An Interview With Ezekiel Emanuel

[okarol]

An Interview With Ezekiel Emanuel

washingtonpost.com

Before Ezekiel Emanuel joined his brother Rahm in the White House, he was director of the National Institute of Health's clinical bioethics programs and an oncologist specializing in breast cancer. Since he began advising President Obama's budget chief, Peter Orszag, on health care, however, he's become a surprisingly high-profile figure. A recent New York Post article dug through his academic papers and branded Emanuel one of Obama's "deadly doctors," accusing him of everything from wanting to refuse health care to the elderly to wanting to let the developmentally disabled perish. Reached in Italy this week, the man the New Republic called "the nicest" Emanuel brother struck back at his critics, explained what a bioethicist does and revealed his foodie side. An edited transcript of our conversation follows.

We've heard harsh accusations in the health-care debate lately, including Sarah Palin's contention that you want "death panels" and Rep. Virginia Foxx's charge that Democrats want "to put seniors in a position of being put to death by their government." So, do you want to euthanize my grandmother?

No. I've never met your grandmother. I'm sure she's a lovely lady.

Anybody else's grandmother?

No. I'm on record against legalizing euthanasia and assisted suicide for over a decade now. As you know from my Atlantic article.

I actually read that article in preparation for this interview. It made me rethink my position on euthanasia.

Wow! I've succeeded as an academic. That's fantastic!

So how did all this get started?

You're asking me? I'm just the victim here. All I know is the New York Post ran a article attacking me. I think lots of people decided it might be an easy way to kill health-care reform.

The New York Post quoted a 1996 article you wrote saying that some people believe health-care resources shouldn't go to those "who are irreversibly prevented from being or becoming participating citizens." What was your point?

I was examining two different, abstract philosophical positions to see what they might offer in the context of redoing the health-care system and trying to reduce resource consumption in health care. It's as abstractly philosophical as you can get on a practical question. I qualified it in 27 different ways, saying it wasn't my view.

Before you joined the White House, you were a bioethicist. What does a bioethicist do?

Worries about some of the hardest questions society has to face. One of the quotes in the New York Post came from an article we recently published in the Lancet where the question we were confronting may be the most difficult question the health-care system faces every day. We don't have enough solid organs for transplantation; not enough kidneys, livers, hearts, lungs. When you get a liver and you have three people who need it, who should get it? We tried to come up with an ethically defensible answer. Because we have to choose.

Our system is expensive in part because we've refused to choose, because we've refused to answer some of these questions, like how we deal with end-of-life care, or what minimum benefits should be guaranteed to every American. But isn't not answering those questions a sort of answer, too?

Yeah. You can't avoid these questions. Even if you don't provide an overt justification for them, you end up making decisions. Sometimes those aren't good decisions, or they're decisions you regret. We had a big controversy in the United States when there were a limited number of dialysis machines. In Seattle, they appointed what they called a "God committee" to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions.

Many see the health-care system as aimed at preventing death, and whenever someone dies, that's a failure. So we don't build in options around death because that would be admitting the possibility of failure.

Having been an oncologist and having cared for scores, if not hundreds, of dying patients, when you don't have a treatment that can shrink the tumor and the patient will die, it's a very difficult conversation. It's emotionally draining. Then to talk to the family and figure out how to give the best quality of life in the final weeks or months -- those are hard decisions.

You've argued that one of the reasons we've had trouble achieving universal health care is that we don't have an agreed-upon ethical system for health care. As such, we don't argue from common premises and no one trusts each other.

Issues that we cannot seem to resolve in our society reflect a lack of shared values. The situation around Terri Schiavo was a deeply held conflict over what to do if someone isn't going to return to consciousness or competence. Who will decide? Even there, where we had settled legal rules, we still had disagreement. We're torn about these things.

Are the bills under consideration dealing with these problems?

Fifteen years ago, I thought that cost growth meant we would have to confront the rationing question. But the more I studied it, the less I think rationing of health care is the key question. The bigger question seems to be improving the quality and efficiency of the system. We have a lot of unnecessary care. The big issue here is how to redesign the health-care delivery system so we're doing the appropriate data-driven care that we know will improve someone's life and not doing unnecessary, and potentially harmful, care.

So it's not rationing if you don't need it?

I think we have so much unnecessary care that's not improving quality of life or length of life, that our first order of business is to get rid of that. That, we can all agree on. We need to change incentives, change how doctors behave and make decisions, so they're more focused on what the data shows.

To switch gears, you're a foodie.

We're going from euthanasia and rationing to food?

Washington isn't known for being friendly to your kind. What's your favorite restaurant here?

A series of great meals at Cafe Atlantico. A quasi-Minibar they made for me was wonderful. I was there two weeks ago. They served about six or eight hors d'oeuvres, and then they had this series of small entrees that were spectacular. The crescendo was a duck confit that was brilliant.

I hear you're also trying to change how the federal government eats.

President Obama, about two months ago, had a number of CEOs of major American corporations explain how they improve the health and wellness of their workforce. I was charged with applying their ideas to the federal workforce. One of their ideas was to change the food and nutrition available to workers. Both at cafeterias and vending machines, giving them healthier options and subsidizing more nutritious foods, but also making available to them better foods they can bring home through farmers markets.

What is your brother Rahm's favorite food?

Good question. I don't know, actually.

I've heard it's the still-beating hearts of his enemies.

Oh, my brother is a lovely person. He doesn't do any of that.

One last question: If you're lying and you do create any death panels, can you put in a good word for me?

Ezra, you're at the top of my list.

I guess that can mean a lot of different things.
...............



"So it's not rationing if you don't need it?"

Excellent, excellent question.

His answer really didn't address it. This really is a challenging question- not just on a political level-- but purely on a medical level.

"Waste" is determined at a population level. Treatment is determined at an individual level. A large study may suggest patients from a given patient population with certain baselines characteristics responds better to X than Y. Or no response at all. But when an individual patient and doctor are deermining treatment options, their particular situation is somewhat different, in some fashion, from the "average" patient in the study. At a population level, the correct treatment option is clear. But if YOU'RE the patient, the correct treatment option is a lot less clear.

When you translate this medical quandary into a political question, I'm not sure you can get away from "reducing waste" not being perceived as rationing. At least not in our current "me first" culture.

Posted by: wisewon | August 14, 2009 3:00 PM | Report abuse

PS No question on universal vouchers? It'd be good to highlight the best option for universal health care.

Posted by: wisewon | August 14, 2009 3:01 PM | Report abuse

Ezra, Can you provide a link to Ezekiel Emanuel's work on improving the diet of State employees? As an employee of a State University Hospital, the amount of sugar, fat, and salt in the cafeteria is atrocious. I look forward to a change in policy.

Posted by: alessandra_barbadoro | August 14, 2009 3:23 PM | Report abuse

Much as I miss the Prospect Blog, interviews like these really make a case that the move to the WaPo has its benefits.

Posted by: MosBen | August 14, 2009 3:27 PM | Report abuse

Palin has no interest in health care reform. She is just a stooge for the Republican party. And each of her latest statements contains distortions and lies. There are related posts at http://iamsoannoyed.com/?page_id=588

Posted by: carlyt | August 14, 2009 3:51 PM | Report abuse

That was a reasonably good interview.

'wisewon' commenting above targets two valid points: the question of vouchers is an option worth exploring and the question of 'Who decides' must somehow be addressed.

The 'settled rules' mentioned, are, sadly, from the start of the past century: at the time, women could not vote, the blood of 'races' could not co-mingle, and it was decided that the "principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes [of an unwilling patient]."

The question of rationing was nicely dodged, but also must be answered. The CS Monitor has been following the 'Do We Have Enough Doctors?' topic, and to date I've only seen carefully-crafted answers in the negative suggesting that [in paraphrase] 'People who in the past used physicians' time would be encouraged to utilize the services of nurse practitioners and lesser other-than-trained-physician staff members'.

In a nutshell, when you asked "Are the bills under consideration dealing with these problems?" you received a tactful answer 'No.'

The answers you received are probably the most sincere that I've read to date, and they are truly appreciated.

Perhaps we need to consider this whole health insurance reform issue a bit more: argument actually seems to be bringing valid ideas and concerns to public and legislative attention, with a small (and ultimately short-lived) penalty of some hot-headed angry words. Before creating yet another program to join the failures of Medicare and Medicaid, programs which even the President describes as "unsustainable", shouldn't we think -- actively think -- a bit more?

Even you, Ezra, have changed your position a bit in the course of the discussion: those of us not as intellectually agile as you might need some time to catch up. The only reason for haste seems to be some sort of misguided partisan warfare tactic... 'let's do this before people vote us out' versus 'let's do this so people will vote them out'.

Posted by: rmgregory | August 14, 2009 3:54 PM | Report abuse

"So it's not rationing if you don't need it?"

Ah, but you can't assess "need." You evaluate an expensive procedure with a low success rate as "unnecessary" simply because not everyone benefits from it. For the people who *do* benefit from it, the same procedure is LIFE-SAVING.

By simply declaring it "unnecessary," you rationalize the rationing. IT IS RATIONING. You're intellectually dishonest, Ezra.

You take the one entity who arbitrates whether care is appropriate -- the one to whom doctors and insurers alike are all accountable -- and have it ration care on the basis that what is currently medically justifiable care is suddenly "unnecessary."

A person can get the procedure from his doctor. A person can get the procedure from his insurer. But you can't get the procedure from government: It's "unnecessary." Translation: RATIONING.

Posted by: whoisjohngaltcom | August 14, 2009 4:03 PM | Report abuse

We are not talking about rationing health care, we are talking about rational health care.

When the Mayo Clinic can attain BETTER results at half or three-fourths the cost, when Kaiser Bay Area can reduce costs for cardiac care and at the same time the knock heart disease from its historic spot as the number one cause of death, and when almost every developed country can deliver health care for half to three-quarters what we do and get better results. Something is wrong.

Wisewon is right that every patient is different. But to some extent, that is an excuse, since as a doctor I also know that all patients are also the same. If they weren't medical care would be an impossible crap shoot.

Perhaps the best example we have is management of high blood pressure, one of the most common problems we have in the US. A few years ago, a very large study showed that the best steps to manage high blood pressure involved generic drugs that cost less than $100 a year. Last year, the scientists returned to the topic and found that many Americans were not receiving those treatments, but instead getting expensive proprietary drugs that had been proven less effective and more dangerous.

As long as we use meaningingless slogans rather than facts to govern health care, we are giving in to the forces that see health care as a cash machine rather than as a way to help people.

If you honestly believe that Mayo is doing a bad job at health care, then the comments higher on this thread make sense. If you do not, then they are just rhetoric designed to preserve a system that will bankrupt us at the same time that it denies many Americans the health care it needs.


Posted by: PatS2 | August 14, 2009 5:38 PM | Report abuse

Yawn. Now all you have to do is explain why all these insurance companies keep approving all these "irrational" procedures.

All I hear about is how they won't approve care if your hangnail is a pre-existing condition, yet all of a sudden now the problem is that insurance companies are approving too much "unnecessary" medicine. You can actually reconcile these inconsistencies? Knock yourself out.

It's to be rationed. Exactly as I described.

Posted by: whoisjohngaltcom | August 14, 2009 6:16 PM | Report abuse

Dr. Ezekiel Emanuel hasn't told OMB anything about Advance Care that Newt Gingrich hasn't proposed himself.


See:


http://notionscapital.wordpress.com/2009/08/14/20317-newt-gingrich-advance-directive-advocate/

Posted by: MikeLicht | August 14, 2009 6:20 PM | Report abuse

"PS No question on universal vouchers? It'd be good to highlight the best option for universal health care. "

Well there's a subsidy in HR3200 for low-income people buying from the health insurance exchange. That's essentially a "voucher" but based on income.

Posted by: bluegrass1 | August 14, 2009 8:40 PM | Report abuse

Oh, and individual vouchers would be a lot more expensive than vouchers or subsidies on the health insurance exchange, because the insurance would be more expensive than with the HIE's negotiated rates. Either that or the voucher/subsidy would cover less of the insurance cost. Either way the HIE is a better deal for those seeking individual insurance.

Posted by: bluegrass1 | August 14, 2009 8:42 PM | Report abuse

"It's to be rationed."

All finite resources must be rationed. Some just want the rationing to be by price. Others want low-income people to live as long (and be productive for as long) as high-income people.

Posted by: bluegrass1 | August 14, 2009 8:46 PM | Report abuse

How about reciprocity in organ donation? In other words, if you sign up to be a donor, and at some point in the future end up needing an organ yourself, then you get higher priority on the waiting list than someone who did not sign up to donate? It seems reasonable that those willing to accept an organ from someone else should also be willing to give one of their own if it came to that. This would encourage more people to sign up as donors who wouldn't sign up otherwise, greatly increasing the supply of organs and so saving many lives. There likely wouldn't be much if any net harm done to those who still choose not to donate, since those who do choose to donate will have added to the number of available organs at any given time, and so even if you're lower on the list than you would be otherwise, you'll still have about the same chance of getting an organ in time because the supply will be commensurately higher--though you still can improve your chances by agreeing to donate yourself. If there are donors who object to being given priority and wish do donate solely altruistically, they can be allowed to opt out of the priority privilege.

Doing a quick Google search it seems that there have been some proposals to do something like this, but I don't know what the public acceptance of such a reciprocal donation system would be. Any thoughts?

Posted by: bluegrass1 | August 14, 2009 8:56 PM | Report abuse
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http://voices.washingtonpost.com/ezra-klein/2009/08/an_interview_with_ezekiel_eman.html

[okarol]

Wednesday, Aug. 12, 2009
Ezekiel Emanuel, Obama's 'Deadly Doctor,' Strikes Back
By Michael Scherer / Washington

Dr. Ezekiel Emanuel, the medical ethicist and oncologist who advises President Obama, does not own a television, and if you catch him in a typically energized moment, when his mind speeds even faster than his mouth, he is likely to blurt out something like, "I hate the Internet." So it took him several days in late July to discover he had been singled out by opponents of health-care reform as a "deadly doctor," who, according to an opinion column in the New York Post, wanted to limit medical care for "a grandmother with Parkinson's or a child with cerebral palsy." (Read an interview with Obama on health care.)

"I couldn't believe this was happening to me," says Emanuel, who in addition to spending his career opposing euthanasia and working to increase the quality of care for dying patients is the brother of White House chief of staff Rahm Emanuel. "It is incredible how much one's reputation can be besmirched and taken out of context." (See pictures of health care for the uninsured.)

It would only get worse. Within days, the Post article, with selective and misleading quotes from Emanuel's 200 or so published academic papers, went viral. Minnesota Representative Michelle Bachmann, a fierce opponent of Obama's reform plans, read large portions of it on the House floor. "Watch out if you are disabled!" she warned. Days later, in an online posting, former Alaska Governor Sarah Palin attacked Emanuel's "Orwellian thinking," which she suggested would lead to a "downright evil" system that would employ a "death panel" to decide who gets lifesaving health care. By Aug. 10, hysteria had begun to take over in places. Mike Sola, whose son has cerebral palsy, turned up at a Michigan town-hall meeting to shout out concerns about what he regarded as Obama and Emanuel's plans to deny treatment to their family. Later, in an interview on Fox News, Sola held up the Post article. "Every American needs to read this," he declared. (Read "What Health-Care Reform Really Means.")

By this point, Emanuel, who has a sister who suffers from cerebral palsy, had arrived in northern Italy, where he planned to spend a week on vacation, hiking in the Dolomites. Instead, he found himself calling the White House, offering to book a plane home to defend his name. "As an academic, what do you have? You have the quality of your work and the integrity with which you do it," he said by phone from the Italian Alps. "If it requires canceling a week's long vacation, what's the big deal?" (Read TIME's cover story "Can Obama Find a Cure?")

The attacks on Emanuel are a reminder that there is a narrow slice of Americans who not only don't trust government, but also have come to regard it as a dark conspirator in their lives. This peculiar brand of distrust helps create the conditions for fast-moving fear-mongering, especially on complex and emotionally charged topics like the life and death of the elderly and infirm. Prairie fires of that kind are hard to douse when the Administration's own plan for health care remains vague, weeks away from being ready for a public rollout. The health-care bill that recently passed the House does not contain, as some have suggested, any provisions that would deny treatment to the elderly, infirm or disabled like Sola's son. One provision allows doctors to be reimbursed for voluntary discussions of so-called living wills with patients, but does not in any way threaten to deny treatment to dying patients against their will. The legislation anticipates saving hundreds of billions of dollars by reforming the health-care system itself, a process that would try to increase the efficiency of medical care by better connecting payments to health outcomes and discouraging doctors from unnecessary tests and procedures. The Obama Administration hopes that many of these reforms will be made in the coming years by independent panels of scientists, who will be appointed by the President and overseen by Congress. (See 10 health-care-reform players.)

This is where the criticism of Emanuel enters the picture, since he is just the sort of scientist who might be appointed to one of those panels. For decades, Emanuel has studied the ethics of medical care, especially in situations where a scarcity of resources requires hard decisions to be made. His work sometimes deals with the hardest possible decisions, like how to choose who gets a single kidney if there are three patients in need, or the reasons that doctors order tests with little medical value. Emanuel's reputation ranks him among the top members of his field. He is published often in the best journals; he has been given multiple awards for work to improve end-of-life care. At the White House, he has taken a free-floating role at the Office of Management and Budget, advising on a wide range of health issues.

But in a country where trust is in short supply, Emanuel has become a proxy for all the worst fears of government efforts to rein in costs by denying care. "The fundamental danger is that the American people are being asked to delegate all these life-influencing decisions," explains Betsy McCaughey, the conservative scholar who wrote the New York Post attack on Emanuel. "There is a lack of transparency here."

In her Post article, McCaughey paints the worst possible image of Emanuel, quoting him, for instance, endorsing age discrimination for health-care distribution, without mentioning that he was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources. She quotes him discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy. She notes that he has criticized medical culture for trying to do everything for a patient, "regardless of the cost or effects on others," without making clear that he was not speaking of lifesaving care but of treatments with little demonstrated value. "No one who has read what I have done for 25 years would come to the conclusions that have been put out there," says Emanuel. "My quotes were just being taken out of context."

For Emanuel, the entire experience has been a painful education in the sometimes brutal ways of politics, something his brother has long endured and doled out. "I guess I have a better appreciation for what Rahm had to go through for years and years," Emanuel says. But that appreciation does not solve the question raised by the controversy. There is universal understanding that the nation's fiscal course is doomed without major changes to health care, but whom will the American people trust to carry it out?

Emanuel, for his part, plans to continue his work, which is focused on finding the most equitable and ethical way for this reform to be carried out, even if he has opted against returning from the Italian Alps. "I am an Emanuel," he says. "We are pretty thick-skinned. I am not going to change my colors. I am not going to crawl under a rock."

http://www.time.com/time/nation/article/0,8599,1915835,00.html

[okarol]

Time Magazine's Disgusting Michael Scherer Whitewash of Ezekiel Emanuel     
Written by Sultan Knish   
Friday, 14 August 2009 06:23

No one can at this point claim to be surprised to see the media routinely lie or distort the truth, smear Obama's political opponents and generally function as the propaganda organ for the White House. It was inevitable then that the media would try to whitewash Dr. Ezekiel Emanuel, whose high profile status as the brother of the White House Chief of Staff, has made his ugly views into an extremely high profile matter.

ezekiel_emanuelMichael Scherer's Time Magazine hatchet job is nothing groundbreaking. It is unfortunately exactly the sort of thing Americans have come to expect from the media, and particularly from Time Magazine. It has the same blend of oozing sympathy for anyone associated with Obama and contemptuous disdain for anyone who disagrees with Obama. It is heavy on first person journalism, and spends more time discussing Ezekiel Emanuel's reaction to hearing that there are allegations against him, than actually stating the allegations. And of course it lies blatantly in defense of Ezekiel Emanuel, but that's a given these days, isn't it?

We get the tragically beleaguered Dr. Emanuel's reaction to the allegations;


Time: "You have the quality of your work and the integrity with which you do it," he said by phone from the Italian Alps. "If it requires canceling a week's long vacation, what's the big deal?"

Naturally most Americans will sympathize with Ezekiel Emanuel's great sacrifice in selflessly giving up his taxpayer funded vacation in the Italian Alps because he got caught with his eugenics down. At least most Americans who are highly paid writers for Time Magazine.

Time: Within days, the Post article, with selective and misleading quotes from Emanuel's 200 or so published academic papers, went viral.

There are the article's repeated statements that Ezekiel Emanuel's quotes are somehow distorted or taken out of context. Yet oddly enough Michael Scherer's article does not find time in between discussing such vital facts as Ezekiel Emanuel's favorite vacation spots, his feelings on the internet or putting scare quotes around any statement critical of Emanuel... to actually cite one of those Emanuel quotes verbatim. Which if those statements are as innocent as Scherer and Ezekiel claim they are, is a no brainer.

Michael Scherer does not bother interviewing a single critic of Ezekiel for balance. Instead he puts scare quotes while citing a few dramatic adjectives. He describes Mike Sola, the father of a son with cerebral palsy, who stood up at a Town Hall meeting as the product of hysteria.

Time: By Aug. 10, hysteria had begun to take over in places. Mike Sola, whose son has cerebral palsy, turned up at a Michigan town-hall meeting to shout out concerns about what he regarded as Obama and Emanuel's plans to deny treatment to their family. Later, in an interview on Fox News, Sola held up the Post article. "Every American needs to read this," he declared.

Scherer is cynically careful enough to avoid literally calling Sola hysterical, instead he formulates the phrasing in a way that gives that exact impression instead, piling cowardice on the already ugly act of smearing the parent of a disabled child whose one crime was to voice opposition to Obama's health care plan.

Then completely devoid of irony, Michael Scherer flashes back 8 years, completely ignoring everything Time Magazine had been writing during the Bush Administration to claim that;

Time: The attacks on Emanuel are a reminder that there is a narrow slice of Americans who not only don't trust government, but also have come to regard it as a dark conspirator in their lives.

Naturally Scherer is not referring to Code Pink or the ACLU or Paul Krugman, or the legion of liberal columnists and pundits who distrusted the Bush Administration and regarded it as a "dark conspirator".

For example there's the following bit of "paranoia" by a narrow slice of one American who viewed government as a dark conspirator.

 

The Next Worst Thing

Is the federal government's expansion of biodefense research paving the way for the bioweapons of the future?

The paranoid fellow who wrote that was Michael Scherer, of course that was back during the Bush Administration, when making up conspiracy theories about secret government conspiracies was cool. Now of course that the Dems are in power it means you're a dangerous extremist.

But maybe Michael Scherer could use the reminder that his "narrow slice" is not so narrow as he would like to pretend. It's something his former colleagues at Mother Jones magazine could tell him something about.

Finally though near the bottom of the article, Scherer gets around to addressing any of the specifics of the allegations against Ezekiel Emanuel.

Time: In her Post article, McCaughey paints the worst possible image of Emanuel, quoting him, for instance, endorsing age discrimination for health-care distribution, without mentioning that he was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources.

Emanuel does use organ donation and flu pandemics as examples, but he is not speaking only of extreme cases. He also lists beds in intensive care units in his article introduction as an example. He is speaking of how to address medical resource shortages, which would be a reality under a national health care plan.

Emanuel also mentions dialysis machines and penicillin as other examples. He is clearly not discussing only organ donations or absolute scarcities. In fact based on Emanuel's own introductory words, he is saying that any number of medical resources may be considered scarce, even if they are available, because their cost would be better utilized somewhere else.

For some interventions, demand exceeds supply. For others, an increased supply would necessitate redirection of important resources, and allocation decisions would still be necessary.

So ironically it is Michael Scherer who deliberately misrepresents Ezekiel Emanuel's views, in order to pretend that Emanuel is speaking about organ donations and only the most extreme situations in which there is no alternative but to ration. In fact Emanuel views even some available treatments as not worthwhile if they do not meet his criteria.

Time: She quotes him discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy.

In fact the denial of care for dementia is mentioned in the conclusion of Ezekiel Emanuel's article. It is not treated as hypothetical in the sense that Emanuel mentions it without recommending it, instead he quite clearly treats it as one of those substantive practices he treats as an obvious example of what we should be doing.

"This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia."

Ezekiel Emanuel is clearly not citing this example as something he disagrees with. It is in fact something he is recommending. For Michael Scherer to claim otherwise is a blatant lie.

Time: She notes that he has criticized medical culture for trying to do everything for a patient, "regardless of the cost or effects on others," without making clear that he was not speaking of lifesaving care but of treatments with little demonstrated value.

In fact that is not clear at all. In the JAMA article, "The Perfect Storm of Overutilization", Ezekiel Emanuel cites a number of factors in the high cost of US medical care. These include,

"the abundance of amenities. Hospital rooms in the United States offer more privacy, comfort, and auxiliary services than do hospital rooms in most other countries. US physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms."

... as well as overutilization itself.  Ezekiel Emanuel defines overutilization as;

higher volumes, such as more office visits, hospitalizations, tests, procedures, and prescriptions than are appropriate or more costly specialists, tests, procedures, and prescriptions than are appropriate.


One of the causes he blames for this is physician culture;

Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them... This mentality carries over into practice. Peer recognition goes to the most thorough and aggressive physicians. The prudent physician is not deemed particularly competent, but rather inadequate. This culture is further reinforced by a unique understanding of professional obligations, specifically, the Hippocratic Oath's admonition to "use my power to help the sick to the best of my ability and judgment" as an imperative to do everything for the patient regardless of cost or effect on others.

This paragraph above is the source of the quote. The discussion is not about treatments of limited value as Michael Scherer wrongly contends, but what Ezekiel Emanuel feels is doctors being too thorough in excluding possible but less likely dangerous conditions, rather than simply treating the patient in the most "prudent" and efficient" way.

For example then a patient who comes to see a doctor with blood in her urine, would be treated with antibiotics for an infection, and given an ultrasound. Ezekiel Emanuel would consider this a waste of medical resources from a too aggressive physician who is trying to rule out more dangerous problems that the patient might have.

lethal_injection_execution_chamber_raleighThe Emanuel way would be cheaper, and it would result in more undiagnosed medical problems, including cancers. It's the kind of thing liberals rail against when HMO's do it. But when it comes to Ezekiel Emanuel, Time Magazine and Michael Scherer work to cover it up, by transposing Ezekiel's view from one paragraph in the article, to the next, which discusses treatments of dubious value.

In thes sole paragraph in Michael Scherer's article dedicated to actually listing specific criticisms of Emanuel based loosely on his words, Scherer gets all 3 statements wrong. Which suggests that he either did not read Emanuel's articles, did not understand them, or deliberately misrepresented them. Either way it's a level of incompetence or deceit that a major publication would not have tolerated once upon a time.

Scherer concludes by giving us the heroic image of Ezekiel Emanuel passing up on a return trip to the Italian Alps, surely an image right up there with a crowd of slaves rising to proclaim, "I Am Spartacus".

Emanuel, for his part, plans to continue his work, which is focused on finding the most equitable and ethical way for this reform to be carried out, even if he has opted against returning from the Italian Alps. "I am an Emanuel," he says. "We are pretty thick-skinned. I am not going to change my colors. I am not going to crawl under a rock."

Yes it's hard to crawl under a rock, when the rock has been lifted up and you've been exposed to the light. It'll take a lot more than articles like Scherer's to pull that rock back over him again.

http://www.rightsidenews.com/200908145959/editorial/time-magazines-disgusting-michael-scherer-whitewash-of-ezekiel-emanuel.html