Strengthening Constitutional Self-Government

No Left Turns

The Health Darwinians

Betsy McCaughey introduces us to some of President Obama’s main advisors on health care.

There’s Dr. Ezekiel Emanuel, the Chief of Staff’s brother, who is not much of a saviour for certain classes of people:

Emanuel bluntly admits that the cuts will not be pain-free. "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," he wrote last year (Health Affairs Feb. 27, 2008). . . .

Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says 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). . . .

He explicitly defends discrimination against older patients: "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).

And there’s Dr. David Blumenthal:

Blumenthal has long advocated government health-spending controls, though he concedes they’re "associated with longer waits" and "reduced availability of new and expensive treatments and devices" (New England Journal of Medicine, March 8, 2001). But he calls it "debatable" whether the timely care Americans get is worth the cost.

It seems that the Progressives are returning to their roots. Although historians have covered for them, eugenics was the quintessential Progressive science. William Jennings Bryan attacked Darwin because of how Darwin was being used to attack the idea that all men are created equal, and endowed by their Creator with certain inalienable rights. More broadly, the Progressives thought that social science (recall that the social science PhD was a new invention then, and inspired great hopes in many) could manage society more calmly, rationally, and justly than could the American political system as it had previously been known.

Discussions - 8 Comments

If morality is just about current priorities and only a human endeavor, then age is not invidious discrimination and the inefficiency and drag on the system that the old represent makes them (and someday us) ripe for euthanasia, which would be kinder than non-treatment for treatable, but painful, diseases. You do read something similar in the scientific progressives of the last century, but I never read one so direct and think hey would have been uncomfortable with these statements. That was really not logical, given their ethos of efficiency.

Why leave out John Holdren from the eugenics concept. There also is the truth about Planned parenthood and margret sanger. The environmentalist like to think like eugenicists as well, here is David Suzuki back in the commune days. I'm sure this all has nothing to do with the untested flu vaccine being given to children right now.

The issue isn't triage, but public control of health resources. Darwinian logic is generally correct -- nature clearly demonstrates that "winnowing out" is the rule, and mostly without mercy. As human beings, we cannot completely ignore the natural order (isn't that what we accuse the Left of doing?). It really doesn't make sense to spend hundreds of thousands of dollars on heroic measures for the comatose, for instance.

Having said this, I strongly believe that families should have the choice of doing so...if they have the resources to medically maintain an otherwise hopeless life, no government should prevent them. But it really isn't fair to ask the whole population to foot the bill for what is, essentially, sentiment. I wish it were different, but Nature (that marvelously complex system that God created) often dictates cruelty in the service of kindness.

Besides, having been at the beside of dying relatives, I can tell you that "life at all costs" is rarely adhered to in the breach. Euthanasia occurs (informally & illegally) in this nation every hour of the day. Probably best to leave it that way.

Isn't allowing someone to die, despite the heroic efforts that might keep the body going, different than euthanasia? The way we sorted it out was like this; if dad is on the way out the door of death, there is no point in hindering him.

However, government rationing life and even health, to keep down expenses seems horrible. To your point, Redwald, what will legislators do if people become irate when their sentiment is ignored? Will it be more politically popular to demand that doctors do the heroic, or the economical, when the argument is about "government" money?

Let's test Obamacare on Michelle Obama's 71 year old mother who lives at the white house.

Kate, my only point is that it isn't reasonable to expect taxpayers to foot the bill for heroic measures that can't make much difference. For that reason alone, I prefer to keep the current "system." Wherever we go for "efficiency" and "accountability" we are forced to created one-size-fits-all rules, and that often forces us to treat people like "cases" rather than "people." Sucks the humanity right out of the process.

As for euthanasia, that's what I'm talking about. It's very, very common to dose up a dying patient to easy them out of life (morphine, generally). All done quietly with the approval of the family...happens every day.

Redwald, no, it is not reasonable. I am suggesting that with national health one of two things will happen, either the government will standardize the delivery of medical care in favor of cost-reduction (government will set up the morphine drip as it sees fit - think what this could do for the Afghan economy!) or popular sentiment will drive the health care system into a horrible mess. Come to think of it, perhaps that is part of why it is a mess. Insurance companies do not decide that people should die (or at least I do not hear of that) and not all relatives choose to dose up their dying loved one. I have asked my children to do so; my husband is appalled and on his watch, I would be like Alcasan in That Hideous Strength.

We seem to agree that government intervention, especially by folks like those mentioned in the post is highly undesirable.

There is a difference between having a family option for hospice care and being told by the government that based on their opinion of your likely quality of life, you should take a pain pill and shut up forever. Obama's recent comments about heart conditions and tonsil surgeries give some idea of the combination arrogance, cluelessness, and inhumanity that would define such a system.

There is also the problem (as Yuval Levin pointeed out) of the creation of artificial scarcities. Since in a government-run system (however we get there), medical resources will be allocated by the budget and government bureaucracy, the supply and demand will be less responsive to price signals. On one hand this sounds great. You don't have to worry about the (official) price of a service. But since the government will may set an artificially low amount of the resource, you get a scarcity that might not have occurred if there were a competitive market. You get waiting lists where you wouldn't. I've read some people argue that if you wanted better than government service that you could get a secondary private insurance policy. If you are rich, that is exactly what you do - that or pay for the procedures out of pocket as they come up. But the point of the House bill was to put such policies out of the reach of the working and middle classes by destroying the private insurace market.

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