Neoliberal Bioethics: Just Die Already

 Ezekiel Emanuel, health policy adviser in the Obama administration, lists his current credentials as oncologist, bioethicist, and vice provost of the University of Pennsylvania.

His idea of ethics is writing a propaganda piece in The Atlantic which insinuates that Bernie Sanders's Medicare For All ("messy care") proposal is politically impossible, because Americans are like battered women trapped in a toxic relationship. Citing the results of recent push-style polling which conclude that the 70 percent of respondents who initially claim to be in favor of single payer health care suddenly change their minds when (falsely) told they'll lose benefits under a government-run system, Emanuel says the real enemies of single payer health care are not Republican think tanks and politicians, but the US citizenry. 

As much as Americans hate insurance companies in general, they want the right to have a love-hate relationship with their own insurer. During the battle over the Affordable Care Act, President Barack Obama promised, “If you like your plan, you can keep it.” When a handful of Americans lost their plans, the backlash was tremendous—even when the cancellations had nothing to do with the new law. The polling data today are clear: When Americans are told they might have to give up their current insurer, fewer than 40 percent support Medicare for all. That’s nowhere near enough to override the entrenched interests in health care.

Emanuel is so ethical that he doesn't stop at simply debunking the vicious Republican propaganda about socialized totalitarian medicine and death panels. He sets up a brand new straw man with which to gaslight his audience and attack Medicare For All. If we get sick and die because we are uninsured, he explains, it'll be our own damn fault for getting obliquely lied to by push-pollsters. We cannot blame our poor beleaguered congress critters for failing to pass a true universal guaranteed health care payment system. We can only blame ourselves and our neighbors who listen to nasty right-wing talking points and watch insurance industry-sponsored Harry and Louise-type TV commercials.

Needless to say, Emanuel's bioethics do not include informing people that true single payer is not only simple, but that coverage would be guaranteed and that private insurance would not only be rendered superfluous but people would end up with more money in their pockets by not paying premiums, co-pays and deductibles and their employers would save money and hopefully pass the savings on to their workers in the form of better pension plans as well as higher wages. He doesn't explain that the taxes to be collected would be much lower than the premiums charged by the insurance industry.

But to give him credit where it's due, Emanuel does nonchalantly and ethically inform readers toward the end of his piece that

Between Bernie Sanders and a buy-in are two more practical and politically appealing plans. One is Medicare for America, a proposal drafted by the Center for American Progress. (Full disclosure: I helped design it. I’ve also received speaking fees from groups representing insurers, hospitals, doctors, and employers.)

That little snippet is so inconsequential that he puts it in parentheses so you get the message that his grifting activities have nothing at all to do with his true concern for his gaslit audience.

Just as, if not more, important as guaranteed universal coverage from cradle to grave, Emanuel thus concludes, are the guaranteed and continuous windfall profits for the predatory and admittedly abusive-at-times private insurance industry. One way to improve and expand upon Obamacare would be to implement Medicare Advantage For All, and allow private companies to impose their narrow restrictive networks and suck up even more exorbitant profits from the myriad services which would be deliberately excluded from coverage under any new government plan. Medicare drug coverage plans already are privately run, and the prices of many drugs therefore would still be kept artificially high under the plan Emanuel helped design.

Although named Medicare Extra For All, not everyone will pay the same premiums, which will be based on income. Subscribers would still have to fork over co-pays and deductibles, again based on income, with discounts offered if services are rendered at a "center of excellence."

And all this would be available gradually, over a period of eight (!) years. 

It's a lot more convoluted than true single payer. There's a lot more space for watering down and tinkering by lobbyists.

The whole point is to keep cut-throat competition as the health care marketplace's driving force, and to keep treating health care as a privilege or lottery and not as a basic human right. Capitalism is so slick and smooth and well-groomed compared to "messy care for all" as envisioned by messy old Bernie. Giving people immediate relief and peace of mind simply does not meet the requirement of "efficiency" -- code for keep it unnecessarily complicated, and maybe it'll all just go away.

Emanuel's plan, with no apparent sense of irony, also adds reams of paperwork and whole new layers of bureaucracy to the already messed-up system, and thus is almost guaranteed to garner complaints, with much justification. He explains to the bewildered:  

There are also good policy rationales to preserve a role for private insurers. While progressives often claim these companies do nothing for the health-care system but add paperwork and extract profits, this view is anything but universal. Medicare Advantage plans offered by private insurers currently enroll about a third of seniors and are the fastest-growing part of Medicare. The evidence—only 2 percent switch back to regular Medicare— suggests that seniors like these plans and, by implication, the private insurers that offer them. In addition, having multiple payers adds competition, which can improve performance and prevent the government’s health plan from ossifying.

The fact that even old people stay in abusive relationships does not mean that victims love their abusers. It means that they're afraid of their abusers. It's human nature to be afraid of change. They're afraid that if they stop giving in to blackmail and extortion and protection rackets, they'll be left with nothing at all. They might even die.

Emanuel does not explain this, or attempt to set the record straight or soothe any manufactured fears. He does not ethically explain what he even means by the dreaded "ossification" of a government-run single payer health system. I suppose he wants to impart the notion that Medicare For All isn't sexy enough. Our lives are not precarious enough. We need constant intrigue and excitement. Why be bored and complacent knowing that the good old stodgy reliable government will always be there to promptly pay for our medical care, when we can enjoy seductive and dangerously titillating trysts with Cigna or Aetna or Blue Cross-Blue Shield?

Never knowing when or even if they'll show up is half the fun. What's your phone for, after all, but to spend countless hours trying to locate an insurance company adjuster and beg them to reverse a claim denial? It's as emotionally appealing as trying to track down a cheating or inattentive or missing spouse or partner.

And what an aphrodisiac it is when they finally do deign to talk to you or show up and make up for your bruises with a bouquet of flowers (or a surprise partial reimbursement check.) Abusive relationships are to die for.

Ezekiel Emanuel hasn't been this persuasive about the joy of pain since 2014, when he wrote in The Atlantic that since he doesn't want to live past the age of 75, neither should selfish old you -- Medicare Advantage plan or not. 

I wrote a critique of that slimy bit of neoliberal propaganda, cross-published in Truthout, which up to then had been regularly running my pieces. "Medicare, Dr. Mengele and You" apparently was not, I heard from a reliable source, well-received from on high, because the liberal site suddenly dropped me like a hot potato. An ossified, unpaid hot potato. 

Granted, my critique of Zeke was fairly brutal. An excerpt:

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.

Sad to say that judging from his most recent "Messy Care" narrative, Emanuel is as ossified in his tomb of a capitalistic belief system as ever. The continuing neoliberal message is that if you can't learn to survive within an abusive, cutthroat market-based health care system and cannot appreciate all the Advantages accruing thereto because you have no money and no clout, then you might as well just die already. 

Emanuel is really, really bad at bioethical gaslighting. If there was such a thing as journalistic malpractice, he'd be sued. His shameless propaganda should make us more determined than ever to keep agitating for single payer health coverage for everybody.