Obama's doctor puts a price on your health

The only programs that Barack Obama refuses to spend money on are those that are wildly successful.

"As the Obama administration slowly unveils its global AIDS plan, the drive to put more people on drugs is being scaled back as emphasis is shifted to prevention and to diseases that cost less to fight, including pneumonia, diarrhea, malaria and fatal birth complications."

AIDS advocates complained bitterly that they had been betrayed and that the Bush administration’s best legacy was being gutted — and they blame a doctor and budget adviser who is also the brother of the White House chief of staff, Rahm Emanuel.

“I’m holding my nose as I say this, but I miss George W. Bush,” said Gregg Gonsalves, a long-time AIDS campaigner. “On AIDS, he really stepped up. He did a tremendous thing. Now, to have this happen under Obama is really depressing.”

Bush's foreign aid program to combat AIDS has helped Africans immeasurably and bought America much goodwill throughout their impoverished continent. And yet Obama, usually a profligate spender, is cutting money for the drugs relied upon by countless Africans. Why? The answer lies with the aforementioned Ezekiel Emanuel, a radical doctor and brother of Obama's White House Chief of Staff, Rahm Emanuel, who has the president's ear on medical issues.

Ezekiel J. Emanuel

Emanuel is a bioethicist whose approach to health care is entirely empirical and statistics-based. Right now, the generally accepted premise in America is that doctors do whatever it takes to treat a patient, regardless of the cost. Emanuel wants to change all that. He has argued we need to "redesign the health-care delivery system" because "we have a lot of unnecessary care." He has blasted the idea that medical spending -- done to keep people alive and healthy -- is in any way different from other products, writing: "Increasingly, health care needs to be measured by the same metrics as other goods and services -- cost, quality, benefits, and value. It can no longer claim to be treated differently from other social goods". In other words, health care spending is just like auto care spending or buying a new appliance. And lest anyone think the medical slashing he wants is too superficial, he has said, "Vague promises of savings from cost cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for slow and public relations than for true change."

Emanuel's rationing -- costs based not needs based

Tellingly, Emanuel works under budget director Peter Orszag and not for the Department of Health and Human Services. For him, medicine is about costs and not about care.

Its an idea taking root in Barack Obama's White House. Obama's health care legislation contains draconian Medicare cuts on the assumption that some of that spending simply isn't necessary. His bill establishes a health care task force that determines how medical procedures can be funded. His task force recently recommended that funding for mammograms, key to detecting and preventing breast cancer, be slashed in the name of cost-effectiveness. It is estimated that this change would cause the deaths of 47,000 women. The White House hastily distanced itself from the finding, but it fits perfectly with Emanuel's philosophy.

Some have portrayed Emanuel as a modern Dr. Mengele and accused him of wanting to set up death panels. (This isn't entirely fair. Emanuel has opposed euthanasia for his entire career and has never directly discussed the idea of a death panel.) But he did write a paper with the euthanasia-obsessed Dr. Margaret Battin for the New England Journal of Medicine in which he discussed the potential cost savings of allowing physician-assisted suicide. The idea behind their study was, as Emanuel chillingly put it, "Clearly, the more life foregone, the greater the projected savings," although the paper did conclude that any savings from legalizing euthanasia would be minimal.

So another of the gifted Emanuel boys is affecting White House policy. As Ezekiel is officially a special assistant to Peter Orszag, maybe it's time to start calling him the Rationing Czar.