Right-Wing politics often leave me at a loss for words. The attacks aimed at Ezekiel Emanuel before and after the passage of what is commonly called “Obamacare” is one of the most bizarre examples. At the time, Emanuel was Special Advisor for Health Policy to Peter Orszag, acting director of OMB.
Emanuel struck me as a strange target. In 1997, he wrote a strong essay against legalization of assisted suicide and/or euthanasia. His latest essay opposing legalization of assisted suicide appeared on October 2012 in the NY Times.
Here’s what Wikipedia has to say about the attacks on Emanuel:
Betsy McCaughey described Ezekiel Emanuel as a “Deadly Doctor” in a New York Post opinion article.[29] The article, which accused Emanuel of advocating healthcare rationing by age and disability, was quoted from on the floor of the House of Representatives by Representative Michele Bachmann of Minnesota.[30]Sarah Palin cited the Bachmann speech and said that Emanuel’s philosophy was “Orwellian” and “downright evil”, and tied it to a health care reform end of life counseling provision she claimed would create a “death panel“.[10][31][32][33][34][35][36] Emanuel said that Palin’s death panel statement was “Orwellian”.[37] Palin later said that her death panel remark had been “vindicated” and that the policies of Emanuel are “particularly disturbing” and “shocking”.[38] On former Senator Fred Thompson’s radio program, McCaughey warned that “the healthcare reform bill would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” She said those sessions would help the elderly learn how to “decline nutrition, how to decline being hydrated, how to go in to hospice care … all to do what’s in society’s best interest or in your family’s best interest and cut your life short.”[39] As The New York Times mentioned,[40] conservative pundits were comparing the Nazi T4 euthanasia program to Obama’s policies as far back as November 2008, calling them “America’s T4 program—trivialization of abortion, acceptance of euthanasia, and the normalization of physician assisted suicide.”[41]
Here’s a summary of what fact-checkers had to say about the allegations:
The nonpartisan Politifact.com Web site described McCaughey’s claim as a “ridiculous falsehood.”[39][42][43][44] FactCheck.org said, “We agree that Emanuel’s meaning is being twisted. In one article, he was talking about a philosophical trend, and in another, he was writing about how to make the most ethical choices when forced to choose which patients get organ transplants or vaccines when supplies are limited.”[45][46] An article on Time.com said that Emanuel “was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources … ‘My quotes were just being taken out of context.'”[10] A decade ago, when many doctors wanted to legalize euthanasia or physician-assisted suicide, Emanuel opposed it.[4] Emanuel said the “death panel” idea is “an outright lie, a complete fabrication. And the paradox, the hypocrisy, the contradiction is that many of the people who are attacking me now supported living wills and consultations with doctors about end-of-life care, before they became against it for political reasons.” “I worked pretty hard and against the odds to improve end-of-life care. And so to have that record and that work completely perverted—it’s pretty shocking.”[47]
To me, Ezekiel has been one of the “good guys” – pushing for better and more efficient health care for everyone, and staunchly opposed to legalization of assisted suicide and euthanasia.
Last Thursday – January 3 – Emanuel published another essay titled “Better, if Not Cheaper, Care.” Here’s the opening:
IT is conventional wisdom that end-of-life care is an increasingly huge proportion of health care spending. I’ve often heard it said that people spend more on health care in the year before they die than they do in the entire rest of their lives. If we don’t address these costs, the story goes, we can never control health care inflation.
Wrong. Here are the real numbers. The roughly 6 percent of Medicare patients who die each year do make up a large proportion of Medicare costs: 27 to 30 percent. But this figure has not changed significantly in decades. And the total number of Americans, not just older people, who die every year — less than 1 percent of the population — account for much less of total health care spending, just 10 to 12 percent.
The more important issue is that just because we spend a lot on end-of-life care does not mean we can save a lot. We do know that costs for dying patients vary widely among hospitals, which suggests that we can do better. And yet no one can reliably say what specific changes would significantly lower costs. There is no body of well-conducted research studies that has proved how to save 5, 10, much less 20 percent.
Recent studies find that hospice may reduce costs in the last year of life for cancer patients by 10 to 20 percent. But they find no savings from hospice care for patients who die of other conditions, like emphysema or heart failure. No one is sure why hospice care doesn’t save more. It may be because patients are enrolled in hospice care too late, or because hospice services themselves are labor-intensive and not cheap.
Even if we can never save a dime, however, there are good reasons to think about changing end-of-life care practices. While end-of-life care has improved considerably over the last 30 years, many Americans still die in hospitals when they would rather die at home. Nearly 20 percent of deaths occur in an intensive care unit or immediately after discharge, and too many patients experience symptoms like pain that are controllable with appropriate palliative care.
Emanuel goes on to describe four changes in the delivery of care that could improve the lives of patients with serious medical conditions and their families. They are well worth considering.
Over the next week, I’ll share some material regarding another professional who also has some great ideas about reforming “end of life” practice and is already implementing those changes on a “small” scale.
I’ll also share some other info that gives some pretty stark evidence of just how significant the barriers are to making changes that would make the practice of medicine safer and truly person-centered.
This so much reminds me of Ted Nugent. He sang songs about drugs, and claims he never used. He got on to black youths for fathering children out of wedlock, yet he has fathered children he wouldn’t take care of. He made the mother of two of his kids give them up for adoption. Another woman, had to fight him in the courts for years, until he was court ordered to pay child support. And let’s not forget about all his teen aged lovers–a real family values type of guy. It wasn’t until what–the late 70s or early 80s, that the Republicans ever mentioned anything about religion, or abortion. But hey, I guess congrats to them for swaying the majority of the American people into voting against their best interests.
It’s kind of ironic that those dim-wits call him a Nazi since he’s Jewish. Why are there no average American women that get any air time? Where do they find these people? And by the way, nice fight libs.
Everyone needs to pitch in and help protect ill and elderly people from assisted suicide. Both the AMA and UMA is against it. We need to improve the healthcare given to the poor and provide more funding for those with severe, acute, and chronic illnesses. Everyone should be treated equally and no “advanced triage” type references. Each person should be cared for no matter what. Don’t give up the fight for recovery, improvement, and progress.
A great example for some advanced techniques would be Iceland, which ranks #1 on medical tourism and cancer survival (OECD). Interestingly, they are actually publicly funded. They rank 1 higher than us in CT scanners. Their waiting time according to the OECD for treatment is only 1-4 days. Iceland (and Japan too) are creating human organs from stem cells from the person’s own BONE MARROW.
“In Mr. Beyene’s case, an exact copy of his windpipe was made from a porous, fibrous plastic, which was then seeded with stem cells harvested from his bone marrow. After just a day and a half in a bioreactor — a kind of incubator in which the windpipe was spun, rotisserie-style, in a nutrient solution — the implant was stitched into Mr. Beyene, replacing his cancerous windpipe. ” http://www.nytimes.com/2012/09/16/health/research/scientists-make-progress-in-tailor-made-organs.html?pagewanted=all&_r=0
They’re working on making lungs, livers, hearts too (Iceland, Japan). We need to look to the future. Right here, and right now. Everyone deserves a chance.
Thank you for standing up for disabled people and people who can’t speak for themselves. God Bless
Initial comment before second/third readings. (Add reads required by CFS/ME, severe disabling illness..)
As soon as I see source “New York Post”, I know garbage is coming. (The nation’s possibly oldest liberal newspaper is now right wing extreme, barely worth use as something to shred for bird droppings in a cage or open, flat for puppy house-training.)
End-of-life care as way to save money, has double and triple standards based on class, among other criticism. Yes, that dirty word “Class struggle” combined with disabilophobia.
First of all, people of color (Black Latino) are, in large numbers, dying before they even hit the age to collect Social Security. I saw it with several neighbors, some of whom had become disabled.
Moderately well-publicized studies of Medicare practices within the last two decades, now down the memory-hole of U.S. corporate dominated media, indicate there is racial bias in Medicare delivery to patients of color, Black in particular. Where the identical protocol treatment would be called for/required, but the Black patient on Medicare (not talking Medicaid- another but more well-known discriminatory health delivery system for the poor) do not get the same treatment as White patients, even by the same doctors. This includes treatments (or lack) for cancer, aggressive heart treatment – that, I learned means stents, bypass surgery and is also denied or just not thought of for women of all colors, for two examples. Stephen Drake has documented many cases of discrimination in treatment, including denial of treatment, for babies born disabled and adults who survive accidents, still alive with severe disability and/or disabled individuals encouraged to “just die” rather than bother to be a cause for spending money to keep the individual alive. I always marvel at the chutzpah of people in the medical trades in how they speak to us, the disabled- assuming that we are often unreasonable to think we are worthy of care, citing “cost” or “burden on family” to attempt to make someone feel guilty for wanting to be alive.
Finally, on pain and palliative care: In 2006, my mother celebrated her 93rd birthday. She used a cane, but was much more physically fit than I (26 years younger). Within a few weeks, she got shingles, with excruciating pain. She was a woman who did not like much medication, and didn’t have to, except when surgeries for hips, or other, had required very short term usage. She had a stiff knee, with two long-ago surgeries, since age 18 when she fell down a flight of steps – which led to hip problem. So, she got shingles and the CA hospital didn’t want to give her enough pain killer to “work” meaning, give her relief, because “She might become addicted.”. She died in hospital, a couple of weeks later, unable to die at home as she’d always hoped; my sibling having done well until the final event, in keeping my mother living at home, even with her growing incontinence (one of the major “move the old person into a nursing home” because they can’t hold their urine, the other being inability to walk/having to use a wheelchair). I find both “reasons” absurd, unless you realize it’s disabilophobia plus bias toward institutionalization. Heck, I’m a wheelchair user, but that’s another story.
Which brings me, happily, to point out one person and medical care as my fun example of “class warfare” in medical care and so-called “end of life” in the U.S.:
Dick Cheney. How many heart attacks has Dick Cheney had, former Vice President of the U.S.? What kind of special outside-the-heart device does or did Mr.Cheney have that got media attention? It’s in a cage in his chest, can’t get it wet. Is Mr. Cheney’s care cheap? I think they were waiting for a donor for a heart transplant. I certainly hope they didn’t HELP anyone into the donor category
for Mr. Cheney (or anyone else, or for any other organ/organs).
Apparently Snopes and Factcheck have not read Dr Emanuel’s Complete Lives System and are engaging in either denial or intentional coverup. Both Snopes and Factcheck are fond of taking some lame internet tripe and proving it wrong based on one fallacy. They seldom do sufficient research to find the truth regarding the issue. Their conclusions are not sufficient as proof that some of these hysterical tomes do in fact contains bits of truth. I much prefer to go to the source and prove or disprove it for myself, if the desire strikes me. Sadly too many people accept half-baked rhetorical rebuttal as undeniable proof.