President Obama’s White House Health Care policy adviser and brother of Obama’s Chief of Staff and “attack dog,” Rahm Emanuel, has some very disturbing plans for healthcare “reform.” Dr. Emanuel advocates a collectivist system of “merit-based” healthcare services.
In an example of Orwellian TrueSpeak he calls his plan the Complete Lives System.
Dr. Emanuel first published his ideas of merit-based healthcare in the 1996 Hastings Center Report (Volume 26, No. 6) where he declaimed:
This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity – those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations – are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia. A less obvious example is guaranteeing neuropsychological services to ensure children with learning disabilities can read and learn to reason.
You can download the article in PDF format here.
Over the ensuing years Dr. Emanuel fleshed out his plan over the following years and published it in the January, 2009 issue (Volume 373, Issue 9661) of The Lancet. Some excerpts from the article follow:
Some people wrongly suggest that allocation can be based purely on scientific or clinical facts, often using the term “medical need”. There are no value-free medical criteria for allocation.
Consideration of the importance of complete lives also supports modifying the youngest-first principle by prioritizing adolescents and young adults over infants. Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfillment requires a complete life.
When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.
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. Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.
Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending.
The complete article in PDF format, entitled, Principles for allocation of scarce medical interventions, can be downloaded here.
Dr. Emanuel’s Complete Lives methodology of applying his interpretation of both allocative and distributive justice to healthcare is put forth in the context of having scarce medical resources available. That’s an important consideration when reviewing his Complete Lives proposal; it is not meant to address the allocation and distribution of readily available and plentiful medical resources, only scarce ones. It is a two-tiered system divided between basic (guaranteed) and discretionary (not guaranteed) medical services. Some citizens will receive only basic services while others will receive both basic and some discretionary health services.
So we have to take Dr. Emanuel’s ideas in the context in which they were set, which makes them somewhat less monstrous and horrific than some of the commentary on the subject would have you believe.
That being said, one of the oft-stated goals of President Obama’s healthcare “reform” was to reduce costs and the amount of America’s GDP being spent on healthcare. That certainly implies that money – tax dollars or deficit dollars – will essentially be a medical resource. This could very easily create the sort scarcity that would call Dr. Emanuel’s bio-ethical philosophies into play. Dr Emanuel is, after all, a special advisor to the Director of the White House Office of Management and Budget for health policy. He would definitely be consulted on streamlining expenditures.
How does that you feel? It definitely makes my skin crawl more than a little bit. There are just too many ways that Dr. Emanuel’s particular twist on eugenics could be quietly and on-legislatively introduced into any government ran healthcare system for me to be comfortable with the idea.