Fernando J Milanes MD
In their frantic effort to save the Affordable Care Act, better known as Obamacare, the White House has unleashed to the public the person they have labeled as the creator of the law. Dr. Ezekiel Emanuel unfortunately has a style more akin to a rabid pit bullthan the reputable scientist that he is. The problem with this propaganda effort is that regardless of the messenger, the message i.e. Obamacare will not work. Even if some aspects of Dr. Emanuel’s philosophy are present, the framework of this act could have only been put together, as it was, by politicians with many diverse interests and no knowledge of what really ails in our health delivery system and the actions needed for its improvement. As an M.D. Involved in the administration of health care, I was interested and read many of Dr. Emanuel’s writings in bioethics, his specialty. Dr. Emanuel is brother to Rahm, a known politician that worked as Chief of Staff for President Obama. Like his brother, Ezekiel is a vowed liberal that spouses universal health care and the need for collectivism and a strong central government. His background of professional parents active in the community in liberal causes framed their ideology. There is no questioning his integrity and/or his intellect. I also came from a highly trained professional family that ingrained in me the idea of our duty to help the downtrodden. What differentiates me from Dr. Emanuel is that I was also taught the importance of free will, and the idea that all of us, as God’s children, were different, some with more and others with less but all had the same worth. I, since young, rejected the idea that because I might be more educated or even smarter, this advantage gave me the right, or the duty, to dictate to others what I thought was best for them. Helping others achieve what they want rejects the elitist liberal ideology of telling people what they should desire. The only way to be truly free is to be totally responsible with your life, because true peace of mind comes with the effort not the achievement. I disagree with both Emanuel’s that health care is a right. Health, like feeding and seeking shelter are basic personal duties and the only right given to us is the opportunity to seek. As well, it is a personal duty and responsibility to help the ones unable to help themselves, but by personal sacrifice and sharing, not by delegating it to a collective. The ACA is in reality a two tier system. The first group will be insured by making Medicaid, a state fee for service program available to more recipients. This program, already bloated and delivering poor to average care, will only become more costly and its quality decrease even more. The second tier designed for the poorly insured, or persons that were unable to purchase insurance because of preexisting condition was made with an unholy partnership with the insurance industry. Everyone in this country has health needs met. Not everyone has health insurance. This is an important distinction that is the first fallacy repeated by those that want to control the financial aspect of health care. In Obamacare, the taxpayer will guarantee the private health industry profits by forcing young healthy persons to purchase coverage even if they do not desire it or pay a penalty, called tax. It also forces insured individuals and businesses to purchase from several plans with coverage that they might not need and/or higher prices and deductibles. Even if this assumption is not realized, as it looks likely, the companies would be compensated by the government. A panel of experts will determine what is offered and what constitutes appropriate treatment and just compensation for services. This panel has been inappropriately called death, but as they will have to impose rationing, some will necessarily not receive every treatment available. In 2009, Dr. Emanuel wrote an interesting though controversial article expanding on the conflict that all healthcare givers have, how to better utilize limited resources in order to help the majority of people. It is a philosophical and societal dilemma that will have, sooner or later, to be addressed. In our affluent society we desire everyone to benefit with the vast technical and pharmacological advances that we have. We tend to ignore the huge costs of these benefits. As we want our cake and eat it too, there are not enough funds for everything or everyone. I also wrestled with this dilemma only differing with Emanuel that it was society, not government, that had to choose which way to go. In another interesting proposal he elaborated a plan to give everyone a health voucher (UHV) in lieu of private or public insurance. In that writing Emanuel makes clear that, as I, he thinks third party payers are part of the problem not the solution. Most of our health delivery system works, much can be improved. Rational plans are available and have been proposed. It is time that sensible people get together and improve, not radically change what we have. We should start by terminating the ACA and starting over with a consensus of both interests, professional and political.