Opinion: President Obama, Health Care, Rationing and Senior Americans

'The views of this White House on the need to ration health care at the end of life to contain costs are well known.'

FRONT ROYAL, Va. (Population Research Institute) - Many elderly Americans receiving Medicare are alarmed by the so-called "advance care planning consultation" mandated by the health care bill, fearing that they will be visited by government representatives who will pressure them to accept a kind of soft euthanasia in lieu of medical treatment. Are their fears overblown?

Consider Section 1233 of the bill, HR3200, currently under consideration by the House of Representatives. This specifies that the "advance care planning consultation "shall include ... (1)(E) An explanation by the practitioner of the continuum of end-of-life services and supports available", which "may include the formulation of ... an actionable medical order relating to the treatment of that individual that ...may include indications respecting ...(iv) the use of artificially administered nutrition and hydration."

Proponents of the new health care plan have fallen over themselves to explain this away as simply familiarizing elderly Medicare recipients with their options. We at PRI disagree. We hold that an intrusive visit of this nature is intended to cut health care costs--by cutting health care recipients. Why else would the option of withholding food and water from the elderly even be on the table?

The views of this White House on the need to ration health care at the end of life to contain costs are well known. In fact, a senior health policy advisor to the President, Ezekiel Emmanuel, this January published a very revealing "how to" article on the subject in The Lancet. The article, entitled Principles for Allocation of Scarce Medical Interventions, argues for something called the "complete lives system." This system "prioritizes younger people who have not yet lived a complete life and will be unlikely to do so without aid.
Many thinkers have accepted complete lives as the appropriate focus of distributive justice: "individual human lives, rather than individual experiences, [are] the units over which any distributive principle should operate."1, 75, 76 [italics added]. This "complete lives system," to put the matter in plain English, assigns a value to human beings based almost exclusively on their age.

How this "age-based priority" would work in practice is revealed by a graph that Emmanuel helpfully includes in the article and which is reprinted above. As the graph clearly shows, the best health care would be reserved for twenty-some-things. From this peak, the quality and quantity of care available would gradually taper down until about 55, at which time it would plummet. By age 65, when Medicare starts, the probability of receiving scarce medical care would have shrunk to a mere 20%. Note that the chart ends at age 75, after which time the probability of receiving adequate care in the event of a health crisis is effectively nil. Goodbye, Grandma.

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Those concerned about the Culture of Life should also pay attention to the other end of the chart. It shows that newborns would be ineligible for all but the most basic care, and that even children would have a significantly lower probability of receiving care adequate to their needs than young adults. In short, those most in need of health care, the very young and the very old, will have the least probability of receiving it, while those in least need of care, the twenty-some-things, will have the most chance of receiving it. Isn't this backwards?

Why do Ezekiel Emmanuel views matter? Because he is widely considered to have Obama's ear on health matters, that's why. He not only works in the White House, but his brother, Rahm Emmanuel, serves as Obama's Chief of Staff. If the health care bill now before Congress passes, and a government oversight boards is set up to determine who receives medical care and who doesn't, those appointed to serve on such boards will hold these views. Ezekiel Emmanuel himself might very well be appointed to chair such a board. Look at the above chart again and ask yourself: Do you want him making life-or-death decisions for you?

In light of all this, it is difficult to see any other purpose for the end-of-life government visit than to evaluate the affected senior's health, and to pressure them to agree in advance to forgo medical treatment in the event of a serious illness. For many seniors, this will undoubtedly amount to a death sentence.

Obama has said that he doesn't want to "pull the plug on Grandma," but that is exactly what his health advisors propose to do, and what the health care bill before Congress would lead to. Make sure Grandma knows this.

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Steven W. Mosher is the President of the Population Research Institute and the author of Population Control: Real Costs and Illusory Benefits (Transaction).
*I want to thank Dr. Joel Brind for calling my attention to this graph.

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