The Obama Rationing Plan-Why Senior Fears Are Real
by Dr. Tony Magana
The rationing system Obama does not want to talk about does raise a reasonable fear in America’s elderly.
The “complete lives system” is being contemplated as the ultimate medical rationing strategy to be used by the Obama administration to deal with the scarcity of medical resources. This concept was described in minute detail by Dr. Ezekiel Emanuel in an article published in the British medical journal, Lancet, in January of this year. The priorities for receiving care would fall on younger people who have not yet lived a complete life, prognosis for recovery, saving the most lives, lottery, and “instrumental value principles”.
The most important tenet of Dr. Emanuel’s proposal is the prioritization of younger people who without the aid of society will not get a chance to complete “unfulfilled” projects. Right to life advocates would think upon hearing this, that this principle would therefore call for the cessation of abortion and improvement of prenatal care. However, a strange twist of logic is injected into the theory regarding fetuses and young infants. Because society has invested little effort and cost in children until they are adolescents, young children and infants are of little value.
On the other end of the spectrum, the elderly are considered near the end of the road whose major project accomplishments are now past. In his article, Dr. Emanuel admits the complete lives system “discriminates against older people” but says it is not an invidious discrimination because eventually, unless one dies sooner, every person will experience the same treatment.
Albeit, the most controversial aspect of the rationing plan deals with how the disabled are scored in terms of where they would would go on the priority ladder. Those with disabilities would be given a priority score that was created by a multiplier fraction and the number of productive years they have left to live. For example, a blind person’s multiplier might be 0.6 as compared to 1.0 for a person with no disabilities such that medical treatment with scarce resources for blind people would only be made available 60% of time as compared to 100% of time for the non-disabled. On other occasions, Dr. Emanuel has written the the care for those with dementia should include restrictions on the use of expensive technology because there is no possibility of future productiveness.
This week the British astronomer and physicist, Stephen Hawkins, received the Presidential Medal of Freedom. Hawkins was born with neuro-muscular dystrophy which is a progressive disease leading to almost complete paralysis. By 1974 he was unable to feed himself or get out of bed and by the 1980s had lost his ability to speak yet he has made historic contributions to our understanding of the universe and mathematics. Under the plan put forward by Dr. Emanuel, how many Hawkins will never get the chance to help society?
Dr. Emanuel concluded his paper by saying that the allocation system must be considered legitimate and the route to achieving this legitimacy should involve public discussion and revision. Yet he also said that although the rules once established could make for “procedural fairness” they could not assure “justice”.
Some on the right have compared the rationing concept and withholding of treatment put forth by Dr. Emanuel as being similar to the German Aktion T4 euthanasia program carried out under the Nazi regime. Although much of the rhetoric of that time dealt with what we now call “ethnic cleansing”, the truth is there are similarities in the wording and concepts of that terrible era and the “complete lives system”. The Germans killed off the youngest and the oldest based upon their inability to lead “useful lives”.
At the time, Dr. Emanuel wrote this piece he was the Department of Bioethics, The Clinical Center, National Institutes of Health, Bethesda which is an official arm of the federal government. Now he is also a key adviser to the President on health care issues and reform.
To be fair, he is a man clearly of almost unequaled accomplishment, dedication, and intellect into the field of medicine. He has devoted considerable effort and developed deep expertise into the realities of death and limited resources which are challenges we cannot ignore. His “complete lives system” does represent a way to attempt to quantify these difficult resource allocation decisions in a way that is reproducible and fairly dispensed but also unfortunately seems to lack a sense of humanity by defining human life so coldly.
At the time of this writing there is a lot of personal attack being directed towards Dr. Emanuel for his writings but I believe this is being misdirected. The real anger should be directed to the Obama administration for not being honest with the American people that this is very likely to be the rationing system to be used. Mr. Obama seems to be ignoring the advice that Dr. Emanuel gave that there needed to be a public discussion of this issue not a denial that it exists.
Thanks for reading Contempo Magazine blog which discusses issues for McAllen, the Rio Grande Valley, and America from a conservative Hispanic point of view. Tony Magaña grew up in McAllen Texas, attended Texas A&M University, served as an officer in Army Reserve, and holds a doctorate from Harvard University. The co-founder of Contempo Magazine has participated in Valley business for over 20 years. He is a member of the National Association of Hispanic Journalists and also writes for the American Daily Review. Follow him on twitter http://twitter.com/contempomagazin
Copyright 2009, Dr. Tony Magana. Some rights reserved.
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