Dr. Mohammad N. Akhter
March 2013 marked the Third Anniversary of the enactment of the Affordable Health Care Act, the federal health care law that reforms the United States’ health care system. Beginning in January 2014, the health care industry as we now know it will be a thing of the past, and our Spotlight for the Month of July 2013, Dr. Mohammad N. Akhter, Chairman of the Executive Board of the DC Health Benefit Exchange Authority, has been intricately involved in how what will be taking its place will impact the citizens of Washington, DC. We will talk with him about his life’s journey and what is ahead as it relates to health care reform.
Destiny – Pride: Good morning, Dr. Akhter.
Dr. Akhter: Good morning, sir. How are you?
Destiny – Pride: I’m doing well. Thank you for agreeing to be our Spotlight of the Month for July 2013. It is indeed a pleasure to have this opportunity to talk with you about the upcoming changes in health care, but before we do that, I’d like for our visitors to get to know you a little better, so please tell us a little about yourself, beginning with where and to whom you were born and any other things about your early life that you would like to share with us
Dr. Akhter: I was born to a farmer family who had become refugees from India and we came to Pakistan. We were farmers, and when farmers lose their land and cattle, they have nothing else left. We were absolutely helpless when we came. Thanks to the United States of America, there was assistance available that helped us to get established at that time – 1948. My grandfather didn’t know how to write his name and my mother had an 8th grade education. So the family decided, rather than working in the field – we didn’t have land; we didn’t have cattle – to send the children to school. I was the oldest child among the six other brothers and sisters, so they decided to send me to school. One thing led to another and, with the Lord’s blessing, I became a doctor.
Destiny – Pride: You mentioned you had sisters and brothers. Are they also here in the [United] States?
Dr. Akhter: There’s one brother in the States. He is in New York; works for the United Nations. There’s one brother who lives in Canada. My two sisters and another brother live back home in Pakistan.
Destiny – Pride: Let’s talk about your higher education. How did you get to that point of becoming this esteemed Dr. Akhter?
Dr. Akhter: My mother had this dream. She always wanted her son to be a doctor, but I was a very poor student. I just couldn’t see myself becoming a doctor, and so I went through the process, ultimately dropped out of college – just like many children do – and became a clerk at the Water and Power Development Authority, counting pipes. Then one day, a friend of my father’s who, rather than come to Pakistan after the India partition, had gone to England and gotten himself educated. He was visiting back in Pakistan. He asked me what I was doing and I told him that I was just such a poor student – I was terrible. I just failed. I flunked. They threw me out of college, and this is where I am now, doing a clerical job – counting pipes at the Water and Power Development Authority. He said, “Let’s go out for a little walk.”
So we went out of the village and walked around the field and he said, “You know what? I’ve been to England” – and for us, knowing somebody who had gone to Europe was a huge thing. He said, “I’ve been there; I’ve gotten my education over there. All of these exams that you have taken, they measure how much you know. None of the exams ever measures your potential, but I’m going to tell you, you have great potential! If you go back to college and work hard, you could become a doctor and nobody will ever know that you flunked or that you dropped out. “You know, that was the first person in my life who ever said I could do something; that I had potential. Before then, everybody sort of put me down because we were poor, we didn’t have anything. I was small, and that was the story. It is quite interesting how somebody’s words of encouragement to you could lead to something very big.
So I went back to college, worked really hard this time – now thinking I had potential – was number one in my college, and got a scholarship for five years to go to medical school [King Edwards Medical College, Lahore, Pakistan], and that’s the history.
Destiny – Pride: That’s the history! Are you married and are there any children?
Dr. Akhter: Yes. I’ve been very blessed. I have a wonderful wife. We’ve been married for 44 years and we have a daughter. She’s 35 years old; lives in New York and is a staff psychologist at NYU. We’re very proud of her.
Destiny – Pride: What faith are you and how has it, if at all, impacted your life’s decisions?
Dr. Akhter: I’m a Muslim. That’s my faith. My wife is a Methodist Christian.
Destiny – Pride: Do you all have a lot of battles?
Dr. Akhter: We have lived 44 years with a great amount of peace, love and everything. My family is all Muslims, but they love my wife. There’s a saying in my family that if ever we have a conflict between my wife and me, they will disown me and keep her! And her parents did the same for me. They basically adopted me. They are Methodist Christian, very conservative, Republicans, but they just love me just like their own children. They have two sons, but for the last 13 years, their lives have been spent with us – me and my wife – and it’s been a great blessing.
No faith tells you to do anything! That’s not human. Everybody wants you to live in peace, love and harmony, and if we can demonstrate that, then that’s a great thing.
Destiny – Pride: Who would you say has made the greatest impact on you and your life choices so far?
Dr. Akhter: I think there are many teachers and many professional people who give you counsel and advice. I was very fortunate to have very good people and very good teachers. The “tough love” that a teacher can give to you is invaluable. When I came to [Johns] Hopkins to get my Masters in Public Health, I spoke English like Tarzan – you know, “me Tarzan; you Jane” – a great accent! I became a very good friend of the Dean of the School. His name was John Hume. I said, “John, I’ve graduated; I got my Masters in Public Health. I need a job. Will you give me a job?” He said, “No. I’m not going to give you a job. You will be stuck here. You have great potential. I want you to go to New York and do a residency in Harlem. Learn how people live, what their problems are and how you can help solve their problems.”
I took his advice. It was tough advice. He could have given me a job and I would have been happy. Nothing makes a fresh graduate more happy than a job at the end of an education. So, I went. I spent two more years in New York at Mt. Sinai, working in East Harlem. I was doing the children’s examinations – eye tests for the children in the schools in East Harlem. The school doctor. All of the community kids would come running to me and say, “Hey Doc. Do I need glasses?” But that was the best advice that a teacher can give a student.
It was tough. I spent two more years learning and doing. After I finished my residency, I asked my teacher – a Jewish man, Dr. Kurt Deuschel, a great scientist and a great humanitarian – “There’s a job vacant for Assistant Professor. Could I be your Assistant Professor at Mt. Sinai?” He said, “No. I’m not going to give it to you.” He said, “You have great potential. I want you to study hard.” In the meantime, I’m just working a part-time job. My wife has already started her internship, so she’s supporting us. We had a child to support, so all of these things came together at the same time. I said to him “What do you suggest that I do with all of this ‘potential’ that you’re talking about – and no money?” He was very gracious. He said, “What you need to know is that you are a foreigner; you are an immigrant. Nobody is going to give you a chance. Nobody is going to give you a chance – especially with a name like ‘Mohammad’ – until you have superior qualifications than anybody else when they call you for an interview. One of the superior qualifications that you can’t get by getting a piece of paper is to go to Washington and learn how government works. I’m going to ask a friend to accommodate you.”
So I came here as a visiting scholar at the National Academy of Sciences and I attended all of the congressional hearings in 1975 and 1976 in Congress. That was a great education, to see how government works; how laws are made; how things happen in a democracy. After I finished that year here in Washington, learning and doing things, I was hired by the Governor of Illinois to be the Director of the Emergency Medical Services and Highway Safety in the state of Illinois. That was the first high-level job – in fact the first “real” job – I ever had.
Destiny – Pride: Okay. You’ve talked about your journey which is now leading you up to what brought you to the Department of Health for the District of Columbia?
Let me just make one other observation. You can get all of this worldly education; you could get a PhD; you could get a Masters in Public Health; you could get an MD; but the real education lies somewhere else. My wife, who is also a physician – as I was saying to you earlier – had gone to medical school to become a medical missionary. That was her life’s dream. As a child, the missionaries came to church and they talked about the Lord’s work and what you could do, and she just felt “what an exotic thing to do; to go live someplace in a remote village and fight the flies and work for the people.” That was her dream. She wanted to be a medical missionary, so she became a doctor. Then, as life will have it, as she had no plan to get married, being committed to doing this work, we met and married – and married with different faiths! She said, “That’s my dream. I want to be a medical missionary.” I said, “Fine. Let’s do it; let’s do it together.” So we went overseas. We were five years overseas, working in villages, she being the medical missionary. I was like the minister’s wife, doing all kinds of things that she wanted me to do.
Destiny – Pride: What villages? Where were you?
Dr. Akhter: We were in villages in Pakistan – Punjab – the central part of Punjab. There were 53 villages; Christian villages. At some point and time in the ‘20s and ‘30s, they were the best villages in the entire country. They were flourishing. There were high schools; there was a medical clinic; there was a small hospital among those villages. There was great work that they were doing. Why were they doing great work? Because the missionaries were running the system. These all were Christian communities; they had taken all of the untouchables and they converted them to Christianity. So they had given them the land and on that land was grown the fruit and vegetables that the British used, like strawberries and cucumbers and stuff like that. They were growing those vegetables and selling them to the military. They were making tons of money. Everybody was happy. Everything was going well. Then the British left and the decline started. They started fighting among themselves and ultimately they became poorer and poorer.
Some 40 years later, the Church is all back together – the Presbyterians and the Methodists – and said, “Let’s go and send missionaries over there.” That’s how we went to those 53 villages.
Destiny – Pride: So now we’re on our way to DC.
Dr. Akhter: After we completed that, we came back here. I came back and I was just looking for a job – any job; it didn’t matter what. The Church had removed us from the country because the Middle East War had broken out and they wanted no part of it — like what happened in Iran. They wanted all Americans to leave, so we all came home. When we were on the plane, we were told that war had broken out.
We came back here absolutely unprepared. We were paid as a family $500 a month. You can’t survive on $500 a month, so I wrote a letter to Mr. Gray [Mayor Vincent Gray, then Director of the Department of Human Services] saying that I was here with an MD [Medical Degree] and Master’s Degree in Public Health, and asked if there was anything I could do. They called me for an interview. I came for the interview and, as the Lord will have it, one thing led to another and I was appointed the Health Commissioner for the City. That’s how I came the first time under Mr. Gray.
Then we worked here. At that point Dr. Boyd [Linda Wharton-Boyd] was my colleague on the first go around and she’s back again for the second go around.
Destiny – Pride: Third go-around; fourth go-around . . .
Dr. Akhter: After DC, I became Executive Director of the American Public Health Association. I worked for the federal government for a couple of years. I was Executive Director of the National Medical Association and I was Senior Associate Dean and Professor at Howard University. So I did all of these different jobs, minding my own business, doing my own work. Then Mayor Gray was elected [Mayor] and he asked me to come with him [as Director of the Department of Health].
Destiny – Pride: You have worked under several DC Administrations. That, in and of itself, speaks volumes on your ability to deal with diverse Administrations. To what do you attribute that?
Dr. Akhter: I think if your focus is on the people – that’s what they tell you in Church training and everything else – then it’s all about the people. If you’re working for the people, on their issues, it doesn’t matter who is driving the bus. I’m just doing my job. I’ve got to serve the folks who are riding the bus, so it doesn’t matter whether Republican, Democrat or whoever, drives the bus. They drive the bus; that’s their job. My job is serving the people who are on the bus.
Destiny – Pride: As you previously stated, after serving as the DC Commissioner of Public Health in the early 1990s, you were later chosen, in 2011, by Mayor Gray to become the Director of the Department of Health. Was there a dramatic change in health care issues in 2011 as compared to the time when you were the Commissioner?
Dr. Akhter: As a medical doctor, I have seen patients who come to the emergency room. I used to work at the Arlington Hospital Emergency Room and you see people coming in who have no insurance, and they came in when, really, they were close to dying! They had asthma, and they had been suffering from it all day, but they didn’t come, with the hope that it would get better, because they didn’t have insurance. You see how people feel when they don’t have insurance. They could go, sit and wait in the DC General Emergency Room for six hours to get service. This has been a big issue. I have always looked at it from the individual patient’s standpoint.
When I was the Executive Director for the National Medical Association [in 2007], I became very aware of the situation. This is the organization of all African American Doctors in the country. I became very aware, listening to the stories from each one of them, how they see the people who have no insurance or no compensation, and yet they are very, very sick because they don’t seek care. So having health insurance was very important to me; absolutely important to me! I was part of the team who met at the White House after President Obama got elected. They had a White House Summit on health insurance – how to move it forward on his agenda. I’ve been a supporter of his for the health insurance program.
When the bill got passed, the issue then was that the implementation was left to the states. You and I know that civil rights legislation was passed 60 years ago, but we’re still “implementing” it. There is still discrimination going on. So “how” you implement the law is so very important! You could implement it on paper that it’s the law of the land, and nothing changes on the ground, or you could just lay the groundwork where actually the change takes place on the ground, where people live, work and play. I was very interested in doing that, so when Mayor Gray called me and said, “How about coming and working for me,” I said, “I will come because I’m very interested in implementing this health care reform for the District for our own people.” He was very gracious in accepting my coming on board.
Destiny – Pride: Subsequently, the health care bill was passed by Congress, as you stated, and in 2012 . . .
Dr. Akhter: It was actually passed in 2010. When the time came for implementation, we prepared the material, gave it to the Mayor and said, “Mr. Mayor, we need to do it ourselves.” There were three choices at that point. We could ask the federal government to implement it, and 27-28 states decided to do that; they’re not doing it themselves. Virginia isn’t doing it themselves. They’ve said, “Let the federal government do it.”
Then there are five or six states that decided that they want to do it in partnership with the federal government, or with other states. We – the District of Columbia — were one of the 13 states that decided that we were going to do it ourselves. We want to do it ourselves for two reasons: One, that whatever we will build, we will build it from the ground up, with the participation of the people. Over 300 people from our city have participated in the work we are doing. Secondly, we will do it in a way that meets the needs of our people specifically, and I’m going to tell you why we did that and what difference it will make in the lives of the people as we talked this thing over.
And so the Mayor decided, in 2012, to do this. At that point we appointed a Board. The Board consisted of 11 members. Seven of them are voting members. These seven members are professors; they are highly accomplished people, but they know nothing about the government. They have never worked in the government, especially in DC government. Everything took twice as long and was twice as hard to do. You appoint these seven people and say “Folks, go down there and implement President Obama’s health care plan. No office. No money. No way to spend the money. No staff. So how do you suppose those seven people, with a piece of paper stating that they are appointed to this Board, are supposed to implement this?
After I looked at that situation, I went to the Mayor and said, “Mr. Mayor, we need to have somebody with these seven members who knows how to get this thing started. They are great people. I am very proud of my Board members. They are absolutely exceptional people, in terms of their knowledge and expertise. If you have a doctorate in economics, you know everything about economics. But if you have never walked the streets of Southeast, you don’t know how other people live or their circumstances. So I told the Mayor, “Mr. Mayor, I need to be appointed,” and he said, “You can’t be appointed because you work for the government and you draw a salary.” At that point I said, “Mr. Mayor, then I will just leave this. This is very important, to be done right. There’s one opportunity – one shot – and this has to be done right, so I will leave the job, roll up my sleeves and get this thing done.” The Mayor was very gracious in accepting that request and appointing me to the Board. (Click here for leave of absence press release)
So I’ve been here working without any pay for one year, doing the things that I only dreamed of doing some day. My good friend, Dr. David Satcher (former US Surgeon General), used to say that his teacher said one time to him, “David, if your lot in life ever puts you in a position where you are going to affect the lives of the people, do it in a way that their lives are better off than they were before.” My lot in life was this: That I had this opportunity; I was in the right place at the right time and the Good Lord has put me in this position.
Destiny – Pride: What is the ultimate goal of the Health Benefit Exchange Authority and is there an established timeline to achieve that goal?
Dr. Akhter: Yes, the established timeline, I can just tell you, is October 1 of this year , when the door is going to open so people can come and get health insurance.
So we earlier talked about health insurance – the lack of it, what it can do. People don’t get the care. We know that. I’ve seen people who have come in with this big of a tumor that is not operable now, but if they had come earlier on, it could have been removed and their life would have been saved. But we also know that the largest, single cause of individual bankruptcy in the United States is the lack of health insurance. You get sick, you go to the hospital, and then the bill comes for $100,000; you can’t pay it. That’s what you do – you declare bankruptcy. That’s on one side of the equation. On the other side of the equation is the issue of having insurance, which is the gateway to quality health.
But for me, it was something beyond these two things. It was the question of human dignity. If you go and stand in line and you say, “I have insurance; I need this. This is my right.” But if you don’t have any insurance, you’ve got to take whatever they give you. If they tell you to wait for 5 hours, you wait for 5 hours. If they tell you to stand over there, you stand over there. That, I believe, is beneath human dignity. As a doctor, I was taught to take care of a patient while maintaining their dignity. This is one of those things where we maintain the dignity of the individual. They have insurance, so they can go. It’s not that they are asking for charity. It’s not that they are begging. They are demanding their rights.
The goal of this thing is to make insurance available to everybody. It’s the law of the land. The law of the land is that everybody must have insurance and our task is to make insurance available. So people can come in and buy insurance. Those who can’t afford it will get subsidy to be able to buy it. So everybody should be able to do that. That’s our goal. Within the first 6 months, half of the uninsured people – there are 42,000 uninsured in the District of Columbia – should have insurance.
But there’s the other 150,000 people who are “underinsured” – they are paying their premium, but they may not have access to service, or when they go to get the service it may not be there. Our goal, basically, is that on October 1 our office will open and people can come in, they can call in, they can fax in, they can talk through the Internet, and they will be able to buy health insurance on the Exchange. If they can’t afford it – their income is low – we give them subsidy. It’s a very generous subsidy, by the way.
Destiny – Pride: Destiny – Pride recently participated in the Congressional Black Caucus’ 2013 Health Brain Trust on Health Care Disparities, and the constant and resounding theme was getting and maintaining access – for everyone – to affordable health care services and having in place the appropriate systems for delivering those services. However, they were also concerned about the methods that would be used to bring in the participants once the system was in place. Doctors and practitioners all agree that is one of the greatest challenges, so please explain to our visitors how the Health Benefit Exchange Authority is planning to get people signed up for the services.
Dr. Akhter: There are two tasks. One task is to have health insurance available that is affordable, that meets people’s needs. That task we are doing. It’s a technical task. We’ve been working with the insurance companies and with businesses to make sure that that happens. So the table will be set.
That doesn’t mean that you if you build it, they will come. The folks that we are trying to reach are really hard to reach. What we are doing are two or three very different things in our city. First, we have reached out to the faith community because the faith community has direct access to the folks. We have been with Rev. Wilson and Rev. Tucker and we have asked them to gather the folks so that we can train them and pay them a little bit. They will be called “assisters,” so they can go in and not only talk to a brother or a sister in our community and say, “Listen, you need health insurance,” but actually help them fill in the form and send it in, so that we can bring folks in.
Similarly, we have gone to the business community and we’ve asked the same thing: to go to the small businesses and encourage those employees who don’t have insurance to really buy insurance. We did the same with restaurant associations and community-based organizations. So when everything is said and done, there’s going to be five or six hundred people in the city who will be helping the folks. They may be in the grocery stores. They may be in the hospital emergency rooms and when someone shows up and has no insurance, they will sign them up. Our thing is to work through established organizations – the faith community, the business community, the nonprofit community among us – to provide the manpower that will be necessary to go out and reach these folks.
There are four groups of people who are hard to reach in the city, and we know that because of the work that we’ve done. The first group is our young people. You know, up to age 26, people can be on their parents’ insurance. But if the parent isn’t there or they don’t have access to or haven’t really gotten onto an insurance program, many young people out of high school don’t have jobs or have jobs that don’t provide insurance. Reaching the young people is so very critical for us, to bring that segment of folks in, because we don’t know when an accident might take place or something else might happen – they get sick – so we need to have that.
The second group of people is people who work in restaurants. Many of these people are part-timers and the restaurants are not offering insurance. For many of us, the cleaning jobs at the restaurants – cleaning dishes – are the first jobs that we all get, and that doesn’t provide any insurance. We are bringing those folks in. There are subsidies available to cover their costs and, for most of those folks, the coverage is basically free.
The third group of people is people who work in construction. Because of the language barriers and the other difficulties, and not having contact with many people, they don’t have insurance, although they work in a very high-risk industry. They can fall or have other problems.
And finally, the last group of people is the gay/lesbian/bisexual/transgender population among us. They just simply don’t seek. They don’t come out and say, “Listen, we need to have insurance,” yet they need it the most.
So we will be specifically focusing on these groups, getting out there working with the community organizations to make sure that we bring these folks in. There’s no point in having built up the Insurance Exchange and have all this product available if there are people not benefiting from it.
Destiny – Pride: As we wrap up, what would you say has been a major accomplishment in your life so far?
Dr. Akhter: The major accomplishment has been to be able to learn and to serve. I’ve had tremendous opportunities to learn and serve, including this one. You learn; you serve. You learn; you serve. Whatever the Lord’s plan for me was, it is being fulfilled by my so doing. I have no regrets. I am very comfortable with where I am in my life. In every which way, I have been blessed. One hundred percent! So it’s a great opportunity for me to be where I am.
Destiny – Pride: On the flip side, what would be considered a disappointment?
Dr. Akhter: You’re never “disappointed” because the Lord can always make things better. But my disappointment is with our leaders. This is a great country. It has great resources. It has some of the most wonderful people, and I’ve met many of them myself in my journey through the past 40 years; but our leaders have not come together to take care of our own people. In this nation, there shouldn’t be homeless people wondering in the streets. There shouldn’t be folks without insurance. There shouldn’t be people who are hungry. If we can’t do this in the richest country in the world, how can other people do it? Everybody in the rest of the world is looking at us, and our leaders are fighting about petty things that mean nothing.
When was the last time that gay marriage provided jobs for anybody, or fed a hungry person? These are issues that mean nothing in the broader scheme of things as our people are concerned. So my disappointment is with the leaders, but the Lord can change their hearts and maybe then they will come to their senses and start working together for the benefit of our people so that we will become not only the richest country in the world, but the country that takes care of its people.
Destiny – Pride: Dr. Akhter, what are your last thoughts that you would like to share with our visitors today?
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Dr. Akhter: I want to thank you for coming and interviewing me, and also want to thank the Spotlight for selecting me for this segment. We have built a wonderful Exchange where health insurance will be offered to the folks who are uninsured and underinsured, and those who can’t afford it, we will provide assistance so you can buy the health insurance.
Health insurance is the gateway to quality health care and the quality health care is what makes us strong and live long. We need to take full advantage of what is being offered. We are grateful to President Obama for his leadership and to Mayor Gray for what he is doing for our citizens. Now it’s our turn to come in and take advantage of what is being offered. Thank you very much, and God bless you all.
Destiny – Pride: Destiny – Pride truly thanks you, Dr. Akhter, for being our 2013 Spotlight of the Month for July. Your vast knowledge of and experience in the health care field has allowed you to play an integral role and become a major player in health care reform in our nation, and particularly in the nation’s capital, the District of Columbia. We are excited about the changes in health care and the new opportunities that will be emerging out of the creation of the DC Health Benefit Exchange Authority. We wish you well and much success.
Dr. Akhter: Thank you very much.