The Treatment

Have You No Decency?

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Governor Palin issued the following statement on her Facebook page yesterday. I quote it in its entirety so you can judge for yourself.

Statement on the Current Health Care Debate

As more Americans delve into the disturbing details of the nationalized health care plan that the current administration is rushing through Congress, our collective jaw is dropping, and we’re saying not just no, but hell no! ??

The Democrats promise that a government health care system will reduce the cost of health care, but as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost. And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.??

Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion.??

Rep. Michele Bachmann highlighted the Orwellian thinking of the president’s health care advisor, Dr. Ezekiel Emanuel, the brother of the White House chief of staff, in a floor speech to the House of Representatives. I commend her for being a voice for the most precious members of our society, our children and our seniors.??

We must step up and engage in this most crucial debate. Nationalizing our health care system is a point of no return for government interference in the lives of its citizens. If we go down this path, there will be no turning back. Ronald Reagan once wrote, “Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth.” Let’s stop and think and make our voices heard before it’s too late.

- Sarah Palin

Rep. Bachmann's speech can be viewed here.

To be clear, it is downright evil to establish a “death panel” that decides who is allowed to live based on their “level of productivity in society.” Less clear is what the heck Palin or Bachmann are talking about. I can’t find the words “death panel” in any administration position paper, the stimulus package, or the House and Senate draft health reform bills. Don’t take my word for it. Read the bills.

Palin and Bachmann take pot shots at Ezekiel Emanuel, one of President Obama’s health policy advisors. Dr. Emanuel, a prominent medical ethicist and oncologist, makes a juicy target because he is Rahm’s brother, and because his paper trail provides incautiously blunt commentary regarding the pathologies of American health policy. It’s easy to lift one or two sentences from him, throw them onto the internet, and set the right-wing blogosphere aflame.

Palin and Bachmann remind no one of Hillary Clinton in their success in grasping complex policy issues, or in their desire to do so. It may be too much to expect them to trace the origin and veracity of these talking points. These originate in a New York Post op-ed by Betsy McCaughey, which Bachmann essentially recites on the House floor. In the original op-ed, McCaughey mushes together and distorts three articles Emanuel wrote between 1996 and 2008. I wish the Post would exercise greater quality control over what appears in its pages.

Human rights and human dignity indeed belong at the center of medical care. Americans hold vastly different ideas about how to best honor these values when human life nears its end or when basic physical and cognitive functioning can no longer be preserved.

I do know four things.

First, these issues are quite separate from the main issues being debated in health reform. Under a single-payer system, a strong public plan, or under a libertarian’s privatized dream-system, we will still face fundamental dilemmas in caring for our loved ones, and ourselves. This is not merely or primarily a money issue. Like other forms of care, end-of-life care is sometimes wasteful or ineffective, but nobody is looking to skimp on or ration such care to finance health reform. Nor should they.

Second, health reform would address an equally fundamental dilemma of human dignity and human rights: millions of people’s lack of access to basic care. Many of these people are disabled or live with chronic illnesses. Over at Obsidian Wings, Publius yesterday noted the predicament of children with Down Syndrome denied health insurance because they have a preexisting condition. 

Governor Palin writes: “And who will suffer the most when they ration care? The sick, the elderly, and the disabled.” It’s telling that she omitted one category: Poor people, whose care is now cruelly rationed in ways the Obama administration and congressional Democrats are trying to address in health care reform. Palin brings genuine moral passion to the issue of cognitive disability. I wish she would bring that same passion to the plight of uninsured patients forced to seek substandard, delayed care, or the millions of Americans facing the dual challenge of serious illness and large medical bills. If you live in any big city, go down to your local public hospital emergency room. You will probably find people in visible discomfort or illness languishing for hours. A society that cares about human rights and dignity would not tolerate this.

Third, people genuinely worry that comparative effectiveness research (CER) is a stalking horse for rationing or for curtailing care for the sick, elderly, or disabled. This is a misplaced concern. I recently noted an Institute of Medicine CER report. None of the identified high-priority items involved anything approximating the rationing of life-saving or life-extending care. End of life care ranked 28th in their chart of priority areas for CER research. This may be a mistake. Better approaches to palliative care often look very good when evaluated against the standard benchmarks of medical cost-effectiveness.

Fourth and finally, publicity-seeking politicians subtract a lot from these conversations. Palin, Bachmann, and others score cheap points by scaring people and by spreading falsehoods. Their disrespect goes beyond their own political base to those whose views they so recklessly misconstrue.

Dr. Emanuel’s oncology career provides more than passing familiarity with the consequences of devastating, sometimes life-ending illness. He has written widely about the dilemmas of relying on medical care proxies in caring for desperately ill patients, chemotherapy at the end of life, and other intimate clinical concerns. There is nothing Orwellian about him.  He has prominently opposed legalization of euthanasia and physician-assisted suicide, for example.

Emanuel’s work offers a model of sustained achievement that both Governor Palin and Representative Bachmann would be wise to emulate. He deserves better than to be trashed in this way. So do the rest of us

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