The new Obama health law puts important decisions about your care in the hands of presidential appointees. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Chief among these advisers is Dr. Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel. Dr. Emanuel has already been appointed to two key positions: health policy adviser at the Office of Management and Budget and member of the Federal Coordinating Council for Comparative Effectiveness Research.
Dr. Emanuel says that health care 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, or JAMA: “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.”
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 postgraduate 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.”
Dr. Emanuel chastises physicians for thinking only about their own patients’ needs: “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.”
“In the next decade, every country will face very hard choices about how to allocate scarce medical resources,” Emanuel predicted in the Sept. 19, 2002 , issue of The New England Journal of Medicine.
“You can’t avoid these questions,” Dr. Emanuel said in an Aug. 16, 2009, interview in The Washington Post. “We had a big controversy in the United States when there were 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.” Emanuel obviously feels more comfortable than most of us do with the notion of a panel or committee playing God.
In TheLancet.com on 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, and intensive care beds. Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”
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 lifeyears 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.”
Dr. Emanuel urged the president to push forward with the Obama health law, no matter how intensely Americans opposed it. On Nov. 16, 2008, he recommended that the president use Chicago-style arm-twisting if necessary. “If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration’s health care reform effort.”
That’s how the Obama health law got passed.
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