|
In 1984, Colorado governor Richard Lamm gave a now-infamous interview in which he said the very ill elderly should die and get out of the way, thus helping the generations following them to thrive in political and economic environments that have fewer claims on scarce resources (a canard on its face, given that economies are ever-expanding). Thirty years later, along comes Ezekiel Emanuel, brother of Chicago Mayor Rahm, buddy of Barack, and a principal architect of the Affordable Care Act, also known as Obamacare. In a lengthy post at The Atlantic, Emanuel, a physician and ethicist, posits that he’s happy to live to age 75 and then die, because, to paraphrase, better to go quickly than to linger and by then I will have exhausted my talents and you will, too, so why don’t you join me. Setting aside scare tactics about Obamacare death panels (anyone with knowledge of public and private insurance knows there many ways to ration care, they are used every day, and they have been for decades; the sheer cost and waste of medical care in our society is itself a severe form of rationing), I am appalled that a man who helped write the most aggressive health reform law in American history is publicly channeling Richard Lamm. And, not to put too fine a point on it, how distasteful and unnerving is it to have a Jewish man encourage people to visualize their date with fate as a hard target painted with the shadows of inevitable declining productivity and an attitude of “been there, done that, nothing left to do.” He claims he is not making a policy statement, just a personal one; when Presidential advisors talk, they are at the very least providing a peak into the policy making tent. In framing his argument as a noble personal choice, he is not so subtly arguing that you (and I), too, must follow suit. I don’t think so. It is true that Americans have an uncomfortable relationship with death and with conversations about both trade-offs and the costs of our medical desires. Despite our religiosity (and I am a Christian), culturally we struggle with death as though it is eventually surmountable with the right alchemy of gimmicks and medical technology. Unfortunately, it isn’t. I am all for bringing death out of the shadows, so to speak, and those conversations should must rightfully begin in families and churches, with appropriate legal and medical inputs. My wife and I have articulated our wishes for end-of-life care in writing, as part of an Advanced Directive, and the critical criteria for determining whether we stay or go is quality of life. Neither one of us wants to live a life of disability or pain, and we don’t want to burden our only child. But, we also want to teach him that some of life’s most powerful lessons come through struggle and the decision to throw in the towel is not something that can come from arbitrary standards imposed by the authorities. Although my wife and I are fit and diligent about healthy lifestyle choices, at 57 we are well aware both that life is unpredictable and we have fewer years ahead of us than behind us. However, the spectrum along which an individual measures the value or quality of his or her life is very broad and as variable as there are individuals on the planet. It is not for government to corral individual hopes, aspirations, and measures of life satisfaction. Emanuel is wrong when he decries American fanaticism “with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible.” If Americans were truly fanatical about their choices, we would not be the fattest, laziest culture in the history of Western civilization. We are obsessed with talking about exercise and healthy eating, but far too few of us do these things well enough for them to reduce morbidity or mortality or improve quality of life. That baby boomers or Gen Xers may have a shorter lifespan than the WW II generation isn’t the result of fanatical devotion to exercise and healthy eating. It’s the opposite; it’s the result of persistenly poor lifestyle choices and over-reliance on the medical care system to fix things it is not equipped to fix and that we should be taking care of ourselves. The American obsession is to look for magic bullets and quick fixes for things that require decades of concentration and commitment. American indifference to personal responsibility as a crucial driver of good health helped to empower Ezekiel Emanuel and Barack Obama. The quick fix mentality has been fomented by Emanuel’s medical care industry, which has for 20 years now been pushed an ever-growing panoply of screenings and early diagnostics on Americans. The almost uniform deceptive narrative is that screenings save lives or money or make treatment oh-so-much easier. Except that there is almost no data to support these notions. Screenings mostly make money for the providers who offer them or subsequently take charge of the “treatment” of people who test positive but frequently turn out to have no disease at all. It’s important to not forget that Emanuel’s Obamacare vision is to push screenings on all Americans in order to keep the patient pipeline full because that keeps the revenue stream flowing to his healthcare industry pals. Emanuel says he would not get screenings such as colonoscopy as an older adult; in articulating this, he aligns himself with the evidence (and common sense), but he is strangely silent on the far bigger issue of screenings for generally healthy adults who almost never benefit from them. Emanuel says he would stop flu shots at age 75, presumably because dying of the flu at 75 makes for an easy exit strategy. I, on the other hand, have gotten a flu shot every year since 1990, and, in 24 years, I have had the flu three times (an 88% effectiveness rate). My view is that the flu shot has generally worked for me and delivered the result I wanted: kept me mostly disease free and allowed me to work and workout while people who did not get immunized suffered on both counts. Give their low cost, easy administration, negligible side effects, and huge upside to protect personal productivity, it strikes me that this is one of the last things you would drop. Emanuel also bizarrely tries to justify his position by pointing to data purporting to show that aging adults contribute less to society after age 40 and only marginally after 60. Speaking only for myself, my post-40 years have been my most vibrant, and they’re only getting better. Victor Davis Hanson of the National Review and Brant Mittler in MedScape skewer Emanuel along many other useful and interesting lines. Their essays are well worth the time to read. Ezekiel Emanuel’s proclamation should not be brushed as the idle rant of an ideologue. This ideologue was a key player in the law that has riven the nation. The best way, however, to teach Emanuel and his ilk a lesson is to prove them wrong by being what he says you can’t be: happier, fitter, and more productive as you get older and more prepared for the time when you will need to decide whether it is time to go, without trying to preordain it. Zeke, I have bad news for you: I am stronger and smarter than you now, and I will be when we are both 75, and I will be long after you are gone, because people like you, who condescend to everyone else and want to play God in the worst tradition of both modern medicine and governance, deserve our contempt and the application of our energies to do the very things you say we cannot do. You can prove Emanuel wrong by becoming what he believes you cannot be: a strong, healthy, confident, American adult. Learn more in Your Personal Affordable Care Act: How To Avoid Obamacare. Download the free prologue now at http://yourpersonalaffordablecareact.com/buy-now/. The e-book will be available on November 3, 2014 at Amazon and Smashwords.com.
Related Articles -
Ezekiel Emanuel, healthcare, health, Obamacare, Affordable Care Act,
|
