“Savings will require changing how doctors think about their patients” – Ezekiel Emanuel

By Vincent Gioia

“Doctors take the Hippocratic Oath too seriously, as an imperative to do everything for the patient regardless of the cost or effects on others” (Ezekiel Emanuel, Journal of the American Medical Association, June 18, 2008).

Would you vote for a person to be president if you knew that when elected he would appoint someone who thought and said this? Obama did so. The President appointed Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel, to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research. Emanuel added to his comments that Doctors take their jobs too seriously and need to change to reduce costs – “Savings will require changing how doctors think about their patients,” he wrote.

Emanuel knows 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 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. You know what this means; if you are old it’s not cost effective to keep you alive, the money is better spent on a younger person. In the world of Obamacare no longer will doctors try to keep patients alive, they will be told that a doctor’s job is to achieve social justice one patient at a time.

Emanuel 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).

To defend discrimination against older patients, Emanuel says: “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).

Medicare was started in 1965 and since then seniors’ lives have been extended by new medical treatments such as angioplasty, bypass surgery and hip and knee replacements. These procedures have allowed the elderly to lead active lives. But Emanuel criticizes Americans for being too “enamored with technology” and is determined to reduce access to it.

Dr. David Blumenthal is another key Obama adviser; he agrees with Emanuel and recommends slowing medical innovation to control health spending. 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 says whether the timely care Americans get is worth the cost is “debatable.” (If you or a loved one has cancer, do you think it’s debatable – delay lowers your chances of survival?)

Obama appointed Blumenthal as national coordinator of health-information technology. This is a job that involves making sure doctors obey electronically delivered guidelines about what care the government deems appropriate and cost effective.

In the April 9 New England Journal of Medicine, Blumenthal predicted that many doctors would resist “embedded clinical decision support” — a euphemism for computers telling doctors what to do.

Betsy McCaughey, founder of the Committee to Reduce Infection Deaths and a former New York lieutenant governor, thinks you need to know who will be involved in your healthcare decisions and provided the information about Drs. Emanuel and Blumenthal, two of the Obama appointees who will be carrying out Obama’s orders to control lives by controlling what medical care people (other than Obama, congress and government bureaucrats) receive.

“Americans need to know what the president’s health advisers have in mind for them. Emanuel sees even basic amenities as luxuries and says Americans expect too much: “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” (Betty McCaughey – JAMA, June 18, 2008).

The Democrat news media house organs will not tell Americans the thinking behind government health “reform” nor have most people heard about the arm-twisting, Chicago-style tactics being used to force support by Democrat opponents in the House and Senate. In a Nov. 16, 2008, Health Care Watch column, Emanuel 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.”

The health bills in the House and Senate will put decision-making about your care in the hands of presidential appointees with the beliefs of Emanuel and Blumenthal who likely reflect what Obama himself thinks. These people will decide what medical insurance plans cover, how much flexibility your doctor will have and what seniors get under Medicare.

This is what we got when voters responded to the clamor for “change” and elected Barack Obama – Obama has showed a willingness to throw folks “under the bus” when it suits him and old folks are no exception.

Vincent Gioia is a retired patent attorney living in Palm Desert, California. His articles may be read at www.vincentgioia.com and he may be contacted at gioia@gte.net