Conservatives say the renowned bioethicist, brother of Rahm Emanuel, is the man behind the infamous "death panels"
AP/J. Scott Applewhite
Dr. Ezekiel J. Emanuel, special advisor for healthcare at the Office of Management and Budget, speaks at the American Medical Association’s annual conference at the Grand Hyatt Hotel in Washington, Wednesday, March 11, 2009.
Like Sarah Palin said last week, if you’re old, sick or disabled — or have a friend or loved one who is — you should be very wary of Democratic healthcare plans. And, too, you should keep an eye on “the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff.” This is, after all, one of the two advisors to President Obama dubbed “deadly doctors” by the New York Post, a man also known as “Doctor Death,” who, as conservative blogger Gateway Pundit explained, “supports euthanasia … [and] believe[s] medical care should be reserved for non-disabled ‘participating’ members of society.”
It’s become a growing theme on the right: ”Obamacare” will mean mandatory euthanasia for your grandmother in order to save money, and the person who created the ideological underpinnings for that policy is the brother of White House Chief of Staff Rahm Emanuel.
There’s a certain irony to that suggestion. Ezekiel Emanuel, who’s currently advising the administration on healthcare reform through a post at the White House Office of Management and Budget, is actually one of the country’s leading medical ethicists, a forceful defender of people approaching the end of their life. Indeed, he opposes even voluntary euthanasia and physician-assisted suicide.
The charges against the doctor are “a gross distortion of Dr. Emanuel’s 25 years as an oncologist and leading academic researcher,” Kenneth Baer, the communications director at OMB, told Salon. “He has dedicated his professional life to improving the quality of care and giving more choices to terminally ill patients. He was an outspoken public opponent of euthanasia when the Supreme Court was considering the legality of physician-assisted suicide. We all wish that instead of spending time distorting one doctor’s record we all could come together and do the hard work of health insurance reform. This is only a distraction from that important work.” (Emanuel himself was vacationing and unavailable for comment.)
The wave of anti-Emanuel feeling kicked off in earnest when, on July 24, the Post published an Op-Ed by Betsy McCaughey about him and another Obama advisor, David Blumenthal. McCaughey is a veteran of the last war over healthcare reform, in the Clinton administration; “No Exit,” an article she wrote for the New Republic, was instrumental in the defeat of the Clinton plan — the magazine later disowned the piece, due to its numerous factual errors.
Still, the Post gave her plenty of room to mislead its readers, as she wrote:
Emanuel … 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.
The quote McCaughey used here was technically accurate, but was stripped from the proper context, twisted to distort the actual meaning of Emanuel’s words. Notably, she left out Emanuel’s opening qualifier about the view he was discussing: ”Without overstating it (and without fully defending it) not only is there a consensus about the need for a conception of the good, there may even be a consensus about the particular conception of the good that should inform policies on these nonconstitutional political issues.”
Plus, at the end of the passage McCaughey quoted, Emanuel wrote, “Clearly, more needs to be done to elucidate what specific health care services are basic; however, the overlap between liberalism and communitarianism points to a way of introducing the good back into medical ethics and devising a principled way of distinguishing basic from discretionary health care services.” (In a post on his blog, ABC News’ Jake Tapper makes a very good point about how academic writings that are, like this one, “exercises in philosophy,” can be twisted this way.)
This passage of McCaughey’s has been picked up by people like Palin, who apparently saw it as evidence for her claim that her son Trig, who has Down syndrome, would have to face a “death panel.” But Emanuel’s past writing makes it very clear he would vociferously oppose such an idea.
In a March 1997 piece for the Atlantic, he said, “The proper policy, in my view, should be to affirm the status of physician assisted suicide and euthanasia as illegal.” (His emphasis.) In January of the same year, he wrote in the Wall Street Journal, “[L]egalizing euthanasia or physician-assisted suicide would be of no benefit. To the contrary, it would be a way of avoiding the complex and arduous efforts required of doctors and other health-care providers to ensure that dying patients receive humane, dignified care.”
In her Post Op-Ed, McCaughey also said Emanuel “explicitly defends discrimination against older patients” and quoted him as saying, “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.” The implicit argument, made explicit by those commentators who followed up on the article: Emanuel wants to ration healthcare, diverting resources to the young and away from the old.
Not mentioned? The context in which he espoused this view: A situation in which rationing is already happening because supply simply can’t keep up with demand. The U.S. has already laid out guidelines that specify who would get precious flu shots in case of a pandemic, with the elderly given a high priority because of their vulnerability to the virus. In the original paper that laid the groundwork for the article McCaughey quoted, Emanuel and his co-authors were simply proposing a different system — a controversial one, to be sure, and not one the medical community at large espouses, but still not nearly as radical as it’s been made out to be. Instead of prioritizing the number of lives saved, the researchers said that “life-years” should take precedence.
“Most people have the intuition to say, ‘Give it to my 19-year-old. I got to 65; I’ve lived a good life,’” Emanuel explained to the Washington Post in 2006. “We are not interested in purely the number of lives (saved), but also life-years.”
Even if you were to accept the premise that Emanuel really doesn’t care for patients, that he’s just a cold utilitarian, there’s still a major problem with the logical leap his detractors make from there.
Say for the sake of argument that Emanuel is willing to march the old and the disabled off to be turned into Soylent Green if it will save The State some money. (And to be very clear, he’s not.) One big problem remains: He doesn’t actually believe that it would save any significant amount of money. In fact, back in 1994 he co-authored with his then-wife a study showing that the economic cost of caring for the dying isn’t nearly as high as it’s made out to be, and that not much can be done about it anyway.
“We must stop deluding ourselves that advanced directives and less aggressive care at the end of life will solve the financial problems of our health-care system,” the two wrote. In testimony he gave to the Senate Finance Committee later that year, he said, “Just because we are spending a lot of money on patients who die does not mean that we can save a lot of money on end of life care.”
Gingrich lauded “good parts” of Obama health plan
“There are clearly things that we’d like to see continued," he told clients
Newt Gingrich on "the good parts" of Obama's healthcare reform (Credit: AP/Bob Child)
Since Newt Gingrich’s meteoric rise in the polls in the last two months, the Washington Post and New York Times have begun reporting on the Republican front-runner’s dual role as a vocal critic of President Obama’s healthcare overhaul and as a paid consultant who explains the law’s benefits to corporate clients.
What hasn’t been reported yet are two conference calls in June and December 2010 in which Gingrich and his for-profit Center for Health Transformation touted “the good parts” of Obama’s plan and offered advice about how clients might take advantage of a myriad of provisions of the Affordable Care Act.
In a February 2010 investigation into Gingrich’s healthcare business, I found that the Center’s consultants had curried favor for drug companies, health insurers, health IT companies and hospitals, which paid Gingrich hefty retainer fees in exchange for access, advice and health-related earmarks.
The conference calls, co-sponsored by Siemens and NextGen Health Care, were central to Gingrich’s effort. In her introductory remarks, co-host Charlene Underwood, government affairs vice president at Siemens, described the calls as a “GPS” for firms seeking to “navigate what promises to be a circuitous route for health care reform.”
On both occasions, David Merritt, the vice president of Gingrich’s health firm, spoke first, explaining the law and the stages of implementation. Merritt praised many parts of the law, including spending on public wellness programs and incentives for employers to encourage people to focus on preventative care.
”I think the bill, and the provisions that have the most potential to truly transform the delivery side of care, would be in what’s called Title III where a lot of these demonstrations, a lot of these changes to reimbursements, will be found,” he said.
For clients in the business of electronic medical records, Merritt said the Affordable Care Act offered incentives for better reporting standards and that early adopters of health information technology would benefit. Siemens and NextGen Health specialize in health information technology.
Gingrich also spoke on the calls reminding listeners that health reform could be shaped through committee hearings in 2011 and through the repeal-and-replace period in 2012, when (he suggested) a Republican president would take over. Touting his access to the Republican Party, Gingrich said he would be advising the congressional leaders as they took aim at the law.
On one call, Gingrich suggested that his clients — each paying as much as $200,000 in yearly retainer fees — would have a role in crafting policy.
“There are clearly things that we’d like to see continued and we’d like to see legislation passed almost concurrently that will sustain the good parts,” said Gingrich, explaining what would happen if the bill were to be repealed. Showing his savvy at generating business, he added that he would “love the help of all of our members in identifying” which parts of reform should remain law.
Gingrich’s private description of the Affordable Care Act differs dramatically from what he had said to voters publicly. In interviews over the last two years, he has described President Obama’s program as a “centralized healthcare dictatorship” with provisions that “would, in effect, be death panels.” At Republican debates, he said that if elected, he would literally sign the repeal at his inaugural ceremony.
He stuck a different tone on the 2010 calls with his clients.
Gingrich applauded the “rapidly emerging standard of care” that would come with new Medicare reporting patterns prescribed by the law. “I think that those people who understand it and adapt to it, and learn how to use it faster will have a substantial net advantage,” Gingrich advised.
Gingrich has dismissed criticism about his influence peddling, saying he has done “no lobbying.” But according to his clients, he is part of their lobbying operation. In slides before the Gingrich webcast, Siemens listed the Center for Health Transformation and “N. Gingrich” as part of its “Influencers” campaign, along with its team of D.C. lobbyists and trade association memberships.
In 2010, I asked the former speaker about his refusal to register as a lobbyist. Although he met with lawmakers and helped craft industry-friendly legislation with Capitol Hill staff, he told me that his influence peddling did not technically constitute lobbying because it “benefit[ed] the country at large.”
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Listen to June 2010 webcast here
Listen to the Dec. 2010 webcast here:
Federal court tosses lawsuit over health reform
Three-judge panel in Virginia backs constitutionality of Affordable Care Act
President Barack Obama gestures during an event in the East Room of the White House to honor NASCAR driver Jimmie Johnson for his fifth consecutive championship on Wednesday, Sept. 7, 2011, in Washington. (AP Photo/Evan Vucci) (Credit: AP)
A federal appeals court in Virginia has dismissed two lawsuits that had claimed President Barack Obama’s health care overhaul was unconstitutional.
The unanimous decision was issued Thursday by a three-judge panel of the 4th U.S. Circuit Court of Appeals. It is the second appellate court ruling affirming the government’s right to require individuals to buy health insurance or pay a penalty. A federal appeals court in Cincinnati also upheld the law, but an appeals court in Atlanta struck down the insurance mandate.
Two of the judges on the Virginia panel were appointed by Obama, the other by Bill Clinton. They rejected claims by the state’s Republican attorney general and Liberty University that the insurance mandate is unconstitutional.
More than 30 lawsuits have been filed over the law.
What’s happening to a model healthcare system?
Costa Rica's universal system has long been lauded. Now, it's on the verge of going broke
A Costa Rican patient awaits care in a San Jose hospital on July 20, 2011
SAN JOSE — Right-wing radio host Rush Limbaugh once vowed to flee to Costa Rica if President Barack Obama’s health care reforms took effect.
Limbaugh might have overlooked a couple of critical details: Costa Rica’s respected universal healthcare system is highly socialized. It’s also on the verge of going broke.
Costa Ricans credit health care with helping boost its life expectancy to 78.7 years — on par with the richest countries in the world. Costa Rica’s broad coverage ranked better than most of the Americas, including the United States, in a 2000 World Health Organization index.
Now, hobbled by mismanagement, the system has become overwhelmed by a burgeoning population that includes an increasing number of elderly and new immigrants who rely on the public system for care.
A damning report by the Pan American Health Organization, an international public health agency, found that Costa Rica’s social security system, known as “la Caja,” or savings bank in Spanish, spent greater sums than ever on health care even as service in public hospitals faltered.
At hospitals considered among Latin America’s finest, waiting lists run painfully long. A tally of patients awaiting biopsies at one San Jose hospital reached 11,000 last year.
Laura Chinchilla, Costa Rica’s president, told television viewers last month in one of her most somber addresses that la Caja is on the brink of a “serious crisis.”
“The [budget] shortage can no longer be covered by the current system, and any temporary solution will do nothing more than worsen the problem and the future situation of the institution,” Chinchilla said.
The long queues sway patients with means to opt for faster care in private clinics, popular among throngs of “medical tourists” from the United States.
“If it’s a little thing, it’s better to go to a private doctor,” said Susana Trejos, whose family grows fine coffee in the southern region of San Vito de Coto Brus.
But private health care prices are prohibitively high for most Costa Ricans, so they turn instead to la Caja.
To fund it, wage earners pay a little over 9 percent of their salary in social security tax. Their employer matches that with another 27 percent of each worker’s salary, and the government pays into la Caja as well to help cover the poor.
Anyone in the country of about 4.6 million can fill a prescription at a public pharmacy or have an operation, all paid for by Caja insurance.
Now, Costa Rica’s population is aging rapidly compared to the slowing birth rate — with some enduring seniors living past 100.
Many elderly people live on meager state pensions, leaving them to rely on the state for their care. “This can cost a fortune, and it all keeps getting handed out with not a single charge,” said Dr. Fernando Morales, director of the National Geriatric Hospital in San Jose.
Costa Rica’s labor landscape has also changed, with larger numbers of migrant workers and freelancers that feed a thriving informal sector that now makes up an estimated 40 percent of the Costa Rican workforce, who all receive care from la Caja.
Health officials say that tax fraud is another major drain on the system. Some companies underreport staff salaries to snag a lower tax rate. In a crackdown in 2009, the authorities shuttered a soccer stadium just hours before a big game to force the team owners to cough up over $1 million in social-security back pay.
Much of the blame for la Caja’s shortfall has fallen on previous managers. Under the former Caja chief’s watch, the public health system hired thousands of new workers and hiked wages. Pay for sick leave and overtime also ran up the bills. Social-security revenue, meanwhile, failed to keep pace.
The accusations of mismanagement triggered a shakeup in the Chinchilla administration, causing the embattled president to lose top cabinet officials. Recently, the health minister stepped down, saying that she disagreed with the way the president has handled the crisis at la Caja.
Chinchilla has vowed to rescue the system, ordering cash injections and setting up a committee of Caja directors to draw up a report on suggested reforms. There’s no word on when the report might be released, and it will take time to implement any changes it might suggest.
In the meantime, Hospital de Alajuela, the nearest public hospital to the capital’s international airport, has slashed its emergency-room hours due to budget troubles. For now, it seems that deep reform is stuck in the waiting room.
How the Democrats could have saved healthcare
The new law may die in the Supreme Court. If it had included a public option, this all would have been avoided
Two appellate judges in Atlanta — one appointed by President Bill Clinton and one by George H.W. Bush — have just decided the Constitution doesn’t allow the federal government to require individuals to buy health insurance.
The decision is a major defeat for the White House. The so-called “individual mandate” is a cornerstone of the Affordable Care Act, President Obama’s 2010 healthcare reform law, scheduled to go into effect in 2014.
The whole idea of the law is to pool heath risks. Only if everyone buys insurance can insurers afford to cover people with preexisting conditions, or pay the costs of catastrophic diseases.
The issue is now headed for the Supreme Court (another appellate court has upheld the law’s constitutionality) where the prognosis isn’t good. The Court’s Republican-appointed majority has not exactly distinguished itself by its progressive views.
Chalk up another one for the GOP, outwitting and outflanking the president and the Democrats.
Remember the healthcare debate? Congressional Republicans refused to consider a single-payer system that would automatically pool risks. They wouldn’t even consider giving people the option of buying into it.
The president and the Democrats caved, as they have on almost everything. They came up with a compromise that kept healthcare in the hands of private insurance companies.
The only way to spread the risk in such a system is to require everyone to buy insurance.
Which is exactly what the two appellate judges in Atlanta object to. The Constitution, in their view, doesn’t allow the federal government to compel citizens to buy something. “Congress may regulate commercial actors,” they write. “But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”
Most Americans seem to agree. According to polls, 60 percent of the public opposes the individual mandate. Many on the right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.
Had the president and the Democrats stuck to their guns during the healthcare debate and insisted on Medicare for all, or at least a public option, they wouldn’t now be facing the possible unraveling of the new healthcare law.
After all, Social Security and Medicare — the nation’s two most popular safety nets — require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks.
But because Social Security and Medicare are government programs they don’t feel like mandatory purchases. They’re more like tax payments, which is what they are — payroll taxes.
There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits.
Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new healthcare law.
Requiring citizens to buy something from a private company is entirely different. If Congress can require citizens to buy health insurance from the private sector, reasoned the two appellate judges in Atlanta, what’s to stop it from requiring citizens to buy anything else? If the law were to stand, “a future Congress similarly would be able to articulate a unique problem … compelling Americans to purchase a certain product from a private company.”
Other federal judges in district courts — one in Virginia and another in Florida — have struck down the law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli; the Virginia judge to asparagus.)
Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.
The Republican strategy should now be clear: Privatize anything that might otherwise be a public program financed by tax dollars. Then argue in the courts that any mandatory purchase of it is unconstitutional because it exceeds the government’s authority. And rally the public against the requirement.
Remember this next time you hear Republican candidates touting Paul Ryan’s plan for turning Medicare into vouchers for seniors to buy private health insurance.
So what do Obama and the Democrats do if the individual mandate in the new healthcare law gets struck down by the Supreme Court?
Immediately propose what they should have proposed right from the start — universal healthcare based on Medicare for all, financed by payroll taxes. The public will be behind them, as will the courts.
Appeals court strikes health insurance requirement
Federal panel rules individual mandate unconstitutional by a two-to-one margin
A federal appeals court panel on Friday struck down the requirement in President Barack Obama’s health care overhaul package that virtually all Americans must carry health insurance or face penalties.
The divided three-judge panel of the 11th Circuit Court of Appeals struck down the so-called individual mandate, siding with 26 states that had sued to block the law. But the panel didn’t go as far as a lower court that had invalidated the entire overhaul as unconstitutional.
The states and other critics argued the law violates people’s rights, while the Justice Department countered that the legislative branch was exercising a “quintessential” power.
The decision, penned by Chief Judge Joel Dubina and Circuit Judge Frank Hull, found that “the individual mandate contained in the Act exceeds Congress’s enumerated commerce power.”
“What Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die,” the opinion said.
Circuit Judge Stanley Marcus disagreed in a dissent.
The 11th Circuit isn’t the first appeals court to weigh in on the issue. The federal appeals court in Cincinnati upheld the government’s new requirement that most Americans buy health insurance, and an appeals court in Richmond has heard similar legal constitutional challenges to the law.
But the Atlanta-based court is considered by many observers to be the most pivotal legal battleground yet because it reviewed a sweeping ruling by a Florida judge.
U.S. District Judge Roger Vinson’s ruling not only struck down a requirement that nearly all Americans carry health insurance, but he also threw out other provisions ranging from Medicare discounts for some seniors to a change that allows adult children up to age 26 to remain on their parents’ coverage.
The states urged the 11th Circuit to uphold Vinson’s ruling, saying in a court filing that letting the law stand would set a troubling precedent that “would imperil individual liberty, render Congress’s other enumerated powers superfluous, and allow Congress to usurp the general police power reserved to the states.”
The Justice Department countered that Congress had the power to require most people to buy health insurance or face tax penalties because Congress has the authority to regulate interstate business. It said the legislative branch was exercising its “quintessential” rights when it adopted the new law.
During oral arguments in June, the three-judge panel repeatedly raised questions about the overhaul and expressed unease with the insurance requirement. Each of the three worried aloud if upholding the landmark law could open the door to Congress adopting other sweeping economic mandates.
The arguments unfolded in what’s considered one of the nation’s most conservative appeals courts. But the randomly selected panel represents different judicial perspectives. None of the three is considered either a stalwart conservative or an unfaltering liberal.
Dubina, an appointee of President George H.W. Bush, is not considered to be as reflexively conservative as some of his colleagues. But he’s been under particular scrutiny because of his daughter’s outspoken opposition to the health care overhaul. U.S. Rep. Martha Dubina Roby, a Montgomery, Ala., Republican elected in November, voted to repeal the health care law.
Marcus and Hull were both tapped by President Bill Clinton to join the court. But Marcus was also previously appointed by Republican President Ronald Reagan to serve on the Florida bench after several years as Miami’s lead federal prosecutor. And Hull, a former county judge in Atlanta, is known for subjecting both sides of the counsel table to challenging questions.
Page 1 of 173 in Healthcare Reform
Health Care Reform Comes to Comics 
Female soldiers fight the brass ceiling 
Catholic tribalism and the contraceptive flap 
Salman Rushdie fears nothing 
The two Americas clash at CPAC 
Making the perfect cover girl 
A birth-control compromise could divide the right 
Unions in a “death spiral”? Not on my job site 
The answer that’s been staring them in the face 
And the Oscar goes to … “Twilight”! 
Adele: Too fat for fashion designer 
