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"THE health bills coming out of Congress would put the decisions about your care in the hands of presidential appointees. They'd decide what plans cover, how much leeway your doctor will have and what seniors get under Medicare.
"Yet at least two of President Obama's top health advisers should never be trusted with that power.
"Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.
"Emanuel bluntly admits that the cuts will not be pain-free. 'Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change,' he wrote last year (Health Affairs Feb. 27, 2008).
"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).
"Yes, that's what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.
"Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.
"Emanuel, however, believes that '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).
"Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.
"He explicitly defends discrimination against older patients: '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' (Lancet, Jan. 31)."
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