Recalibration

A.I. and Denature took me to task recently for making a poorly supported argument. They were right. I should have calibrated my words differently. 

Today, I did penance by reading through every relevant Emanuel article I could find. I have to admit that there is a lot to admire about the man.  He directs physicians to take the time to listen to their patients’ concerns and he recognizes the problems of excessive bureaucracy in medicine. Furthermore, he does seem concerned with putting an end to euthanasia.

Nevertheless, I think that there is, as P. Chirry points out, still cause to be wary.  Emanuel wrote his Lancet article in January of this year. In it, he showed a preference for allowing younger people to live at the expense of the elderly.

A.I. also points out that Emanuel only specified that he favored this kind of preference in one set of circumstances. He says that we cannot assume that Emanuel would apply this kind of thinking to Obama’s current health policy. He is right, but neither can we assume that he will not.

It is true that values sometimes change. However, since Emanuel’s article was written so recently, I find it unlikely that he would suddenly change his mind or suddenly decide that the elderly were as valuable to society as the young. It is possible that Emanuel only finds younger people more fit for care than older people in end-of-life situations – but that is often when healthcare is most critical. Obama may, as A.I. points out, ignore advice from Emanuel. But he is likely to take it, or he would not have chosen Emanuel as an adviser.

There is other thing that I find disturbing regarding Emanuel.

While researching, I came across his book, The Ends of Human Life: Medical Ethics in a Liberal Polity. In one chapter, he says that it would not be right for a physician to decide that an elderly person did not deserve care, because that would be a “personal quality of life decision. “ However, if society deems that an individual can no longer benefit society, he says, that is another matter. He then goes on to discuss what he thinks society’s criteria in deciding these things should be.  Anyone who has access to the book can have a look at pages 73 and 74. That chapter disturbs me a little bit.

Still, I haven't yet read the whole book, so I may, again, be taking things out of context. But it is something worth scrutinizing.

Comments

[A.I.]

Thank you for the acknowledgment. I hope you do not interpret my comments as dismissive of your concerns regarding who may or may not receive treatment under a reformed health care system and the criteria used to make such decisions. What I wish to convey is that those concerns should be considered in context.

For example, under our current system a chronic illness often results in premium increases far beyond those imposed on healthier people or cancellation of coverage. This is true not only for individual policies, but for groups--meaning either a group's premiums are increased beyond the norm because of an unhealthy member or the group gets rid of that member who, we must remember, is a person. In any case, the fate of the individual is not necessarily linked to any quality of life that might yet be enjoyed or any contribution the person might yet make to family, friends and society. Instead it is linked to the insurer's ultimate goal which is to make a profit.

Note there is no scarcity of treatment involved here beyond the monetary. The person might be a breast cancer survivor requiring costly monitoring and presenting a greater than average risk of needing expensive treatment for a recurrence of the disease. The care needed is readily available; the only obstacle is cost. So I ask, if EE's system were applied to allocation of all medical care--and I do not concede it will be, would it be worse than the criteria applied now?

[FascistSocialist]

http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html

Health care is currently rationed and will always be rationed. We'll never pay for a 50 trillion dollar treatment, for example, but were someone to have 50 trillion dollars personally, they might purchase that treatment to save their own life. Right now the rationing is based on how much money/insurance you have.

Well, when everyone has health insurance and we have a finite amount of resources we would do well to define where the cut off is for various treatments. As explained in this particular article, a treatment that saves a 90 year old for 1 year and equally saves a 9 year old for 50 years should not be treated equally. In this sense we have to define our value on life at different ages since we MUST put value on human life. Right now we have no system to do it, poor people die, wealthy live. That's not palatable for anyone with any semblance of a conscience.