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Thursday, August 27, 2009

Doctor Rationing Emanuel

Doctor Rationing Emanuel:

With nationalized health care on the discussion table in the US, the topic of rationing and who goes to the back of line continues to dog the proponents of Obamacare. Dr. Ezekiel (Rationing) Emanual, health advisor to the President, clearly supports turning our present Hipprocratic Oath based medical care delivery system over to rationing by bureaucrats and decree. Rather than the doctor & patient relationship being sacred, the needs of society would trump the medical needs of the individual. The Wall Street Journal Editorial below makes it clear that Obamacare is focused on socialism goals and societal change, not actually improving health care for US citizens.

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. 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. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

"Principles for Allocation of Scarce Medical Interventions" The Lancet, January 31, 2009

Dr. Emanuel says that health 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 (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).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).

"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was 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."

Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "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. Covering 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." (Hastings Center Report, November-December, 1996)

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).

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 life-years 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. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys." (, Jan. 31, 2009).

To reduce health-insurance costs, Dr. Emanuel argues that insurance companies should pay for new treatments only when the evidence demonstrates that the drug will work for most patients. He says the "major contributor" to rapid increases in health spending is "the constant introduction of new medical technologies, including new drugs, devices, and procedures. . . . With very few exceptions, both public and private insurers in the United States cover and pay for any beneficial new technology without considering its cost. . . ." He writes that one drug "used to treat metastatic colon cancer, extends medial survival for an additional two to five months, at a cost of approximately $50,000 for an average course of therapy." (JAMA, June 13, 2007).

Medians, of course, obscure the individual cases where the drug significantly extended or saved a life. Dr. Emanuel says the United States should erect a decision-making body similar to the United Kingdom's rationing body—the National Institute for Health and Clinical Excellence (NICE)—to slow the adoption of new medications and set limits on how much will be paid to lengthen a life.

Dr. Emanuel's assessment of American medical care is summed up in a Nov. 23, 2008, Washington Post op-ed he co-authored: "The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name.

This is untrue, though sadly it's parroted at town-hall meetings across the country. Moreover, it's an odd factual error coming from an oncologist. According to an August 2009 report from the National Bureau of Economic Research, patients diagnosed with cancer in the U.S. have a better chance of surviving the disease than anywhere else. The World Health Organization also rates the U.S. No. 1 out of 191 countries for responsiveness to the needs and choices of the individual patient. That attention to the individual is imperiled by Dr. Emanuel's views.

Dr. Emanuel has fought for a government takeover of health care for over a decade. In 1993, he urged that President Bill Clinton impose a wage and price freeze on health care to force parties to the table. "The desire to be rid of the freeze will do much to concentrate the mind," he wrote with another author in a Feb. 8, 1993, Washington Post op-ed. Now he recommends arm-twisting Chicago style. "Every favor to a constituency should be linked to support for the health-care reform agenda," he wrote last Nov. 16 in the Health Care Watch Blog. "If the automakers want a bailout, then they and their suppliers have to agree to support and lobby for the administration's health-reform effort."

Is this what Americans want?

Ms. McCaughey is chairman of the Committee to Reduce Infection Deaths and a former lieutenant governor of New York state.

Madison Slow Down Obamacare

US Founder Madison Slows Down President Obama

So what exactly happened in the health care debate this summer? The founding fathers, wary of kings and divine rulers, and willing to sacrifice their own personal gain for the formation of a fledging democracy, wrote a Constitution that featured checks and balances. And their vision for a system of American government for the people and by the people has withstood the onslaught of Washington insiders for over 225 years. The founding fathers created a document; known as the US Constitution that has guided our Republic. Our Constituion includes the 10th Amendment (1791): The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people. It could be argued that the nationalization of health care by the government is prohibited based on this amendment. Exactly where does it say that health care is within the exclusive jurisdiction of the US Government? Just being the President, doesn’t make it so. Not in America.

During this national debate on health care, a rookie President with a majority of the Congress has failed to fully understand the American process. And now he is blaming the American people for being…. well American.

To put Madison’s work into the modern perspective, we feature the work of Peter Wehner, a former presidential advisor and current think tank fellow, who wrote the following in the Weekly Standard:

But Madison has thwarted others who possessed grand, even utopian, designs. And so we are now getting the debate on health care Obama desperately wanted to avoid--with the result that support for his plan is sinking like a stone in the sea. Whatever plan finally emerges, if any plan emerges, will be quite different from what Obama originally had in mind.

None of this is going down very well with our chief executive. The man who promised us a new style of politics, civil and uplifting, is now unleashing his top aides and congressional allies to "punch back twice as hard" against critics. They are attempting to paint opposition to Obamacare as the work of fringe elements, mercenaries, and automatons. If Team Obama actually believes this explains the groundswell of public concern about its health care plan, they are living in a White House even more hermetically sealed than usual.

But the fundamental problem is the Obama view of politics--romantic and even quasi-revolutionary--in which men of zeal remake the world. This is not the American way. Ours is a system of government in which, as Madison noted, "ambition must be made to counteract ambition," where there are more brakes than accelerators, and where massive overhauls and centralized control are discouraged and most of the time defeated. Whatever its limitations, the Constitution remains, in the words of Gladstone, "the greatest work ever struck off at a given time by the brain and purpose of man." It does not bow before a president in a hurry--even a young, charismatic, and impatient one. Excerpt from the Weekly Standard online at

Peter Wehner, former deputy assistant to President George W. Bush, is a senior fellow at the Ethics and Public Policy Center.

© 2009 Jasper Welch, Four Corners Media,

Tuesday, August 11, 2009

Public Option? No Way!

Public Option? No Way

US Senator Tom Colburn (R-Oklahoma) lays out 10 questions for taxpayers to ask their Congressmen and Congresswomen during this August recess. See National Review On-line

The fifth question by Senator Colburn, one of only 2 doctors in the US Senate, is particularly telling:

5. If the public option is so wonderful, will you (as member of Congress) lead by example and vote for a plan to enroll you and your family in the public option?

I offered an amendment in committee to force members of Congress to enroll in the public option. Nine out of eleven Democrats on the health committee who back the public option refused. If the politicians creating the public option don’t have confidence in it, neither should the American people.

Now that the members of Congress are back in their home states and districts, there are a number of questions that the voters and taxpayers are asking. The rest of the questions that Dr. Tom Colburn is asking are putting the Democrats on the defensive, to the point of that some Congress members are discounting the dissent and vocal questions at town halls as “un-American” (See USA Today editorial by Speaker Pelosi) at

Hello! This is American (at least for now) and our Republic was founded on peaceful assembly and the ability to petition the government (see the Bill of Rights on individual freedoms and liberty enshrined in the Constitution). To characterize hard working, taxpaying Americans, who disagree with socialized medicine and government run health care as un-American, is simply ridiculous.

So here are 5 more questions for your Congressperson:

1) Please give us several examples of US Government run health care, such as the Indian Health Services, VA Hospitals or Medicare re-imbursement, that actually work better that my employer provided health coverage?

2) As a member of Congress, will you go on record and sign up for the Government option for your healthcare?

3) How do you propose the US pays for a government run system that is estimated by the Congressional Budget Office (CBO) to increase US government spending dramatically? What spending cuts will you make? What taxes are you proposing?

4) Do you believe that government bureaucrats can make better medical decisions than patients and their doctors?

5) Have you ever provided medical care and/or are you a licensed health care professional? If not, what are your qualifications to decide health care policy for your fellow Americans?

We have one month to simply say No! We don’t want ObamaCare! Clearly the Congress themselves (for their personal health care options) don’t want to sign up for the US Government option! Why should we?

© 2009, Jasper Welch, Four Corners Media

Thursday, August 6, 2009

ObamaCare Equals Healthcare Rationing

Obama Care Equals Healthcare Rationing

There is a great article on the  written Dr. Zane Pollard regarding the reality of ObamaCare:  it will lead to rationing, less quality of care and a shortage of doctors.    Not convinced?    Here is Dr. Pollard's article on American Thinker

If socialized medicine is not what you had in mind with Obama Care, contact your Congressman or US Senator.  They are back home for the August recess.    Attend a town hall meeting or show up at the local Congressional office, and let them know you concerns.

(c) 2009, Jasper Welch, Four Corners Media