The Washington Times - August 14, 2009, 12:16PM

I interviewed Dr. Ezekiel Emanuel yesterday by phone, and my piece in the paper is up here. Emanuel says some interesting things about how his thinking has “evolved” over the years on the rationing of health care.

There is a lot of irony, however, in the criticism of Emanuel by conservatives such as Sarah Palin and Newt Gingrich. As I wrote about in my profile of Emanuel back in March, he “has some very different ideas about health care reform than President Obama and some of his key advisers.”

In fact, Emanuel’s reform ideas are fairly conservative and oriented toward the free market.

Mr. Obama is pushing for universal and affordable coverage but does not want to take people off of their employer-based plans. His plan essentially offers a government-run alternative for those who do not have insurance, funded in part by increased taxes on those making $250,000 or more as well as by about $600 billion in cuts (the administration calls them “savings”) to Medicare.

Emanuel thinks the best option would be to abolish the employer-based system and go to a voucher system providing all Americans with insurance paid for through a value-added tax. Dr. Emanuel also proposes phasing out Medicare and Medicaid, arguing that the voucher system will cover the elderly and the poor sufficiently.

“The universal voucher approach does have many elements that ought to appeal to conservatives:  fiscal balance, choice, competition, freedom to buy more with your own after-tax dollars and more,” said Victor R. Fuchs, the Stanford professor who co-authored a book with Emanuel in 2008 called “Healthcare, Guaranteed: A Simple, Secure Solution for America.”

Jon Gruber, a leading health care economist at MIT, called it “ridiculous and unfair for anyone, least of all conservatives, to criticize Zeke Emanuel on this topic.”

Much of the concern about Emanuel stems from things he’s written in the past. The pertinent lines are in my story, but here are links to the 1996 Hastings article, and here is a link to the January 2009 Lancet article. If you want to go in depth on this stuff, read Jake Tapper’s two blog posts here and here.

The line Emanuel wrote in 1996 stating that those with dementia may not be given the same care as other more productive citizens is certainly alarming, but Emanuel told me yesterday he was not representing his opinion there but was only stating the implications of political philosophies for health care.

“I think if you read around the quotes, the two sentences that are taken out of context. You’ll see that I qualify it in all sorts of ways, that I’m not sure about the extension, that I’m not sure this is plausible. It’s clearly not my voice and not something I’m advocating,” Emanuel said.

As for Emanuel’s piece in Lancet this past January, it seems pretty apparent that he and two other scholars are painstakingly trying to figure out how to deal with rare and difficult circumstances that arise when you have limited medical resources, such as organs, vaccines or hospital beds. The concern from conservatives such as Palin, as I understand it, is that they fear that type of valuation being used across the spectrum of medical care.

President Obama and his supporters, of course, respond that nothing in any of the bills going through Congress do anything to mandate rationing of care. But, of course, Palin and Gingrich argue that once the camel’s nose of a government option is under the tent, rationing would inevitably result down the road.

It does seem ironic, however, that Palin is accusing Emanuel of supporting this, when he has clearly been a proponent of market oriented solutions. In addition, Palin’s use of the Lancet article against Emanuel seems to be an example of punishing a good deed, since he is grappling with real situations that often have only least bad answers.

“It’s tough to be an academic involved in high visibility politics, whether as a judicial nominee or as a health policy advisor. Academics often write things that aren’t politically popular and good academics don’t hide behind euphemisms,” said Henry Greely, a Stanford law professor who is friends with Emanuel.

“Zeke has always been strongly oriented toward patients, so, in that respect, the controversy is ironic.  But he also has a very long list of publications and he has never been one to hide what he is saying,” he said.

Gruber said that on the issue of medical ethics, “few individuals in the nation have been so thoughtful.”

“Fewer still have the skills necessary to think about cost savings strategies that will protect the public health,” Gruber said.  [Emanuel] is the last guy they should be attacking.”

— Jon Ward, White House reporter, The Washington Times


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