What stance can a person take toward a system that does superbly well by him, but fails to serve the needs of huge numbers of his fellow citizens and residents of the United States?

That’s my situation with the American health care system. For many years, I have had the good fortune to be well served by medical professionals, and I much appreciate their efforts on my behalf. And now, thanks to Medicare, I share in a system that assures my age peers and me some financial support for our care.

At the same time, I feel acutely conscious of the millions who lack access to the current system or who fail to get first-rate care. And I am also aware of deficiencies in my own health care plan:  in the event of a long lasting chronic illness, I could face a crisis as well.

So I stand convinced of the need for radical change in the structure by which health care is delivered in this country. In fact, I find it hard to understand how we have tolerated a system that for decades has shown itself inadequate. To me it continues to be a scandal that we allow so many to go without, when our capacity for excellent health care has been long demonstrated.

My views were recently confirmed when I heard Marcia Angell outline the case for a national single-payer system to replace our current seriously flawed approach.

A physician whose many credits include editorship of the New England Journal of Medicine, Dr. Angell is an authoritative and persuasive speaker.

We speak of our current arrangements as a system, but the term is inadequate. Rather, in Dr. Angell’s words, it’s a “hodge-podge of different business arrangements that exist more or less independently from one another.”

As she sees it, three major problems characterize the status quo in health care. First, it is “staggeringly expensive.” Furthermore, despite that expense, “we don’t get anywhere near our money’s worth.” Finally, among the world’s 30 richest nations, ours is the only one that relies on a market approach that bases eligibility on ability to pay, rather than making sure that everyone is included.

Some argue that letting the market work harmonizes with the American way of doing things; but they ignore crucial facts. The most important of these facts is that those least able to pay are usually the ones most in need of health care. In fact, cost shifting stands out as one of the salient features of the current system. As much as possible, insurers try to impose as many costs as they can on patients. This they do by deductibles, co-payments, and denial of some treatments.

Dr. Angell explains: “There’s a great mismatch between medical need and the ability to pay.” Why should the lack of money deprive people of such a basic human need as good health?

Polls suggest that as many as two-thirds of Americans favor changing the current system and putting in place the single-payer model. But two major vested interests continue to stave off any such change. The insurance and pharmaceutical industries, both titans in the political sphere with lots of money and influence, have thus far succeeded in blocking proposals for a new approach.

Dr. Angell holds that one way these huge corporations succeed is by fostering myths about health care. They claim that single-payer would cost more, quite the opposite of what studies show. They also want us to believe that long lines for treatment would result and that new technologies would be unavailable.

Another ploy is to call a national plan “socialized medicine,” with the suffocating bureaucracy that many people attach to this name. The opponents of single payer also rely on the cliché that government cannot do anything right. And, finally, they would have us believe that single-payer plans have no place in the real world.

Dr. Angell sees her proposed system as a way of reducing the gap in our society between the haves and the have-nots. That gap has been growing larger and thus creating fissures in our national community, divisions that damage the vital interests of  rich and poor alike.

Desperately needed as it is, I have no great hope that national health insurance will be enacted any time soon. However, I do believe that a promising sign is the difficulty that some large corporations are experiencing in paying to insure their current employees and those who have retired.

General Motors recently felt forced to ask its largest union to accept cuts in the health coverage offered to its retired workers. Significantly, the union accepted the company’s proposal without notable protest, recognizing that GM’s increasing costs do count as an insupportable burden.

Ideally, the time will come sooner rather than later, when the corporations will exert their power to press for scrapping the current system and instituting a single-payer plan. Until that time comes, we are going to see inexorable rises in costs without any corresponding inclusion of those left outside in the cold.

Richard Griffin

As a child, I remember walking down city streets with my father and feeling embarrassed when beggars reached out to him for money. My embarrassment came from being in a position of superiority over against the poor people who were begging. The situation stirred in me wonder about the way the world’s resources were distributed, a wonder that has never quite left me, so many decades later.

There seem to me two basic and sharply different attitudes toward the world. The first is to accept it as you find it, an awesome mixture of good and bad, of fortune and misfortune. Then life’s task becomes learning how to adapt to situations posed by this world and to come away with the best for yourself and those in your own circle of family, friends and associates.

The second approach is to be radically dissatisfied with things as they are, to recognize that the world needs fundamental change because some of its inhabitants have so much and others have so little. In this vision, life’s task becomes a sustained effort to transform the way the world is shaped, to try and bring about the erasing of its dividing lines, and to heal its wounds.

A common, but surely not universal, tendency among people in late life is to come to terms with the world, to accept its not being what we would like, and to leave to others the struggle for change. Many of us with who have been involved in changing things now feel tired out by the struggle and, in the name of a peaceful existence, are ready to retire from the field of combat.

I doubt Paul Farmer will ever feel that way. This physician, who travels to Haiti, Rwanda, Peru, Siberia and other places marked by destitution, provides health care to the poor with a zeal that seems never to flag. Given his dynamism in early middle age, it seems unlikely indeed that his later life will feature late sleeps and rocking chais.

Back in 1987, when he was a medical student, he led the way in founding “Partners in Health,” an agency dedicated to providing care to people who cannot get it otherwise. With extensive support from individual benefactors and foundations, Partners reaches out to far-flung places around the world.

This organization also undertakes research and advocacy on behalf of the poor in ill health. Dr. Farmer has challenged the view that good health care cannot be delivered in resource-poor settings.

Haiti, in particular, has provided what he calls a “crash course” about the world. That island country’s entire financial resources, he points out, amount to less than the annual budget of the city of Cambridge.

He believes in the radical reform of social structures rather than mere stopgap measures. Good as food pantries are, food security is much better, as Farmer is fond of reminding everyone. But that approach does not prevent him from attending to the needs of the individual patients whom he encounters.

Besides the distant sites, Dr. Farmer also works in Roxbury, Mattapan, and Dorchester, giving people in those communities access to decent health care. It bothers him to see our country reneging on services to its poor. “It feels to me as if we are backsliding,” he said recently. He was speaking to an audience gathered to celebrate the 40th anniversary of CEOC, my city’s anti-poverty agency.

When Hurricane Katrina struck, he happened to be in Rwanda watching the events in New Orleans with citizens of a country that had gone through a bloodbath of civil slaughter. Still, at that moment he felt ashamed of his own country. “The Rwandans were horrified at us letting poor people and people of color be afflicted,” he reported.

He regards it as urgent to fight for the social and economic rights of our people. As remedy for the current malaise, he calls for a widely-based movement to secure those rights. Realistically, however, he terms such a movement “both remote and utterly necessary.”

Farmer might well have taken inspiration from a statement made by Margaret Mead and posted behind the speaker’s rostrum when he spoke. “Never doubt,” she once wrote, “that a small group of thoughtful committed citizens can change the world: Indeed it is the only thing that ever has.”

A thin, fragile looking man, Farmer has become a culture hero, a person who has committed himself radically to the cause of excellent health care for the poor. His story can be found in the 2003 book Mountains Beyond Mountains, written by Tracy Kidder, now available in paper.

Hearing about his work, I admire him but feel some concern about the impact that being so widely extended will eventually have on him. How can one individual, no matter how charismatic, endure the demands placed upon him by so many people in such widely separated parts of the world?

More practically, how can more people who are talented and committed be persuaded to share in a task whose importance cannot be doubted?

Richard Griffin

Growing up, I never once met a Muslim. Nor can I remember ever being in the presence of a person who professed the Islamic faith. In my suburban setting, there seemed be no one of this religious tradition.

When, as an adult, I became a student of theology, the focus of my course of study remained squarely on Christianity. That meant hardly ever mentioning Islam, much less going into its history and teaching. Despite an advanced study of theological issues, my colleagues and I remained almost completely ignorant of this other tradition.

Even when I visited the Middle East in 1965 with a group of Catholic colleagues, I spent only a few days in part of Jordan and there my focus was on the places where Jesus walked.

Looking back, it is hard for me to believe that a faith shared by about a billion other people was a blank slate for me. How could I have remained ignorant of such an important factor in the world’s life?

Fortunately, one of the benefits of living long is the opportunity to remedy some areas of ignorance. I feel thankful at having my life stretch over enough decades for me to begin learning something about Islam.

In that effort I have had the good luck to become acquainted with a person who combines the life-long practice of Islam with a scholar’s knowledge of this tradition. Ali Asani teaches Indo-Muslim culture and languages at Harvard and is often called upon to help people outside the university to attain a better understanding of his faith.

He has long been used to hearing stereotypes about his religious heritage. “How can you believe in a religion like Islam that espouses terrorism and violence?” a graduate student friend once asked him.

“That student could not reconcile images of violence with me,” said Asani, who happens to be a very mild-mannered person.

This identification of Islam with terrorism has taken hold, Asani thinks, because of what he calls “the othering of Muslims in the media.” Americans read, hear, and watch news material likely to implant false impressions in our psyches. Without critical analysis, we easily jump to the association between Islam and violence.

“These perceptions go back centuries” Asani explains. Christians and others have indulged in a mutual stereotyping that dehumanizes people different from themselves. This amounts to a “clash of ignorances” rather than of civilizations. At its most extreme, this kind of collision can lead to ethnic cleansing and other monstrous results.

Western societies are filled with mistaken notions about Muslims. For example, we tend to think that all Muslims are Arabs. But the Muslim population of Asia extends eastward to the Pacific, and most Muslims are not Arabs. And we assume that all Arabs are Muslim whereas, in the United States, 70 percent of Arabs are Christian.

Being a Muslim in one country is very different from being a Muslim elsewhere. Living in Saudi Arabia, for example, contrasts sharply with being Muslim in Senegal, with the latter’s long tradition of peaceful diversity. When Islam is linked to political power, then it takes on a very different face.

What Islam means is submission to the one God. A Muslim is a person who submits to that God. In this definition, the great figures of the Hebrew Bible, starting with Abraham and Moses, were Muslim. So was Jesus, and others in the New Testament.

The notoriously divisive word Jihad means to struggle or to strive. Originally, it was used in a defensive mode as when you struggled to protect your neighbor. But in the 9th century, the word was first employed to justify imperial rule.

As to suicide bombers, Asani states bluntly: “They have nothing to do with religion; there is no scriptural justification for it; these are political acts.” He sees poverty, dehumanization, and colonialism playing into these horrific acts of violence.

Asked about the madrasas, Muslim schools seen in the west as seed beds of violence, this scholar portrays them, in part, as the way poor people, as distinguished from the elite, learn basic skills. To some degree, they are a response to colonialism. It is a mistake to judge that all Muslim education fosters warlike attitudes.

The most important lesson to take away from Asani’s approach is the error of judging a religious tradition outside of its cultural setting. Islam is so diverse that generalizations about it are hazardous. You must remain aware of the sharp differences that characterize this religion from situation to situation.

These insights from a Muslim scholar can serve to indicate how I am attempting to chip away at my own ignorance. Little by little, I hope to learn more about a major force in our world.

Getting to know personally at least one man who is steeped in that tradition is a large step forward. Personal connections probably do more to break down stereotypes than all the books I could ever read about Islam.

Richard Griffin

An inch of brick sticking up in my path is what did me in. Walking blithely along, minutes after a refreshing swim, I failed to see the danger. The next thing I knew, I was lying stunned after falling on my face. Blood was flowing from my forehead and I felt confused. Later, at a health clinic, it would take seven stitches to close the wound.

Plunging downward from a height of six feet is bound to be damaging. It’s also discombobulating and humiliating. You lose your composure, suddenly finding yourself in what feels like a different world. The assurances by which you live have been disrupted and you are left in a gaping no man’s land or twilight zone.

After the confusion cleared, my first interior gesture was to accuse myself of stupidity. The fall could easily have been avoided. Why did I not look where I was treading? How could I have been so distracted as not to be wary of a familiar hazard?

Since the event, I have replayed it in my mind over and over. Where exactly was the tipping point, I seek to discover?

But, as John Updike, in his most recent novel Villages, makes one of his characters reflect, “Accidents are accidents and demonstrate only the vacant absurdity of everything that is.” This is not quite my philosophy but it gives emotional expression to the feelings of chaos that falls provoke.

This kind of calamity happens to the celebritous as well as the rest of us. Complications from falls were a factor in the death of Katherine Graham, the legendary publisher of the Washington Post, and in that of longtime network news anchor David Brinkley.

When Harold Pinter was announced the winner of this year’s Nobel Prize for literature, he was shown in the world’s media with a cane in his hand and a bandage on his forehead, emblems of a fall he had suffered recently.

The day before I wrote these words a neighbor emailed me with news that a mutual friend had fallen getting into a taxi and had broken his leg. And two other friends have done such damage to themselves by falling as to bring on seemingly endless complications.

We elders have no monopoly on falls. Falling is something that happens to people of all ages. I think of the graduate student friend who fell down the stairs of her divinity school. And in winter we see casts, braces, and splints on all sorts of people who have slipped on the ice. Everyone faces the possibility of this experience.

But older people fall more often and, when we do, the results can be much worse. In my city and elsewhere, our pathways are full of hazards, some of them the result of negligence. Cities and towns, individual homeowners, and landlords should be ashamed of the faulty brick sidewalks and other obstacles that endanger the passage of people with disabilities and others who must walk carefully.

Of older Americans, one out of three of us is reported to fall at least once each year. (Some studies suggest that the number is even greater ─ more than half.) And in the year 2002 such falls resulted in death for more than 12,000 of us. Had I landed on a stone railing nearby, my latest plunge to the pavement could have unceremoniously ushered me into that group.

For those with osteoporosis, the risk of breaking bones is acute. Unfortunately, bone breaks often lead to other reverses in bodily well being and, often, complications both long-lasting and grievous.

With stakes this high, all of those in later life have compelling reasons to take care. My latest misadventure has led me to make changes in my gait. Instead of walking with a sliding motion, moving my feet along rapidly, I now take pains to lift them. And when I must move fast, I scrutinize the terrain on my route. The Psalmist says: “Walk humbly before the Lord.” I now do.

The director of the Yale Program on Aging points to the loss of confidence some older people suffer as one highly undesirable result of falling. She says it often makes us cut back on physical activity and hesitate to leave our homes at all, a truly unfortunate outcome.

Almost every house presents hazards, especially on stairs and in bathrooms. Ideally, we should make physical changes to reduce the dangers but, according to one survey, more than a third of older adults say they cannot afford them.

Medications also increase the risk of falling. The side effects of many drugs include dizziness and vision problems. Part of a fall-prevention plan would involve adjusting medications to make sure they do not heighten the risk.

More information on preventing falls is available from the National Council on the Aging, reachable at 202 479-1200. If you have access to the Internet, the address is www.ncoa.org.

Richard Griffin

What American magazine has the largest paid circulation? Which one has twice as many subscribers as the runner-up?

The answer to both questions is, of course, AARP the Magazine, weighing in at 22 million in paid subscriptions. The closest to it, Reader’s Digest, has just 11 million. The front runner has beaten out some 12 thousand other magazines that are published in the United States.

The millions of readers the Magazine attracts are apparently not deterred by its pretentious title, in which the letters AARP no longer stand for the American Association of Retired Persons.

The editor of this periodical, Steven Slon, impresses me as a remarkably nice guy in a business usually too high-powered for nice. But he does have strong views about language acceptable in his magazine, some of which he presented to an audience gathered at the recent American Society on Aging conference in Philadelphia.

If you want to get published in the Magazine, you had better avoid terms such as “old.” The editor faults this word because “it is a judgment.” If you want to use one that is better, he suggests, use “older.”

Slon even objects to “aging,” calling it “a loaded word.” It should not be applied to adults but rather to his grandson who is currently six years old.

Another term nixed by Steve is “senior,” as applied to long-lived people. And, of course, the word “retirement” has become a big no-no, now that the concept has been dropped from the very name of AARP.

Slon approvingly quotes Hemingway, who would seem to know something about words. About this one, the great novelist allegedly called retirement “the ugliest word in the English language.”

Steve is amused by, but does not recommend, the term “wrinklies.” That is what some Brits use, especially those who produce the humor magazine Oldies.

Other sinful words in the presenter’s view are “spry,” “feisty,” and, perhaps the most damnable, that sneaky little word “still.” When Steve hears that weasel of a word, it makes him think of a certain culture hero in my home town.

John Kenneth Galbraith, that neither old nor spry nor feisty patriarch who has been alive for the last 96 years, loves to tell about the op-ed piece he once wrote on “still.” In it he expressed dismay at how often people approached him asking: “Are you still walking, talking, reading, writing?”

What astonished Galbraith was the response. He heard from more readers on the subject of “still” than on anything else he had ever written for a newspaper.

Slon offers a provocative reason for his perception that different generations prefer different words.He calls those who have lived long “pre-ironic.”

This I take to mean that we elders cannot see the delicate meanings in the words that he wants to avoid. This generalization suggests that he has not met many people older than he who have developed a fine sense of irony about life’s absurdities. In fact, however, some of us find it quite difficult to breathe in an irony-free zone.

Some of editor Slon’s preferences about words will strike most people as forced and merely precious. As if to refute him, Abigail Trafford of the Washington Post, the very next speaker on his panel, pridefully introduced herself boasting: “I’m an old broad.”

I certainly do not mind if someone wishes to call me “old.” To me, it comes as a mark of honor, not an insult. What can be better than the gift of longevity?

In fact, I take a strong stand behind “old,” a perfectly fine word even though AARP – –  and American society in general – – keep trying to dump it. AARP has been working for years to purify itself from anything that suggests people’s duration on earth. In doing so, it has successfully created a name for itself that stands for nothing.

But Steven Slon says that to use “old” is unacceptable because “it is a judgment.” Of course it is, but so is just about everything else. “You’re sweet, you’re thin, you’re kind to do that, you’re the top.”

A journalist friend supports my view of “old,” and, hitting back at the purists, calls it “the newest four-letter word.” He may not be a speller, but he is right.

About some other words I feel mixed. I very much dislike the words “senior” and “senior citizen” as applied to people my age. I fault the words largely because they have been already taken by those in the fourth year of high school and college. However, “senior” is perfectly fine when used as a comparative: “She is my senior by six years.”

I recognize “feisty” and “spry” as clichés and resolutely avoid them.

Slon makes some good points. But let’s not condemn ourselves to a linguistic correctness so fussy as to put everyone to sleep.

Richard Griffin

If you are about to retire from your job, and discover that your company is planning a party to mark the occasion, should you agree to take part in this celebratory event?

You are on the brink of retirement and are seriously thinking about moving to a new town. Is this a good idea?

With a view toward the increased leisure that comes with retirement, you are about to commit yourself as a full-time volunteer at your local hospital. Does this make sense?

Yes, to the first; No to the second and third. At least, that is what Bob Weiss would answer. And, at the moment, he probably knows more about retirement than just about anybody else.

That’s Robert W. Weiss, Senior Fellow at the UMass Boston’s Gerontology Institute. Over the past few years, he and his colleagues have made a thorough study of the subject, interviewing 89 men and women retirees. From this research has come a book, The Experience of Retirement, which will be published in November.

Those interviewed, it should be noted, are all from Boston suburbs. Moreover, almost all of them are middle-class and many have had careers in the mainline professions.

Weiss explains that he himself can be considered retired, having stepped down 14 years ago as professor of sociology at UMass Boston. But ever since, he has continued his work in research, lecturing, and writing.

The main reason for accepting the party? It will make you feel better about yourself. “Even a bittersweet retirement event is better than no event,” concludes Weiss. The celebration will also give a positive twist to your thoughts about the workplace and colleagues that you have left.

As to moving your residence, you would not be acting wisely. It would be much better at this time of major transition to test the waters rather than to take the plunge.

The same caution applies to volunteering. In general, it’s a fine thing to do but committing yourself prematurely to a full-time slot forfeits the leisure that offers you many new possibilities.

For those thinking of retiring, Weiss offers an all-purpose rule of thumb: “The more orderly the retirement, the better.” That means advance planning and, especially, linking plans with the wishes of one’s spouse or significant other.

Trying to make this relationship flourish must loom large in any happy retirement.  When handled right, this relationship with a life partner does not remain static but changes, over the years, into a closer companionship.

Another central task for people in retirement, especially for those who live alone, is to stave off social isolation. About this, Weiss says that most handle it reasonably well. But those who derived their community from their workplace will need to adjust or face loneliness.

Often, those who suffer isolation do not recognize what is happening to them. The researcher urges people to try various activities, even if they feel pessimistic in advance that any one involvement will work for them

No single way of organizing retirement works for everyone, but certain approaches have proven worthwhile. Balancing engagement and freedom; choosing activities that replace the ones you like best in the workplace; trying things you always wanted to do but never got around to; finding retirement activities that boost your feelings of self worth ─these are staples.

About volunteer work, Bob Weiss offers a helpful generalization. “The closer your volunteer position comes to being a real job, the better.” But volunteering often produces feelings of frustration when you are not given a meaningful role. Again, the best rule of thumb, he says, is not to commit yourself without trying the position first.

As for paid work in retirement, the author finds that 16 or so hours per week suits most people best. That schedule provides enough time for a desirable mixture of labor and leisure.

In this study I would have liked to see more evidence of retirees who have opted for community service. Asked about retirees getting involved in social action, Bob Weiss says: “That’s unusual ─ almost always they are people who have done it before.”

That strikes me as true, but the idea of huge numbers of retirees in Florida, Arizona, and elsewhere focused on improving their tennis game, preparing for their next luxury cruise, or ready to drive a golf ball down the green fairways, but doing little or nothing for the common good, gets me down.

With all the gaping holes our society shows ─ in schooling the young, in providing health care, in relieving poverty ─ we could use what the Gerontological Society of America calls “the tremendous reservoir of skills and experience in our rapidly growing older adult population.”

Retirement is a time of great potential. The time has come for drawing on it and putting it to use for the benefit of us all.                     

Richard Griffin