Should We All Die at 75?: Addressing the “Emanuel Principe” in Obamacare

Ezekiel Emanuel, one of the authors of the Affordable Care Act spoke publicly this week about his own desire to “die at 75” in a article published in the Atlantic.  In his piece, he argues that as he ages, he wishes to stop all preventative medical measures and “let nature take its course” as he approaches the age of 75.  This includes screenings such as colonoscopy as well as taking flu shots for the prevention of communicable illness.  While currently in excellent health, Mr Emanuel believes that while death is a loss–”living too long is also a loss.” He argues that the American obsession with living longer results in a larger number of elderly, disabled citizens.  I take significant issue with this position and fear that this is simply the beginning of a new phase in the ACA debate–the rationing of care. From the outset, many of us in healthcare and scholars of healthcare policy have seen Obamacare as a way to promote the rationing healthcare (particularly for the elderly).  While the administration has vehemently denied these claims throughout the legislative and implementation phases of the new healthcare law, it is particularly revealing that one of the principal architects of the law firmly believes that we should not pay attention to life expectancy statistics beyond the age of 75.  Medical advances have made it increasingly possible for seniors to lead healthy, productive exciting lives well into their 80s.  Now, I certainly am not arguing for providing futile care in the setting of terminal illness but–Why then should government (instead of doctors) now have the right to determine how healthcare resources are utilized and who gets what?  Is it all about age?  Do we value the young more than the more “seasoned” citizens? The US healthcare system, while certainly imperfect, offers some of the greatest technological advances in the world and the most significant thing that has always set US healthcare apart form others has been CHOICE.  With Obamacare in place, we now have less choice in our healthcare and very little improvement in access.  This latest article by Mr Emmanuel is no surprise–he has been clear about his belief in allocating health care dollars away from activities which may extend lifespans for Americans.  While, Mr Emmanuel certainly has the RIGHT to refuse care for himself at a certain age neither he (NOR OBAMA or any GOVERNMENT agent) should be able to determine an “acceptable” life span for each of us. Quality of life and health status can be very subjective and care must remain individualized rather than mandated (or withheld) based on actuarial tables or government rationing of resources. Medicine is all about innovation and the development of new technologies.  Through technology we are able to provide longer, more productive lives for our patients.  Our patients are able to retire from a life of work and enjoy spouses, family and friends–well into their 80s and 90s WITH a quality of life.  In fact one of my favorite “golf buddies” is 80 years old and going strong–He can still shoot in the 80s from time to time and never misses a game. In MEDICINE one size does not fit all.  OBAMACARE wants to force a ONE SIZE FITS ALL healthcare system on all of us and as a physician I find this to be unacceptable.  Just as we must cater therapy to individual patients—when (and how) you die must also be catered to each individual patients needs, desires and beliefs. Chronological age such as 75 may be different for different people AND we must respect individual needs.  Medicine is a clearly a science but in many cases the practice of medicine –particularly when making decisions about end of life issues–makes it more of an ART.  The government has no place in dictating ART.  Government should help to preserve and curate art–not regulate and mandate the way in which medical care is delivered to individual patients based on age. Ultimately, left to its own devices, I believe that the ACA will create rationing of care for Americans and we will have two classes of people–those that are wealthy and can afford private care and can pay cash for it–these can make their own healthcare decisions and decide when enough is enough.  The others–most of us–will be lumped into the disaster that IS obamacare and will have little or no choice in how our healthcare is delivered.  Waiting lists for advanced procedures and denials of advanced care for the elderly will be the standard–Just as Mr Emanuel envisioned it when he crafted the law just a few short years ago.


2 responses to “Should We All Die at 75?: Addressing the “Emanuel Principe” in Obamacare

  1. Thank heavens that logical minds are taking issue with Emanuel’s stance. It is intrinsically immoral to withhold health/medical care from someone on the basis of their age alone. Old people have huge value to our communities and our society and I am disgusted that anyone would suggest basically putting them out on an iceberg when they turn 75.

  2. Dr. Campbell- This is a thought-provoking article. There is something distressing about the notion that the government could dictate that medical treatment beyond the age of 75 not be covered under Medicare or that it be significantly restricted. In that regard, the purported purpose of the ACA to make healthcare more accessible for everyone wouldn’t be the case. However, to some degree, there has always been some rationing of healthcare that the health insurance companies do in their pre-certification process. Decisions are made that certain procedures are not medically necessary, are unreasonable, or are experimental, hence insurance coverage for them is denied. I don’t like the idea of the government or the health insurance companies dictating healthcare decisions, but I also don’t particularly like the idea that the free market determines who gets healthcare either, which often means that the wealthy get the latest and most advanced treatments, while the economically challenged don’t have similar access. It is a moral and an economic dilemma. One thing is for sure, the cost of medical treatment in this country is ridiculously high. There has to be some way to contain that cost so that medical care is affordable for everyone. In that regard, I never have understood how medical providers can charge so much for the uninsured, but accept for the same treatment greatly reduced amounts when it is paid for by insurance carriers and the government (Medicare/Medicaid), adjusting or writing-off the balance of the original charges. I thought that the people who set the Medicare reimbursement rate for medical treatment supposedly set that rate based upon the actual cost of the treatment, plus some reasonable amount for overhead and a modest profit. If that is the case, then the charges for that treatment listed on medical provider bills must be greatly inflated. I am not necessarily being critical of doctors. They deserve appropriate compensation for their expertise and the many years of training (including the huge costs for that education and training for which many of the younger members of the medical profession have crushing debts that must be repaid), and the hours they keep providing quality medical care. There is also the cost of running a medical practice, including the cost of medical malpractice insurance. But hospitals and ancillary service providers, and especially the drug industry, seem to be the unfair drivers of the increasing cost of healthcare in America. The ACA may not be the answer, but something needed to be done to address those problems. So I have no problem with trying to amend the ACA to make it more workable and fair to everyone.

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