money or property brought by a bride to her husband at marriage) is still almost endemic in India, despite the fact that an anti-dowry law was passed in 1961. In 2010, there were 8,391 reported cases of dowry deaths – young women who were murdered or driven to suicide by their husbands or their in-laws for not bringing in an adequate dowry -- according to the National Crime Records Bureau. Women’s rights activists say that for every dowry death reported, there are dozens that go unreported. Of the reported cases in 2010, only one-third of the perpetrators were convicted. 

The majority of rapists, too, get off scot-free. And not just in India.

In most African countries, rape convictions are not common. Worse, affected women don't get immediate access to medical care, and DNA tests to provide evidence are unaffordable. Which is perhaps why two years ago in South Africa, Dr. Sonnet Ehlers designed a female condom with “teeth” to it. Jagged rows of teeth-like hooks line the inside of the latex condom and attach to a man’s penis during penetration. Once Rape-aXe, -- as the condom is called – lodges in the penis, only a doctor can surgically remove it. While doing it, the doctor can summon law officials to arrest the man. 

But if the electrified bra and the condom with “teeth” are meant to empower women, these inventions only show the state of women’s powerlessness -- and their lack of faith in laws meant to protect them.

India’s new rape law, which, in addition to harsher sentences for rape and acid attacks, criminalizes “eve-teasing,” which as Lavanya Sankaran points out in a column in The Guardian, is a “coy and euphemistic name for the sexual harassment – the stalking, groping and lewd comments – that every Indian woman is forced to navigate every time she walks out of her home.”

The law also expands the definition of rape and clearly states that the absence of physical struggle doesn’t equal consent. And no longer will misogynist police offers be able to not register complaints and compromise survivors’ rights during investigations.

All of that sounds wonderful, but is the law really going to protect women? Not until there is a change in culture, beginning with the way mothers and fathers teach their sons to be men. After all, as Sankaran notes, social pressure in India is far more powerful than any law.

The solution is not to get women to buy a new high-tech kind of rape whistle. The mindset of men must change, and the change has to begin at home.

Pakistani Assemblywoman: Girls’ Education Key to Ending Terrorism

The attempted assassination of Malala Yousufzai, the 15-year-old Pakistani girl being treated in a hospital in Britain after she was shot in the head by the Taliban Oct. 9 for championing girls’ education, has united her country like few other incidents in recent memory. That's according to Khushbakht Shujat, a member of Pakstan’s National Assembly from the MQM party, who spoke with New America Media editor Viji Sundaram.

Would you say that the attempted assassination of Malala has made Pakistanis more mindful than ever before of the growing threat of the Taliban in their midst?

While the majority of Pakistanis do not approve of U.S. drone attacks, or of militants crossing borders and creating havoc on both sides of the border of Pakistan and Afghanistan, everyone disapproves of the attack on Malala. The attack on her has made many realize finally that terrorists are terrorists. [That] they are not doing jihad or following the word of Allah. [That] they are ignorant and naive. This girl has brought the nation -- and even the world -- together.

You are known for championing girls’ education and their empowerment. But in neighboring Afghanistan, the Taliban has succeeded through scare tactics in discouraging girls from going to school. That has led to a number of underground girls schools. Could the Malala incident have a similar effect in Pakistan?

It is important that steps are taken to keep families from becoming scared and not sending their daughters to school. The government should provide more incentives and offer encouragement so girls in Pakistan seek education. We should set a goal of getting every girl educated in Pakistan. Educated females mean an educated nation. And an educated nation means rooting out ignorance, which will remove terrorism from the equation.

Has any political good come out of the Malala attack and can that be sustained?

The government and military are doing a lot, but a lot more needs to be done. The attack has sparked the debate in Parliament whether Pakistan should go after militants in North Waziristan [believed to be a safe haven for terrorists]. On the day of the attack on Malala, I stood up in Parliament and raised a point of order in protest against the attack. MQM and the leader of our party, Altaf Hussain, asked the army to come forward and step up action against the militants in Waziristan and other hideouts.

There is a lot of anti-U.S. sentiment in Pakistan now, generated by the so-called "collateral damage" from the drone attacks by the United States that have claimed the lives of scores of civilians, along with some terrorists. Would the Malala attack make Pakistanis want U.S. protection on the ground now, or would they prefer dealing with the terrorism problem on their own?

Pakistan has suffered a lot due to terrorism. People in the United States don’t realize the price the people of Pakistan have paid for supporting the United States in its war against terrorism. There are protests here from all political parties and religious groups on a regular basis.

So does this mean you would like to see the end of U.S. military presence in that region?

America and NATO forces have agreed on withdrawal in 2014. I hope by that time Afghani forces are properly trained to defend their nation. Peace talks are also underway and I hope they bring positive results. I do hope America doesn't abandon Pakistan and Afghanistan, like they did after the Soviets left Afghanistan. Pakistan needs support from America to provide security to schools in these regions.

You seem to strongly believe that the best way to quell terrorism in any part of the world is by educating girls.

I want women to be strong and self-sufficient. MQM, the political party I belong to, is constantly raising its voice against injustice [against] women. We are one political party in Pakistan that I believe has done the most in terms of women’s empowerment. I do believe the previous governments may not have done enough and now it is high time we focus on women’s empowerment and education. The attack on Malala has exponentially increased the movement toward promoting women’s empowerment.

Are you optimistic about the end of terrorism in Pakistan?

I have devoted my life to the field of education. [The] bottom line in the war against terrorism is education and awareness. We need to equip our youth with books and take guns out of their hands.

I'm very optimistic that in Muslim countries, particularly in Pakistan, a change is coming. Women are a majority in Pakistan. If we want this nation to be successful, we need to educate and empower them. It's as simple as that. Democracy is spreading across the Middle East. We want the world to support us and respect our challenges and appreciate what we are doing in the war on terror.

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