Health care reform may be the topic topic of the day/week/month, but we've really barely scratched the surface of all the weirdness that will come out when people start hashing out the details (and it's all pretty much details). Frequent Hit & Run commenter and blogger Alan Vanneman responds to the response to comments by Dr. Ezekiel Emanuel, brother to Rahm and a health-care advisor to the prez in his own right. Emanuel is in the spotlight for having written in the past about questioning treatment for folks with chronic conditions. Conservatives, particularly former New York Lt. Gov. Betsy McCaughey in a New York Post op-ed, says that Emanuel and those around him propose to cut health-care costs by ending treatment for whole swaths of folks. Liberal defenders of the doctor say he was only philosophizing on various topics and that his past thoughts on the matter can't be taken seriously.
Dr. Emanuel goes on to say the following about this "conception of the good," which he absurdly pretends he isn't pumping for: "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."
So why is it wrong to say that the good doctor is saying that we ought to let the demented wander the streets-if they can-unless they or someone else can pay for their health care with private funds? And the same for anyone else "irreversibly prevented from being or becoming participating citizens"? Such as a child with Down syndrome, for example? Or my brother, when he was dying of multiple sclerosis, unable to move and scarcely able to speak. He wasn't a "participating citizen," not really, and he clearly wouldn't be getting better.
In his article, Dr. Emanuel calls for "public forums that present citizens with opportunities to enter into public deliberations on social policies." Well, doc, you're in one. And if you can't stand the heat, get out of the kitchen.
Would you like to see Dr. Emanuel heading up a national panel that would determine which services "promote the continuation of the polity"? I wouldn't.
The exchange above underscores the need to maintain viable health care options beyond any sort of "public option" that will most certainly cap care based on notions of ability to "participate" in various sort of political and civic arenas (first and foremost, the ability to hector your congressman into getting your needs taken care of). If the public option goes through, and (predictably) takes over all or most of health care coverage, it will be harder and harder to escape a system that is fully determined by politics. Which is never a good development.
My two cent bet on health-care reform: At the end of the day, due to sagging polls and annoyance at all the political players involved and the resolute lack of sense of emergency among Americans for a complete overhaul of the system, we see some sort of legislation that will "cover" (finally) the 20 million to 50 million Americans who are supposedly uninsured for reasons beyond their control. It will be expensive, but not as expensive as a bigger reform and everyone will claim victory, either for passing it or defeating something worse.
Here's a simpler plan, one that could go into effect today, to cover half the nation's uninsured: