Obama advisor champions rationed health care

[Hannah Bell]

Ezekiel J. Emanuel...serves as a special advisor on health policy to the director of the White House’s Office of Management and Budget and is the chair of the Department of Bioethics at the Clinical Center of the National Institutes of Health...In March, Emanuel, a breast oncologist, was appointed to the Federal Coordinating Council for Comparative Effectiveness Research. The 15-member body was authorized by Obama’s American Recovery and Reinvestment Act (ARRA) to provide “information on the relative strengths and weaknesses of various medical interventions” in relation to federal programs.

Obama has pledged to slash more than $600 billion from Medicare and Medicaid as part of his health care plan. Utilizing comparative effectiveness research (CER), this council will recommend cuts—in the form of cost-cutting “efficiencies” to these federal programs for the elderly, disabled and poor. The cuts are central to Obama’s overhaul of the health care system and are supported by all versions of legislation currently under consideration in Congress.

In his advisory capacities, Ezekiel Emanuel—the brother of White House Chief of Staff Rahm Emanuel—has been placed in a strategic position to influence the Obama administration...Opponents of Obama’s health care initiatives have attacked Emanuel for writings in which he advocates rationing care, particularly for the elderly, infants and those with mental or physical disabilities...

Many of the attacks on Emanuel have come from the right, including Republicans who are masquerading as defenders of health care for ordinary Americans. However, these right-wing opponents of Obama’s proposals are seizing on aspects of Emanuel’s theories that are, in fact, deeply reactionary...

Emanuel writes that “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.” <2> ...in the January 2009 Lancet, spells out his attitude towards limiting “scarce” medical resources for the elderly. “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..."

"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…. It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does.” <4>

In the Hastings Center Report cited above, Emanuel puts forward what he considers to be the criteria for deciding how health care should be distributed under conditions where it is limited by the workings of the “free-market.” It is instructive to quote his exposition at some length, as it reveals the class basis of his supposedly ethical justification. He writes:

“The fundamental challenge to theories of distributive justice for health care is to develop a principled mechanism for defining what fragment of the vast universe of technically available, effective medical care services is basic and will be guaranteed socially and what services are discretionary and will not be guarantee socially. Such an approach accepts a two-tiered health system — some citizens will receive only basic services while others will receive both basic and some discretionary health services. Within the discretionary tier, some citizens will receive few discretionary services, other richer citizens will receive almost all available services, creating a multiple-tiered system” (emphasis added). <5>

In other words, the majority of the population would be relegated to a basic minimum level of care, while those with the financial resources would be able to purchase the finest medical services and take advantage of the latest technologies.

http://www.wsws.org/articles/2009/sep2009/eman-s15.shtml