Posted by: John Gilmore | September 16, 2006

Obama’s Health Rationer-in-Chief

The following is an article on Dr. Ezekiel Emanuel – health adviser to President Obama. Anytime I see someone in our government who believes something like this – I immediately think – the socialism train continues to move forward.

“Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs”

Wouldn’t it be in the best interests of society to help individual patients? Isn’t this why the Hippocratic Oath was created? What, exactly, does Dr. Emanuel mean when he says ‘the greater good of society’? The rest of the article gives us a few clues.

“In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient’s needs.”

Wow. I don’t know about you – but when I go to the Doctor – I prefer that the Doctor is focused on me – not ‘the greater good of society’. I don’t want anything that isn’t required – and I would hope that the Doctor would only do what was necessary (using his/her knowledge and expertise to determine the best course of action). I don’t want to go to the Doctor and wonder if I’m getting the care I need because the best course of action for me isn’t best for ‘society’.

‘But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained “to provide socially sustainable, cost-effective care.”’

I don’t believe Americans want Doctors ‘serving’ anyone or anything – least of all ‘society’ – and I feel reasonably confident when I say that I’m sure Doctors don’t want to ‘serve’ society. Let me translate – by ‘society’, Dr. Emanuel means our government. All of this socialism rhetoric is the same. We need to serve ‘society’, the ‘state’, the ‘greater good’, etc.

What we want is for our Doctor to give us an open and honest evaluation – and recommend a best course of action based on their expertise and some common sense. What we don’t want to hear is – ‘I can’t perform that procedure or administer that treatment because – in the long term – it’s not socially sustainable’. I don’t even know what that means. What nonsense.

‘Dr. Emanuel argues that to make such decisions, 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:’

I’ll translate again – Dr. Emanuel proposes that our government will dictate to our medical professionals how to treat individuals ‘in a way that keeps society going’. What does ‘keep society going’ mean? Let’s find out.

“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. . . . As the legal philosopher Ronald Dworkin argues, ‘It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,’ this argument is supported by empirical surveys.” (thelancet.com, Jan. 31, 2009).”

So, the health advisor to the President of the United States advocates a healthcare system that discriminates against the oldest and the youngest of us. It doesn’t matter what the condition is – or what may be required – if you are older or younger than the general population – you are at the end of the healthcare line. I imagine that the people who share Dr. Emanuel’s view must look at this issue with a coldness I do not possess. The question I would ask Dr. Emanuel is this – if his infant son or daughter needed an immediate heart operation to save their life – but couldn’t get it because of this system – what would he do? If his father or mother couldn’t get a needed operation to save their life because of this system – how would he feel then? Would that same cold intellect remain or would feelings interfere?

It’s easier to talk about healthcare discrimination from a 30,000 foot level – it’s much harder if we consider the real world consequences. If my son or daughter’s life was threatened, I’m afraid that the ‘greater good of society’ would take a backseat to my child’s health. In fact, my own life would take a backseat to the health of my child. We need to value everyone’s life – regardless of age, race, etc.

Knowing how the global elite operate and how they are pushing a socialist agenda forward around the globe – this type of healthcare discrimination rhetoric is only the start. If we allow this – it won’t stop there. Once you allow discrimination based on age – it’s a very small step to enact laws that prevent healthcare altogether to certain people – people who do not adhere to your unbiblical laws – who do not go along with your evil plans. Remember – those who do not have the ‘mark’ of this political beast – will not be able to buy or sell – or be part of the world system. A socialist healthcare system is going to be a piece of that system. I assure you – the global elite at the top of this socialist hierarchy will not have a problem getting healthcare. Once again – this isn’t simply about healthcare – it’s about control of the world’s population.

Once again we see that lies are trumpeted as the truth (below) to push an agenda. Standard operating procedure.

“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.”

Before I decided to overhaul our healthcare system – I would start by researching the following things completely:

1. What is actually driving healthcare costs to astronomical levels? I would like to see how a hospital charges patients and their cost basis for the products and services they provide. A child of a friend of mine recently had outpatient oral surgery – no overnight stay. The price was over $10,000. Is it the products (anesthesia) or services (surgeon’s time) or both that are causing a bill this high? Are bills being excessively padded due to other people who cannot pay? How do pharmaceutical companies price drugs? Do they give any pricing consideration to high volume drugs or drugs that are crucial for some people – or do they exploit the system? I don’t know the answers – but if you want to really understand what’s happening – this is the place to start.

2. How much power and influence do healthcare insurance companies wield? Based on my own experiences – I would say – a lot. Are these companies actually trying to reduce costs and provide a needed service or are they using their power and influence to increase profits at the expense of the healthcare system? Why should we be at the mercy of a huge corporation when determining whether or not we should undergo a certain procedure or whether or not we should receive a certain type of care? Shouldn’t we have enough trust in our Doctors to let them make the decision based on our health and the most cost effective way to treat our problem? Do I trust a huge bureaucracy or my Doctor? Do these companies have certain lucrative contracts that funnel products and services to certain providers, suppliers, hospitals, etc. – that may be more expensive to us and provide substandard care? Why do we even need insurance for everything? I don’t have the answers – but someone who is really trying to solve this problem – should.

3. From what I read, malpractice insurance rates seem to be increasing by ridiculous amounts – which I’m sure is driving up costs for everyone in the system. How many malpractice lawsuits are filed each year? What are the reasons? Are the reasons valid? How much of the money from lawsuits goes to the plaintiffs versus the lawyers? Are there lawyers who specialize in this (That would tell us something – either the lawyers are simply profiting from the healthcare system or we have a tremendous amount of incompetent Doctors in the system)? The overriding question is – are we filing lawsuits because someone intentionally caused us harm – or are we simply chasing after money? If a doctor made an honest mistake – did the mistake cause significant harm requiring additional care and monetary assistance – or are we simply using the mistake to make some money?

4. To some extent, we need the ability to to manage our healthcare expenses ourselves. Most of us who have insurance – just do what we’re told – without looking for other, less expensive options. When given a prescription – do you ask if there is a less expensive option? When you need to go to the hospital (non-emergency) – do you compare prices? We typically don’t – because it’s almost impossible to get any type of idea what prices will be. This needs to change. In a truly free market – I should be able to compare prices and services and make my own decision.

5. What is the relationship between Doctors, hospitals and medical (pharmaceutical, medical equipment, etc.) companies? Are we prescribing more expensive medicine simply because we all make more money? What types of incentives are being offered to Doctors and hospitals by these companies? Are there monopolies in this business that are driving costs/prices much higher than necessary? Are the pursuit of profits driving up prices unnecessarily?

6. What would happen to our healthcare system if we all stopped eating so much fast food and processed foods and actually ate healthy, nutritional food? What if we stopped watching so much TV, stopped playing so many video games and spent time outside doing stuff with our friends and families?

You get the idea. Instead of hearing knowledgeable debate on these issues – all we ever hear is – the system needs to ‘change’, many Americans don’t have insurance, healthcare expenses are out of control, we are some of the most unhealthy people in the world, etc. etc.

What we should be asking is – why does the system need to change? Why do we need insurance for everything? Why are healthcare expenses out of control? Why, as a nation, are we unhealthy? Why don’t the people in Washington D.C. pushing for universal healthcare have the answers to these questions? No one seems to want to dig into the details and find out the real reasons for these things. No, that would require intelligence and hard work – we’d rather just change the system.

It seems to me that we all want better healthcare – but we’re not willing to do the things to be healthier (eat better, exercise) and we’re not willing to do our homework and find out the real reasons the current system is so expensive.

Nothing in this world is easy. If we want to really solve this problem – we need to work hard to solve it – and not simply give political speeches about it laced with sound bites that may or may not be true.

What we don’t need – is a government ‘solution’ that will lead to even more bureaucracy.

jg – August 27, 2009
_______________________________________
AUGUST 27, 2009

Obama’s Health Rationer-in-Chief

Wall St. Journal

By BETSY MCCAUGHEY

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House’s health initiative.

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

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.”

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient’s needs. He describes it as an intractable problem: “Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.” (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained “to provide socially sustainable, cost-effective care.” One sign of progress he sees: “the progression in end-of-life care mentality from ‘do everything’ to more palliative care shows that change in physician norms and practices is possible.” (JAMA, June 18, 2008).

“In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations,” he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

“You can’t avoid these questions,” Dr. Emanuel said in an Aug. 16 Washington Post interview. “We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a ‘God committee’ to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions.”

Dr. Emanuel argues that to make such decisions, 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)

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 (see Dr. Emanuel’s chart nearby).

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. . . . As the legal philosopher Ronald Dworkin argues, ‘It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,’ this argument is supported by empirical surveys.” (thelancet.com, Jan. 31, 2009).

To reduce health-insurance costs, Dr. Emanuel argues that insurance companies should pay for new treatments only when the evidence demonstrates that the drug will work for most patients. He says the “major contributor” to rapid increases in health spending is “the constant introduction of new medical technologies, including new drugs, devices, and procedures. . . . With very few exceptions, both public and private insurers in the United States cover and pay for any beneficial new technology without considering its cost. . . .” He writes that one drug “used to treat metastatic colon cancer, extends medial survival for an additional two to five months, at a cost of approximately $50,000 for an average course of therapy.” (JAMA, June 13, 2007).

Medians, of course, obscure the individual cases where the drug significantly extended or saved a life. Dr. Emanuel says the United States should erect a decision-making body similar to the United Kingdom’s rationing body—the National Institute for Health and Clinical Excellence (NICE)—to slow the adoption of new medications and set limits on how much will be paid to lengthen a life.

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.

Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. “The desire to be rid of the freeze will do much to concentrate the mind,” he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. “Every favor to a constituency should be linked to support for the health-care reform agenda,” he wrote last Nov. 16 in the Health Care Watch Blog. “If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration’s health-reform effort.”

Is this what Americans want?

—Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state.

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