Complete Lives & Obama's Plans for Your Healthcare


When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.

The above statement was uttered by Ezekiel Emanuel, brother of President Obama’s Chief of Staff, Rahm Emanuel. He is also the chief healthcare policy adviser to the President. This quote is regarding the Complete Lives System, which Emanuel has commented on extensively.

While the Obama administration and other leading proponents of government-run healthcare have been busy poo-pooing opponents’ claims about end-of-life decisions being made for the elderly under such a system, Emanuel has been making other statements such as the following…

Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old woman is intuitively worse than that of a 2-month-old girl, even though the baby has had less life. The 20-year-old has a much more developed personality than the infant, and has drawn upon the investment of others to begin as-yet-unfulfilled projects…. Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments…. It is terrible when an infant dies, but worse, most people think, when a three-year-old child dies, and worse still when an adolescent does.

He goes further regarding this issue of who deserves care in regards to the age of the patient…

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.  Treating 65-year-olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.

The more I hear about the administration’s plans for healthcare, the more alarmed I am.  The President is not telling us the truth.

All this can be read straight from the source, Emanuel’s article titled “Principles for allocation of scarce medical interventions“.

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12 Responses

  1. […] Principles For Allocation Of Scarce Medical Interventions The Lancet January 31, 2009 […]

  2. Thanks for the link to The Lancet article! I’ve put it on my blog.

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  4. You don’t explain why these are scary, wicked, or vile things to say or think. I am left with the notion that you 1) you think that the death of a 20 year old is better or equal to that of an infant. I’m also left with the notion that 2) you are unaware that in terms of things like organ transplants the private sector already considers things like age, recreational and professional activities and the like in their decision making process. Two patients equal in all respects but age, a young adult waiting for a liver is going to get it before an elderly patient.

    Certainly there is a level where “all life is equal” but we don’t get the luxury of allocating resources (publicly or privately) by that axiom. It is an unfortunate reality that in a world of limited resources choices need to be made and when they are made there should be sound reasoning behind it.

    You offer no arguments here and I’m left what you think is wrong with Emanuel’s argument and what alternative system you’d propose.

    • The comments by Emanuel are more generalized and not confined just to things like organ transplants and, yes, I am familiar that a young adult probably receives priority over an elderly patient. However, having the government deciding that kind of thing as it relates to the current healthcare debate doesn’t instill a whole lot of trust in me.

      I don’t understand your point #1…The death of a 20-year old is not better or less than that of an infant.

      The whole “what alternative system would you propose” argument is a diversion…I’m not smart enough to devise an alternative system and that’s not the purpose of the article. The purpose of the article was to point out that Obama’s advisers are discussing things like this (that, in and of itself is not wrong) when the Obama administration and some in the press seem to think anyone who brings up that kind of thing is kooky and that no one is really considering anything like this, etc., etc.

      Emanuel was also saying that the death of a 20-year old was “intuitively worse” than that of an infant. Where is he coming up with that idea? That, for me, is enough to question who and what the President is listening to.

  5. If you had read the article you link to, and I assume you did, Emanuel himself gives you four criteria sets to judge, the Complete Lives proposal and three others…The United Network for Organ sharing plan and two more recent additions to the dialogue that have been proposed as its replacements.

    You say that asking for your proposal is a diversion, but it isn’t, but claiming that it is is a crafty diversion of your own.

    You state that the purpose of your article was to “point out that Obama’s advisers are discussing things like this,” but if that was true and your intention was totally neutral you wouldn’t have said you were “alarmed.” Your intention is to spread alarm that the conversation is taking place and not over its quality or content. Your objective is to imply a critique of Emanuel’s process. What you have asked of your readers is for them to, like you, be alarmed at something they don’t know anything about…that you admit you don’t know anything about…and to not question anything about it but to just accept that the quotes you share are somehow prima facie scary. They are not.

    It’s not alarming that people are discussing things like this. It’s a good thing. And if you’d read the article–again–I’m assuming you did–then you must note that throughout it Emanuel evinces a strong pull toward a moral and religious right and respect for life , i.e. not just saving young people, but also saving the most lives…and doing so through the most objective means possible Money, looks, entertainment and use-value do not come into play as much as in the current system. Complete lives, even by the standards of most people who are critiquing the fabled Death Panels, is an improvement over what we already have.

    Emanuel is a bioethcist by trade. His job, like other bioethicists at universities and hospitals and law firms all over the country–the world, even–is to sit around and think about these issues and write about them. It’s not at all alarming that he did so. Nor are his conclusions or his methodology alarming. Nor are they wildly off-base. They are, in fact, quite sensible and morally weighted. None of his ethical judgments are controversial nor is his Complete Lives model, especially when seen in contrast to 1) the system we have right now and 2) the other two proposals (which both rely on quantifying the unquantifiable).

    So, if you want to critique his thinking, then you need to critique his thinking. If you merely want to alarm others that people are thinking about the proper way to allocate scarce medical resources, then you should be prepared to tell us what we should be alarmed about and part of that would be telling us why it’s alarming that people are even thinking about the issue.

    Moreover, you need to be aware and should communicate to your audience that we already have a system in place that governs the process that Emanuel was talking about and where was your alarm when it was being created?

    No, I think the truth is that Emanuel, because he wrote honestly about the process by which doctors choose to let some live and others die, opens him up to fear-based criticism like this one but it can only stand as criticism if we fail to admit that there is such a system already in place and more importantly no conceivable way out of having to make such choices.

    And asking you what you would prefer Emanuel to say instead is not a distraction, it is central to what makes Emanuel open to any criticism at all. If he offers the best solution to a difficult problem I see no reason not to adopt it. If you see a reason not to adopt what he’s saying, you should tell us what it is.

    • I never said my intention was totally neutral. Far from it.

      Also, I stated in my last reply that, in and of itself, it’s not a bad thing to discuss things like this. The intention was to point out that, yes, these things are being discussed by close advisers to the President, when it seems like they would have you believe that it’s not. I’m sure it’s a hot potato that they don’t really want to bring up in public. Regardless, just because my main purpose was to bring this to light doesn’t mean that I don’t express opinions about it.

      As far as what I should and shouldn’t do, that isn’t really up to you to tell me. What I should do is strive to provide the facts and my opinion on them as I see it. That’s what I should do. If you don’t think my opinion or the facts as I present them are correct, that’s fine.

  6. In terms of your neutrality, you didn’t claim anything one way or the other, but you implied it when you said: “The purpose of the article was to point out that Obama’s advisers are discussing things like this.” That sentence lays claim to “educate the public” as not just a primary, but a sole goal since you do not then go on to say, “And make an opinion on it.” But that’s neither here nor there.

    The real problem is that you’ve just set up a straw man. Emanuel himself, as I linked to in the comment section of my own blog in response to a comment you made there, is freely giving interviews on this very topic. The article you linked is published in one of the top two most popular and famous medical journals in the business. Obama has been talking about the issue to the media and so has Sebelius and other key member of his staff.

    So, if you’re point was to merely mention, that yes, people whose job it is to talk about sensitive medical issues are talking about them, then you did it. The problem is that no one has ever denied they’re talking about them. What they deny is that there is a “Death Panel” run by the government that will kill you if fail to meet some eugenics-based criteria. And they are right to deny that because there is no such panel and the article you link to doesn’t get anywhere near proving that such death panels exist.

    And moreover, you said you were “alarmed” by these quotes and you have still yet to say what makes them alarming. Certainly you are not obligated to tell anybody why you are alarmed, but I think that are repeated refusal to do so is because you know that there is nothing to be alarmed about in this article. That’s not to say there might not be something in the world related to this that is alarming, but it isn’t here. So don’t take offense that I’ve told you that you “should” do it. Think of it as a suggestion. I’ll phrase it as a less offensive conditional: If you want me to share in your alarm you should tell me what I am supposed to be alarmed about.

    • Sorry…Thought it was pretty evident from what I posted and I’ve already stated why I’m alarmed multiple times. No refusal here.

      To clarify…I’m alarmed because the Obama administration has claimed multiple times that nothing like this is on the table. However, it is on the table, whether they like to think it is or not. If they want to move to a single-payer system, something like this is a real possibility. If it doesn’t lower costs like they say it will (and who has any reason to trust what they say, regardless of party affiliation), rationing of healthcare is a real possibility and the logical end is people, bureaucrats most likely IMO, deciding who should receive care and who should not.

      Here’s an excerpt from another article…”That’s the reason people are so frightened and enraged about the proposed measure that would allow Medicare to pay for end-of-life counseling. If the government says it has to control health-care costs and then offers to pay doctors to give advice about hospice care, citizens are not delusional to conclude that the goal is to reduce end-of-life spending. It’s irresponsible for politicians, such as Sarah Palin, to claim — outlandishly and falsely — that there’s going to be some kind of “death panel” to decide when to pull the plug on Aunt Sylvia. But it’s understandable why people might associate the phrase “health-care reform” with limiting their choices during Aunt Sylvia’s final days.”

      http://davekellogg.wordpress.com/2009/08/11/healthcare-and-end-of-life-issues/

  7. 1. There is already healthcare rationing. Today insurance companies are doing the rationing tomorrow it may be the government. But whether its through access to certain doctors, certain procedures that arent’ covered, required referrals to specialists, or just being overpriced, there is rationing in already built into the current system.

    2. Obama is not denying that end of life counseling is being discussed. He’s denying that there Death Panels. End of life counseling is responsible thing to do. It not only insures that costs are considered and responsible decisions can be made but it also makes sure that final wishes are fulfilled including that wills are written. Millions of dollars…private dollars…are sucked up by the State because of wills that were never made.

    Obama has said over and over again, and the language of the bill (when it was still in there) reflected that end of life counseling is end of life counseling not termination of care. Moreover, since the private sector and private sector insurance will still be available, if anyone is concerned that end of life counseling will be designed to convince Aunt Sylvia to turn off the life support, then by golly, Get Aunt Sylvia on a private plan. But rest assured that private insurers don’t counsel you on end of life options, they cut off service. Period. The Obama plan was less, not more, stringent, in this regard.

    3. You love to appeal to “opinion” in matters of fact. We can determine from the language of the bill who would be in charge of these decisions. This isn’t a matter of opinion. Just read the language of the bill. The decisions will be determined by insurers, doctors, and patients. Moreover, insurers are already involved in the process under the private system. And an employee of an insurance agency is no less a “bureaucrat” than a government employee. “Bureaucrat” is a scary term to toss around but all it means is “an employee of a multi-departmental organization.” There are already “bureaucrats” making healthcare decision for you. The difference is that one cuts of care early enough to keep a steady profit margin and the other one wouldn’t.

    At any rate, I appreciate your good faith effort to enter into this rant-fest with this dogmatic lefty. I would encourage you though to remember as you get worked up about a public plan, that we have a moribund private plan already that costs more and more money every year with less and less to show for it, while other countries have already proven that a public and private plan can co-exist for less money and equal or better health results. Rather than concentrate on make-believe death panels we should be discussing the real pros and cons of 1) the status quo and 2) the actual proposals on the floor.

    • Gaaaa!!!…I had a decent response typed up to this and lost the whole thing. It’s been a crap day and I don’t feel like burning off more brain cells, so here’s the Cliff’s Notes version…

      1. Agreed. As much as I distrust the insurance companies to do it, I trust the government even less. Lesser of two evils deal here.

      2. I’ll have to concede this point…I’ve been following this pretty closely and I haven’t heard much said on it by the administration but I don’t have the proof to back it up at this point.

      3. As much as we’ve seen the government over the last few years purposely hiding things from the public and rushing bills through at the last minute before even any of the legislators had even read the bill, I can’t say that I trust them to live up to what the bill actually says. If you want to trust them, that’s fine but I think you’re naive if you do. Anyone who trusts in government is liable to be severely disappointed. I learned my lesson when Repulican politicians sold out conservatives when they were the majority and I think you’re going to experience the same thing, if you haven’t already, with the Democrats in control.

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