Former New York Lieutenant Governor Betsy McCaughey recently wrote an editorial in the Wall Street Journal titled Obama's Health Rationer-in-Chief regarding the role of Dr. Ezekiel Emanuel—health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research.
Ms. McCaughey notes that Dr. Emanuel has written extensively about who should get medical care, who should decide, and whose life is worth saving. She assigns Dr. Emanuel to 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.” As a result, she argues that “many physicians find that view dangerous, and most Americans are likely to agree.”
Accordingly, she recognizes that the present attempt for health care reform in Congress will “put important decisions in the hands of presidential appointees like Dr. Emanuel.” For example, appointees “will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare.” In other words, government will begin to ration care, and make decisions about whom, when and why a person is eligible for help.
Consequently, Ms. McCaughey points out a Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA) The Cost-Coverage Trade-off: "It's Health Care Costs, Stupid" that clarifies exactly how Dr. Emanuel feels about government-run healthcare:
"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."
While we certainly know that prevention will not save us money, Dr. Emanuel thinks that reform “must include redefining doctors' ethical obligations.” Moreover, “Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care” in the June 18, 2008, issue of JAMA The Perfect Storm of Overutilization by stating that: "Medical school education and post graduate education emphasize thoroughness." What else could Americans want from their medical students and future physicians?
His beliefs also criticize “physicians for thinking only about their own patient's needs.” Is that not what doctor’s professional, ethical, and legal responsibilities are? Instead, Dr. Emanuel believes that such ‘thoroughness’ and ‘patient focus’ is a violation of the Hippocratic Oath because "many physicians [a]re willing to lie to get patients what they need from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007). The evidence for this is missing however.
Among his beliefs, Dr. Emanuel believes doctors should serve “the patient and society, and that medical student should be trained to provide socially sustainable, cost-effective care." An example he uses to show cost-effective care is "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).
What concerns Ms. McCaughey, and should concern Americans more is that Dr. Emanuel himself admitted in the New England Journal of Medicine, Sept. 19, 2002, that “there is no consensus about what substantive principles should be used to establish priorities for allocations." Yet, instead of focusing on those what those principles should be, Dr. Emanuel instead writes “about who should set the rules, who should get care, and who should be at the back of the line.” To that effect, Dr. Emanuel believes that:
“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)”
While some believe this quote is taken out of context, it is obvious that Dr. Emanuel has opinions on the very surface of whether certain people should receive care. In fact, he uses a "complete lives system for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. This system would basically say: “we should always save five lives rather than one.” What happens when that one is your mother?
Even Emanuel himself set it is unclear whether "”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.” What is clear to Dr. Emanuel is that treating patients differently by age is not age discrimination. I wonder how the Supreme Court would rule on that: a 65 year old denied treatment to replace a kidney because a 20 year old needed one as well.
Another disturbing point Dr. Emanuel argues is “that insurance companies should pay for new treatments only when the evidence demonstrates that the drug will work for most patients.” How on earth could science alone prove this? Clinical trials, research and studies try to take representative samples of groups and demographics. Does he really want patients to wait years and years to test ‘most patients,’ when it is highly likely that a drug will work for them? His theory of do nothing is something Obama speaks out against when it comes to healthcare.
Furthermore, Dr. Emanuel asserts that the "major contributor" to rapid increases in health spending is "the constant introduction of new medical technologies, including new drugs, devices, and procedures.” How much more of an oxymoron could that statement be? Americans are becoming healthier, physicians and researchers are finding new treatments and diseases they never knew of, and we are effectively treating them, all through collaboration and funding from industry. While that may cost money now, think about the lives it will save.
As a result, “Dr. Emanuel says the
Lieutenant Governor McCaughey makes some great points on health care reform. Though I think that some of her past attacks on Dr. Emanuel have been over the top, this Wall Street Journal editorial after reviewing the source documents is a very compelling argument to be careful with well meaning but misguided bureaucrats.
Moreover, in light of these revelations, Americans must begin asking their government officials how many other Obama appointees like Dr. Emanuel, with his visions and writings, have the power to decide when you will get your care, and if you are too old.
Most likely, Americans will find that the few who are in position to make such choices would rather choose helping costs, rather than helping you.