One thing that continues to surprise me is the constant surprise to how much Barack Obama is surrounding himself with people he has known for years. As the Mrs. likes to say:
“If somebody shows you who they are, believe them”
Therefore it comes as no surprise that President Obama would surround himself with people he knows and has worked with previously. His Chief of Staff is Rahm Emannual.
Rahm is said to have been the muse for the West Wing’s Josh Lyman (which might be the biggest compliment one could give a political operative)
Rahm has a brother named Ari that is supposedly the muse for Ari on Entourage (NSFW):
But apparently Rahm and Ari are pussycats compared to their middle brother, Dr. Ezekial Emmnauel (you tube video omitted because there hasn’t been a show about a bioethicist policy wonk who can provide humor despite the deep dialogue on what value senior citizens bring to society), who according to many accounts on the web is the evil mastermind behind the “Death Panels“. Specifically, Zeke has gotten most of his flack from former New York State Lt. Govenor, Betsy McCaughney.
Well if you thought that the healthcare debate couldn’t get any more interesting, check out the following WSJ article Obama’s Health Rationer-in-Chief by the aforementioned Betsy McCaughney. Since we live in 2009 and nobody actually reads anything longer than 140 characters (you guys do know that Twitter is just Ashton Kusher Punking all of us right? Need proof? Check this: Twitterholic) I will give you my favorite excerpts to save you from overexerting the healthcare policy part of your brain:
“Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs.”
Dr. Emanuel wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care 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 post graduate 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.”
In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient’s needs. He describes it as an intractable problem: “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. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.” (JAMA, May 16, 2007).
In the Lancet, 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, intensive care beds, and others. “One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one. “However, other things are rarely equal—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 another 10 years each—is unclear.” In fact, Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel’s chart nearby)
Now that is what I call some honest dialogue. The elephant in the room is that there is no way to provide health insurance to the 40M+ uninsured without rationing healthcare. I was having lunch a few weeks ago with one of the smartest guys I know and he said:
“There is no way to provide healthcare to everyone without bankrupting the system as it works today. We either have to ration care or be okay with 40M+ people not getting healthcare. What this really comes down to is whether or not I am wiling to give up some of my current health benefits in order to make sure everyone gets the care they need. This is not a policy issue as much as it is a moral issue.”
So is it possible that Dr. Emmanuel and Betsy McCaughney can both be correct? Betsy is saying that Dr. Emmanuel wants to ration care and Dr. Emmanuel is saying that we must ration care. And if that is the case is there anyway that we don’t ration care? If that is the answer, who makes the rationing decisions? I personally like my doctor abiding by the Hippocratic Oath and doing everything he can to save me instead of some policy wonk in Washington. Whatever this bill includes I hope it is does include this:
Pragmatic or the Devil? Why choose?
Pragmatism is a well-paved road to damnation; hence the phrase, “a devil’s bargain,” which refers to doing or allying with evil in order to get something accomplished.
I somewhat disagree with his assumption that the oath is what causes the over utilization in healthcare. I was recently made aware of a Medicare report which showed my state, NJ, had the highest utilization of specialized in the last six months of life. The difference was not a percentage point or two but a whopping 43% higher than the national average. There is something more than the oath at work here.
Robert – I am about to put up a new post outlining how Doctors in the US get paid. Until that post is up, I will say this: You are correct the NJ is one of the most expensive state for healthcare, along with New York, Texas and Florida. There are numerous reasons for this, but as often happens in our society we are polarizing the parties in this discussion. Dr. Emanual is clearly not “Dr. Death”, but he points out a very real issue; if every doctor, because of the Hippocratic Oath, provides healthcare regardless of cost, we will bankrupt the system and no one will receive healthcare. However, I want my doctor to exhaust every option to prolong my life regardless of the cost. This is the problem.