When Ezekiel J. Emanuel, a key presidential health care adviser, told The Washington Times on Thursday that his "thinking has evolved" on the subject of health care rationing, he was making a distinction without a difference. Even his "evolved" ideas amount to nothing more than government rationing by another name.
Here's what Dr. Emanuel told news reporter Jon Ward: "When I began working in the health policy area about 20 years ago ... I thought we would definitely have to ration care, that there was a need to make a decision and deny people care." And: "I think that over the last five to seven years ... I've come to the conclusion that in our system we are spending way more money than we need to, a lot of it on unnecessary care. If we got rid of that care we would have absolutely no reason to even consider rationing except in a few cases."
First of all, notice that he gives himself an out "in a few cases." That is the health-care-rationing equivalent of being just a little bit pregnant. You either ration or you don't.
Second, when it is the government, rather than private individuals through the open market, deciding what is or isn't "unnecessary care," and deciding what care to get "rid of," then that by definition is government rationing. Government acts by compulsion. If government decides what is "necessary," and grandma's hip-replacement surgery is deemed "unnecessary" even if grandma wants the surgery, then grandma's care has been rationed by the power of the state -- no matter what words you use to describe it.
The reason people were wary of Dr. Emanuel in the first place is because of his writings from the 1990s in which (to quote one of them), he advocated giving younger people first dibs on medical care: "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." In late 1996, he wrote that "services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed."
As noted Friday by Ralph Reiland in the American Spectator online, Dr. Emanuel had not seemed to change much even as late as 2008: "Last year in 'Health Affairs: The Policy Journal of the Health Sphere,' Emanuel wrote that 'Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely lipstick cost controls, more for show and public relations than for true change.' "
Ironically, those "vague promises of savings" are exactly the ones President Obama has been making in his fruitless attempts to claim that his plans won't be exorbitantly expensive. Dr. Emanuel was right then: The only way to implement Mr. Obama's proposals without breaking the bank is to impose the sort of rationing that Dr. Emanuel formerly pushed. That is morally unacceptable.