DEADLY DOCTORS

O ADVISERS WANT TO RATION CARE

Dr. Ezekiel Emanuel: Believes in withholding care from elderly for greater good.

By BETSY MCCAUGHEY
New York Post
July 24, 2009


THE health bills coming out of Congress would put the decisions about your care in the hands of presidential appointees. They'd decide what plans cover, how much leeway your doctor will have and what seniors get under Medicare.

Yet at least two of President Obama's top health advisers should never be trusted with that power.

Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.

Emanuel bluntly admits that the cuts will not be pain-free. "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change," he wrote last year (Health Affairs Feb. 27, 2008).

Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, "as an imperative to do everything for the patient regardless of the cost or effects on others" (Journal of the American Medical Association, June 18, 2008).

Yes, that's what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

Many doctors are horrified by this notion; they'll tell you that a doctor's job is to achieve social justice one patient at a time.

Emanuel, however, believes that "communitarianism" should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those "who are irreversibly prevented from being or becoming participating citizens . . . An obvious example is not guaranteeing health services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

Translation: Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy.

He explicitly defends discrimination against older patients: "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" (Lancet, Jan. 31).

Unplugged: Are Town Hall Protests "Manufactured"?

Posted by Michelle Levi


Democratic National Committee's press secretary Hari Sevugan said nationwide protests of democratic health care town hall events were "manufactured outrage " today on "Washington Unplugged."

Sevugan debated Max Pappas from Freedomworks.com on the show.

"We are very flattered at the idea that we could gin up this many people with this level of excitement. But you can't gin that up," Pappas said. "This only happens when people are really concerned."

Sevugan acknowledged that there is real concern over health care, "but what is not helping is sort of the venomous, angry yelling and screaming that we are seeing at these town halls."

"I think a lot of the events that you are seeing here are manufactured outrage," Sevugan said.

"Perception is reality," Politico's Josh Kraushaar explained in an earlier segment. "When you see images of angry and concerned constituents and protests…that is a bad image for the administration to be seeing."

Kraushaar said that regions where these protests have occurred since the weekend are actually very Democratic and polls have indicated that people there support the president's health care plan.

"The notion that there is a grassroots activism in those areas is somewhat unlikely. It suggests that you are seeing the pressure of outside groups," he said.

He also noted that at the same time, response from local Democrats is unexpectedly low.

Democrats Show Strain of Heated Battles

By NAFTALI BENDAVID and JONATHAN WEISMAN

WASHINGTON -- A bruising session marked by politically volatile legislation strained relations between congressional Democrats and the White House and spawned cracks in the party's coalition.

Since Mr. Obama's inauguration, Congress has enacted a stream of significant legislation. The gamut runs from an economic-stimulus package, children's health care, pay parity for women, tobacco regulation, consumer credit-card protections, public service and land conservation, in addition to key budget bills.

But on some marquee issues, White House officials and Democratic congressional leaders concede the schedule has slipped -- while noting that nothing major has failed. In addition, some Democrats say their colleagues misunderstand the White House role, which is to shape public discourse and resolve party disputes, not dictate policy specifics.

Many of the Democrats' internal disputes stem from growing friction between the party's conservative and liberal wings. Several years ago, then-Rep. Rahm Emanuel (D., Ill.), in an all-out push to retake Congress, aggressively recruited conservative Democratic candidates.

Now Mr. Emanuel, as White House chief of staff, finds the very lawmakers he courted slowing the more-progressive president's agenda. Some liberals complain Mr. Obama is overly protective of those newly elected Democrats and too willing to cut deals.

"The chickens are coming home to roost," said Rep. Maxine Waters, an outspoken liberal Democrat from California.

Conservatives Democrats have their own complaints. Mr. Obama and his top aides have worked diligently to show they are heeding conservatives' concerns about a health-care overhaul's costs. But the president's political operatives -- at the Democratic National Committee and the grassroots group Organizing for America -- haven't been so solicitous.

Television ads running in some moderates' districts urging support for Mr. Obama's health initiative left them feeling bullied and betrayed. "Those ads really created problems," one House leadership aide said.

Other Democrats complain that by not providing enough clarity on where the health-care overhaul is headed, the White House has left them exposed politically as they face constituents' scrutiny -- and rivals' attacks -- during the August recess.

"Specificity is what is needed," said Sen. Dianne Feinstein. "What's most helpful now is: 'This will reduce costs, and here is precisely how.' " Asked if the White House had provided this specificity, the California Democrat said, "No."

Republicans are seizing on the tensions to bolster their criticism of the Democratic agenda. "Many within the president's own party are now standing up and telling the administration to slow down and reassess," Senate Minority Leader Mitch McConnell of Kentucky said this week.

Similar unhappiness surrounds the president's energy initiative, which was meant to reduce carbon emissions in the hope of slowing global warming. Mr. Obama chose not to spend political capital stumping for the House measure, while Republicans have been savaging moderate Democrats for supporting what they call a "cap-and-tax" bill.

Some argue that Mr. Obama's relations with his party are good, by historical standards. Presidents Jimmy Carter and Bill Clinton alienated fellow Democrats almost immediately with their perceived disdain for Congress.

Mr. Obama, a former U.S. senator, has been solicitous of lawmakers and put Capitol Hill veterans in key positions, from Mr. Emanuel to Budget Director Peter Orszag, a former director of the Congressional Budget Office.

When Mr. Obama took office in January, Democratic leaders set high expectations that they would accomplish almost as much as the New Deal Democrats of the 1930s.

Then, in May, Mr. Obama demanded that Congress provide money to close the U.S. detention facility at Guantanamo Bay, Cuba, but declined to specify what would happen to its inmates. Afraid of being accused of releasing terrorists into their districts, Democrats rebelled and refused to allocate the funds.

One unexpected problem was a breakdown in the White House's legislative game plan. The Senate was supposed to move before the House on health care, officials say, giving skittish House members assurance before they moved forward on the difficult issue.

Instead, the House kept its end of the bargain, pushing through a climate bill only to find the Senate stuck on health care and doing nothing on energy.

On health care, "I just think that they are giving out a very poor message," said Sen. Bernie Sanders, a liberal Vermont independent who caucuses with the Democrats. "At the end of the day, if they think everyone will be so excited because they passed something, I think that is wrong both from a public-policy and a political perspective."

Minnesota Rep. James Oberstar and other Democrats, meanwhile, have sharply criticized an administration move to postpone a roughly $500 billion transportation bill.

Looking ahead to the fall session, dissatisfaction is growing as campaign promises give way to the nitty-gritty of legislating. "Our fear, or concern, is that the legislative branch not become a cheerleader for the executive branch," said Democratic Rep. John Tanner of Tennessee.

Write to Naftali Bendavid at naftali.bendavid@wsj.com and Jonathan Weisman at jonathan.weisman@wsj.com

Obamacare Pushes Abortion

by Michael S. Steele

There is much about President Obama’s government-run health care plan that should have Americans alarmed. It would make health care more expensive. It would raise taxes on families and small businesses. It would let a government bureaucrat determine what treatments patients can receive. And it could force 88 million Americans off of the private health insurance they now have.

None of that is likely the kind of change the American people expect when President Obama and Congressional Democrats talk about reforming our health care system. But it must have big-government liberals jumping with joy. It gets worse, however. Hidden deep within the over 1,000-page House Democrat health care bill is language that could require all health insurance plans to provide taxpayer-funded abortions.

Under the Democrats’ scheme, insurance plans would have to provide people an “essential benefits package.” This package would be created by the secretary of the Department of Health and Human Services based on recommendations from a new federal advisory committee. As the bill is written, there is nothing that could keep federal bureaucrats from mandating that coverage of abortions be included in the “essential benefits package.”

This abortion mandate would not just apply to the Democrats’ government-run “option.” Any private plans that receive taxpayer subsidies to provide coverage to people with low to moderate incomes -- and under the Democrats’ plan that would be nearly all of them -- would have to provide coverage for abortions, and pay for them with taxpayer dollars, too.

President Obama claims he wants to reduce the number of abortions in America, but he has not raised a single concern with this language in the House Democrats’ government-run health care plan -- despite objections from conservative Democrats whose votes he needs to pass his health care experiment. The president’s press secretary, Robert Gibbs, even called concerns over taxpayer-funded abortions in the Democrats’ health care reform plan a “red herring.”

Either the president’s claim of wanting to reduce abortions is nothing but lip-service to mask his true liberal agenda, or he is kowtowing to Nancy Pelosi and other House liberals to get his government-run health care scheme passed as quickly as possible. One thing is certain: the Democrats’ ill-conceived government-run health care experiment is the most dangerously liberal legislation we’ve seen in some time, and it should scare the living daylights out of all Americans.

It is bad enough that liberals in Congress regularly attempt to impose their taxpayer-funded abortion-on-demand agenda on America at every opportunity. Now they are sneaking language in their health care reform bill that leaves the door wide-open for taxpayer-funded abortions and has absolutely nothing to do with improving health care. It is not a “red herring” -- it is a poison pill.

I have said that President Obama’s experiment with America’s health care system is something that will fundamentally transform the very way of life of our country and its citizens. I have warned that the Democrats are attempting to rush through Congress a dangerously flawed government-run health care plan that does too much, too fast and too soon. This abortion mandate is further proof that those warnings are correct.

President Obama says he wants to reduce health care costs. Republicans agree. Health care today simply costs too much. Health insurance premiums have risen three times faster than wages. Health insurance costs families and businesses too much, and we need to fix that.

But why will the Democrats’ plan to save money actually cost us more money? How come their plan to reduce health care costs will cost us trillions more in tax dollars? Let’s just use a little common sense -- when has Washington, D.C. ever made anything cost less? If you are a small business owner, you will see a tax hike on your income, your payroll, and your investments, none of which will help you to grow and create new jobs. If you are a senior citizen, you face over $300 billion in cuts to Medicare and Medicaid. If you are a physician, you face a federal bureaucrat determining the treatments, tests and procedures you can provide to your patients.

That is simply the wrong diagnosis for our health care system. But President Obama and Democrats are determined to rush their dangerous health care bill through Congress without taking a moment to consider if it would really work, or worse, to think about the consequences it could have on our nation. They want their liberal wish-list right now -- a government-run health care system financed with higher taxes that requires taxpayer-funded abortions -- and they won’t stop until they get it.

Voters want health care reform. So do Republicans. But we don’t want the kind of radical reform Democrats are proposing. Republicans will continue to stop this dangerous experimentation with our health care system while continuing to promote reform that fixes what’s wrong in our health care system while protecting what is right.

Visit www.BarackObamaExperiment.com to learn more about the Democrats’ flawed health care plan.

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Michael S. Steele is Chairman of the Republican National Committee

Common Sense May Sink ObamaCare

OPINION: DECLARATIONS

It turns out the president misjudged the nation’s mood.

By Peggy Noonan

This is big, what’s happening. President Obama appears to have misstepped on a major initiative and defining issue. He has misjudged the nation’s mood, which itself is news: He rose from nothing to everything with the help of his fine-tuned antennae. Resistance to the Democratic health-care plans is in the air, showing up more now on YouTube than in the polls, but it will be in the polls soon enough. The president, in short, may be facing a real loss. This will be interesting in a number of ways and for a number of reasons, among them that we’ve never seen him publicly defeated before, because he hasn’t been. So we may be entering new territory, with new struggles shaped by new dynamics.

His news conference the other night was bad. He was filibustery and spinny and gave long and largely unfollowable answers that seemed aimed at limiting the number of questions asked and running out the clock. You don’t do that when you’re fully confident. Far more seriously, he didn’t seem to be telling the truth. We need to create a new national health-care program in order to cut down on government spending? Who would believe that? Would anybody?

The common wisdom the past week has been that whatever challenges health care faces, the president will at least get something because he has a Democratic House and Senate and they’re not going to let their guy die. He’ll get this or that, maybe not a new nationalized system but some things, and he’ll be able to declare some degree of victory.

And this makes sense. But after the news conference, I found myself wondering if he’d get anything.

I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense. I suspect voters, the past few weeks, have been giving themselves an internal Q-and-A that goes something like this:

Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees or fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

The White House misread the national mood. The problem isn’t that they didn’t “bend the curve,” or didn’t sell it right. The problem is that the national mood has changed since the president was elected. Back then the mood was “change is for the good.” But that altered as the full implications of the financial crash seeped in. The crash gave everyone a diminished sense of their own margin for error. It gave them a diminished sense of their country’s margin for error. Americans are not in a chance-taking mood. They’re not in a spending mood, not after the unprecedented spending of the past year, from the end of the Bush era through the first six months of Obama. Here the Congressional Budget Office report that a health care bill would not save money but would instead cost more than a trillion dollars in the next decade was decisive. People say bureaucrats never do anything. The bureaucrats of CBO might have killed health care.

And this makes sense. But after the news conference, I found myself wondering if he’d get anything.

I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense. I suspect voters, the past few weeks, have been giving themselves an internal Q-and-A that goes something like this:

Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees or fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

The White House misread the national mood. The problem isn’t that they didn’t “bend the curve,” or didn’t sell it right. The problem is that the national mood has changed since the president was elected. Back then the mood was “change is for the good.” But that altered as the full implications of the financial crash seeped in. The crash gave everyone a diminished sense of their own margin for error. It gave them a diminished sense of their country’s margin for error. Americans are not in a chance-taking mood. They’re not in a spending mood, not after the unprecedented spending of the past year, from the end of the Bush era through the first six months of Obama. Here the Congressional Budget Office report that a health care bill would not save money but would instead cost more than a trillion dollars in the next decade was decisive. People say bureaucrats never do anything. The bureaucrats of CBO might have killed health care.

The final bill, with all its complexities, will probably be huge, a thousand pages or so. Americans don’t fear the devil’s in the details, they fear hell is. Do they want the same people running health care who gave us the Department of Motor Vehicles, the post office and the invasion of Iraq?

Let me throw forward three other things that I suspect lessen , or will lessen, support for full health-care reform, two of them not quantifiable.

The first has to do with the doctors throughout the country who give patients a break, who quietly underbill someone they know is in trouble, or don’t charge for their services. Also the emergency rooms that provide excellent service for the uninsured in medical crisis. People don’t talk about this much because they’re afraid if they do they’ll lose it, that some government genius will come along and make it illegal for a doctor not to charge or a hospital to fudge around, with mercy, in its billing. People are afraid of losing the parts of the system that sometimes work—the unquantifiable parts, the human parts.

Second, and this is big, some of the bills being worked on in Congress will allow for or mandate taxpayer funding of abortion. Speaking only and narrowly in political terms, this is so ignorant as to be astounding. A good portion of the support for national health care comes from a sort of European Christian Democrat spirit of community, of “We are all in this together.” This spirit potentially unites Democrats, leftists, some Republicans and GOP populists, the politically unaffiliated and those of whatever view with low incomes. But putting abortion in the mix takes the Christian out of Christian Democrat. It breaks and jangles the coalition, telling those who believe abortion is evil that they not only have to accept its legality but now have to pay for it in a brand new plan, for which they’ll be more highly taxed. This is taking a knife to your own supporters.

The third point is largely unspoken but I suspect gives some people real pause. We are living in a time in which educated people who are at the top of American life feel they have the right to make very public criticisms of . . . let’s call it the private, pleasurable but health-related choices of others. They shame smokers and the overweight. Drinking will be next. Mr. Obama’s own choice for surgeon general has come under criticism as too heavy.

Only a generation ago such criticisms would have been considered rude and unacceptable. But they are part of the ugly, chafing price of having the government in something: Suddenly it can make big and very personal demands on you. Those who live in a way that isn’t sufficiently healthy “cost us money” and “drive up premiums.” Mr. Obama himself said something like it in his press conference, when he spoke of a person who might not buy health insurance. If he gets hit by a bus, “the rest of us have to pay for it.”

Under a national health-care plan we might be hearing that a lot. You don’t exercise, you smoke, you drink, you eat too much, and “the rest of us have to pay for it.”

It is a new opportunity for new class professionals (an old phrase that should make a comeback) to shame others, which appears to be one of their hobbies. (It may even be one of their addictions. Let’s stage an intervention.) Every time I hear Kathleen Sebelius talk about “transitioning” from “treating disease” to “preventing disease,” I start thinking of how they’ll use this as an excuse to judge, shame and intrude.

So this might be an unarticulated public fear: When everyone pays for the same health-care system, the overseers will feel more and more a right to tell you how to live, which simple joys are allowed and which are not.

Americans in the most personal, daily ways feel they are less free than they used to be. And they are right, they are less free.

Who wants more of that?

How to Stop Socialized Health Care

Five arguments Republicans must make.

By Karl Rove

It was a sobering breakfast with one of the smartest Republicans on Capitol Hill. We can fix a lot of bad stuff President Barack Obama might do, he told me. But if Mr. Obama signs into law a "public option," government-run insurance program as part of health-care reform we won't be able to undo the damage.

I'd go the Republican member of Congress one further: If Democrats enact a public-option health-insurance program, America is on the way to becoming a European-style welfare state. To prevent this from happening, there are five arguments Republicans must make.

Getty Images

The first is it's unnecessary. Advocates say a government-run insurance program is needed to provide competition for private health insurance. But 1,300 companies sell health insurance plans. That's competition enough. The results of robust private competition to provide the Medicare drug benefit underscore this. When it was approved, the Congressional Budget Office estimated it would cost $74 billion a year by 2008. Nearly 100 providers deliver the drug benefit, competing on better benefits, more choices, and lower prices. So the actual cost was $44 billion in 2008 -- nearly 41% less than predicted. No government plan was needed to guarantee competition's benefits.