By Peter J. Smith

WASILLA, Alaska, August 11, 2009 ( – Former Alaska Gov. Sarah Palin ignited a firestorm over the weekend by calling the health-care reforms pushed by President Barack Obama “downright evil” for proposals that could usher in rationing, and turn federal health boards into “death panels” that would decide whether the elderly and the disabled, like her infant Down’s syndrome son, Trig, were “worthy of health-care.” Palin’s provocative statements, however, have brought fresh scrutiny of the dangers of the proposed “Comparative Effectiveness Research Commission,” if it were to adopt guidelines of a “Complete Lives System” advocated by Obama’s policy advisor on health care reform, Dr. Ezekiel Emanuel.

Many Americans have flocked to town-hall meetings to protest what they see as the imminent government-takeover of the health-care industry, which makes up one-sixth of the total American economy. But more and more Americans revolting at Congress’s health-care reforms have expressed fears for the health-care of the elderly and disabled, whom they fear will be victims of rationing and even passive euthanasia by way of the “advance care planning consultation” provisions featured on pages 424 – 443 of HR 3200, “the American Affordable Health Choices Act.”

“The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil,” said Palin communicating through her Facebook page, which has over 715,000 subscribers.

Although the White House and members of the mainstream media rushed to dismiss Palin’s statement as “nuts,” the threat of the government insurance plan becoming a “death panel” for the weakest members of society may not be far off the mark. ABC News recently reported that the Oregon Health Plan refused to cover cancer drugs that cost $4000 per a month for Barbara Wagner, a 64 year-old terminally ill patient with lung cancer. Instead they offered to give her a one-time prescription for lethal drugs to end her life, which would cost the state health provider only $50.

Palin attacked the promise of Congressional Democrats that the government plan would reduce the cost of health care, saying “as the economist Thomas Sowell has pointed out, government health care will not reduce the cost; it will simply refuse to pay the cost.”

“Health care by definition involves life and death decisions. Human rights and human dignity must be at the center of any health care discussion,” concluded Palin.

But Palin pointed out the enormous danger for federal health boards becoming “death panels” through a policy of rationing, esp. by following the policy proposed by Dr. Ezekiel Emanuel, an issue first raised by Rep. Michele Bachmann (R-Minn.)

Emanuel is a key advisor of Obama’s health care reform as health-policy adviser at the White House’s Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research. A member of the National Institutes of Health’s Clinical Bioethics Council and brother to Obama’s Chief of Staff Rahm Emanuel, he advocates “The Complete Lives System,” which as he described in a Jan. 31, 2009 article, “prioritizes younger people who have not yet lived a complete life.”

Emanuel’s approach has five principles which he lays out in “Principles for Allocation of Scarce Medical Interventions” published on January 31, 2009: “youngest first, prognosis, save most lives, lottery, instrumental value.”

“When the worst-off can benefit only slightly, while the better-off could benefit greatly, allocating to the better off is often justifiable,” wrote Emanuel.

He continued that the CLS discrimination based on age is not “invidious discrimination” because “everyone who is 65 years now was once 25 years.” But in the CLS, care would also be rationed away from young people with a “poor prognoses” because they lack “the potential to live a complete life.” (Read here)

Emanuel has also stated that doctors take the Hippocratic Oath too seriously, and stated that “Savings [in the medical industry] will require changing how doctors think about their patients” in a 2008 article written for the Journal of the American Medical Association. In a separate 1996 article for the Hastings Center Report, Emanuel spoke about rationing care away from those “who are irreversibly prevented from being or becoming participating citizens” to the non-disabled, adding “An obvious example is not guaranteeing health services to patients with dementia.”

Approximately 33 percent of medical spending occurs in the final year of a patient’s life, and throughout the legislation (HR 3200), enormous pressures are put upon on physicians and medical professionals to incentivize them to cut costs.

While Emanuel’s approach, as published in the Lancet, is a theoretical approach to rationing, a practical concern is raised when one considers that either private insurers or the public option could integrate CLS into their rationing practices, if they are included among treatment protocols developed and promoted through the proposed Center for Comparative Effectiveness Research and the Commission that oversees its work (sec. 1401 of HR 3200), under the Executive Branch.

The Center’s duties would be “to conduct, support, and synthesize research âEUR¦ with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically.”

Opponents, especially at tumultuous town-halls, have expressed fears that current provisions in the bill for government-run health-care could lead to doctors thinking of the bottom line first, could end up pressuring patients through “advanced care planning consultations” (sec. 1233) into accepting lower-quality care or care they do not want, out of a feeling that they pose some kind of burden on their families or society. Under that section in the version under discussion by the House Ways and Means Committee, doctors would formulate with patients end-of-life orders, regarding their desire to continue or discontinue antibiotic treatments or nutrition and hydration under particular circumstances.

Read H.R. 3200 “American Affordable Choices Act

Read more on Dr. Ezekiel Emanuel in New York Post “Deadly Doctors

Read Ezekiel Emanuel’s article on Complete Lives System

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