Obama health policy advisor on rationing

Tuesday, July 21, 2009 Comments

If Obamacare is implemented, it stands to reason that demand for care will go up while supply of care will go down. On the one hand, I believe that some doctors will choose to leave practice (and students will opt to avoid medical school) rather than work under even more government control than already exists. Aside from that, the government is fixated on "cutting costs" with regard to healthcare despite it's free-spending ways when it comes to everything else.

Such an environment will create a scarcity of care, much like what has already happened in countries with socialized medicine like Canada and Britain, which invariably leads to government rationing of care. Given that, it's worth asking how will care be rationed?

For some insight into that, we can look to the recommendations of Dr. Ezekiel Emanuel, NIH bioethicist (an ironic title IMO), Rahm Emanuel's brother, and most importantly, Barack Obama's "Special Advisor for Health Policy."

So, what are Dr. Emanuel's views on rationing of care? He recently coauthored an article on the topic, "Principles for allocation of scarce medical interventions," in the Lancet. While the article references specific care like organ transplants, kidney dialysis, and vaccines in the event of a pandemic, it is also clearly meant to apply any time there is a "scarcity" of care (which Obamacare would undoubtedly create).

After considering a number of possible rationing methods that could be used, Dr. Emanuel and his colleagues recommend a combination of criteria which they call the "complete lives system":

"It prioritises younger people who have not yet lived a complete life and will be unlikely to do so without aid. ... also supports modifying the youngest-first principle by prioritising adolescents and young adults over infants (figure)."

While I was disgusted to see the curve take a nose-dive around age 50, I can't say I was surprised, based on Obama's recent statement regarding the elderly, "Maybe you're better off not having the surgery, but taking the painkiller," (translation, go home and die?). However, I admit I was surprised (and appalled) to see babies and young children also targetted to be denied care. What would this mean for preemies? Would life-saving NICU care be deemed "too expensive" by the bureacrats?

It gets even worse when you see his justification for such discrimination against the "very young."

"Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. Similarly, adolescence brings with it a developed personality capable of forming and valuing long-term plans whose fulfilment requires a complete life. As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies and worse still when an adolescent does'; this argument is supported by empirical surveys. Importantly, the prioritisation of adolescents and young adults considers the social and personal investment that people are morally entitled to have received at a particular age, rather than accepting the results of an unjust status quo."
That paragraph is just wrong and abhorrent on so many levels. What parent considers their love and time spent parenting as an "investment"? What parent would consider the loss of a baby less tragic than the loss of an older child? What parent would agree that it is acceptable to let a baby or young child die on the grounds that they haven't "invested" much time in that child yet (or worse, that the state hasn't "invested" in their education yet)? And to say, "this argument is supported by empirical surveys"?! WHO THINKS LIKE THAT?!? It makes me physically ill. No wonder these people don't care to protect the unborn or even newborns. If babies, toddlers, and even children who haven't yet reached adolescence mean so little to them, surely an unborn child would be worth even less in their eyes. I guess that answers my question about preemies...

Here's more:

"A young person with a poor prognosis has had few life-years but lacks the potential to live a complete life. Considering prognosis forestalls the concern that disproportionately large amounts of resources will be directed to young people with poor prognoses."
And who determines prognoses? Something tells me it won't be doctors and families.

"When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated (figure)."
Attenuated. Good luck with that. How's that "hope and change" working out for ya?

As to potential objections that such a policy discriminates against the elderly, the authors have this to say:

"Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."
Sure, ok. Well, I feel better now. It's not like we'd be discriminating against anyone on the basis of age or anything. :rolls eyes:

On the need to influence public attitudes to accept such a system:

"the complete lives system requires only that citizens see a complete life, however defined, as an important good, and accept that fairness gives those short of a complete life stronger claims to scarce life-saving resources."
In other words, the belief in the sanctity of life in general must go, and be replaced by the notion that a "complete life" is more important than just any life, that some lives are more worthy of saving than others. If you're over 40, just accept that you need to step aside and not expect much care, someone younger has a "stronger claim" to that care. And if your child is not yet 15 or determined to have a lower "prognosis," accept that someone older or healthier has a "stronger claim" to care. Anyone else feeling outraged yet, or is it just me?

But, let's not be too hasty. They're not quite advocating this system be applied to the entire health care system, at least not until we take some other steps first:

"Accepting the complete lives system for health care as a whole would be premature. We must first reduce waste and increase spending."
Huh? I thought we were supposed to be making healthcare more affordable, not increasing spending... won't that just increase the cost to taxpayers under a government-controlled system?

Dr. Emanuel and his colleagues are careful to distance themselves from so-called "objective" methods of discounting the value of life on the basis of disability or "quality of life," but their objection is to the attempt to quantify it. They have no problem with more qualitative methods of taking "instrumental value" into account. The fact that they advocate only resorting to that in the event of an "emergency" might be intended to reassure us, except that our current government is in a constant state of "crisis."

So what do they mean by "instrumental value"?

"Instrumental value allocation prioritises specific individuals to enable or encourage future usefulness. ... Responsibility-based allocation—eg, allocation to people who agree to improve their health and thus use fewer resources—also represents instrumental value allocation."
What exactly does "usefulness" mean? While they claim their system doesn't discriminate on the basis of disability, does anyone reading this really think that such language won't be used to discriminate against those with special needs if some bureacrat decides their "future usefulness" is less than someone else's? And how about anyone deemed "inconvenient" to society? What is the criteria for "usefulness," who decides, and why should it even matter? Can you imagine going to the doctor and being asked questions to determine your "usefulness" to society before being offered any care? The idea is unconscionable, and the sanctity of all life would be meaningless under such a system.

Where have we heard such notions before? I hate to bring up Nazi references but the similarities in thought are there. The Nazis also believed in "life unworthy of life" and saw the elimination of such people as a "healing" process for society as a whole. To be clear, Dr. Emanuel and his colleagues are NOT advocating killing anyone as the Nazis did, but denial of care via rationing would ultimately result in needless loss of life. Most importantly, it would result in loss of life that would not occur under our current system. Emanuel & friends obviously saw the potential for readers to see such parallels because they addressed it:

"Ultimately, the complete lives system does not create 'classes of Untermenschen whose lives and well being are deemed not worth spending money on', but rather empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible."
Whew... I feel better now. Well, not exactly. Obamacare will CREATE "genuine scarcity" in many, many areas where it does not exist today, making such decisions more and more "necessary." And in reality, denying or limiting care is no less than a death sentence in many cases.


"To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo."
Interestingly, Obama tends to favor that term "status quo" also, and he uses it in a similarly derisive tone. Heaven forbid we hold onto a system that doesn't require rationing, especially centralized rationing, for the vast majority of care.

We keep hearing about how our current healthcare system is in a state of crisis. It's not. Are there some things that need to be improved? Of course, it's not perfect. But let's not burn down the whole town just to fix a few potholes in the road.

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Obama's power grab via "czars"

Monday, July 20, 2009 Comments

Does Congress not see that they are gradually being marginalized, their power taken and amassed within the executive branch via "czars"?

The whole concept of "czars," presidential appointees that are not under congressional authority but report solely to the president, needs to end. I realize it's been done before, for years actually, but never on the scale of what Obama has done. At last count he now has over 30 "czars," many of whom are duplicating (and likely replacing from a practical standpoint) official cabinet positions. Others are entirely new positions with new and far-reaching power, power not granted to them by Congress and not approved by Congress.

There is no vetting process (at least not one open to scrutiny by Congress or we the people) and no accountability other than to the president. Transparency anyone?

It's a blatant circumvention of the constitutional separation of powers and it needs to stop. To me, it appears to be not only unconstitutional but a clear attempt to consolidate power in the executive branch while marginalizing the power of Congress. As Senator Byrd said in a recent letter to Obama, "The accumulation of power by White House staff can threaten the Constitutional system of checks and balances." Indeed.

Perhaps some in Congress are waking up to what's happening.

Taxpayers for Common Sense has a running list of the czars with additional detail on each one.

Here's the current list:

1. Afghanistan czar
2. AIDS czar
3. Border czar
4. CA Water czar
5. Car czar
6. Climate czar
7. Domestic violence czar
8. Drug czar
9. Economic czar
10. Energy czar
11. Faith-based czar
12. Great Lakes czar
13. Green jobs czar
14. Guantanamo closure czar
15. Health czar
16. Information czar
17. Intelligence czar
18. Mideast peace czar
19. Mideast policy czar
20. Pay czar
21. Regulatory czar
22. Science czar
23. Stimulus accountability czar
24. Sudan czar
25. TARP czar
26. TARP oversight czar
27. Technology czar
28. Terrorism czar (umm, shouldn't that be the man-caused disaster czar?)
29. Urban affairs czar
30. Weapons czar
31. WMD/Terrorism czar

and two not appointed yet:

32. Copyright czar
33. Cyberspace czar

33 and counting...

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"Science Czar" a proponent of forced abortion, involuntary sterilization

Saturday, July 18, 2009 Comments

Obama's so-called "science czar" John Holdren goes beyond environmental extremist notions that "responsible" citizens should limit their family sizes, into the realm of forced abortion and involuntary sterilization.

Here are a few excerpts from a book that Holdren wrote with Paul and Anne Ehrlich. The book is called Ecoscience: Population, Resources, Environment and although it was written in 1977, Zombietime notes that Holdren has never denounced the things he wrote at that time so it stands to reason that he still holds these beliefs:

"Indeed, it has been concluded that compulsory population-control laws, even including laws requiring compulsory abortion, could be sustained under the existing Constitution if the population crisis became sufficiently severe to endanger the society."
Forced abortion?! Whatever happened to a woman's "right to choose"? Whatever happened to "my body, my choice"? Oh... well, as long as it's for the "greater good," right?

"One way to carry out this disapproval might be to insist that all illegitimate babies be put up for adoption — especially those born to minors, who generally are not capable of caring properly for a child alone. ... It would even be possible to require pregnant single women to marry or have abortions, perhaps as an alternative to placement for adoption, depending on the society."
Oh look! So women might be given some choices... have your baby forcibly taken by the government and given to someone else, get married, or we're back to forced abortion. Wow, how thoughtful of the totalitarian regime to offer some choices after all.

Then again, this guy has thought of everything. The whole notion of forced abortion doesn't necessarily have to happen if we have forced sterilization, right?

"The development of a long-term sterilizing capsule that could be implanted under the skin and removed when pregnancy is desired opens additional possibilities for coercive fertility control. The capsule could be implanted at puberty and might be removable, with official permission, for a limited number of births."
It just gets more and more disturbing. He thinks the government has the right to decide who can and who cannot have children. Anyone who gets pregnant outside of that "approval process" would be subject to having their child forcibly taken from them, or being forced to kill their own child. I can't even begin to tell you how outraged I am by this whole notion. And again, this is the person that president of the United States as appointed as his personal science advisor. As such, he is in a position to make recommendations to the president. And these are his beliefs when it comes to "reproductive health" as the liberals are calling it these days.

But wait, there's more... implanting and removing "sterilization capsules" could be costly and time-consuming. Isn't there a more cost-efficient way to force sterilization on the masses?

"Adding a sterilant to drinking water or staple foods is a suggestion that seems to horrify people more than most proposals for involuntary fertility control. Indeed, this would pose some very difficult political, legal, and social questions, to say nothing of the technical problems. ... To be acceptable, such a substance would have to meet some rather stiff requirements: it must be uniformly effective, despite widely varying doses received by individuals, and despite varying degrees of fertility and sensitivity among individuals; it must be free of dangerous or unpleasant side effects; and it must have no effect on members of the opposite sex, children, old people, pets, or livestock."
No mention of ethical or moral problems here, but extensive discussion on the logistical challenges. I mean, it's one thing to subject an entire population to involuntary sterilization (presumably without their knowledge or consent), but we wouldn't want to have any side-effects to livestock.

In the event that they decide to grant you permission to have children, such "rights" would be limited.

"In today's world, however, the number of children in a family is a matter of profound public concern. The law regulates other highly personal matters. For example, no one may lawfully have more than one spouse at a time. Why should the law not be able to prevent a person from having more than two children?"
Really?! Are you kidding me?! How is it anyone's concern other my husband, myself, and God how many children we bring into our family? Whatever happened to keeping government out of the bedroom?

Apparently anyone who is not on board with such suggestions is a... racist?

"Another related issue that seems to encourage a pronatalist attitude in many people is the question of the differential reproduction of social or ethnic groups. Many people seem to be possessed by fear that their group may be outbred by other groups... Obviously, if everyone tries to outbreed everyone else, the result will be catastrophe for all."
Hmm... now this strikes me as interesting. It would never occur to me to have children on the basis of making sure my "social or ethnic group" isn't "outbred" by another. The fact that it does occur to Holdren is telling. I mean, many of his ilk are already limiting their family size to two or less children for any number of reasons (and although they have absolutely NO right to force such choices on the rest of us they are well within their rights to determine what size family is best for them). But after I read his comments on that topic, I wonder if it is actually he and others who think like him who feel the need to limit the family size of others in order to keep from being "outbred" by others who don't share their ideology. After all, we wouldn't want to let "pronatalist attitudes" (translation: the notion that babies are good) become too common.

Sigh. As if all this isn't bad enough, Holdren doesn't just want the U.S. government making these decisions for us. He wants an international "planetary regime" to be in charge.

"The Planetary Regime might be given responsibility for determining the optimum population for the world and for each region and for arbitrating various countries' shares within their regional limits."
This man is frightening beyond words, and what he proposes is no less than a brutal totalitarian regime that has absolutely no place in a country that has for 200+ years been the beacon of freedom and liberty to the world. The fact that he has the president's ear and the ability to push for such policies is all the more cause for alarm.

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Global warming alarmists & abortion advocates - an unlikely pair?


A few months ago, I came across this article:

Couples who have more than two children are being “irresponsible” by creating an unbearable burden on the environment, the government’s green adviser has warned.

Jonathon Porritt, who chairs the government’s Sustainable Development Commission, says curbing population growth through contraception and abortion must be at the heart of policies to fight global warming.


Porritt, who has two children, intends to persuade environmental pressure groups to make population a focus of campaigning.


Porritt, a former chairman of the Green party, says the government must improve family planning, even if it means shifting money from curing illness to increasing contraception and abortion.

Gee, do you think it's a coincidence that the number of "permissable" children according to this guy just happens to be the same number of children that he has?

This was the first time I had really thought about the connection between the global warming alarmists and the pro-abortion crowd, but upon reading this it made sense. If the far-left crazies think that abortion is necessary to "save the planet" then of course they will do everything they can to make abortion seem "acceptable" in mainstream society. After all, how can one encourage everyone to do something that they find repulsive? You do it in stages. First you try to convince everyone that abortion is perfectly ok. Then you have a socially "acceptable" solution to offer when you start telling people they need to limit their family size, to whatever the so-called "experts" say it should be.

Then abortion becomes not just ok, but it's for the "greater good." After all, anyone who doesn't choose to limit their family size is being "irresponsible" and selfish.

It's reprehensible. It would be easy enough to write this guy off as a quack but in fact he chairs the UK Sustainable Development Commission. As such he is in a position of some influence obviously in England, but to some extent here in the United States as well given our own government's (the liberals anyway) love affair with everything European and desire to follow them even if it means following them off a cliff.

Although Mr. Porritt keeps his suggestions in the realm of voluntary limitation of family size, it doesn't take a genius to see that others might continue the slide down that slippery slope and suggest forcing the matter, all in the name of the common good. It's not unprecedented. Consider China's "one child" limit - enforced in part through forced abortions. Again, easier to accomplish if society has been adequately convinced that abortion is acceptable.

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Calling your representatives is terrorism?

Tuesday, July 14, 2009 Comments

Stumbled onto this recently, from HotAir. Here's an excerpt:

This would be great satire, except that California’s Speaker of the Assembly, Karen Bass, was foolish enough to say it — and believe it. In an interview with the Los Angeles Times, Bass responded to a question about conservative talk radio by calling show hosts terrorists, and openly wondering why we allow people to call politicians and give their opinions (via The Corner):

How do you think conservative talk radio has affected the Legislature’s work?

The Republicans were essentially threatened and terrorized against voting for revenue. Now [some] are facing recalls. They operate under a terrorist threat: “You vote for revenue and your career is over.” I don’t know why we allow that kind of terrorism to exist. I guess it’s about free speech, but it’s extremely unfair.

There’s a lot of stupidity and tyranny locked into those few words. The First Amendment guarantees the right to petition the government for redress of grievances, even apart from the “free speech” issues Bass casually discards. Elected politicians are accountable to the people who elect them in a free society.


Beware the politicians who consider dissent terrorism. They’re either idiotic beyond belief, or tyrants waiting for an opportunity. Bass might just be both.

Why is it that liberals can't bring themselves to use the "t" word (terrorism) when describing actual known terrorists ("man-caused disaster" sounds so much more pleasant, no?) but they have no problem describing law-abiding citizens who dare to voice their opinions to the politicians THEY elected to represent them as "terrorists." She bemoans that people's jobs are threatened if they vote a certain way. Well, if the majority of the people who put you in office disagree with how you conduct yourself in office, then they should vote you out of office. That's how democracy works!

During the Bush years, liberals loved to remind everyone that "dissent is the highest form of patriotism." And they were right on that point, although IMO some of them crossed the line from "dissent" to actively undermining America's interests at home and abroad. Now that their beloved leader is now in office though, they are quickly rebranding dissent - simply voicing an opposing opinion to the administration's policies - as "terrorism" or even "treason."

The hypocrisy and stupidity here is mind-numbing, and the trend to increasingly label anyone who disagrees with the government as an "extremist," "terrorist," or "traitor" is very, very dangerous. It should be seen as a threat to the freedom not only of conservatives but of all Americans.


As a side note, I just have to take issue with Ms. Bass' terminology "voting for revenue." "Revenue" is money that is EARNED for providing goods or services. What Ms. Bass is talking about is not revenue, it's TAXES and yes, if you're voting to increase taxes on your constituents, you better be ready for some complaints. Especially when you've been spending a large portion of your already-bloated budget on stupid and wasteful things. Don't waste the taxpayers' money and then get all defensive when they aren't eager to give you even MORE of their hard-earned dollars to make up for your overspending in the first place! How about do what every other American has to do when they don't have enough money - cut spending!!

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Free speech in action

Saturday, July 11, 2009 Comments

The world continues to feel upside down and inside out, but dh found this online and I thought I'd take a break from the serious to share something funny.

This is a musician who flew United and the baggage handlers threw and broke his guitar (they were seen from the plane). He tried for months to get them to compensate him for the loss (it was an expensive guitar) and finally decided to write three songs about his experience. This just cracked me up. Apparently, United has since called him to try to make things right. Good for him.

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Freedom is not free

Saturday, July 4, 2009 Comments

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.


We, therefore, the Representatives of the united States of America, in General Congress, Assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the Name, and by Authority of the good People of these Colonies, solemnly publish and declare, That these united Colonies are, and of Right ought to be Free and Independent States, that they are Absolved from all Allegiance to the British Crown, and that all political connection between them and the State of Great Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. — And for the support of this Declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

~ Excerpt from the United States Declaration of Independence

As we celebrate our nation's Independence Day, please take a moment to remember the brave souls who fought (and many died) to establish a nation founded on liberty, as well as the sacrifices of patriots through the years since that time to defend and protect our liberty. May all of us as Americans today "mutually pledge to each other our Lives, our Fortunes, and our sacred Honor" and do our part to preserve liberty for the generations to come.

Happy 4th of July!

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Make Mine Freedom

Thursday, July 2, 2009 Comments

Old cartoon explains why freedom is what makes America great, and predicts exactly what is happening now:

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