, has been a cardiologist in private practice in San Antonio for the past 38 years and has an active litigation practice in healthcare law. In this guest post, Mittler explains why one man's personal preferences pose a danger to public policy.
"Genocide requires well-educated professionals. They are necessary for its technology, its organization, and its rationale."
The Genocidal Mentality, Robert Jay Lifton and Eric Markusen
"... In technopoly, science is used to make democracy 'rational.'"
Technopoly, Neil Postman
You should take everything Dr. Ezekiel ("Zeke") Emanuel says seriously. Especially the subtitle of his latest long essay in the The Atlantic on Sept 17: ""
As a principal architect of Obamacare, a White House insider, a frequent contributor to the New York Times and MSNBC's "Morning Joe," a former director of the National Institutes of Health Department of Clinical Bioethics, and a professor at the University of Pennsylvania School of Medicine, Zeke makes pronouncements on health policy that are likely to become law.
And that means that if he wants to force you and me to "ask whether our consumption is worth our contribution," we better start asking how soon Medicare and insurance companies will demand we justify our existence or be ushered out of this world to preserve America's global competitiveness.
Zeke, like all technocrats, likes to use statistics to advance his argument. It's what Neil Postman called using science to make democracy rational in his book Technopoly.
Or, explained another way, it's what Washington insiders use to convince the public that they have made "rational" decisions about who gets to live and die, as opposed to basing those decisions on who will deliver the most votes or biggest political contributions. Zeke, with a PhD in political philosophy, clearly understands how healthcare decisions are made inside the Beltway.
He uses a graph, "Creativity of People With High Creative Potential," to show that productivity peaks at age 40. Clearly the message is that if you are over 40 and have disabilities or diseases that cost a lot, you are consuming more than you are producing.
That graph is similar to the "evidence" shown in a graph in his 2009 Lancet article ." There he showed that after age 40 there was less reason to allocate scarce medical resources to you in terms of your future potential. The same held for those less than 15 years old.
Back when Obamacare was being debated, Sarah Palin and Betsy McCaughey cited the Lancet article as evidence that Zeke was pushing "death panels." It's no stretch to assume that he and the Beltway economists who set health policy want to use some metric of creativity and societal contribution to justify the "scientific" basis for the yet-to-be-appointed Independent Payment Advisory Board to allocate care to Medicare beneficiaries.
My reaction to Zeke's article is one of disgust and outrage. Even if he is the smartest guy in the room, he's dumb when it comes to understanding what the average person wants. How dare he claim to know that someone over age 75 who walks slowly, has some memory lapses, and has some medical disabilities and limited resources doesn't deserve to enjoy music, sunsets, or the company of children and grandchildren?
And why will Zeke stop at age 75? When will he and his political cronies -- of both major political parties -- decide that a disabled paraplegic wounded warrior is consuming more than he is contributing?
While Emanuel claims he's only musing about his own personal decision to forgo colonoscopy after age 65 and flu shots, antibiotics, cancer care, and doctor visits after age 75, his writings are dangerous because they influence major media and national leaders.
The subtitle of this irresponsible article proves he wants to influence you to follow his lead, while he admits at the end of the article he reserves the right to change his mind. Sure, you jump off the cliff first. Zeke will follow you. Not.
Emanuel's essay smacks of the pseudoscience of the eugenics movement which began in the U.S. over a century ago and was promoted by the top academic medical journals, including the Journal of the American Medical Association and the New England Journal of Medicine.
While eugenics was about engineering the gene pool through controlling reproduction by "scientific" methods, Emanuel endorses another population control method: culling the herd of undesirables, or in this case, at first, self-culling. Eugenics began and was developed in the U.S., but was taken to monstrous ends in Nazi Germany and led to the Holocaust.
Emanuel's ominous attempt to define human productivity is as dark as the unethical "science" of using "feeblemindedness" and "seizures" as the basis for forced sterilization in the U.S. well into the 1970s. And it pits generations against each other.
Emanuel's essay on dying to help balance the federal budget comes not coincidentally on the very same day the Institute of Medicine, of which he is a member, released its report, "Dying in America," which not coincidentally terms fee-for-service medicine a "perverse incentive."
The previous week, Hilary Clinton, speaking to a group of cardiologists, and , both questioned the viability of fee-for-service medicine.
Emanuel has spent too much time around Washington insiders and fawning media to know that patients and families want to enjoy the simple pleasures of life. They want the political class to leave them alone and not tell them how long they should live and how productive they are. They want a doctor they can trust, not a doctor who is a hired hand gathering data for a prognostic index of "life unworthy of life."
But guys like Zeke want to play God, and that never ends well for society. So get ready to take one for the country. It's your patriotic duty to die when Zeke says it's time to go.
Disclosures
The author disclosed no conflicts of interest with regard to the above post.