Thursday, August 13, 2009



Opponents of efforts by the Obama administration and Congressional Democrats to overhaul the health system have entered the twilight zone, suggesting that the plan contains seeds of government sponsored “death panels” and euthanasia courts.

Why the hysteria? Many of the histrionics have their origin in the White House Budget Office’s hiring of Dr. Ezekiel Emanuel, an oncologist and medical ethicist who has taught at Harvard and worked at the National Institute of Health and who is also the brother of Rahm Emanuel (White House Spokesman Ken Baer says Dr. Emanuel’s being Rahm Emanuel’s brother had nothing to do with his hiring. Even if the Emanuel brothers were not from Chicago, one would have a hard time believing that.), as a consultant on health care issues. As an academic and theoretician, Dr. Emanuel is paid to think out loud and consider alternatives without having to worry about the political ramifications of such consideration. (For example, he wrote in a 1996 article that “An obvious example (of ways to save on health care spending) is not guaranteeing health services to patients with dementia.” Notice that he was not advocating denying health care to those with dementia; he only cited it as one of the methods proposed for saving money on health care. (And, in any case, note that he spoke of “guaranteeing,” not “providing.”) If I were to say “One of the ways to cut the federal deficit would be to aggressively increase taxation on those of Irish origin,” does that mean I am advocating increasing my taxes? People ought to be allowed to list, and even consider, egregious alternative solutions to problems without being accused of advocating the approaches they are listing and considering, the latter generally just before dismissing those alternatives nearly out of hand.), but that hasn’t stopped the screechers from seizing his comments as examples of what they consider Nazi like provisions in the health care proposals. For example, in a January, 2009 article, Dr. Emanuel said age could be used as a factor in deciding who gets scarce organs or vaccines. As quoted in the Wall Street Journal (Thursday, 8/13/09, page A4), he stated:

“Unlike allocation by sex or race, allocation by age is not invidious discrimination. Every person lives through different stages.”

What are the ramifications of such dangerous thinking? Say we have a heart, one heart, ready for donation. It can go to an otherwise healthy 25 year old or an otherwise healthy 75 year old. If we consider age in making this choice, we could give the heart to the 25 year old. Most people, including most 75 year olds I know, would favor giving the heart to the 25 year old. A step further: Give the choice to the 75 year old who would receive the heart, and he or she would, in most cases, insist on giving the heart to the 25 year old. Doing so would seem to be common sense and a practical and compassionate application of medical ethics.

Besides the comments of Dr. Emanuel, opponents of the health care reform plans of the Democrats have seized on a provision in proposed health care legislation providing for end of life counseling. Zealots have been screaming that what such counseling would amount to is the government advising people on how to end their lives and, I’m sure someone is saying, a promise of lifetime employment for Jack Kevorkian.

But what’s really going on with end of life counseling? Currently, doctors are not reimbursed by Medicare for counseling on things such as living wills, DNR orders, etc., and hence don’t provide such counseling. As a consequence, in many cases, people were provided no guidance as to how they wanted to be treated at the end of life and therefore were being overtreated, often against their wills. Cecil Wilson, president-elect of the AMA (that notorious bastion of left wing death merchants that also happens to be a major bankroller of the GOP), argues that the provision ensures that doctors will be (Horrors!) paid for their time. He goes on to say of the end of life counseling provisions:

“We were delighted to see this in the legislation. This (demagoguing the issue) is one of the most egregious examples of mischaracterization that I have seen.”

So a White House advisor suggests that age is a legitimate characteristic to consider when dealing with limited supplies of organs and vaccines. Health care legislation contains provisions to pay doctors for counseling patients on steps they can and should take in order to make sure their wishes for end of life care are carried out.

So what do we get from the Republicans?

Minnesota Representative Michele Bachman says

“The president’s adviser defends discrimination against older patients.”

Sarah Palin, never accused of having a thought, let alone an original thought, rails in her characteristic thoughtful, measured tone:

“…my parents or my baby with Down’s syndrome will have to stand in front of Obama’s death panel.”

Champion of all things moral Newt Gingrich piously intones:

“…you’re asking us to trust turning over power to the government, when there clearly are people in America who believe in establishing euthanasia.”

At least one of these wailing hysterians, Mr. Gingrich, has a point. Many people in this country do believe in euthanasia. (Doubtless many people also believe in bestiality.) But if enough people had such facinorous designs on the lives of the elderly, the federal government could easily implement a nationwide euthanasia plan since, through the Medicare program, it already is the provider of health care for just about 100% of the senior citizens in this country.

There are plenty of reasons to oppose Obamacare or Democare, or whatever one wishes to call it, that have their bases in facts and careful thought rather than vacuous talking points and febrile fear mongering. But perhaps, in modern America, where people don’t think because they find it easier to absorb and regurgitate, such demagoguery is the most effective means to derail ill-advised plans to nationalize health care. But one wishes that the more misguided aspects of the plan could be defeated with sound reasoning and logical arguments, not screeching, wailing, and gnashing of teeth. One also wishes, I suppose, for the ability to fly, but, like sound, logical argumentation in 21st century America, such self-avionics are not going to become available any time soon.

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