Monday, July 20, 2009

Health Care Battle: The Post to End All Other Posts

This is a very long post, but please try to read it in its entirety. This may be the most important post I have ever written.

Last week I was listening to Mark Levin and he had a guest, Betsy McCaughey, go through some of the more frightening aspects of Obamacare. One person that she mentioned was Dr. Ezekiel Emanuel, the Chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health, and Rahm Emanuel's brother. Ezekiel also just so happens to have been appointed as a health care policy advisor to the White House.
The brother of White House Chief of Staff Rahm Emanuel, Dr. Ezekiel J. Emanuel, a noted bioethicist, is advising the Obama administration on health care reform.
Dr. Emanuel is a special advisor to the director of the White House Office of Management and Budget for health policy. He told me he is "working on (the) health care reform effort."
This is important because of Ezekiel's personal opinions on health care systems, including allocation of medical resources. Betsy McCaughey read a few direct quotes made by Ezekiel either in person or in his published, peer-reviewed journal articles, and I thought I was going to have a heart attack. What follows are quotes taken directly from one such peer-reviewed article, references to specific parts and pages of the health care legislation making its way through Congress, and my own analysis. This morning I also found reference to this article at Free Republic. Thank you to Mark Levin and Betsy McCaughey for introducing these items to me.

Persad, G., Wertheimer, A., & Emanuel, E. J. (2009 January 31). Principles for allocation of scarce medical interventions. The Lancet, 373, 423-431.
(You can find the online article here.)

Background and summary
This article attempts to analyze eight allocation principles (created by whom?) that can be classified, according to the authors, into four ethical categories. "Interventions" simply mean any medical resource such as hospital beds, vaccines, organs, antibiotics, etc. They discuss each of these principles and categories, positing their solution to the question of distribution of scarce medical resources at the end. They call their solution the "complete lives system." The portions I have selected to share are, in my opinion, the most disturbing. Some of the quotes are the authors' statements supporting or criticizing the various principles, and it is within these arguments that I find the most telling and important information about the minds of these men.

I will now share the opinions of Dr. Emanuel, health care policy advisor to President Obama, taken directly from this article.

We recommend an alternative system-the coplete lives system-which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, saves the most lives, lottery, and instrumental value principles.

(Table 1, a table of these princples can be found here. Note the Recommendation column for the principle of Reciprocity, "Include only irreplaceable people who have suffered serious losses." The idea of "irreplaceable" people comes up again later.)
The major disadvantage of lotteries is their blindness to many seemingly relevant factors. Random decisions between someone who can gain 40 years and someone who can gain only 4 months, or someone who has already lived for 80 years and someone who has lived only 20 years, are inappropriate.

[The first-come, first-served principle] allows physicians to avoid discontinuing interventions, such as respirators, even when other criteria support moving those interventions to new arrivals.
On its own, sickest-first allocation ignores post-treatment prognosis: it applies even when only minor gains at high cost can be achieved.

[The sickest-first principle] myopically bases allocation on how sick someone is at the current time—a morally arbitrary factor in genuine scarcity.
When we cannot save everyone, saving the sickest first is inherently flawed and inconsistent with the core idea of priority to the worst-off.

Prioritising the youngest gives priority to the worst-off—those who would otherwise die having had the fewest life-years—and is thus fundamentally different from favouritism towards adults or people who are well-off.
'...treating people of different ages differently does not mean that we are treating persons unequally.'

Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old young woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects.

How to weigh these other relevant considerations against saving more lives—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 10 years each—is unclear.

...why give an extra year to a person who has lived for many when it could be given to someone who would otherwise die having had few?

In view of the multiplicity of reasonable values in society and in view of what is at stake, social value allocation must not legislate socially conventional, mainstream values.

Prioritising essential health-care staff does not treat them as counting for more in themselves, but rather prioritises them to benefit others. Instrumental value allocation thus arguably recognises the moral importance of each person, even those not instrumentally valuable.

However, where a specific person is genuinely indispensable in promoting morally relevant principles, instrumental value allocation can be appropriate.

For important health-related values, reciprocity might involve preferential allocation to past organ donors, to participants in vaccine research who assumed risk for others' benefit, or to people who made healthy lifestyle choices that reduced their need for resources.
Reciprocity might also be relevant when people are conscripted into risky tasks. For instance, nurses required to care for contagious patients could deserve reciprocity, especially if they did not volunteer.

For instance, former organ donors seem to deserve reciprocity since they make a serious sacrifice and since there is no surplus of organ donors. By contrast, laboratory staff who serve as vaccine production workers do not incur serious risk nor are they irreplaceable, so reciprocity seems less appropriate for them.

Ultimately, no principle is sufficient on its own to recognise all morally relevant considerations. Combining principles into systems increases complexity and controversy, but is inevitable if allocations are to incorporate the complexity of our moral values.
(Table 2, a table analyzing four multiprinciple systems can be found here.) QALYs (quality adjusted life years) to someone who has had few life-years differs morally from giving them to someone who has already had many.

And now we find ourselves at the authors' proposition, the "complete lives system." The multiprinciple system that is supposedly the solution to this pesky problem of distributing scarce medical resources to a population.
[The complete lives system] prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid.

Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants. 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. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfilment requires a complete life.

A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life.

When the worst-off can benefit only slightly while better-off people could benefit greatly, allocating to the better-off is often justifiable. Some small benefits, such as a few weeks of life, might also be intrinsically insignificant when compared with large benefits.

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.
(The authors' figure depicting this allocation priority can be found below and here.)

Age-based priority for receiving scarce medical interventions under the complete lives system.
...the complete lives system justifies preference to younger people because of priority to the worst-off rather than instrumental value. Additionally, the complete lives system assumes that, although life-years are equally valuable to all, justice requires the fair distribution of them.

Unlike allocation by sex or race, allocation by age is not invidious [hateful] discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years. 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 complete lives system requires only that citizens see a complete life, however defined, as an important good, and accept that fairness gives those short of a complete life stronger claims to scarce life-saving resources.

We must first reduce waste and increase spending.

[The complete lives system] empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible.

We delare that we have no conflict of interest.

Please go read the entire document for yourself and you will see that none of these quotes were taken out of context, but rather they represent very accurately the mindset of one of the President's top health care policy advisors. And if you think for one minute that this philosophy - letting the old and weak perish - will not be embraced by Obama or the Democratic leadership then you need a real big cup of wake the flood up.

From Obama himself, regarding his own grandmother's health:
"I don't know how much that hip replacement cost," Obama told the Times. "I would have paid out of pocket for that hip replacement just because she's my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else's aging grandparents or parents, a hip replacement when they're terminally ill is a sustainable model, is a very difficult question."

President Barack Obama suggested at a town hall meeting at the White House last Wednesday that some end-of-life education and planning could help save on medical expenses.

I am all for hospice - if the choice is left to the patient! The horrific prospect here is that the choice for acute vs. hospice care would be made by some little government employee, sitting in an office somewhere, totally removed from the patient and his/her loved ones. When hospice is no longer a personal choice, we cease to be a civilized society. My parents are in their 60's and I'll be damned if they will get left behind because Obama and Pelosi and Emanuel no longer consider their "life-years" worthy of the cost of treatment. Bastards. All of them. This is why we should not have ANY government-run health systems at all. Get rid of them all. Let private industry take over every single system.

Do not forget. The ONLY instance in which discussions of allocation, priority, rationing, forced hospice, etc. is applicable is when your health care system is a collectivist, state-run enterprise. When a society's health care options are determined by the state, then the ultimate factor used to make decisions is cost. In a free market system, this desperate fight for resources does not exist, or it at least does not exist in the same way. In a free market there is always, always an option. You can take out a loan, borrow money from friends or family, receive charity and donations... there is some way to make it work. In a collectivist health care system, we all become little stazi; watching our friends and neighbors to ensure they are not using more than "their fair share." Ezekiel's entire journal article is ONLY APPLICABLE in a centralized, government-run health care system.

I can just hear it now, "Oh but with Obamacare we get to keep our private health care, so this won't actually happen to us." Try again.

From Betsy McCaughey's article in the New York Post, published on July 17th, 2009. She references the actual page numbers in the House and Senate bills, unlike the Obama administration's Ministry of Truth referencing Obama's "Three Principles." Sounds like the vague and empty rhetoric of "hopenchange" to me. Here are some highlights from her article, but you must go and read the entire thing yourself.
Two main bills are being rushed through Congress with the goal of combining them into a finished product by August. Under either, a new government bureaucracy will select health plans that it considers in your best interest, and you will have to enroll in one of these "qualified plans." If you now get your plan through work, your employer has a five-year "grace period" to switch you into a qualified plan. If you buy your own insurance, you'll have less time.

And as soon as anything changes in your contract -- such as a change in copays or deductibles, which many insurers change every year -- you'll have to move into a qualified plan instead (House bill, p. 16-17).

When you file your taxes, if you can't prove to the IRS that you are in a qualified plan, you'll be fined thousands of dollars -- as much as the average cost of a health plan for your family size -- and then automatically enrolled in a randomly selected plan (House bill, p. 167-168).

It's one thing to require that people getting government assistance tolerate managed care, but the legislation limits you to a managed-care plan even if you and your employer are footing the bill (Senate bill, p. 57-58). The goal is to reduce everyone's consumption of health care and to ensure that people have the same health-care experience, regardless of ability to pay.

One troubling provision of the House bill compels seniors to submit to a counseling session every five years (and more often if they become sick or go into a nursing home) about alternatives for end-of-life care (House bill, p. 425-430). The sessions cover highly sensitive matters such as whether to receive antibiotics and "the use of artificially administered nutrition and hydration."

If you would like to look these pages up yourself, you can find the House bill here, and the Senate bill here.

If you care an inch for real health care, freedom of choice, liberty, privacy, the elderly, the weak, the infirm, any of these, then PLEASE call the Blue Dog Democrats and every Senator and Representative that you can. I'm building a handout that you can print and copy as much as you'd like, to take with you around your community. Starting today the Obots will be out canvassing YOUR neighborhoods. Beat them to it. Take this information with you.

Exit question #1: demand to know if Congress is exempt from this suicidal public health plan, and if they get to keep the plan they have now. I'm sure Ezekiel would deem them all as "irreplaceable."

Exit question #2: where is AARP on this?

Previous: Health Care Battle: Post #1 and Health Care Battle: Post #2


  1. Great synopsis!! Thank you. If the goal of this Administration and this Congress were to REFORM Health Care, they would be doing things totally differently. Instead of setting up a new, monstrously huge, federal bureaucracy to control every aspect of health care in this country, they would have actually analyzed the problems, held hearings with expert witness testimony to weigh different solutions, carefully considered the cost to taxpayers and our economy and deliberated on which options would help us acheive real REFORM of healthcare. This is not REFORM; it is MALICIOUS DESTRUCTION.

  2. Great job as usual, Keli. Thanks for sticking up for your countrymen and women!

    More on the lack of choice to stick with private insurance:

  3. Thank you for posting this. I heard Ms McCaughey on the Levin show and was hoping her comments would get additional press. Time for medical professionals to speak up loud and strong.
    As for those Emanuel brothers - what a bunch.

  4. You ask, "Where is AARP on this?" AARP puts its business interests before its public policy concerns. They offer insurance products and could stand to gain from this drastic health care reform. They are a liberal group who support Democrats and leftist causes.

  5. I agree with Dan the AARP is a liberal organization.
    I had a similar article from Sherry at and posted it last month on eastsideteaparty about bioethics. Scary people, with very scary ideas.
    It is particularily troubling that the msm press is still acting like ostriches on all these devious plans for the remaking on America into a socialistic nightmare where life itself will depend on the ability of government management abilities. Since they are yet to demonstrate any competence in that area we are truly all in jeopardy!

    BTW-If you heard Levin tonite he touched on Obama calling us that oppose him "special interests", calling Obama and friends the true special interest's!

  6. I am a nurse with 35 years experience. This is frightening, I felt as if reading a science fiction horror story with the above post. I have called my Senator and House of Representatives, and I will begin with calls to the Blue Dog Democrats. God help us all if this passes. I have been involved up close and personal with healthcare, and to think of rationing care, or being selective on who is treated and who is turned away goes against the very core of the pledge healthcare professionals take when licensed and allowed to practice. Healthcare in USA needs some adjustments and tweaking, but not this path.

  7. This is truly scary. The new eugenics. These masters of the universe will be making decisions on who deserves to live and who should die.

    You hit the nail right on the head when you ask if Ezekiel and the rest of the Obamanazis will be deemed "irreplaceable".

  8. These people and their plans of socialism through government takeover of the American healthcare system must be stopped immediately. All citizens are urged to do whatsoever legally possibly to defeat their proposals. To this end I have made a blog entry to alert my readers.

    Thanks for all your help in alerting the Americam People of this evil plot against the citizens of the United States.



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