Contemplating Health Care Reform

Thursday, August 27, 2009

Not my brother

Ezekiel Emanuel (brother of Chief of Staff Rahm Emanuel) is gaining prominence as chief medical advisor to President Obama in the healthcare debates.

Dr. Emanuel adds a scary dimension to the discussion.
He has written extensively about bioethics, and believes that it is the job of the state to decide who gets treatment and who should be left to die, given the right set of circumstances, and in spite of his oath to do no harm.
In a 2008 Washington Post Op-Ed, he wrote:
The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed nations on virtually every health statistic you can name.

This statement reveals a dangerous ignorance of morbidity and mortality statistics, and is factually wrong.
When adjusted for premature death, US life expectancy ranks first. The same is true of cancer survival rates.

Dr. Emanuel also bickers,
Society ended up paying the whole bill for dialysis instead of having people make those decisions.

Since Dr Emanuel caused the dialysis machine shortage via government restrictions, Dr. Emanuel probably should rethink his conclusion.

Medical (and most other) insurance pools attempt to anticipate costs among voluntary group participants, i.e. insurance company, co-op, underwriter syndicate, or other pool. Participants and investors in those pools are direct stakeholders.

Under state-run health care, everyone is an involuntary participant, and no one is accountable.

If Dr. Emanuel's suggestions are implemented, physicians will be required to judge what is best for an amorphous society rather than what is best for the patient he is treating. In a 2008 article in JAMA, Dr. Emanuel expressed a belief that the Hippocratic oath is taken too seriously by physicians:

"This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others"

Instead, Dr. Emanuel prefers "to provide socially sustainable, cost-effective care."

Physicians are neither equipped to nor wish to treat the pecuniary problems of society. Treating individual patients is an arduous enough task without becoming keepers of a false aggregate labeled "society" as well.

The argument that the US spends more on health care than other countries is irrelevant. Dr. Emanuel is economically ignorant and ethically suspect. Do doctors and patients really want a committee of Dr. Emanuels making decisions about something as personal and individual as our medical care?

1 comment:

  1. A note on comparative national statistics: The US tries and succeeds in saving far more premature births that other nations.

    America is also more generous in defining live births.

    That saves more lives but of course hurts published infant mortality.

    No good deed goes unpunished.