Medicare, Dr. Mengele, and You

So, the multimillionaire architect of Obamacare went on a luxury trek up Mount Kilimanjaro recently with two of his trust-fund nephews. I am guessing that much to his dismay, he got a bit winded moving through all those exotic ecosystems. His 57-year-old body, so buff, so pampered, must have protested with a few creaks and groans. His middle-aged elite lungs probably gave out a few embarrassing wheezes. His technocratic brain, deprived of oxygen at the freezing summit, sent him a Eureka moment message:

If Ezekiel Emanuel, M.D. can't live forever in a young body, then neither should you. If Ezekiel Emanuel's attack of male menopause freaked him out, then you should freak out too. If Ezekiel Emanuel fears a decline, then the rest of the aging population should just quietly disappear, even before they get sick or senile.

 Ezekiel Emanuel has decided that if he can't function like a rich jerk forever, he would just as soon die before he reaches 75. Therefore, nobody else should live past 75 either. Once you stop being entertaining or remunerative, you should just check the hell out.

Ezekiel Emanuel seems to hate old people, believing that they are eyesores and albatrosses around the necks of High Society. This is a Democrat, mind you: a highly influential member of Obama's inner circle of health policy advisers. And you thought Republicans were terrifying fascists? It just goes to show how severely right-wing, nihilist, cruel and cynical this country's ruling class has become. The culling of the herd is nigh. The time has come for Exceptional America to go all nomadic, leaving the old folks behind, so that only the fittest may survive.

The Manifesto of Death to Grandma was published in The Atlantic, which hilariously included an oversize photo of a goofily grinning Emanuel to accompany his Social Darwinism screed. The subliminal message of the photo is that the passive-aggressive dying experience will be fun for the entire family. Don't go away by suicide, assisted or otherwise: just go away. Play a game of Russian Roulette by daring to skip the colonoscopy and the mammogram... and simply fade away through attrition. Your heirs will thank you. The plutocrats of Wall Street will definitely thank you.

Let Natural Selection take its course.... especially if you're dependent on Medicare and Social Security for your continued survival. Let a benevolent smirking rich guy like Zeke be your guide:

But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

Full disclosure: I am a physically disabled person, yet somehow I do not feel as deprived as Emanuel thinks I should. Until I read his article, I'd had no idea that my being in a wheelchair has robbed me of my creativity, and even worse, that my continued existence in a less-than-perfect body will rob my children of any pleasant memories of me for the rest of their lives. My living will stipulates only the physical and mental conditions for ending extraordinary intervention, not an arbitrary age for doing so. Moreover, since I still have quite a ways to go before my own date with Diamond Jubilee Destiny, does that mean I'm still safe, despite my "faltering" state?

 But I digress. Let Dr. Death explain further by projecting his own will on everybody:

  By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations. Dying at 75 will not be a tragedy. Indeed, I plan to have my memorial service before I die. And I don’t want any crying or wailing, but a warm gathering filled with fun reminiscences, stories of my awkwardness, and celebrations of a good life. After I die, my survivors can have their own memorial service if they want—that is not my business.

It's all about Ezekiel Emanuel. If he can't hear the smarmy accolades at his own funeral, then why even have one? (Speaking of limitations, he already has a major one, one that he was probably born with: a congenital absence of the empathy trait. He is, after all, the brother of Rahm "Mayor One Percent" Emanuel.)

I am talking about how long I want to live and the kind and amount of health care I will consent to after 75. Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal.

I reject this aspiration. I think this manic desperation to endlessly extend life is misguided and potentially destructive. For many reasons, 75 is a pretty good age to aim to stop.

I think oxygen deprivation at the summit of Kilimanjaro must have either permanently impaired Emanuel's brain function, or his death-wish may even represent a form of late onset manic-depressive psychosis affecting mainly elites. According to his logic, Ruth Bader Ginsburg should never have been (successfully) treated for her pancreatic cancer. If Hillary Clinton is elected president, she should forgo physical exams midway through her first term, lest Chelsea suffer needlessly in the event that a health problem in Mom is discovered and treated. Albert Einstein should have skipped his annual check-ups, because once he discovered the Theory of Relativity, he was surplus flesh. Ditto for E.M. Forster, who stopped writing 60 years before his death at 91. How pathetic is that? And forget Harper Lee: her artificial leg is a complete and utter waste of Medicare dollars, given that she was a one-hit wonder: Ezekiel doesn't think it'd be a sin to kill that bird.

He finally cuts to the chase after cherry-picking through data that purports to show that while Americans live longer, they live longer most miserably. This is  also all about his Dad, who simply refused to die in the best shape of his life:

My father illustrates the situation well. About a decade ago, just shy of his 77th birthday, he began having pain in his abdomen. Like every good doctor, he kept denying that it was anything important. But after three weeks with no improvement, he was persuaded to see his physician. He had in fact had a heart attack, which led to a cardiac catheterization and ultimately a bypass. Since then, he has not been the same. Once the prototype of a hyperactive Emanuel, suddenly his walking, his talking, his humor got slower. Today he can swim, read the newspaper, needle his kids on the phone, and still live with my mother in their own house. But everything seems sluggish. Although he didn’t die from the heart attack, no one would say he is living a vibrant life. When he discussed it with me, my father said, “I have slowed down tremendously. That is a fact. I no longer make rounds at the hospital or teach.” Despite this, he also said he was happy.

Then Daddy must be demented, or at least getting close. As Ezekiel hypomanically continues:

Even if we aren’t demented, our mental functioning deteriorates as we grow older. Age-associated declines in mental-processing speed, working and long-term memory, and problem-solving are well established. Conversely, distractibility increases. We cannot focus and stay with a project as well as we could when we were young. As we move slower with age, we also think slower.

It is not just mental slowing. We literally lose our creativity. About a decade ago, I began working with a prominent health economist who was about to turn 80. Our collaboration was incredibly productive. We published numerous papers that influenced the evolving debates around health-care reform. My colleague is brilliant and continues to be a major contributor, and he celebrated his 90th birthday this year. But he is an outlier—a very rare individual.

I don't know about that. Everywhere you look, there are amazingly brilliant octogenarians and nonagenarians who still dare to function at the peak of their abilities. Several of them contribute to this blog. (see 91-year-old Pearl's scathing remarks in my comments section.) And there is a New York Times commenter named Larry Eisenberg who can produce a limerick on any topic in the space of a few minutes. He is 94. Creative older people are "outliers" only in Emanuel's closed, elitist mind.

Here's a section sure to strike dread into the heart of every gerontologist:

At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless. And that good reason is not “It will prolong your life.” I will stop getting any regular preventive tests, screenings, or interventions. I will accept only palliative—not curative—treatments if I am suffering pain or other disability.

How much you want to bet that Zekey-Boy will be screaming for extraordinary measures at the age of 98, ripping the oxygen-mask off the 75-year-old down the hall just to get a last sucking selfish mouthful of life?

He finally gets to the real reason (besides his gerontophobic disgust at looking at Daddy) for his faux-altruism: America is in decline. For a civilized country, our mortality rates are nothing to brag about. Despite being the richest country (the most billionaires on the planet) we rank only 40th in life expectancy. This is not so much because of biology, but because of our cruel social policies and continuing high poverty rate. The plutocrats of Wall Street and the political hacks like Emanuel who serve them want their Grand Bargain of safety net cuts. They don't want even the smallest portion of the wealth that they've managed to siphon off for themselves to trickle back down to medical care for the old, disabled and indigent.

The Bowles-Simpson Catfood Commission went down in ignominy. The debt and deficit are no longer popular campaign themes. So what is an oligarch to do? For starters,  Doc Zeke has come to their rescue with his cheery article, keeping the macabre herd-culling conversation alive. 

What Emanuel has indulged himself in is just more poor-shaming and psychological elder abuse, albeit couched in the most liberal, caring, and sensible terms. Please don't take him to mean that he espouses the easy Ernest Hemingway suicide route out, because Emanuel (says he) is absolutely against that, along with euthanasia. He protests (too much, methinks) that he is no Dr. Kevorkian!  But do skip the flu shot voluntarily this year, old people. Your grandchildren and the Medicare trust fund will be ever so grateful.

Did I mention that Dr. Zeke is director of the Bioethics Department of the budget-slashed National Institutes of Health? And they said that irony is dead.

     “The rich were dull and they drank too much, or they played too much backgammon. They were dull and they were repetitious. He remembered poor Scott Fitzgerald and his romantic awe of them and how he had started a story once that began, ‘The very rich are different from you and me.’ And how some one had said to Scott, Yes, they have more money. But that was not humorous to Scott. He thought they were a special glamorous race and when he found they weren't it wrecked him as much as any other thing that wrecked him.” -- Ernest Hemingway, from the original version of "The Snows of Kilimanjaro".