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All this sounds very scary.

Would our growing population of children with autism be another “obvious example” of those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ‘96).

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The NY Post had an interesting article about the President’s healthcare plan on July 24th, written by Betsy McCaughey, who is founder of the Committee to Reduce Infection Deaths and was also a former New York lieutenant governor. Ms McCaughey emphasizes that the health bill in Congress WOULD put the decisions about your care in the hands of presidential appointees. The bill is written in a way that it empowers the government to decide what plans are available to us and how much leeway our doctors will have and what seniors get under Medicare.

McCaughey expresses concerns with this plan, especially as it relates to two of President Obama’s top health advisers. The first person mentioned is Dr. Ezekiel Emanuel, who is the brother of White House Chief of Staff Rahm Emanuel. Dr Emanuel has already been appointed as a health-policy adviser at the Office of Management and Budget and as a member of Federal Council on Comparative Effectiveness Research.

Ms. McCaughey reports that Dr Emanuel bluntly admits that the $500 billion in healthcare cuts in Medicare and Medicaid will not be pain-free. She quoted Dr Emanuel as saying, “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change.” This was quoted from an article he wrote last year in Health Affairs, Feb. 27, 2008. McCaughey references another article written by Dr Emanuel in the Journal of the American Medical Association, June 18, 2008, where he writes that savings will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others.” McCaughey reports that Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
The article states that many doctors are horrified by Dr Emanuel’s notion and prefer to believe that the job of a personal physician is to achieve social justice one patient at a time. But McCaughey writes that Emanuel holds the belief that “communitarianism” should guide decisions on who gets care. She credits Dr. Emanuel as saying that medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ’96).
The article discredits Dr Emanuel for explicitly defending discrimination against older patients, remarking in an article that “Unlike allocation by sex or race, allocation by age is not invidious 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” (Lancet, Jan. 31).
McCaughey also reports that the president’s budget director, Peter Orszag, in understanding the rising dissapproval from the public to these cost cutting ideas, has urged Congress this week to delegate its own authority over Medicare to a new, presidentially-appointed bureaucracy that wouldn’t be accountable to the public.
McCaughey also discusses how new medical treatments in the recent decades (angioplasty, bypass surgery and hip and knee replacements) have transformed Medicare seniors’ lives and allow them to lead active lives well into later ages. But Emanuel is again cited as being critical to Americans for being too “enamored with technology” and is reported as being determined to reduce access to it.
The other key Obama adviser highlighted in the article is Dr. David Blumenthal, who recommends slowing medical innovation to control health spending. McCaughey describes Blumenthal as a long-time advocate of government health-spending controls, though he conceded in a March 2001 New England Journal of Medicine article that controls are usually “associated with longer waits” and “reduced availability of new and expensive treatments and devices.” But Dr Blumenthal considers it “debatable” whether the timely care Americans get is worth the cost. Blumenthal was reported to have been appointed by the President as national coordinator of health-information technology and oversees doctors adherence to electronically delivered guidelines about what care the government deems appropriate and cost effective.
McCaughey cites Blumenthal in an April 9th New England Journal of Medicine article where he predicted that many doctors would resist “embedded clinical decision support” –which means that doctors would resist computers telling them how to care for their patients.
McCaughey explains that she wrote this article to alert Americans about what the president’s health advisers have in mind for them through this healthcare legislation. Dr Emanuel is quoted as being critical to Americans for expecting too much from their healthcare; saying, “Hospital rooms in the United States offer more privacy . . . physicians’ offices are typically more conveniently located and have parking nearby and more attractive waiting rooms” (JAMA, June 18, 2008).
Finally, McCaughey mentions how Chicago strong-arm tactics are currently being used in the development of this healthcare reform bill in Congress. A Nov. 16, 2008, Health Care Watch article written by Dr Emanuel, was cited where he explained how business should be done: “Every favor to a constituency should be linked to support for the health-care reform agenda. 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.”
Readers are asked by McCaughey if they want a “reform” that empowers people like this to decide for us?

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chris Reply:
July 31st, 2009 at 9:39 am

@Sue, Everyone should check out this Friday’s 20/20 episode (July 31, 2009). Stossel went to Canada and Great Britain and will report on what he experienced in their healthcare settings.

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