by the Night Writer

Congressional and other townhall defenders of the nationalized healthcare proposals — collectively lumped as “Obamacare” — are quick to deny that rationing of healthcare is intrinsic in the proposals, or that the old and the very young are at risk from a sliding scale prioritizing who receives care. While no politician is likely to put his or her name on such a specific plan, in practice the implementation of such a bill will be up to the political appointees and advisors who will create the regulations that set the directives and protocols. People such as Dr. Ezekiel Emanuel, health adviser to President Barack Obama, health-policy adviser at the Office of Management and Budget, member of the Federal Council on Comparative Effectiveness Research and brother of WH Chief of Staff Rahm Emanuel.

In an opinion piece in today’s Wall Street Journal, Betsy McCaughey describes Dr. Emanuel as President Obama’s Health Rationer-in-Chief and, rather than putting words into the good doctor’s mouth, uses his own copious writings (with citations) to demonstrate his disdain for the bothersome Hippocratic Oath and his stated views on properly prioritizing care for those of most use to the “polity”:

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.”

… the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: “Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.” (Hastings Center Report, November-December, 1996)

So, “Citizen”, as long as you are lucid, or still have a chance to contribute, you’ve got a chance. Start drooling, however, and the tax dollars you’ve paid in over the years might get your sheets changed on a regular basis. (Say, I wonder if one’s active – but politically incorrect – participation in public deliberations could be judged by government experts as a form of dementia?) But never fear, Dr. Emanuel wants to save the maximum number of lives, as long as they’re the right lives…

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a “complete lives system” for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. “One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

“However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear.” In fact, Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated …

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: “Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.”

The youngest are also put at the back of the line: “Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . .

Oh those poor, under-capitalized infants. Actually, that reminds me of a case in Great Britain I once wrote about: Charlotte’s Web: When the State Decides if Your Baby Shall Live or Die.

Of course, the “20-year-old that might live another 60 years” would then be 80-years-old, assuming he didn’t lose his ability to participate in public discourse when he was 70 and the national health service didn’t decide to write-off it’s “investment” at that point. And let’s not overlook this contribution to the public discourse from Dr. Emanuel:

Dr. Emanuel’s assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: “The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name.”

This is untrue, though sadly it’s parroted at town-hall meetings across the country. Moreover, it’s an odd factual error coming from an oncologist. According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel’s views.

There’s a lot more so read the whole thing, especially if you want to have the direct quotes and citations handy.

HT: Amy Ridenour’s National Center blog.

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