Will Obama Come After Grandma with a Pickax?
That is the question that right-wingers and health-care opponents are forwarding; you have probably heard the claim that Obama’s health care package would lead to the euthanization of seniors.
So, where does this claim come from? One front stems from the fact that Ezekiel Emanuel, noted bioethicist and Chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health (and, least importantly, Rahm Emanuel’s brother) has been tapped as an advisor for the health care reform project. While right-wingers call him “top advisor to Obama,” he is in fact “Special Advisor to Peter R. Orszag, Director of the Office of Budget and Management (OMB),” which means that he’s on a panel of people who are providing input which will shape health care policy.
Why is this even an issue? Well, Dr. Emanuel, as a bioethicist, has naturally written papers on bioethics. When social health resources are limited, triage must be performed–for example, when there are ten candidates for a liver transplant but only one liver is available, who gets it? This is always a controversial subject, and I doubt it is possible to write anything specific which cannot in some way be easily twisted to suggest that the writer is a cold-hearted villain for denying a life-saving procedure to nine people. The fact is, we must choose–the very real application of the question “if you see ten people drowning and must save only one, how do you choose?” You have probably been asked that question at some point in your life and have had to think about how we prioritize life, but for you it was almost certainly a purely academic question. Not so for bioethicists.
The right wing is getting its ammo from a couple of papers written by Emanuel, in which he advocates a triage system which favors younger patients. In a paper titled “Where Civic Republicanism and Deliberative Democracy Meet” (PDF, hosted on a right-wing site) written 13 years ago, Emanuel wrote [emphasis on words highlighted by critics]:
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. 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. Conversely, 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. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.
This has been taken to mean that Emanuel is suggesting that all health services should be taken away from the elderly and they be allowed to die. A bit of a stretch, of course; while Emanuel’s words “not guaranteeing health services” seem to suggest the removal of all health services, a read of the entire article suggests that he is talking about public-funded health care services which treat the specific irreversible illness–not euthanizing those with illnesses like dementia. Nor is it proffered as an absolute, but rather as a triage device when one must choose between providing government-subsidized care for one person or another in the context of preventing public health care from encompassing every single medical service available and thus breaking the bank (something that conservatives would demand).
A key point here is that the charge is one-sided, and completely ignores that there is a choice being made. The accusation that Emanuel is suggesting we do not provide public medical care for people at the end of their lives suffering from irreversible illnesses could be turned around, and the accusers could be characterized as wanting to deny treatment which could save the life of a child in favor of providing care to someone who is incurably ill and is going to die anyway. They’re baby-killers! Those bastards!!
This is why bioethics is sticky, and is easy fodder for politics: it deals with heart-wrenching decisions that we cannot avoid, and can easily taken out of context and used to wrongly accuse someone of being a cold-hearted killer.
Then consider that this is not being forwarded as the official policy of Obama’s health care plan, but rather is an opinion forwarded by one of many advisors to someone writing the plan in a paper written thirteen years ago. Emanuel is not fully in charge of the plan, is not dictating terms, and there is zero proof that what critics are blasting him for is being adopted in the plan currently before Congress.
A source of more hysterical right-wing frenzy on this is a provision in the health care bill which would add funding for extra optional counseling of people facing end-of-life circumstances:
… such consultation shall include the following: An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to; an explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses; an explanation by the practitioner of the role and responsibilities of a health care proxy.
In essence, the section provides funding for seniors, if they so choose, to meet with health care providers about how to plan for their twilight years, to prepare for death and its consequences. The idea is to give people near the end of their lives all the information necessary to face their situation–not to give up fighting, not to surrender health care. In fact, quite the opposite–this would be an expansion of services for people nearing the end of their lives.
Right-wingers have twisted this into a “mandatory” counseling with government bureaucrats who will tell seniors “how to end their life sooner.”
Not exactly the same thing.
So, as it turns out, the criticisms are completely bogus. Obama is not out to hack grandma to pieces to save a few bucks.
Surprise!
I think you are missing the point the “right wingers” are making. Obama wants a public health care plan.
Part of the problem with a public, government run health care plan is what Emmanuel describes in his paper (though he wouldn’t call it a problem) You have to RATION health from one group of people to another. It happens now in Britain, Canada, and other single payer systems.
You see … when all health care becomes public funded, there is no other choice, so your elderly with dementia, or whatever other illness the government decides falls into this category, will not get treatment because big brother says so.
The fact is, Obama has some very radical people advising, but you’re willing to brush it under the table as nothing. People have every right to question him, his policies, and his advisers, just as they did with Bush. He is not untouchable, and he is not He, as so many seem to think.
Oh … and when you cut Medicare, that is directly going after the elderly.
Random Guy:
And the point that you and the right-wingers miss is that every problem that social insurance has, private insurance has EVEN WORSE.
Do you actually believe that private insurance does not ration? Of course they do! They deny even more procedures than private health insurance.
With any insurance system, X amount of money goes into the system.
With socialized health care, that money is then used to (a) pay for the management of the system, and (b) care for the patients.
With private health care, the money is used to (a) pay for the management of the system, and (b) care for the patients, and (c) pay the shareholders as much profit as can possibly be squeezed from the system.
That’s what private businesses are for–not to care for people, but to take profits. With health insurance, more profits for the company means more customers sick and dying. You PREFER that?
Therefore, by definition, private health insurance ‘rations’ MORE than social insurance–a major reason why most of the world has socialized health care, and why the U.S. has such crappy health care despite spending obscene amounts of money compared to everyone else.
Hell, private health plans do not so much ration as they simply DENY payment.
Ummm… Point #1: it’s the right-wingers who want to cut Medicare; Medicare was created by the Democrats, is protected by the Democrats, and is always attacked by the Republicans.
Point #2: Medicare IS Socialized Medicine.
And #3: Obama is not “cutting Medicare.” This is another of the many, many lies put out there by the right-wingers which you lapped up without checking the facts. Obama has not proposed cuttings Medicare services, he has proposed cutting Medicare costs. In fact, he is not even going to cut Medicare costs, he’s going to cut the rate of growth of Medicare costs.
Part of that is easy: repeal Bush’s stupid prohibition against Medicare negotiating drug prices down. As one of the biggest customers of pharmaceuticals, Medicare has a great deal of power to negotiate better prices, saving taxpayers money and getting more bang for our buck–and Bush stopped that. Other ways include introducing competitive bidding for Medicare contracts and using electronic records, along with streamlining and other cost-reduction methods. NOT to cut SERVICES.
One more talking point for the right wing is to ask, “Do you want a government bureaucrat standing between you and your doctor?”
What a stupid argument.
The biggest flaw in the argument is that the person “standing between you and your doctor” represents the person who decides how health care is rationed.
In the case of public health care, it’s a bureaucrat who works for a politician who answers to YOU. They make calculations based upon how to best spend all available funds.
In the case of private health care, it’s a lawyer who answers to profit taking SHAREHOLDERS who is tasked with denying you as much care the company can get away with. They make calculations based upon a calculation of how much lawsuits for breach of contract would cost.
So the question is not “Do you want a government bureaucrat standing between you and your doctor?” the question is, “Do you want a money grabbing lawyer whose job it is to deny you medical care standing between you and your doctor?”
What’s your answer?
This is another point, looking back at what you wrote. “Radical people”? Emmanuel is not “radical,” he is highly respected; as I pointed out in the article, his writings have been taken out of context and twisted to say something they are not.
Second, right-wingers are not “questioning” his plan, they are smearing it with bald-faced lies and thug tactics in an attempt to derail it in deference to their Insurance/Pharma contributors.
“Questioning” would be to have people come up and ask Emmanuel, “what did you mean by this comment? Are you saying…” and so forth. That is NOT what right-wingers are doing.
What they’re doing is going back to a 13-year-old writing, severely distorting its meaning, and then coupling it with a clear lie about counseling sessions offered to seniors to build an utter fabrication about how the government is ordering seniors to meet with bureaucrats who will tell them how to commit suicide.
It is stark, shameless lying. That you see this as “questioning” is rather startling.