Ezechiel J. Emanuel, MD PhD; America's Ethicist and Health Czar.

Die wunderkindern Emanuels von Chicago! One of the sons of Dr. Emanuel of Chicago is also a medical doctor and a Chicagoan: Ezechiel J. Emanuel, MD, PhD. I have posted a recent photograph and some complimentary biographical comments courtesy of a Chicago newspaper columnist. And I post parts of a recent paper Dr. Emanuel published in JAMA, as below:

WASHINGTON--While the Obama White House is searching for a replacement for health czar Tom Daschle, policy work on health care reform--a priority for the administration--Is ongoing with one key advisor especially well connected.
The brother of White House Chief of Staff Rahm Emanuel, Dr. Ezekiel J. Emanuel, a noted bioethicist, is advising the Obama administration on health care reform.
Dr. Emanuel is the Chair of the Department of Bioethics at The Clinical Center of the National Institutes of Health and a breast oncologist.
Dr. Emanuel is a special advisor to the director of the White House Office of Management and Budget for health policy. He told me he is "working on (the) health care reform effort." He is "detailed" to the OMB spot and is still officially an employee of the NIH.
Until last August, Dr. Emanuel was commuting between his Chicago home in West Rogers Park and Washington. He moved to Washington last August after his youngest daughter graduated from Northside College Prep at Bryn Mawr and Kedzie.
One of three wildly successful Emanuel brothers (Ari is a Hollywood superagent) Dr. Emanuel also advised the Clinton White House on health care issues. He is a graduate of Amherst College, receiving his masters of science from Oxford University in Biochemistry. His M.D. is from Harvard Medical School. He holds a Ph.D. in political philosophy from Harvard University. In addition, in 1987-88, he was a fellow in the Program in Ethics and the Professions at the Kennedy School of Government at Harvard.
According to his NIH bio, Dr. Emanuel is "widely published on the ethics of clinical research, advance care directives, end-of-life issues, euthanasia, the ethics of managed care, and the physician-patient relationship, Dr. Emanuel's articles have appeared in The New England Journal of Medicine, Lancet, Journal of American Medical Association, and many other medical and ethics journals. His book, The Ends of Human Life, has been widely praised and received the Rosenhaupt Memorial Book Award by the Woodrow Wilson Foundation.
"Dr. Emanuel served on the ethics section of former President Clinton's Health Task Force, the National Bioethics Advisory Commission, and the International Advisory Board on Bioethics of the Pan American Health Organization. He has been a visiting professor at the University of Pittsburgh School of Medicine, UCLA, and Brin Professor at Johns Hopkins Medical School."

The Cost-Coverage Trade-off
"It's Health Care Costs, Stupid" (His words, not mine; my italics.) Ezekiel J. Emanuel, MD, PhD
JAMA. 2008;299(8):947-949

Figure. Cost-Coverage Trade-off in the United States by State in 2005
Each state's uninsured rate for 2005 for the population younger than 65 years (because Americans aged 65 years and older are nearly all covered by Medicare) vs family health insurance premiums as a percentage of median state household income to attain a determination of "affordability of health coverage." Controlling for median state income, proportion of minorities, part-time workers, and women in the workforce shows that for every 10% increase in the average family health insurance premium, the rate of the uninsured younger than 65 years increases by 0.55%. The points for Iowa and Florida illustrate how rates can differ markedly between states. The curve was fit using the least squares method.

Dr. Emanuel is the brother of Ari in Hollywood and Rahm in Washington. He is the new Health Czar replacing former senator Tom Daschle. Too numerous articles to cite, much less to quote. The above article will give a little of the flavor, though. He is arrogant, intelligent, outspoken, and ambitious. He is a genuine elite in medicine. And he has pointed out repeatedly that a life is not a life is not a life (as opposed to Gertrude Stein and roses). He puts actual emanuelized values on a human life. Not as a philosopher, either. He is writing as health care czar, bioethicist-in-chief for the Obama administration, and cost cutting theorist in charge. Read some of his writings on the matter of valuation of a human life and cutting the cost of medical care in America and you will wonder how exactly he derived his ethics. I submit to you, dear readers, the oath of Hippocrates, the oath of Maimonides, and the Jewish version of the Ten Commandments. I also submit that there is nothing in atheism to use as a system of ethics, nothing at all. (Moral atheists are borrowing parts of a parent culture to construct their own morality--Jews/Jewish morality; Christians/Christian morality; Muslims/Muslim morality, take the parent culture, extract some elements of its moral code, and arrive at your own atheist morality.) When he puts grandmother on the ice flow in order to free up monies for children's vaccinations he is devaluing grandmother's life. Check for yourself in the Big Three sources for physician ethics. See how many tenets Dr. Ezechiel Emanuel violates.


Obama lies; grandma dies; Ezechiels advise.

The Ten Commandments courtesy of : http://www.holidays.net/shavuot/ten.htm.


On the third day of the Hebrew month of Sivan, Moses was commanded by G-d to prepare the Jewish people for G-d's descent and visit. The Israelites washed and purified their clothes and their bodies. Three days later, on the sixth day of Sivan, the people were awaken by thunder and lightning. Thick, dark clouds hung over the mountain. The sounds of the Shofar, the ram's horn, were heard echoing across the desert. The earth began to tremble and shake. Then the Israelites heard a voice, G-d's voice, as he spoke to them from out of the clouds.
And G-d gave them his Ten Commandments*
*(Please note: Because Shavuot is a Jewish celebration we are presenting the Jewish interpretation of the Ten Commandments. Different religions have different versions of the commandments)
"I am the Lord your G-d, Who has taken you out of the land of Egypt, from the house of slavery"
"You shall have no other gods but me"
"You shall not take the name of your Lord in vain"
"You shall remember and keep the Sabbath day holy"
"Honor your father and mother"
"You shall not murder"
"You shall not commit adultery"
"You shall not steal"
"You shall not bear false witness against your neighbor"
"You shall not covet your neighbor's goods. You shall not covet your neighbour's house. You shall not covet your neighbour's wife, nor his manservant, nor his maidservant, nor his bull, nor his donkey, nor anything that is your neighbour's."
*(Please note: Because Shavuot is a Jewish celebration we are presenting the Jewish interpretation of the Ten Commandments. Different religions have different versions of the commandments)
Moses went up the mountain and returned with the Tablets that contained the Ten Commandments.

The Oath of Maimonides courtesy of www.fordham.edu/halsall/source/rambam-oath.html .

"The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
May I never see in the patient anything but a fellow creature in pain.
Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling."

The Oath of Hippocrates courtesy of the National Library of Medicine.

The Hippocratic Oath is perhaps the most widely known of Greek medical texts. It requires a new physician to swear upon a number of healing gods that he will uphold a number of professional ethical standards. One of the best known prohibitions is, "to do no harm".

"I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract:


To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

In purity and according to divine law will I carry out my life and my art.

I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.

Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate."

(Translated by Michael North, National Library of Medicine, 2002.)


Italics are mine, DJH.

The arrogance of the wunderkindern Emanuels is irksome but one would not expect anyone to die of it. In the right circles it might impress people. But in America's Health Care under Obama this arrogance combined with Dr. Ezechiel J. Emanuel's peculiar post Judeo-Christian ethics will propel an ugly agenda in which the lives of all Americans are not equal in value and in which none are sacred. Our new Health Czar is a true medical elite. But he is also one of the Chicago group of thugs and crooks who presently control our country. For now this cabal controls our destiny, too--at least until we wake up and show them all the exit door.

Wolves in sheep's clothing might bruise us in the Treasury Department or Education or Agriculture. They will kill us in Health Care Reform. Literally! A life is not a life is not a life. Write to your senator and representative to demand a better czar!

We the People need to budget.

Just as a ordinary citizens review the household expenses and income weekly or monthly as part of personal budgeting, we the people ought perhaps to review our republic's budgeting. After all, whose republic is it? And, if it is ours, do we trust our elected representatives to do it? Here goes:

GROSS DOMESTIC PRODUCT: SECOND QUARTER 2009 (SECOND ESTIMATE)
CORPORATE PROFITS: SECOND QUARTER 2009 (PRELIMINARY ESTIMATE)

(Please skim this part fast, get to the highlighted paragraph.)

Real gross domestic product -- the output of goods and services produced by labor and property
located in the United States -- decreased at an annual rate of 1.0 percent in the second quarter of 2009,
(that is, from the first quarter to the second quarter), according to the "second" estimate released by the
Bureau of Economic Analysis. In the first quarter, real GDP decreased 6.4 percent.

The GDP estimate released today is based on more complete source data than were available for
the "advance" estimate issued last month. In the advance estimate, the decrease in real GDP was also
1.0 percent (see "Revisions" on page 3).

The decrease in real GDP in the second quarter primarily reflected negative contributions from
private inventory investment, nonresidential fixed investment, personal consumption expenditures
(PCE), residential fixed investment, and exports that were partly offset by positive contributions from
federal government spending and state and local government spending. Imports, which are a subtraction
in the calculation of GDP, decreased.

The much smaller decrease in real GDP in the second quarter than in the first primarily reflected
much smaller decreases in nonresidential fixed investment and in exports, an upturn in federal
government spending, smaller decreases in private inventory investment and residential fixed
investment, and an upturn in state and local government spending that were partly offset by a much
smaller decrease in imports and a downturn in PCE.

Motor vehicle output added 0.20 percentage point to the second-quarter change in real GDP after
subtracting 1.69 percentage points from the first-quarter change. Final sales of computers subtracted
0.05 percentage point from the second-quarter change in real GDP after adding 0.06 percentage point to
the first-quarter change.

________________________
FOOTNOTE.--Quarterly estimates are expressed at seasonally adjusted annual rates, unless otherwise
specified. Quarter-to-quarter dollar changes are differences between these published estimates.
Percent changes are calculated from unrounded data and are annualized. “Real” estimates are in
chained (2005) dollars. Price indexes are chain-type measures.

This news release is available on BEA’s Web site along with the Technical Note and Highlights related
to this release.
________________________

The price index for gross domestic purchases, which measures prices paid by U.S. residents,
increased 0.5 percent in the second quarter, 0.2 percentage point less than in the advance estimate; this
index decreased 1.4 percent in the first quarter. Excluding food and energy prices, the price index for
gross domestic purchases increased 0.8 percent in the second quarter, compared with an increase of 0.2
percent in the first.

Real personal consumption expenditures decreased 1.0 percent in the second quarter, in contrast
to an increase of 0.6 percent in the first. Real nonresidential fixed investment decreased 10.9 percent,
compared with a decrease of 39.2 percent. Nonresidential structures decreased 15.1 percent, compared
with a decrease of 43.6 percent. Equipment and software decreased 8.4 percent, compared with a
decrease of 36.4 percent. Real residential fixed investment decreased 22.8 percent, compared with a
decrease of 38.2 percent.

Real exports of goods and services decreased 5.0 percent in the second quarter, compared with a
decrease of 29.9 percent in the first. Real imports of goods and services decreased 15.1 percent,
compared with a decrease of 36.4 percent.

Real federal government consumption expenditures and gross investment increased 11.0 percent
in the second quarter, in contrast to a decrease of 4.3 percent in the first. National defense increased
13.3 percent, in contrast to a decrease of 5.1 percent. Non defense increased 6.2 percent, in contrast to a
decrease of 2.5 percent. Real state and local government consumption expenditures and gross
investment increased 3.6 percent, in contrast to a decrease of 1.5 percent.

The change in real private inventories subtracted 1.39 percentage points from the second-quarter
change in real GDP, after subtracting 2.36 percentage points from the first-quarter change. Private
businesses decreased inventories $159.2 billion in the second quarter, following decreases of $113.9
billion in the first and $37.4 billion in the fourth.

Real final sales of domestic product -- GDP less change in private inventories -- increased 0.4
percent in the second quarter, in contrast to a decrease of 4.1 percent in the first.


Gross domestic purchases

Real gross domestic purchases -- purchases by U.S. residents of goods and services wherever
produced -- decreased 2.5 percent in the second quarter, compared with a decrease of 8.6 percent in the
first.


Gross national product

Real gross national product -- the goods and services produced by the labor and property
supplied by U.S. residents -- decreased 0.8 percent in the second quarter, compared with a decrease of
6.6 percent in the first. GNP includes, and GDP excludes, net receipts of income from the rest of the
world, which increased $6.4 billion in the second quarter after decreasing $6.1 billion in the first; in the
second quarter, receipts decreased $16.8 billion, and payments decreased $23.2 billion.


(You have arrived:)

Current-dollar GDP:

Current-dollar GDP -- the market value of the nation's output of goods and services -- decreased
1.0 percent, or $34.7 billion, in the second quarter to a level of $14,143.3 billion. In the first quarter,
current-dollar GDP decreased 4.6 percent, or $169.3 billion.


America is a rich country with a huge GDP. But let's look at costs, obligations present and future, and ways to return to fiscal balance. Let's start with Medicare, and Medicaid, costs of which are are projected to grow robustly at the very same time as our economy is projected to grow slowly.

Thoughtful, skilled, and sober experts predict that our unemployment will remain high and inflation will return with vigor at the same time that entitlement spending balloons. The bright light at the end of our (present) tunnel is not daylight. One does not need a degree in economics to see that our country is on a collision course.

Promises have been made to citizens and money has been collected from them, so there is Mandatory Spending. Accurate estimations of these costs can be made into the future. Actuarial science and standard accounting principles leave little room for error here.

Large deficits loom over the entitlements. Was the money never put aside? Did the Great Society #1 raid the lock box? Is it right to have called it a "lock box?" What will Great Society #2 do with the money citizens give back to their government, in good faith, for their health and comfort in old age? Is money being transferred from one segment of the society to another? Will "means testing" eventually disenfranchise the very segment of the society that put the money into Medicare, Medicaid, and Social Security? "From each according to his ability, to each according to his need." Except that in this new Obama marxism, if you both put in and need, you will not receive. This goes beyond communism and will be the gift that keeps on giving.



President Obama stated in May 2009: "But we know that our families, our economy, and our nation itself will not succeed in the 21st century if we continue to be held down by the weight of rapidly rising health care costs and a broken health care system...Our businesses will not be able to compete; our families will not be able to save or spend; our budgets will remain unsustainable unless we get health care costs under control."

The present value of unfunded obligations under all parts of Medicare during FY 2007 is approximately $34.1 trillion. In other words, this amount would have to be set aside today such that the principal and interest would cover the shortfall over the next 75 years.[15]

We have an unfunded obligation of 34.1 T, as above, but our annual federal government intake is as below:

This does not look workable. We need to stop our dreaming. Obama needs to do the job we elected him for--put our house in order after the ruination of George W. Bush's terms. (No, he did not have to spend our money on "regime change" and "nation building" in the Middle East.) We the people elected Obama to change the system, true enough. But change it to fiscally responsible, not from free enterprise capitalism (to Social Democrat Labor Unionist). Get on with the job, Mr. President. Balance our budget. Spread the pain and suffering, not spread the wealth. We're all out of wealth right now.

For starters, a budget for Health Care in America:

Inasmuch as our economy is 14 T/year and we are said to spend 15% on health care, we might say that we spend 2.1 T/year for our health care. Let's try an overly simplistic budget for Health Care using these numbers:

1.0 T/year for Medicare

1.0 T/year for Medicaid

Everyone who is older goes into Medicare.

All others go into Medicaid.

Now, we need to make Medicaid more appealing, so we put everyone not in Medicare in Medicaid. Everyone from our president on down is in Medicaid or Medicare. No special deal for unionists, legislators, members of the federal judiciary, members of the executive branch past or present, veterans, Indians, retired railroad workers, big CEO's, fat cats and skinny cats. Even visiting foreigners are in one or the other. I know this would spiff up tired, dowdy, unresponsive, under providing and under performing Medicaid overnight. Do you think Michelle Obama would accept Medicaid in its present form as insurance for her family? Few good doctors will accept Medicaid patients. (And fewer and fewer good doctors and clinics take Medicare patients.)

And we will need to make Health Care more efficient and cost effective across the board. I suggest we employ a version of the methodology used in the French health care system, where government writes the check but hospitals, clinics, doctors, and various other providers of proven beneficial health care compete for the privilege of caring for the citizens. Pay for curative interventions and important palliative maneuvers. Let the people pay for unproved nostrums out of their own pocket. Do not expect better preventive care to save money--it won't. But if it can be proven to be effective, employ it anyway. Improve the methodology of Evidence Based Medicine, and mounting large scale randomized and prospective studies to resolve clinical questions so we have more answers than questions in medicine. Quality, efficacy, efficiency should be the standard. Eliminate the foolish waste of defensive medicine by reworking the system of medical malpractice while still keeping our ancient law of torts.

Health Care is not the only budget buster to be addressed. I believe we need to do some other things, too. We need to stop dreaming of Great Society #2--no money for that right now. We should repeal some of the promises made in Great Society #1 while we are at it--same reason. We must scale back overseas imperial adventures. (Great Britain ceased to be Great because of the Boer War, which was her Iraq, and WWI, which some say she started.) We must scale back our military presence overseas, even though this will leave Japan, Germany, and South Korea unprotected. (Unprotected from whom? Let them buy military paraphernalia from our manufacturers so they defend themselves.) We have to curtail spending on military items no longer of any use--or redirect the money to items likely to serve our purposes better now and in the future. We need to implement the same changes in education and state and federal government that were made by companies in the private sector, and by the same means: eliminate layers and layers of managerial workforce by fully utilizing the power of the computer. We need to modernize or tax code and the methodology of tax collection.

America balanced its budget under President Clinton. Let's ask him to select a commission to balance the federal budget. I think he is likely to be fair and not balance our budget on the backs of those who do not vote blue. Nor would he unfairly disenfranchise the old, the poor, or the sick. We are a rich country with a huge Gross Domestic Product. We can balance our budget. We will need to grow up politically, and heed St. Paul's advice in 31 Corinthians 13: 11 "When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things." King James Version, my italics. Amen.

President Obama, get on with the job for which you were chosen. Put us back on the road to fiscal responsibility. Insist on the single payer system but add some of the French essence. Use your supremely skillful oratory to get us back to where we were under President Clinton. Spread the pain and suffering not the wealth. If you want your head on Mount Rushmore, you will need to lead (the people) not follow (your misguided, misinformed, and misplaced) advisers.

Thanks to www sources including the Government Accounting Office and Wikipedia for data displayed.