Rationing Health Care

Obama Administration officials are saying it in every way there is to say it and the mainstream media is not paying attention.

In his speech to the American Medical Association, President Obama said what White House health advisor Ezekiel Emanuel and Office of Management and Budget Director Peter Orszag have said in print some time ago. The only way to control health care costs is to get doctors to provide less care — fewer tests, fewer procedures, fewer everything. Of course, the Administration wants to eliminate only that care that is "unnecessary." But HMOs say the same thing.



Clearly the Administration does not consider doctors the best judge of what people need. The obvious end game: Washington will tell doctors how to practice medicine.

One method they have in mind: the power of the purse. The Administration is asking for independent authority to set reimbursement fees for all providers under Medicare. The easiest way to discourage "unnecessary care" is not to pay for it in the first place.

An example of what can be done is actually in legislation being written on Capitol Hill. Buried somewhere in the 1,000 plus pages is a provision to severely limit what Medicare pays for CT and MRI scans performed in doctors' offices. This would force elderly patients, for example, to go to the hospital for their radiology — where there are often lengthy waits. Patients in rural areas who must travel long distances to get to hospital-based testing facilities may be discouraged from getting the tests done at all.

To assist in this effort, the Administration is proposing a new federal health board to decide whether health care services are "effective" or "appropriate." When he first advanced this idea in Critical, Obama health care guru, Tom Daschle, pointed to the British National Institute for Health and Clinical Excellence (NICE) as the model. NICE has adopted a rule of thumb that health expenditures are inappropriate if they involve spending more than $22,000 to save six months of life. As a result, British cancer patients do not have access to drugs that are routinely available in the United States. The World Health Organization (WHO) estimates that 25,000 British cancer patients die prematurely every year because of these restrictions.

If health care is to be rationed, what's the right way to do it? Zeke Emanuel (who is also the brother of White House Chief of Staff Rahm Emanuel) wrote an entire article on this subject in the Lancet on January 31, 2009. Emanuel advocated allocating health resources in order to maximize collective life years. Suppose a 25-year-old and a 65-year-old have a life threatening disease. Since the 25-year-old has many more potential years of life ahead of him, he should receive preferential treatment, says Emanuel. He justifies denying care to elderly patients in the following way:

The complete lives system discriminates against older people…. 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.

There's more. In a different article written more than 10 years ago for the Hastings Center Report, Emanuel said health services should not be guaranteed to "individuals who are irreversibly prevented from being or becoming participating citizens." He continues, "An obvious example is not guaranteeing health services to patients with dementia."

To anticipate a possible charge of hypocrisy or inconsistency, let me acknowledge that I have for some time advocated empowering a health care czar with the ability to negotiate with providers. It is an idea I have been working on with former Medicare/Medicaid director Mark McClellan and many others — on the left and the right. Under our proposal doctors, hospitals and other providers would be freed to approach Medicare with offers to repackage and reprice their services so long as these offers promise to lower Medicare's costs and improve patient care.

Our proposal to liberate the supply side of the health care marketplace is the exact opposite of the Administration's desire to control doctors by using the purchasing power of the federal government to tell them how to practice medicine, however.

Comments (53)

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  1. Vicki says:

    Stunning. Thanks for bringing this to our attention.

  2. Ken says:

    Emanuel’s writings are very revealing. Amazing that he is a top health advisor to Obama, however.

  3. Joe S. says:

    Ken, revealing and scary.

  4. Tom H. says:

    I bet the president does not discuss this topic tonight.

  5. Anita Fields says:

    It is just another Scam, like a Bernie Madoff scam,
    to scam all the people that aren’t paying attention!!!!!!

  6. Bob says:

    Yup. You can save a lot of money by denying care to Grandpa. Sounds good to me. Oh, wait—I’m Grandpa now!

  7. Paul Nachtwey says:

    it’s still lifestyles. it’s still diet and exercise. if you don’t diet and exercies properly you should have to pay more or get less coverage. there’s your rationing. 70% of healthcare costs are lifestyle related! I just delivered my 4th consecutive annual sub 6% healthcare renewal to a company that adopted a meaningful difference in benefits based on weight targets.

  8. Frank Timmins says:

    Interesting information for sure. The idea of a Healthcare Czar that actually acts in the best interests of all parties would be great if such expectation is reasonable. A talk show host today pointed out that it is a bit odd that a politician can advocate that healthcare is a “right” for every American while denying same to an elderly person because of age. I guess “rights” have a stale date in Obamaworld.

    We know that what they are really saying is that “insurance coverage” is a right, not “healthcare”. You are correct in that the media just won’t connect the dots.

  9. R Allan Jensen says:

    Paul N’s comment that 70% of healthcare costs are lifestyle related is specious and not supported by multiple studies. That said, many health care events can be avoided by lifestyle related choices.

    A very big factor is the costs of healthcare are the mandates placed upon the healthcare delivery system by government — they’ve created a self-fulfilling prophecy. NO ONE is addressing this!!!

    As to John’s point, politicians cannot be point on the entire end of life issue. Society must deal with this in its uniquely American way, inside of families, in churches, with close advisors, etc. I am stunned by government health systems that knowingly calculate the cost savings from the deaths of their own citizens due to rationed and withheld care. Is this what is required to become a civilized society? What a pile of stink!

    John’s group is on point — the healthcare system would respond to market forces if they were allowed to operate — but of course the current debate is not about helping people or making rational choices — it’s about creating a new class of voter clients.

  10. rich says:

    i wonder if oboma daughter was 25 and his wifes father 65, and both very ill, i am sure he would not care who’s illness got first priority….. RIGHT!!!!!

  11. Mark Kellen says:

    I would appreciate it if Mr. Jensen could share the studies which study lifestyle and healthcare costs, because I have been unable to find such studies. As a physician, walking around a hospital, it always seemed to me that about 60-75% of the patients were there for self inflicted problems. Remember the other part of the equation is patients using treatments of marginal value becaue for the patient medical care seems to be “free”, so they do no personal cost benefit calculations to determine if a drug or medical service is worth the money.

  12. Guy says:

    Every gov’t agency is eventually captured by the industry it is supposed to regulate, e.g. the FDA has been captured by the pharmaceutical industry. Don’t believe me — the FDA recently removed pyradoxamine [a form of vitamin B6] from the market so that a pharmaceutical company could try to sell it as a drug. You and I can no longer buy a safe and inexpensive supplement so that a drug company can make monopoly profits.
    Mr. Goodman’s ‘health care czar’ will quickly be captured by the sickness maintenance industry, and we will be worse off than we are now. We need less gov’t interference not more.
    Each individual has the right to spend their health care dollars as they see fit, whether you or I agree with their decisions or not. If you want to help those who can’t afford whatever you think they should have, put your money where your mouth is and keep your hands off my money [I have the right to use my money for my own healt care].

  13. Julie Elliott says:

    We need to stop this insanity. Please do all you can in your neighborhood, community and work to stand up for your rights and what you believe in. The Tea Parties are a start, but we need to be vigilant and steadfast. Everyone needs to call their Senator and get involved.

  14. Brant S Mittler MD JD says:

    Excellent analysis. Now the House Energy and Commerce Committee is about to vote on an amendment to ban all CT, MRI and PET scanners in doctors’ offices. All but radiologists that is. They’re not consider “self referrers.” This is going a step further than limiting payments. It’s a proposal for Congress to tell doctors and patients which tests can be run where. Sounds like HMOs. Unfortunatley this was inspired by the greedy radiology lobby who want to capture all technical testing component dollars for themselves. The reality is that Medicare pays too little for cognitive services and pays a lot more for testing of all types.

  15. Marti Settle says:

    Why is there a crisis in medical care for the uninsured? Being unwed, unemployed, living in California did not prevent Octomom from enjoying the benefits of expensive artificial insemination (7 times) and delivery 14 kids, eight of which were so tiny that there hospital bill cost the state of California $10,000,000. Illegal aliens get free medical care every day in our emergency rooms. The only people who cannot get medical care are the working poor who make just a tad more than the minimum which keeps them off of medicaid. Since when did the Constitution of the United States tell the government that it’s job was to provide medical care for everyone. It does not require that government even provide an education, equal or unequal. The only requirement of the federal government is to provide for the common defense. How have we gone so far astray? Departments of Agriculture, FEMA, FDA, the entire alphabet soup of entitlements is insanity run amok. I don’t think we need a government medical policy at all. Medicare for the elderly is in place. Let is stop there. If people choose a lifestyle that does not allow them to purchase medical insurance then they should have stayed in high school, gone to a trade school, worked two jobs, busted their butts just like the rest of us. I am single, 65 and darned sure never asked the government for one red penny. Who are these people who make there decisions with bleeding hearts and teary eyes filled with empathy. They are spending our money folks, not theirs. They are using us to fulfill the vacuums in their souls because they are unfulfilled human beings. They have no gravitois. They have no courage. The are bean bags in suits. Look at Chris Dodd, Barney Frank, Nancy Pelosi, Dick Durbin, Harry Reid, Chuck Shumer, Barack Obama. That’s are really nasty hand to be dealt but it’s what we have to stare at and listen to. Not one of them has the intelligence to coordinate a garbage collection route in a medium sized city. Imagine this group of numbnuts trying to run national health care. Let me off this planet, please.

  16. Jackie Zeimet says:

    I have an uncle with Kidney cancer and my mom’s gum cancer just came back. Both are in their sixties. I don’t want any care denied to them. They also want to complain about people with dementia costin too much. What’s next? Complain about the diabetics too. I have a 10 year old with Type 1 diabetes and I’m afraid all the nonsence involved in a national health care system could shorten and decrease her life’s quality. These policies aren’t national health care, they are national euthanasea.

  17. Anna says:

    Government mandated genocide! Our politicians are selling their souls.

  18. Doris says:

    I support some health care reform. I do not support politicians telling healthcare professionals how to practice!!!
    I don’t see many legislators jumping off their “special” health care policy bandwagon to help us.
    May they all contract a terminal illnes: the worse, the better.
    Only the Ted Kennedys can afford to fly all over the country to treat an incurable glioblastoma

  19. Bruce Baker says:

    I have had cancer twice, and operated on to get rid of it, so far so good. (knock on wood), And i have to have cat scans every six months to keep an eye on it. I have no adrenal glands either and am on pills for the rest of my life. My wife dose’nt work she’s 58 im 64, WHEN I TURN 65 AM I GOING TO BE TOLD I CANT HAVE ANY HEALTH CARE TO? I say boot them all out of thier offices and take them all off the payrolls that we have given to them and let them go on social securety and see how fast they fix it

  20. Grace says:

    I watched Obama last night and was very confused when he was done. Either he was ill-prepared or just not being honest. As he usually does, he took way too long to answer the questions asked and in most cases didn’t answer the question. You know he’s longwinded when the question asked is shown at the bottom of the screen to remind people what was asked. I’m amazed that this Administration wants to change our entire healthcare system, when the two facets they run work so poorly. I think if Medicare and Medicade could be reformed that would be a step in the right direction. He slam against Doctors was unfair. He obvioulsy don’t know what he’s talking about.

  21. David Norwood says:


    We must demand, with a loud voice, that federal employees become a part of any plan they force us into…

  22. […] that’s a problem for Cass Sunstein, then what are we to make of various Democratic proposals to allocate fewer health care resources on the basis of their expected value to society?  My colleagues and I have been critical of the Administration’s desire to insert […]

  23. Janet Davis says:

    Jackie and Anna are so on it! They get it, when the devil is in the details, this is what we get. As I see it, this nightmare began with “Managed Care”, HMO’s and lobbyists promising the moon to legislatures, if they would jump in the bed with them all. They did and here we are. They are all getting wealthy on the backs of ill citizens only wanting a chance to feel better at the least and cured at the most. I am 62,have an incurable disease and 7 grandchildren who love me and don’t want to be without me. Does “Uncle” care if their hearts are broken for loosing their beloved Granma way too soon?

  24. C.J. Cockerell says:

    I just heard the travesty called a “news conference” which was a pedantic lecture on health care. I am a physician. Here are some major issues with his proposals:
    1. Our system simply cannot “rapidly” absorb 47 million new patients. There are not enough doctors or ancillary health providers to absorb an onslaught of these individuals. (And the plan to increase providers that is in some of the bills won’t work either as it takes years for programs to expand and train more doctors. Furthermore, it costs about 60-70,000 dollars a year to train a doctor. Is the cost of training these individuals being considered?) This will DEFINITELY result in long waits by average American patients who currently have excellent care to see a doctor. This will erode the quality of care that the vast majority of Americans have. Also, an unexpected consequence of this plan will be that more patients will die inadvertently, just like they do in Canada and England, as there will need to be a massive triage “rationing” system with individuals with the most acute problems being treated first. A number of those who wait for their condition to become emergent won’t make it like there. People without insurance currently “self-regulate” their health care utilization as they take care of minor things themselves. Once they are given free care, they will begin utilizing it abundantly. This is very similar to what we see in the VA system currently where patients go into the hospital in the morning, essentially stay there all day, see a practitioner to get a free medication refill and visit friends. While this sounds a bit harsh, unfortunately, it is something that goes on over and over again every day. There is NO WAY that this plan can be implemented without costs increasing dramatically. The problem is that we have an ever increasing, aging population who will need and expect more and more care and if this is made widely available and “free”, it doesn’t matter how much taxation of the rich or cutting payments to doctors, hospitals and insurance plans, it will never be able to be paid for. It will bankrupt the country. Republicans should be thinking NOW about plans to reverse whatever is passed and scaled back to a reasonable program.
    2. What we really need is something that is a “safety net” so that if someone gets a catastrophic illness, that is covered. This is a relatively rare thing and is something that should be able to be accomplished. We do not need a comprehensive health care coverage for everyone. Not everyone’s acne and well child visits need to be covered by insurance. Patients should pay for inexpensive visits themselves. There are also numerous community health clinics that deal with these types of visit already and these could be expanded. All the examples that we have been given relate to relatively rare, albeit catastrophic, examples of anecdotal cases. We should not be trying to change an entire system to deal with a very small segment.
    3. We heard examples of “waste”, i.e., why perform the same test multiple times, etc. There is a very good reason for this: tests often need to be repeated to confirm their results and furthermore, if a test is not performed, there can be medicolegal liability. One aspect of this entire plan that continues to be forgotten is the need for MEDICAL LIABILITY REFORM. It should be made illegal for malpractice attorneys to advertise fishing for lawsuits against doctors and pharmaceutical companies.
    4. The President’s “examples” of how to make people healthier like the diabetic foot that is amputated that could be prevented by better diet show how little he actually knows about medicine in general. Unfortunately, better diabetic control doesn’t always prevent serious complications. Furthermore, mentioning things like offering more mammograms and these would be paid for with the plan and save money—this is also something that the data doesn’t support. At which age will patients be eligible for these? This is something that medicine has been fiercely debating for years and data suggests that this could result in far more expenses related to false positive findings leading to more biopsies and testing, etc.
    5. Comparing our health care system to that of other countries such as France, Germany and Sweden is not reasonable. We have a much larger population with many different groups and regional differences. We need to quit comparing ourselves to other countries and look at what we can do to improve our system here in a way that is in the best interests of the American people. What works for France or England will not work here; we need an American plan that is better and we should not settle for second best.
    6. We would like to see improvement in the system. The insurance companies are certainly not the friends of doctors. At the end of the day, the most important thing remains patient care. While costs are certainly very important, they are not the most important thing. We cannot compromise patient care. This needs to be a win-win, not a win-lose plan and the current proposals have winners and losers. This is not a consensus plan and the administration is trying to railroad this down the throats of the American people in a rapid and reckless way. It is way too important to be rushed to completion. The average American unfortunately doesn’t understand the complexities of this issue and won’t really know what will be hitting him or her until it’s too late.

  25. Carla Axtman says:

    This post wrongly suggests that if health care reform reduces medical costs at the end of life, this must be at the expense of good care and necessary treatment. Recent research confirms what we’ve learned from decades of experience improving care and expanding end-of-life choices: More treatments do not mean better care. Futile and painful end-of-life procedures often yield nothing but needless suffering, even as they add great expense. Real reform requires shifting from profit-centered to patient-centered care.

    We cannot reform our health care system without addressing the fact that it is driven by profits. We must adjust the system when the drive for profit works against excellence. Medicare, as a public system, is the only source of comprehensive data on expenditures. Approximately 5% of Medicare beneficiaries die each year and in 2006 30% of the Medicare expenses were for their end-of-life care. 10% of all Medicare costs occur in the final 30 days of life. Most of the money in those last 30 days pays for intensive care and invasive, unwanted treatments intended to extend life, like feeding tubes and mechanical ventilators.

    Ironically, these exorbitantly expensive procedures do not even serve their goal. A large, authoritative study appearing this March concluded:

    Analysis demonstrated that higher medical costs in the final week of life were associated with more physical distress in the last week of life and with worse overall quality of death as reported by the caregiver. There was no survival difference associated with higher health care expenditures at the end of life.

    Few patients get the chance to discuss end-of-life preferences with their doctors. Patients who do have these conversations are much more likely to reject futile, painful procedures and select hospice care. But fee-for-service payment systems – both Medicare and private insurance plans – encourage health care professionals to do as many things to people near death as is medically possible.

    We need a health care system driven by what patients need, not what profit demands, a system that pays doctors to talk with patients about peaceful endings when death is imminent and pays for hospice care in the home as readily as it pays for intensive care in the hospital.

    True reform will remake this profit-centered industry into a patient-centered one that delivers the comfort care and supportive services people truly want and need at the end of life.

    Carla Axtman
    Online Community Builder
    Compassion & Choices

  26. Don Levit says:

    You bring up some excellent points.
    I listened to a fellow from an organization that promotes ending one’s life, compassionately, as an option to receiving relatively futile, exzpensive care.
    I forget the name of the organization.
    I posed the question to the speaker about Medicare paying a percentage of the covered medical charges as a death benefit, in lieu of receiving the medical treatment.
    Has this option been discussed in your organization?
    Don Levit

  27. Cindy Boyd says:

    I agree with David. We should definitely insist that all federal employees (congressmen, military, ALL) have the same plan they force us into. If it is good enough for us, it should be good enough for them; this would make the legislators think twice about the provisions of the program.
    We also should insist on no deal unless tort reform is part of the package. Torts must be limited or costs will never go down and responsibility to deal with claims should be transferred to a claims court with expert judges just like other programs. The Trial Lawyers Association has done more than big insurance companies to drive costs. Why is Obama so silent on this when he says that “eveything is on the table?”
    The more socialized our health care becomes, the more rationing will be experienced. That’s for sure, and as a senior this is terrifying to me.
    I am also not crazy about providing health care to non-citizens; it should at least be more limited. I am concerned about all of these issues as Congress debates our future. However the first two points (the fed. empl. participation and the tort reform) are of special concern and real deal breakers. If those two issues were addressed fairly, the costs would be contained and the rationing would be not be a problem.

  28. ALice Pitts says:

    As far as the Obama administration goes, it’s worse than we have ever seen up to now. Now we have discrimination against the elderly and others, pay outs for corrupt banking and more. Every day there is some kind of comment by a public elected official and/or bill going that is against the constitution and civil rights. Iacoca has written a book. Read it.

    How many of you would like to see a third party. A party that represents the people of the USA NOT the President’s personal agenda?
    I can’t fo into the details but want to see how many would like to see it happen. Comments appreciated

  29. Brian says:

    I would love to have another party, not because the president is wrong but to insert diversity into the political arena. Both parties have voted not on merit but on party-lines. Infractions for bi-partisanship are severe.
    I am tired of being victimized by republican agendas and democratic agendas. The present parties do not represent America as it is. They are interested not in actually governing but in securing their own position. This has been highlighted by the current healthcare debate. Republicans are not interested in healthcare reform and Democrats are not concerned over fiscal responsibility. There is a middle ground which neither Republicans or Democrats will ever reach.
    It is past time to appoint legislators that are there to do the job, not just sit back and enjoy the scenery, walk the party-line against the interest of America, and stand up for the American citizen rather than how much money they get from lobbiests.
    The President is supposed to lead, not write legislation. I am glad that Obama has asked for healthcare to be done but has let congress work it out. TRhat is the way it is supposed to be. What it shouldn’t be is another dictatorial president like Bush. For once we have a president who is not abusing his position, intimidating congress, lying to American citizens.

  30. Doris Schiller says:

    It is easy to inflame people with a few choice sentences pulled out of context. I hope people will read the whole Emanuel articles so they will understand what he wrote. Sadly, most will not take the time and will be content to be uninformed.

  31. David P. Logue says:

    Where do I sign UP?

  32. Gene S. says:

    Have any of you considered it is not about healthcare? I am convinced this is one step in a series of many steps to gain complete control over our lives. This has been in the making for a long time. Actually it all began – in seed form – just prior to the 20th century. Obama is the chief community organizer but dumb if he thinks it would be this easy to pull his "snow job" on the American people. STAND UP AMERICA AND STOP THIS INSANITY! This just may be the last chance we have to save our Republic and our way of life.

  33. lou lotesto sr says:

    like cindy boyd said ….whatever healthcare they want to give(force) down our throats, either were all and i mean all in or leave me out!

  34. Bryan says:

    As to not start a flame against me, let me first state that I am against 0bama-care.
    But have any of you read the Lancet article?? It is interesting. And it got me to thinking about rationing and if it is already taking place. It is in some situations. For example, an EASY example, is organ transplants. In other situations such as cancer treatments and medicine distribution I am not sure. However, and here is why rationing is such a concern, there will be a problem created as a direct result of Obama-care. That under his plan there will be such a burden on the current health care system with such a great expansion of people covered that rationing will have to take place. The article discusses many methods. And from my limited knowledge, some seem to already be ‘in practice’. Read the article.

  35. Bob in Indianapolis says:

    One glaring issue that I have not seen anyone address is NOT the future of access to health care BUT, the future of ADVANCES in health care. We have the best health care now and have been the beneficiaries of many of the world’s advances in medicine because of market incentives to be paid for new medicines, treatments, etc. Think about innovations in heart care, cancer treatments, etc. that never would have come to fruition if politician’s had their way and told elderly or terminally ill patients to just “suck it up” because they owed it to others to die without a fight.

    I have a young son with a very rare medical condition who has been the beneficiary of advances in medical treatments. I shudder to think about my 6 year old’s quality of life if the medical profession had not been incented over the years to make advances and get better at what they do.

    So, for me at least, the major concern isn’t access to a hospital or doctor, it’s that the advancement of the medical profession will eventually stagnate. If you can’t rea the rewards of hard work, creativity and bringing new ideas, medicines, procedures, etc. to market… then over time they will simply stop occuring.

    I would love to hear someone – anyone – tak abut the long-term consequences this has of the future of healthcare itself.

  36. Cee says:

    The article written by Zeke Emanuel (brother of White House Chief of Staff Rahm Emanuel) shows a lack of detailed, in-depth thinking on the matter.

    Zeke Emanual advocated allocating health resources in order to mazimize collective life years; he used an example of a 25 year old and a 65 year old with a life threathing disease. BUT what if the 25 year old did not seek medical care soon enough, which resulted in their illness not being detected UNTIL it had reach such a progressed state that their changes of survial, even with treatment, was only 5% – 10%? BUT what if the 65 year old sought medical care, their illness was caught (by a caring Doctor) at the begining of their illness, and their change of survial with treatment was 95%? Who would/should get perferential treatment in this case!?

    Zeke Emanual “attempted: to example how his “idea” was NOT discrimmiation. All discrimination laws state clearly — no one (including the goverment) can discriminate against a person based on Race(includes caucassin), Sex, National Origin (legal citizens) or AGE! Allocating health resources in order to collectively maxamize life years, is AGE discrimination, pure and simple.

    Several important aspect are appaullingly omitted by Zeke Emanuals thinking and article — the moral and human aspects! ALL people should be treated with dignite, respect and caring at ALL stages of life! With holding medical care and medication from the old — is appaulling. Medical care and medications for the old (or people at the end of life) is necessary to ease their pain and to provide and maintain their dignity! Oh, that’s right it is all about “money”! Well, one suggestion to cut goverment spending would be — stop spending trillions of dollars here and there, with all the pork added in! Another — in one year 12 million (or was it billion) dollars was spent and lost (by the goverment)on Medicare fraud. Clean this up, take action to ensure this money, lost on medicare fraud is stopped, review in depth the companies hired by the goverment to pay out Medicare Claims are doing their jobs! This will the SAVE goverment (and tax payer’s) money!

    There are 72% of the people who are satified with their health care (and pay their insurance) — 72%! Our goverment is “for the people, by the people”. It is the duty and responsiblity of our goverment (current administration, Senators, Congressmen) to work on behalf of and for ALL the people. After all, it is ALL the people who pay (though taxes) their salaries. Rationing health care to certain group is NOT upholding the goverments duty and responsibility to ALL the people!!

    Our current Administation, Senators, Congressmen, “holywood bunch”, and all their families, does NOT have to fall under the “goverment health reforms”. Becasue, as in Canada and Great Britian, those who have the money to pay for their medical care 100%, using their own money, can see any doctor, get any test, get any treatment money can buy. But the majority of the population, who pay thouogh high taxes, will be forced into it and who will suffer with new health care reforms ran by the goverment.

    NO vote should ever be cast on Health Reforms, by any voting party, simply becasue they like the person or they like the party or want to a part of the “Washington in group”! We need people with intellegent, integrate, honesty, morals and COMMON SENSE in Washington. Regardless of the college, university one attended or how my degree’s obtained — Integrete, honesty, morals and common sense does NOT come with the dgree or the college — it is there or it is not there!

  37. Steven C. Dossin says:


    Please see our latest article at http://www.comingtogether.info/HealthReform.html for our take on the topic of health care rationing.

  38. Barbara says:

    My gut tells me that we have reached a point where “Survival of the Fittest” will be the order of the day. All this talk about rationing health care will have no impact on those who are wealthy and powerful. They will get whatever medical treatment they want. The rest of us, we’re on our own.

  39. b dowd says:

    when we stop paying for every “ILLEGAL ALIEN”, schooling, healthcare, welfare, spanish computers in our schools and throw them out, maybe there would be money for people who really need help!!!!
    sick of this double standard, the people who work, pay their bills, taxes, etc. and the others who just take all handouts!

  40. Rebecca says:

    Having read Emanuel’s articles that you posted on your blog, I must state that you completely misrepresent him. These articles highly complex philosophical discussions about the ethics of health care, in which Emmanuel explores the logical outcomes of various arguments. In one, he and his co-authors explicitly state at the end of the article that they do not endorse an immediate move to the “complete lives system” they just spent several pages talking about because there is already so much wastage in the existing system. In fact, one article is more a critique of liberalism and less an explanation of what a national health care system should look like, which again concludes with a statement that “more work” needs to be done on a topic. Like many academics, Emanuel spends a great deal of time talking about hypothetical situations.

    As someone with a parent suffering from a debilitating hereditary disease, I would never support an administration that denied giving health care services to the disabled or the elderly. I do not think this is actually what Emmanuel is saying. But let’s face it, lots of elderly and disabled people are currently denied health care if they happen not to wealthy enough to pay for it themselves. My own parent is a good example of this.

    Perhaps you should encourage your readers to read the articles for themselves, because do raise very troubling legal and ethical questions, though that would require thinking through hard, subtle writing and difficult topics that make us all uncomfortable.

    What we need in this country is a real debate in the press over ethical issues regarding the distribution of care … because health care is already distributed privately … just to individuals with excellent salaries and high-paying jobs. Instead, what I see are scare tactics being used to avoid having a real debate.

  41. cmhmd says:

    well said, rebecca.

    I am a trustee of the Pennsylvania medical society and we had oour annual retreat a couple weeks ago, devoted entirely to health care reform

    We discussed CER and the facilitator, a non-physician, conservative economist, seemed quite surprised that we were, to a person as best i could tell, quite comfortable with CER evaluating both effectiveness and costs of treatments. He double checked: Do you really mean that? Yes.

    Physicians are mostly very comfortable with this aspect of medicine. The Charter of Medical Professionalis specifically states that part of our duty to society is to advocate for fair allocation of finite resources.

    We can do this.

    Oh, yeah, to the doc above who said we can’t absorb 47 million uninsured: I thought they could all get all the health care they wanted, that they weren’t being denied care, that they were just young free loaders who didn’t need health care? Hmmm. Suddenly we can’t absorb them?

  42. DJ says:

    Mark Kellan,
    Here is an article that cites a study in Holland about obesity and smoking and healthcare costs. It’s not exactly what you asked for but close.

  43. […] article on Dr. Emanuel: http://www.john-goodman-blog.com/rationing-health-care-2/ ▶ Comment /* 0) { jQuery(‘#comments’).show(”, change_location()); jQuery(‘#showcomments […]

  44. george highsmith says:

    QUESTION????? Under the Zeke Emanuel plan what will happen to all the handicapped,pregnant women and nursing home patients when “we have an emergency?????
    They will become medically “expendable”. Suggest one read the book the “Nazi Doctors” The Medical Killing and the Psychology of Genocide. This is the way the Hitler Plan worked.There should be serious ethical concern that we are heading in this direction with this
    Medical Care Reform Bill in the future.

  45. Emerson Browning says:

    We must fight to keep this Health Reform Bill fro m passing !!!!!!!!! We must Fight , Fight , Fight !!!!!!!! Away with all the Left Wing Nuts in the White House and the Democratic Nuts in Congress !!!!!!!!!! It’s the Hippies for sure!!!! They are out to destoy our country!!!!! They have been working for a long time to do this !!!!!! Please God ” we pray ” that you help us save our country from these Bad People !!!!!!!!!!!

  46. Cheryl says:

    Please do not give hippies a bad name by comparing them to this governmental cluster @#$%. No matter how you feel about a nationalized plan, we just cannot afford it unless we are all taxed into oblivion. We’re pretty close to oblivion now. I’m fine with having a plan for uninsured or unemployed U.S. CITIZENS. Enough of taking care of freeloaders. They need to leave those of us with our own insurance alone.

  47. Kostub Deshmukh says:

    Very interesting revelations. Why hasn’t the government considered that instead of trying control and squeeze costs by limiting what physicians can do, let the consumers (patients) decide what procedures they want depending on their affordability.

    This allows the market to determine the cost. The more certain procedures are required, physicians will counter by lowering costs.

    An analysis of why costs in developing countries like India are significantly lower than then US for the exact same treatment:

  48. […] it fair to bring up the writings of Zeke Emanuel and Tom Daschle? I think it is. As noted at this blog, Daschle’s book makes comparative effectiveness, as practiced by the National Institute for […]

  49. fongbong2 says:

    Paul Nachtwey Says:
    July 22nd, 2009 at 3:48 pm

    70% of healthcare costs are lifestyle related! I just delivered my 4th consecutive annual sub 6% healthcare renewal to a company that adopted a meaningful difference in benefits based on weight targets.

    Gooforyou Paul, just don’t acidentally get hit by a TRUCK while you’re standing there admiring your weight targets. Bassic health care is to cover emergencies.

  50. Progressive or Liberal = Social Darwinism + Eugenics | SBRC Blog says:

    […] for Health and Clinical Excellence (NICE) that approves or rejects treatment. For example, NICE has a rule of thumb that states health expenditures are inappropriate if they involve spending more […]

  51. IAI says:

    Healthcare: Killing America

    FOR MORE DETAILS VISIT IAIResearch.wordpress.com

    Americans spent an estimated $2.5 trillion to maintain our health in 2009, or roughly $8,000 per person. This is more than the gross domestic product (what is spent on everything) in every other country in the world except Japan, China, Germany, France, or the United Kingdom.

    Spiraling healthcare costs are on track to bankrupt America. Medicare will be insolvent by 2017 and is projected to generate a $37 trillion deficit. Increased healthcare costs are one more reason jobs flee America. And all this extra cost has given us very little return as most of the gain in life expectancy came during the first half of the 20th century due to improved sanitation and nutrition.

    The cost of healthcare could be cut in half, but what do our politicians want to fix first? They want the most fraud-riddled, inefficient system—our government—to take over more of our care! They want to cover 47 million Americans without insurance rather than fix the cost of care for all 307 million Americans!

    We can drive down costs to levels that existed before government decided to “fix healthcare” in 1965. This means we all have to change:

    · Consumers must live healthier lives, manage their own care, and bear more of the direct cost of care. We must remember that, insured or not, we pay for healthcare through lower wages, higher prices, or higher taxes.
    · We must find a way to live our last years without bankrupting our children, our grandchildren, and our neighbors.
    · Lawyers can no longer be allowed to pillage our medical system for private gain.
    · Providers must take a lower share of our national wealth. In return they would become less likely to be sued, go unpaid, or bear excessive overhead costs.
    · Government must back away from managing care and focus on policing illegal behaviors and driving efficiency through shared knowledge.

    Most important, government and industry leaders must push for change that is good for the country rather than for political contributors and lobbyists. Our founding fathers realized our republic would only survive if its leaders possessed public virtue. This crisis is another test of that virtue and I fear as Congress buys each vote with special interest gimmicks, our nation is further undermined.

  52. Hi administrator I rejoice in w/ ur content . can i copy this answer for my academic check ? thanks

  53. Larocaine says:

    It would seem 5-IAI has become the “in” thing” for todays generation. As soon as one is banned a new strain is released. What is the fix for this?