Your Hell-th Care Future: The Scarcity System of Dr. Emanuel’s “Complete Lives”
A blogger with the pen name “jonolan” at a website called Reflections From A Murky Pond has provided a link to an article co-authored by Rahm Emanuel’s brother Dr. Ezekiel Emanuel.
The January 2009 article from The Lancet talks about how to treat patients “fairly” when medical resources are scarce.
The article theorizes how to allocate scarce health care resources: note the title! “Principles for allocation of scarce medical interventions.” One might well wonder why medical resources would become scarce, until one realizes that scarcity of resources will be the result, if not the intention, of what I call the Democrat Hell-th Care Unsurance Plan.
Dr. Ezekiel Emanuel, adviser to NObama, calls it The Complete Lives System.
A few excerpts:
The complete lives system also considers prognosis,
since its aim is to achieve complete lives. A young person
with a poor prognosis has had few life-years but lacks the
potential to live a complete life. Considering prognosis
forestalls the concern that disproportionately large
amounts of resources will be directed to young people with
poor prognoses. When the worst-off can benefit only
slightly while better-off people could benefit greatly,
allocating to the better-off is often justifiable. Some small
benefits, such as a few weeks of life, might also be
intrinsically insignificant when compared with large
(I eliminated footnotes: check the original.)
Note the assumption again of scarce resources: the article continues in this flat bureaucratic style, which reminded me – sorry, but… – of bureaucratic documents from the KGB, STASI, and GESTAPO which I have seen. A bland matter-of-fact dealing with judging who should live or die. Emanuel and his co-authors (Alan Wertheimer is an interesting character: Google his name.) use graphs and talk about how the UK system places a number on various factors to measure allocation of medical interventions.
Placing numbers on moral and ethical considerations drives me crazy! e.g.
Allocation systems based on quality-adjusted life-years
(QALY) have two parts (table 2). One is an outcome
measure that considers the quality of life-years. As an
example, the quality-of-life measure used by the UK
National Health Service rates moderate mobility
impairment as 0·85 times perfect health. QALY
allocation therefore equates 8·5 years in perfect health to
10 years with moderately impaired mobility.
And at the end we have this:
Accepting the complete lives system for health care as a
whole would be premature. We must first reduce waste
and increase spending. The complete lives system
explicitly rejects waste and corruption, such as multiple
listing for transplantation. Although it may be applicable
more generally, the complete lives system has been
developed to justly allocate persistently scarce life-saving
interventions. Hearts for transplant and influenza
vaccines, unlike money, cannot be replaced or diverted to
non-health goals; denying a heart to one person makes it
available to another. Ultimately, the complete lives system
does not create “classes of Untermenschen whose lives and
well being are deemed not worth spending money on”,
but rather empowers us to decide fairly whom to save
when genuine scarcity makes saving everyone impossible.
(My emphasis above, and again footnotes eliminated.)
Untermenschen is German for sub-human. Note the language! In fact, by causing and accepting and perpetuating scarcity, one does indeed create a group of Untermenschen!
This is the man advising NObama on medical issues, Rahm Emanuel’s brother.
For other comments see the above link: http://blog.jonolan.net/politics/complete-lives-system/