His Words
An article in yesterdays WSJ about Dr. Ezekial Emanuel, the health advisor to the President.
He views rationing as the only way to cut costs, or at least he did, in previous writings. This article takes information from those writings. You should read the whole thing.
Highlights:
He views rationing as the only way to cut costs, or at least he did, in previous writings. This article takes information from those writings. You should read the whole thing.
Highlights:
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).People that think like this scare me. And the fact that people that think like this are in control, scares me even more. I'm sure a survey does tell them that. But when it's your infant that the government doesn't want to save ... what then?
Comments
I don't see how anyone can say this plan is a good plan if the people that are writing it are exempting themselves from participating.
And really, the wealthy will still pay for the best care. The poor will be rationed. The poor will die.
If it was really about reform they would change the rules for Medicare and Medicaid. It's not about reform, it's about getting us on single payer. Which I'm wholly against.
I think the big question that everyone needs to be asking is How are they going to pay for all they say they will do. How are they going to cut the costs of health care.