Obama advisor champions rationed health care

[Hannah Bell]

Ezekiel J. Emanuel...serves as a special advisor on health policy to the director of the White House’s Office of Management and Budget and is the chair of the Department of Bioethics at the Clinical Center of the National Institutes of Health...In March, Emanuel, a breast oncologist, was appointed to the Federal Coordinating Council for Comparative Effectiveness Research. The 15-member body was authorized by Obama’s American Recovery and Reinvestment Act (ARRA) to provide “information on the relative strengths and weaknesses of various medical interventions” in relation to federal programs.

Obama has pledged to slash more than $600 billion from Medicare and Medicaid as part of his health care plan. Utilizing comparative effectiveness research (CER), this council will recommend cuts—in the form of cost-cutting “efficiencies” to these federal programs for the elderly, disabled and poor. The cuts are central to Obama’s overhaul of the health care system and are supported by all versions of legislation currently under consideration in Congress.

In his advisory capacities, Ezekiel Emanuel—the brother of White House Chief of Staff Rahm Emanuel—has been placed in a strategic position to influence the Obama administration...Opponents of Obama’s health care initiatives have attacked Emanuel for writings in which he advocates rationing care, particularly for the elderly, infants and those with mental or physical disabilities...

Many of the attacks on Emanuel have come from the right, including Republicans who are masquerading as defenders of health care for ordinary Americans. However, these right-wing opponents of Obama’s proposals are seizing on aspects of Emanuel’s theories that are, in fact, deeply reactionary...

Emanuel writes 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.” <2> ...in the January 2009 Lancet, spells out his attitude towards limiting “scarce” medical resources for the elderly. “Unlike allocation by sex or race, allocation by age is not invidious discrimination: every person lives through different life stages rather than being a single age..."

"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…. It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does.” <4>

In the Hastings Center Report cited above, Emanuel puts forward what he considers to be the criteria for deciding how health care should be distributed under conditions where it is limited by the workings of the “free-market.” It is instructive to quote his exposition at some length, as it reveals the class basis of his supposedly ethical justification. He writes:

“The fundamental challenge to theories of distributive justice for health care is to develop a principled mechanism for defining what fragment of the vast universe of technically available, effective medical care services is basic and will be guaranteed socially and what services are discretionary and will not be guarantee socially. Such an approach accepts a two-tiered health system — some citizens will receive only basic services while others will receive both basic and some discretionary health services. Within the discretionary tier, some citizens will receive few discretionary services, other richer citizens will receive almost all available services, creating a multiple-tiered system” (emphasis added). <5>

In other words, the majority of the population would be relegated to a basic minimum level of care, while those with the financial resources would be able to purchase the finest medical services and take advantage of the latest technologies.

http://www.wsws.org/articles/2009/sep2009/eman-s15.shtml

[Hannah Bell]

1. In his 2008 book, Healthcare, Guaranteed: A Simple, Secure Solution for America,

Emanuel elaborates in more detail the health care system he would like to see implemented—the Guaranteed Healthcare Access Plan...

The plan would be financed through a dedicated 10 percent Value Added Tax, or VAT, on purchases and services. Emanuel claims such a tax is egalitarian. VAT is, in fact, a highly regressive form of taxation, disproportionately effecting lower-income people. Health care expenditures would be capped according to the amount of revenue raised by the VAT, unless Congress authorized an increase in the VAT rate."

http://www.wsws.org/articles/2009/sep2009/eman-s15.shtml

[TicketyBoo]

2. Would you PLEASE stop referencing material

from the World Socialist Web Site?

[BlooInBloo]

3. I'm pretty sure you know the answer that question.

[TicketyBoo]

12. Not really.

I'm fairly new around here.

I just find referencing that particular site offensive. If others insist on going there, maybe this isn't the place for me.

[Luminous Animal]

13. ABSOLUTELY! The fact that only .00000000001% of the memberrs

on this board reference that site is totally a reason to leave this board.

Of course, I notice that you did not take the time to address any of the ideas in the OP.

[TicketyBoo]

18. I didn't come here to defend myself.

I can do that on a daily basis up close and personal in Red State Nebraska.

But THAT far left I don't care to go.

[Hannah Bell]

19. so don't. debate the content or ignore it. i'm a registered democrat

who voted for obama.

wsws is good counter-point to the nyt/wa post/wsj party line.

"that far left" my ass. as if the dems' policies hadn't moved to the right of nixon.

[nightrain]

22. knr. yes. thanks for posting this article. I am very interested in the

potential impact that Zeke is having on Obama and where Obama wants to take healthcare.

[TicketyBoo]

25. So am I.

And so did I.

I guess I trust him a lot more than you do.

[BlooInBloo]

24. Oops - sorry - didn't realize you were a nublet....

Welcome to DU!

And no, they won't stop. Unfortunately.

[inna]

30. why do you "find referencing that particular site offensive"?

what about it is so "offensive" to you? i'm really curious.


DU admin blacklists many "controversial"/"unreliable"/"bigoted" sites (and deletes threads with articles from those sites), but wsws.org is NOT one of those blacklisted sites.


what is your beef/problem with that site? :shrug:


personally, i'm sick and tired of red baiting, and i don't see anything wrong with democratic, progressive socialism, but... it's just me. ~

[Ulysses_The_Red]

31. Red baiting is lame

And it's good to see that some people here push back against it. In fact, it's what made me join the site.

And as usual, most people respond to unpleasant news by shooting the messenger. Big surprise.

[Hannah Bell]

4. no. it's not racist, sexist, or illegal. debate the article or prove the claims are mistaken.

[Luminous Animal]

9. It's got the word socialtist in it, thus it is suspect.

Ideas? That's for nerds. Except if you are Al Gore, then ideas are the bomb.

[cali]

14. it's simply filled with lies and propaganda

and it's all you obediently swallow, just like a good little follower.

[Hannah Bell]

16. prove it.

[Hannah Bell]

27. i see you can't, as per usual.

[BlooInBloo]

5. (shrug) All scarce goods are rationed. The only question is *how* are they rationed.

[Luminous Animal]

8. Popular wisdom says we have the most glorious health care system

second to god. How then, can we justify our health care as "scarce goods."

[BlooInBloo]

10. I'm sorry you don't know what the words you're using mean.

[Luminous Animal]

11. Yes I do.

I am rubber. You are glue. Fuck, you are an idiot.

[cali]

15. and YOU are completely off the rails, dearie. Do try to exercise just

a wee bit of self-control. Or keep reaching into your diapers for more poo to fling.

[Hannah Bell]

17. I think the use of personal invective shows who's off the rails.

I notice you generally prefer that to actually doing the work of debating the material.

[cali]

20. so, in your world "fuck, you are an idiot" is a mere pleasantry?

And hannah, it's not as if you EVER argue anything. You simply post shallow propaganda, my dear.

[Hannah Bell]

21. i didn't post that comment, cali. evidentally you're not paying attention.

maybe you should go cool off.

[bluestateguy]

6. And now for this morning's far left socialist drivel

So far to the Left, it's to the Right.

[Hannah Bell]

7. red-baiting. shocker.

[mmonk]

23. I'm going to start a thread of Ezekiel Emanuel in his own words

and let people judge for themselves

[Hannah Bell]

26. these *are* his own words.

Emanuel writes 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.” <2>

...in the January 2009 Lancet, spells out his attitude towards limiting “scarce” medical resources for the elderly.

“Unlike allocation by sex or race, allocation by age is not invidious discrimination: every person lives through different life stages rather than being a single age...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…. It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does.” <4>

[cm0431]

28. Dr. Emanuel also said...

"Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).

Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, "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).

He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

Dr. David Blumenthal, another key Obama adviser, agrees. He recommends slowing medical innovation to control health spending. Blumenthal has long advocated government health-spending controls, though he concedes they're "associated with longer waits" and "reduced availability of new and expensive treatments and devices" (New England Journal of Medicine, March 8, 2001).

It's all there in black and white and cited by publication and dates.

[mmonk]

29. Thanks for those.