In another article from Secondhand Smoke sent to me by ECM, Wesley J. Smith writes about Ezekiel Emanuel, Obama’s chief bioethicist at the NIH. It turns out that Emanuel has written about rationing health care based on age (at least in some cases) and quality of life.
Here are Emanuel’s own words:
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-yearolds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.
And he also wrote:
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.
I think we need to be careful about electing people who want to make all our decisions for us.
WINTERY KNIGHT 
you’re assuming an unlimited supply of doctors, money and medicine – none of which is true. We have a shortage of doctors and of money…and our medical system is broken. Doctors have to “spend” so much more than they should in order to practice defensive medicine (and I’ve read the most recent report on prevelance of defensive medicine and I know of no doctor that believes it – my wife is forced to double/triple her spending on her patients because her attendings always want to be “safe”). We’ll never have enough doctors since medicaid/medicare simply pay too little compared to what insurance and med-school cost. Private insurance is too complicated and costly to deal with, so you end up having to charge the patients for all of the tests/procedures the private companies deny – hence you almost never get paid for them because not too many people can afford to pay those bills.
So you’re left with a system with too few doctors and even less money. So you have to start rationing medicine eventually or just flood the profession with many unqualified people (which will work – many will get sued out of practice and deaths will skyrocket, but we’ll have open-market medicine). So lets assume we keep the quality of doctors high and the shortages continue as well as the money – how do you propose we divy these resources up? Do we spend it on geriatrics who will need constant and ever increasing infusions of cash to keep the alive (not health, but alive) or on younger people to get/keep them healthy so they can contribute to society?
I just want to know your non-sarcastic answer – how do you divy up these scarce resources?
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I’m glad you asked.
Here:
Some podcasts that explain consumer-driven health care
Bobby Jindal’s strategies for fixing health care
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hey wait a minute – suppose he/she lived healthier and the first 65 years were less costly to the system than others’? Does he or she get credit for that ?
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Thanks for your comment. If you live healthier than others for the first 65 years, it is irrelevant. You pay into the system based on income, not based on risk or amount of services used. If you lived 65 years and put 40% of your income into the system without making one claim you would get in line behind someone who paid nothing in and had made choices that caused them to require medical care, drugs, prison, therapy, breast implants, in vitro fertilization, sex changes, drug needles, etc. It is nothing but a scheme to equalize life outcomes by taxing the rich. It’s redistribution of wealth.
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