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."
Emanuel wants to spend the bulk of our health care dollars not on the sick or injured -- the people most in need of health care. He wants to spend the bulk of our health care dollars on people in the prime of life. He justifies this with a cold utilitarianism. In a Juanuary 31, 2009 piece in The Lancet, Emanuel and his co-authors present a "complete lives system" for allocating health care resources.
Kids in particular earn Emanuel's scorn as a total waste of health care dollars, a philosophy he justifies by saying, "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."
So don't come to Dr. Emanuel with your sick baby, any more than you'd come to him with your sick grandmother or your disabled brother.
This man is a key advisor on Obamacare. And those of us who fear rationing are "ignorant" and "angry".
Damned right we're angry. Because we're not ignorant.
Suppose we could prolong your Grandma's life for one day, at a cost of one quadrillion dollars.
ReplyDeleteShould we do it?
If we don't do it, would that be what you call "rationing"?
"Rationing is the controlled distribution of resources and scarce goods or services. Rationing controls the size of the ration, one's allotted portion of the resources being distributed on a particular day or at a particular time."
ReplyDeleteRationing doesn't look at individuals. It looks at masses. And it allocates based on impersonal bureaucracy.
A doctor with a dying patient makes decisions based on what is *right* for that patient. Not necessarily what squeezes the most days out of that patient's life, but what is best for that person as a human being.
When I was an EMT we got a call that was basically to reassure a family that Grandpa was really dead. He'd been diagnosed with terminal cancer six months earlier. He and his doctor and his family had discussed his options. He could go all out and try to fight the cancer -- which would mean miserable bouts of radiation and chemo -- or he could stay home with his family, with palliative care. The doctor, patient, and family all agreed that for this man, palliative care made the most sense.
The decision wasn't made because of bureaucrats looking up data on some chart and deciding that Patient X was a waste of money. The decision was made based on the totality of who this man was.
On the other hand, when my friend's youngest baby was born, she was a micro preemie. From a purely statistical standpoint she had only one thing in her favor -- being female. (Premature girls have a better survival rate than premature boys.) She was tiny, only 24 weeks of gestation but the size of an 18 week baby. But she was a fighter. She made it plain that she wanted to live, and her family and the doctors decided that if she DID die, it wasn't going to be because they'd failed her. They pulled out all the stops, and in spite of many setbacks that looked like the end, she ended up not only surviving but thriving.
A bureaucrat looking at charts of gestational ages and birthweights would have rationed care and decided that this baby wasn't worth it. But doctors and family looked at the baby in front of them, and decided to go for it.
Rationing would have let both of these patients die -- both the old man who'd already had a full life and was ready to move on, and the tiny baby with her whole life ahead of her. The Hippocratic Oath allowed both patients' doctors and families to make decisions based on what was best for the patient.
THAT is the difference between rationing and deciding that something isn't worth the cost -- and it's the HUMAN cost, not just a matter of dollars.
“A doctor with a dying patient makes decisions based on what is *right* for that patient.”
ReplyDeleteThis is not true. Physicians rarely if ever make single “decisions” that determine a patient’s trajectory, but often have to deal with myriad considerations, including demands from the hospital, insurers, family, attending staff and time constraints.
“A bureaucrat looking at charts of gestational ages and birthweights would have rationed care and decided that this baby wasn't worth it.”
What baffles me about your argument is that insurance companies have already been doing this for decades. But yet there was no “popular” “outrage” over this practice until it was associated with Obama. Smells kinda fishy…
Chad
Chad, if doctors are currently looking at a chart, saying, "Sorry but your baby is twelve grams under the weight where we declare them liveborn", then we need to be bitching about it, not doing more of it.
ReplyDeleteGranny
ReplyDeleteChad, if doctors are currently looking at a chart, saying, "Sorry but your baby is twelve grams under the weight where we declare them liveborn", then we need to be bitching about it, not doing more of it.
This is a red herring. Nobody is claiming that we should do more of it. It’s that your timing is incredibly suspect. It seems that now everyone is “against rationing” ever since Obama attempted to change health policy.
Chad