Update: Ed Koch has questions about Zeke Emanuel and rationing and ‘Death Panels’…Health Care as Social Justice: Rahmbo’s brother and rationing health care…

Has anyone reported Mayor Koch for ‘fishy’ questions?

Update: 8/11: Former NYC Mayor Ed Koch has some questions about rationing and Zeke Emmanuel, from RCP via Instapundit:

Most alarming for people like me, who at 84 years of age recently needed a quadruple bypass and aortic valve replacement, are the pronouncements of President Obama’s appointee, Dr. Ezekiel Emanuel, brother of Obama’s Chief of Staff Rahm Emanuel, who, according to a New York Post op ed article by Betsy McCauley, former Lt. Governor of the State of New York, stated, “Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, ‘as an imperative to do everything for the patient regardless of the cost or effects on others’ (Journal of the American Medical Association, June 18, 2008).”

He also stated, “…communitarianism’ should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those ‘who are irreversibly prevented from being or becoming participating citizens…An obvious example is not guaranteeing health services to patients with dementia.’ (Hastings Center Report, Nov.-Dec. ’96). “

Opponents of Obama’s health care proposals raise the specter of a panel making decisions on who should receive health care. I am not aware of any proposed panel. However, an article in today’s New York Times, referring to a Senate bill, stated, “The legislation could have significant implications for individuals who have bought coverage on their own. Their policies might be exempted from the new standards, but the coverage might not be viable for long because insurers could not add benefits or enroll additional people in noncompliant policies.”

So, where lies the truth? I don’t know. But I do know that I want the continued right to purchase and have available insurance that will permit me, no matter my age and physical condition, to purchase with my own money all the medical care I can afford….

Damned right Ed!

Scales of Social Justice applied to health wealth and prosperity..

Scales of 'Social Justice' are being applied to health wealth and prosperity..

Original Post: July 7, 2009:

Update, Emanuel’s CV here pdf , courtesy of Tollhouse, another savvy commenter on BelmontClub. Notice it is LONG on academics and ethics boards and short, in fact almost totally devoid of any actual practice in caregiving. Many scholarly articles, on managed care in cost containment, and a majority of articles on ..surprize EUTHANASIA!! The end of the circle of socialized medicine rationing and early death. Good Gawd, call your critters. Notice on the chart of care under their ‘soopergenius’ rationing system below, theBAMABOT voters age group is ensured the most treatment, coinkydink or planning? You make the call, to your CongressCritters!

Via a comment from Tynian at Ace, important enough to lift it entirely:

346From The Belmont Club:

Ezekiel Emmanuel MD, Rahm Emmanuel’s brother, who is Barack Obama’s “Special Advisor for Health Policy”, is described by the Huffington Post article as engaged in a very important mission: redesigning the US health care system.
. . .

Emmanuel recently authored an article in the Lancet describing the various models of non-market health care rationing. Titled “Principles for allocation of scarce medical interventions”, its is co-authored with Govind Persad and Alan Wertheimer. In it the authors simply review the pros and cons of the various ways of deciding who gets treated and who doesn’t.
. . .


The authors are not very satisfied with the current metrics used for making medical decisions based on saving the most life-years. . . . They write:

Because none of the currently used systems satisfy all ethical requirements for just allocation, we propose an alternative: the complete lives system. This system incorporates five principles: youngest-first, prognosis, save the most lives, lottery, and instrumental value. … 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 … the complete lives system is least vulnerable to corruption. Age can be established quickly and accurately from identity documents. Prognosis allocation encourages physicians to improve patients’ health, unlike the perverse incentives to sicken patients or misrepresent health that the sickest-first allocation creates.

Under this system, patients would receive scarce care according to the graph shown below.

[Look at that the graph — it’s terrifying]
. . .

The paper concludes: “the complete lives system combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. In pandemic situations, it also allocates scarce interventions to people instrumental in realising these four principles. Importantly, it is not an algorithm, but a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.”

There goes that word ‘just’ again, that social justice is redistribution of health just like wealth….
. . .From an astute commenter discussing the Lancet article authored by Ezekiel Emmanuel:

Another juicy bit from the paper:

In a public health emergency, instrumental value could also be included to enable more people to live complete lives.

The definition of instrumental value, for those of you scoring at home, is:

Instrumental value allocation prioritises specific individuals to enable or encourage future usefulness.

For instance:

where a specific person is genuinely indispensable in promoting morally relevant principles, instrumental value allocation can be appropriate.

So, in a public health emergency, “genuinely indispensable” people will get treated first. Like, say, elected officials, government staff, and (of course) medical ethicists.

I guess that means we’ll be living in a state of perpetual emergency.

In more ways that one…

This is really scary stuff.

If the shit hits the fan the government will officially blow you off for anyone deemed genuinely indispensable in promoting morally relevant principles.

We’re gonna be living Animal Farm really soon.

Posted by: Tinian at July 07, 2009 04:01 PM (7+pP9)

August 11, 2009. Tags: , , , , , , , , , , . Economy, Healthcare, Obama Administration, Politics.


  1. Ezra Klein acknowledges ‘the insurance industry is not a particularly profitable industry’… « Moderate in the Middle replied:

    […] premium increases, and thereby hitting the Snowe ‘trigger’ and dumping us all on to the Zeke Emanuel/Liverpool Pathway to […]


  2. Steve replied:

    Wait, I thought the complaint was that health care would be rationed. Now you’re complaining that it would be unlimited?

    Your premise that “unlimited benefits” would put any private company out of business is unsupported. Certainly you need reasonable controls to prevent waste, but given responsible use of available health care resources there is NOT unlimited need, thus there IS a natural cap to how much an insurance company would need to pay out.

    If you want to call that “rationing”, then we have rationing now. If you’re concerned about “bureaucrats getting between you and your doctor”, we have that now.

    All the blather about how horrible “government run health care” would be, yet the same people say “and don’t touch my Medicare”. Medicare is a government run single-payer health care system. I’m a lot more scared of a big insurance company’s profit motive killing me than I am of the government killing me.

    We really need to get away from the idea that health insurance is something that should be provided by an employer. You’re limited to a few choices that some bureaucrat chooses based on costs, if you have a choice at all; your employer can change your plan any time they think they can save money somewhere else. You usually don’t have a choice as to whether to even participate. If you’re self-employed, you can’t get coverage at anywhere near the same price.

    Unless you advocate “killing off grandma” because she’s too poor to pay for the health care she needs to survive, a universal single-payer plan makes the most sense. It saves a lot of money simply be eliminating a lot of overhead. The so-called “public option” is a way to test-drive that; it won’t become a single-payer system unless it is wildly popular (so objecting to it because it might lead to a single-payer system is placing ideology before reality). If government-run healthcare is so horrible, people will stick with the safe, friendly insurance companies.

    Maybe Republicans are against reform because they secretly want to “kill poor people”…?


  3. Steve replied:

    I guess it depends on what you mean by “rationing”. Your insurance policy almost certainly doesn’t have unlimited benefits, your bank account is almost certainly not unlimited, so the amount of health care you can get is limited. That isn’t “rationing”.

    Are you under the mistaken impression that in Canada or the UK you can’t pay your own money for extended insurance or care? If it was “rationed”, you couldn’t do that, it simply wouldn’t be allowed.

    N Vaughn is absolutely correct, Emanuel’s papers are taken way out of context. I know, I know, they’re HARD to understand, that isn’t an excuse to misrepresent them.

    By the way, Zeke Emanuel is on record as being adamantly OPPOSED to euthanasia. Perhaps that’s why he has papers on it?

    Freedom of speech sure has interesting side effects when you mix it with stupid people, and it’s even more interesting when dishonest politicians exploit them. That’s “interesting” in the sense of the supposed Chinese curse “May you live in interesting times” (see http://en.wikipedia.org/wiki/May_you_live_in_interesting_times for more on the origins of that phrase).

    For a more honest commentary on Zeke Emanuel’s writings, see the abcnews.com article at http://blogs.abcnews.com/politicalpunch/2009/08/zeke-emanuel-on-sarah-palins-accusation-of-death-panels-its-an-absolute-outrage.html

    For two excellent stories on the hypocrisy of some of the Republicans on this issue, see http://www.msnbc.msn.com/id/26315908/#32410950 and http://www.msnbc.msn.com/id/26315908/#32411068


    • ginaswo replied:

      of course not, with unlimited bennies which is what TOTUS is proposing any private company would go out of business. I have a 2 mill lifetime cap :0) If I a worried about family hx I can buy a catastrophic coverage plan individually, call AFLAC!


  4. Ella replied:

    I’m sorry, N Vaughn, but can you name a single place with socialized health care that doesn’t ration health care through bureaucratized boards?


  5. N Vaughn replied:

    I read the complete article in the Lancet. Beck is describing Emanuel’s paper as a way of rationing health care, and that is not what it is at all. What Emanuel is writing about is how to allocate limited resources when demand exceeds supply. This would be the case with limited organs needed for life saving organ transplants where more people need an organ transplant than there are organs available. Or it discusses how to allocate a limited quantity of vaccinations in the case of an unexpected worldwide pandemic where there are more sick people than vaccinations available. He talks about how difficult it is to ethically determine who will receive those resources, and analyzes methods to make those difficult determinations when demand exceeds supply.

    The paper has nothing to do with health care or creating death panels, and Beck is completely taking it out of context. Health care may very well turn out to be more expensive than expected. But that does NOT mean that in order to save money, Obama will create death panels or ration health care. That hysteria just keeps on getting perpetuated. It’s irresponsible and it needs to stop.


  6. Ella replied:

    It’s not even “youngest first.” Small children get less coverage and consideration than the (likely to be euthanized) elderly. So, you know, you better pray for completely complication-free pregnancies, or your kids just need to die.


  7. TJenkins replied:

    How the hell is this not getting more play? This sounds scary as fuck


    • ginaswo replied:

      agree, Sarah Palin raised it now so in their rush to slam her they have opened the door for others to do actual fact checking and see its factual

      see HA Legal Insurrection’s post from the Green Room yesterday 🙂


  8. Tea Party Patriots: Little Rock, AR 8/5 Children’s Hospital – Mike Ross and Vic Snyder Townhall… « Moderate in the Middle replied:

    […] On Ezekiel Emanuel!! LOOK AT OUR BEAUTIFUL INFORMED PUBLIC!! The Complete Lives System explained to the Blue Dogs!! How awesome! […]


  9. Steven Terrell, Sr. replied:

    The proper term for this is Utilitarian Bioethics. Obama wants to cull the herd. Bad………


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