We discussed last week the risks to which a person exposes himself by betting and gambling, showing that these constitute injustice to oneself, and they are, therefore, forbidden in Islam. We concluded by stating that these are totally different from health insurance. Our discussion is based on what Dr. M. Haitham Al-Khayat has written on the subject. We resume our summary of his views.
In essence, insurance is an act of avoiding God’s will by God’s will, as expressed by the second Caliph, Omar ibn Al-Khattab. Or we may use the words of God’s messenger and say that it repels one act of God’s will by another. The Prophet was asked whether prayers, medicines and forms of disease prevention could prevent an act of God’s will. He answered: “These are part of God’s will.” Moreover, health insurance, or insurance generally, is an act of mutual love and compassion which strengthens ties between believers so as to enable them to be like a whole construction in which each part supports the rest.
We see in insurance clear cooperation to prevent what may undermine the welfare of believers. According to the Prophet, “a Muslim is a brother to every other Muslim: He neither acts unjustly toward him nor gives him away.” Another version of this Hadith related by Muslim adds: “nor lets him down.” If a Muslim sees his brother being exposed to a grave risk or a great loss but does not take steps to protect him and spare him such risks and losses, then he actually gives him away and lets him down.
Furthermore, insurance is a means to relieve stress and hardship. An authentic Hadith outlines a great promise: “Whoever relieves a Muslim of one hardship of this life will be relieved by God of one of the hardships of the Day of Judgment; and whoever makes things easy for a person in difficulty will have his things made easy by God both in this life and in the life to come.”
Having established these broad and comprehensive principles, with their momentous effect, Islam allows Muslims to determine how to implement them according to their particular circumstances. The only proviso it makes is that such implementation must not make lawful what God has forbidden or forbid anything He made lawful. The proper way to prevent natural risks, in the universe and in human life, and to spare or reduce their effects when they occur is to break up their effects and to provide cooperation in bearing the losses they produce. An authentic Hadith clearly supports this principle. According to both Al-Bukhari and Muslim, Abu Musa Al-Ash’ari quotes the Prophet as saying: “When the Ash’aris are on an expedition and they happen to run out of food supplies, or if food becomes scarce for their families in Madinah, they put together everything they have in one lot and divide it all equally among themselves. They belong to me and I belong to them.” Commenting on this Hadith, Khayat says: “This is a highly effective lesson showing how the whole community shares equally the consequences of any hardship that befalls some of its members.”
In our present day, insurance has countless forms, all of which have a common feature giving the insured security against a total loss that could have broken his back or left him helpless.
Contemporary scholars who pronounce a ruling prohibiting insurance through specialized companies consider the insured person’s ignorance of what he receives in return for his premiums as the basis of their ruling. This ignorance is totally or virtually removed when we apply the law of large numbers and actuarial arithmetic.
Their argument also refers to an element of betting or gambling involved in insurance; but insurance, in all its forms, has nothing to do with either. They also say that insurance involves some usury of either one of its two types, but this applies only to monetary exchanges, which are nonexistent at least in health insurance (which is the main thrust of Khayat’s paper). They further argue that the insurer does not undertake any work on behalf of the insured.
This is again a false argument, because insurance companies invest the premiums paid by the insured so that there will be sufficient funds should there be a flurry of claims as a result of a general calamity. The investment also aims to provide shareholders with dividends on their investment. In health insurance, there is an added return in the form of improving the quality of health services. Furthermore, the investment undertaken by the insurance companies may lead to reducing the premiums paid, and this is a direct benefit to the insured.
Khayat concludes his paper with a clear exposition from which we quote: People in different countries have established ways and means of cooperation in disease prevention, control and treatment. Such cooperation certainly comes under the general principle of cooperation in furthering what is good and beneficial, laid down by God in the Qur’an and expounded by the Prophet who cites a variety of its practical examples.
The most common feature in such different ways of cooperation is that the state continues to shoulder the greatest responsibility in disease prevention and control, and case diagnosis and treatment. Other institutions may contribute to the fulfillment of the great responsibilities undertaken by the state.
All such institutions are insurance institutions which provide cover against the risk of contracting a disease without having sufficient funds to pay for its proper treatment and cure. The method followed by such companies to provide such insurance cover relies on breaking down the cost of disease so that it could be shared by a large number of people, each of whom pays a specific amount which he makes available to others when they need it. Similarly, such funds are made available to him when he needs them.
Some of these insurance companies, however, are pure cooperatives, which means that their funds are paid only by the insured who benefit by such insurance in the form of case diagnosis and treatment or disease prevention. In some cases a third party makes contributions without receiving the same benefits of health services. This third party may have its returns in a different form, such as reducing absenteeism and loss of productivity due to illness. This is the case when a company or the state contributes to health insurance premiums on behalf of its workers and employees. Alternatively, the third party may receive a share of the profits in return for his investment in the insurance company, as in the case of shareholders.
It appears – but God knows best – that all these forms of cooperation come under what is encouraged and urged by Islam. They are all equally free of “ignorance of the resulting benefit”, and have no element of betting or gambling. Moreover, the monetary benefit that shareholders receive, other than direct medical treatment, does not adversely affect the legitimacy of this whole enterprise. It is perfectly acceptable in Islam that a person should be rewarded and thanked for his effort, even when what he undertakes is an act of worship. God says that pilgrims may fulfill their worship duty and may, at the same time, “experience much that shall be of benefit to them, and that they may extol the name of God.” (22: 28)
Hence, whichever form of health insurance we may follow is appropriate from the Islamic point of view. The preferred form, however, is the one that provides maximum benefit for the insured, and guarantees maximum equity, quality, efficiency and disease prevention in the provision of health services. Needless to say, this differs from time to time and place to place.
This paper on health insurance, regardless of whether one agrees with its conclusions or not, provides yet another example of the revival that brings scholarship in Islamic Fiqh back to its vigorous days. Thus, Islamic Fiqh will regain its ability to organize human life in a way that ensures obedience of God’s commands, avoidance of what He has prohibited, and serves the interests of the community and prevents what is harmful to it.
These are the ultimate objectives of Islamic law. It is on the basis of this most important principle that scholars should work so that those of them who come up with the right verdict earn double rewards and those who make mistakes earn a single reward. All this is an aspect of God’s bountiful grace.
