Earlier this month (“ObamaCare as a Moral Clunker”), I wrote that there are three insurmountable moral objections to the president’s and Democrats’ versions of mislabeled “health care reform”:
- They are all designed and destined to ration care. This will lead, as it has in state-run systems virtually everywhere, to long waits for even critical services. In Tuesday’s Wall Street Journal, Harvard professor and chairman of President Ronald Reagan’s Council of Economic Advisers Martin Feldstein confirmed this obvious and inconvenient truth, writing that “rationing health care is central to President Barack Obama’s health plan.”
- Under the idea of “Comparative Effectiveness Research” (CER), which has already been funded to the tune of over $1 billion, the inevitable and unavoidable rationing just described would more than likely be carried out under a regime of care denial driven by age-based and “quality of life” criteria. This will, formally or informally, lead to a system similar to that found in the UK, where its National Health Service, under the concept of “Quality-Adjusted Life Years” (QALY), won’t pay for medical procedures that “cost” more than $50,000 for each year of additional life expected to be gained (“cost” is in quotes because I believe that such “costs” are often overloaded with fixed overhead that largely should not be relevant to such decisions).
- The people who would be in charge of implementing a state-controlled system, which remains the objective of President Obama and Congress as long as they seek any kind of “public option” or government-managed “co-operative” set-up, have viewpoints that are ethically questionable at best and morally abhorrent at worst.
The administration appears to be trying to allay the justifiable concerns about Item 3 and seems to believe that if it can do that, Americans won’t be as worried about Items 1 and 2. Sadly, despite the worldwide track record of state-run and state-controlled systems, there is some plausibility to this strategy. Even with the vocal and growing opposition to ObamaCare as a whole, Rasmussen reports that “57% oppose the plan if it doesn’t include a government-run health insurance plan to compete with private insurers.”
This is where Dr. Ezekiel Emanuel (“Zeke”), brother of President Obama’s Chief of Staff Rahm Emanuel, comes in.
Zeke has been and apparently still is chair of the Clinical Center Department of Bioethics at the National Institutes of Health, where he is still listed as an employee. I have confirmed that Zeke is still employed there. He has been with the Obama administration as health policy adviser at the Office of Management and Budget since February, and is a member of the Federal Coordinating Council on Comparative Effectiveness Research.
Hmm. He’s a busy guy. I wonder how many taxpayer-funded income streams he receives.
Zeke has an ugly paper trail that goes back a long way. What follows are just a few examples.
On the Hippocratic Oath, Zeke said in 1997 that it “represented the minority view in a debate within the ancient Greek medical community.” Well, if everyone had been following an ethical framework, the Oath wouldn’t have been necessary, would it? One might as well say that in the 1950s, the majority of white southern Democrats opposed the voting rights for black Americans. So what? Does that make Rosa Parks and Martin Luther King presumptively wrong?
In a study released in 2001 based on a review of 1996 death and patient records, Zeke and a team of researchers found, as summarized by the New York Times, that “many cancer patients receive chemotherapy at the end of life, even if their kind of cancer is known to be unresponsive to the drugs.” Sounds familiar to the risible claim by the president a few weeks ago that pediatricians are taking out tonsils for purely financial reasons, doesn’t it? But Zeke & Co. rigged the test by bright-lining the difference between “responsive” and “unresponsive” cancers. According to this American Cancer Society link, for liver cancer, one of those the study deemed unresponsive to treatment, “[chemo] drugs shrink less than 1 in 5 tumors, and the responses often do not last long.” Hold it right there. First, chemo does work at least occasionally; when you have serious cancer, “occasionally” sounds pretty good. Second, rather than giving up on chemo for liver cancer, researchers are now investigating the possible effectiveness of hepatic artery infusion (HAI) for delivering the chemo drugs. Following Zeke’s logic, attempting chemo for liver cancer would have been abandoned and it’s likely that the idea of trying HAI might never have been conceived.
Perhaps Zeke’s most infamous recommendation is in an essay (pages 12-14 at link) in the November-December 1996 Hastings Report. In it, while quite frequently using variations of the word “communitarian,” he wrote that “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.” Charming.
But now we’re supposed to forget about all of that old stuff. Zeke recently embarked on a reputation rehab tour and now squeaks that he’s no longer so bleak. You can tell that the administration knows it has a serious problem on its hands, because the doctor even found time in his interview rounds to get with the lefty-despised Washington Times. Here is some of what he told Times reporter Jon Ward on August 13:
“When I began working in the health policy area about 20 years ago … I thought we would definitely have to ration care, that there was a need to make a decision and deny people care,” said Dr. Emanuel, a health care adviser to President Obama in the Office of Management and Budget, during a phone interview.
“I think that over the last five to seven years … I’ve come to the conclusion that in our system we are spending way more money than we need to, a lot of it on unnecessary care,” he said. “If we got rid of that care we would have absolutely no reason to even consider rationing except in a few cases.”
To nuke that “five to seven years” assertion, I only had to go to one source, namely Betsy McCaughey in the July 24 New York Post. McCaughey cited three examples from the last two years contradicting the existence, let alone the timing, of Emanuel’s conversion:
- Doctors take the Hippocratic Oath too seriously, (in Emanuel’s words) “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008).
- McCaughey says that Emanuel repeated his “not guaranteeing health services to patients with dementia” assertion in a February 27, 2008, article (“The Cost-Coverage Trade-off: ‘It’s Health Care Costs, Stupid’”) in the Journal of the American Medical Association.
- She writes that “he explicitly defends discrimination against older patients” in a January 2009 Lancet article. Indeed he does, advocating something he calls “the complete lives system.” Its relevant care-determining factors include “youngest-first, prognosis, save the most lives, lottery, and instrumental value.”
I’ll add another example as a bonus. During the 2006 bird flu concerns, Zeke had his own ideas about how vaccines should be administered in a scarcity situation:
In a column in today’s issue of Science, they [Zeke and co-author Alan Wertheimer] say vaccine rationing should not be based on medical questions — such as who has the weakest immune system.
Rather, the ethicists argue, experts should consider the philosophical question of who would benefit most in the long term. …
In their column, they argue every person, ideally, should have the opportunity to experience all the stages of life. But in a pandemic, kids should not be a big priority, since they have not invested enough into their lives yet; on the other end, older people have experienced more of life’s stages, so they don’t deserve priority either.
They suggest a “cycle of life” priority that gives preference to people 13 to 40 years old — as long as they are reasonably healthy. If they have high-risk conditions that make them a lower bet for a long life, they drop down on the priority list.
It’s simply amazing. No matter what the medical issue at hand happens to be, Zeke always ends up at the same place: not treating the somehow unworthy or letting them die.
Unfortunately, Zeke is only one of many in the Obama administration, up to and including the president himself, whose outlandish views should never be granted real power in the health care system. The mere prospect that such people might someday, as Mark Steyn aptly puts it, “nationalize your body” should be enough to persuade anyone that any and all attempts at enhancing state power over our health care system must be stopped once and for all.