Skip to comments.Electing God
Posted on 07/07/2009 1:15:06 AM PDT by Avoiding_Sulla
Ezekiel Emmanuel MD, Rahm Emmanuel’s brother, who is Barack Obama’s “Special Advisor for Health Policy”, is described by the  Huffington Post article as engaged in a very important mission: redesigning the US health care system.
Emanuel and the White House are attempting to reorganize the delivery and reimbursement systems of health care, changing what the types of procedures doctors rely on, making people more aware of disease prevention, encouraging insurance companies to expand coverage, and so on. It is a process rife with sensitivities, trickeries and, of course, the potential for failure. It is not, he insists, impossible.
“It is a complicated process and we have to try and make the choices clear and give people good reasons for making them,” Emanuel explains. “I don’t think that’s an impossible task and thankfully we have one of the great communicators, Barack Obama, at the helm of this ship of state.”
Emmanuel recently authored an article in the Lancet describing the various models of non-market health care rationing. Titled  “Principles for allocation of scarce medical interventions”, its is co-authored with Govind Persad and Alan Wertheimer. In it the authors simply review the pros and cons of the various ways of deciding who gets treated and who doesn’t. The allocation mechanisms they discuss are divided into strategies and substrategies. The pros and cons of each are laid out.
Treating People Equally
The authors are not very satisfied with the current metrics used for making medical decisions based on saving the most life-years. Both the “Quality-adjusted life-years” model and the “Disability-adjusted life-years” have shortcomings which they believe can be addressed by another model of their own: “The complete lives system”, which takes all the factors into account. They write:
Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles: youngest-first, prognosis, save the most lives, lottery, and instrumental value. … When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated … the complete lives system is least vulnerable to corruption. Age can be established quickly and accurately from identity documents. Prognosis allocation encourages physicians to improve patients’ health, unlike the perverse incentives to sicken patients or misrepresent health that the sickest-first allocation creates.
Under this system, patients would receive scarce care according to the graph shown below.
The paper concludes: “the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.”
What’s not mentioned anywhere in the discussion, except by implication is the identity of the narrator. Who is the “we” in “Principles for allocation of scarce medical interventions” that decides who gets scarce medical care? The answer is tangentially provided in the paper itself, which writes that “the complete lives system is least vulnerable to corruption”.The “we” is a system; a system that can possibly be corrupted; hence Dr. Emmanuel’s efforts to design one in which such distortions will be held to a minimum.
Ultimately health care reform is as much about politics as it is about medicine. The discussion in Dr. Emmanuel’s paper is incomplete if limited to pure public health considerations. Politics is central to the whole issue. Whatever “guidelines” are chosen, however rational, however humane, can never implement themselves. Human beings in positions of power are required to do that. And while it is important to note that even under the current system these decisions are being made by someone or by some consensus, it is also vital to realize that in any “health care reform” effort, one of the principal outcomes is to shift the power to make those decisions to someone else. That may not be a fit subject for the Lancet, but it is the elephant in the operating room in the national health care debate.
I read this as a metric of the increase of prognosis expected from medical care. Otherwise we'd be flooding the system with first aid cases. That is only little less tempting for doctors to overrate sickness than a sickest-first metric. I mean if the doctors say you have a broken arm but will be all well by next week, that looks better than saying you have a sprained wrist but will be all well by next week.
This story finally breaks the preferred illusion that fears of radical human population control is nothing more than the product of a fevered imagination.
There are also Biblical connotations to this story other than the title “Electing God.” This is not the first time men have tried to play God.
Zero’s healthcare geniuses think that the term useful individuals is speakable — out in an open paper, the Lancet — for the first time since the Third Reich.
There has always been such a thing as triage in a limited care situation (such as a battlefield). We have to understand the base assumption behind all these scenarios, which is that a free market must by all means be shunned.
In the Lancet??? This should induce forced emesis in a lot of medicos....
That was a lovely pastoral scene that Sol (Edward G. Robinson) viewed while being turned to soylent green. I expect to be seeing it soon!
They (government bureaucrats) get to play God: With health care rationing, they decide who gets health care and who doesn't. They decide who lives and who dies.
God players all, liberals now get to officially do what they have always dreamed of doing, controlling individuals down to the very end of life, in fact, granting or withholding life itself.
Once one accepts the initial premise advanced for the government providing universal healthcare, all this becomes inevitable. No matter that the participation of government itself creates shortages which justify granting or denying life-saving ministrations. To justify their God-playing, liberals presume that shortages will become evident in privately provided healthcare to the point where the market decides that some people might die earlier and some people might die later. Whether that choice is made by people acting prudently or imprudently in a free market, or by Almighty God himself, liberals cannot tolerate such power in the hands of others.
I accuse liberals of seeking control over health care because, just as environmentalism means control over the economy, controlling healthcare gains control over life. This is the ultimate game for liberals.
The ironies abound. Liberals demand universal health care controlled by the government to make it "fairer" and eliminate "shortages." Yet, even as they plan the takeover, they plan for the inevitable shortages. They want health care to be "fairer," so they say that they have to decide what is fair and what is unfair. If I am a prudent man, and provide for the exigencies of expensive healthcare in my old age by sacrificing financially and exercising and dieting while younger, why is it "fair" for the government to consign me to death only because my prudence has kept me alive so long?
Liberals delight in setting up categories describing the characteristics which will prompt them to decide who lives and who dies: Are you old? Are you politically correct? Are you expensive? It really does not matter what the litmus tests are, it only matters that liberals get to lay them down.
Do not believe that once these categories are laid down by liberals they will be carved in stone. Not at all, exceptions will have to be recognized, modifications to the exceptions, new rules will be engrafted, the process will be endless and liberals will be able to play God with your lives until they die themselves for lack of available health care-unless they can try to fall within one of their own "exceptions".
Lupus afflicts Jews and requires dialysis. Sickle cell anemia afflicts African Americans. AIDS disproportionately afflicts the bugerers. Can you imagine the government making a statistical finding that it is uneconomical to treat these diseases in Jews, Blacks and Queers so the three groups must be left to their fate?
By the very politically correct choices the government makes in treating diseases which are the flavor of the month, the government creates incentives to invent the machines and the drugs for that treatment, thus making the treatment more costly. As the philosopher said, one cannot observe or report history without distorting it. How much more is the distortion created by financing the system!
Are women going to suffer the diversion of money from the treatment of breast cancer to the treatment of lupus, sickle cell anemia, or AIDS? That is the inevitable result after all. Inevitably, the government must choose whether to kill Jews or blacks so that the other group can live.
But there is a happy ending, every distortion will require a liberal to fix it. They're just ate no end to doing good.
“Ezekiel Emanuel, MD, Rahm Emanuel’s brother, who is
Barack Obama’s “Special Advisor for Health Policy”, is described by the Huffington Post article as engaged in a very important mission: redesigning the US healthcare system.”
What absolutely brilliant people. They must be many times higher on the evolutionary scale than the rest of us. They have to be beyond brilliant; they have to be shining stars of tremendous thinking ability. One wonders if these “Special Advisors” can make a diagnosis without the aid of any silly machines that this current, flawed, unjust health-care system has at its disposal.
This world must be on the verge of being delivered to the most knowledgeable, the most brilliant, the most loving, compassionate and magnanimous people who ever walked the earth. What an amazing time to be alive; to be nurtured by brilliant, all-knowing, smart, intelligent, holier-than-the-rest-of-us individuals who know so much more than anyone else. Absolutely amazing.
Yep. And words mean things.
This video is a great find, wolfcreek. How did you come by it? It deserves a thread of its own.
The video is of a panel discussion where Ezekiel Emanuel faces the charges briefly. Then he denies the meaning we all can see.
The importance of the obvious conclusions that had been made by historian Anton Chaitkin, he summarizes as: “My reputation has been besmirched here.”
He thanks the panel and commentators, and then storms out.
Avoid caffeine while you read ping..
Ping to ya and bk mk 4 later