Michael Scherer's Time Magazine hatchet job is nothing groundbreaking. It is unfortunately exactly the sort of thing Americans have come to expect from the media, and particularly from Time Magazine. It has the same blend of oozing sympathy for anyone associated with Obama and contemptuous disdain for anyone who disagrees with Obama. It is heavy on first person journalism, and spends more time discussing Ezekiel Emanuel's reaction to hearing that there are allegations against him, than actually stating the allegations. And of course it lies blatantly in defense of Ezekiel Emanuel, but that's a given these days, isn't it?
We get the tragically beleaguered Dr. Emanuel's reaction to the allegations;
Time: "You have the quality of your work and the integrity with which you do it," he said by phone from the Italian Alps. "If it requires canceling a week's long vacation, what's the big deal?"
Naturally most Americans will sympathize with Ezekiel Emanuel's great sacrifice in selflessly giving up his taxpayer funded vacation in the Italian Alps because he got caught with his eugenics down. At least most Americans who are highly paid writers for Time Magazine.
Time: Within days, the Post article, with selective and misleading quotes from Emanuel's 200 or so published academic papers, went viral.
The quotes are actually based primarily on three of Emanuel's articles, not 200. But here are the article's repeated statements that Ezekiel Emanuel's quotes are somehow distorted or taken out of context. Yet oddly enough Michael Scherer's article does not find time in between discussing such vital facts as Ezekiel Emanuel's favorite vacation spots, his feelings on the internet or putting scare quotes around any statement critical of Emanuel... to actually cite one of those Emanuel quotes verbatim. Which if those statements are as innocent as Scherer and Ezekiel claim they are, is a no brainer.
Michael Scherer does not bother interviewing a single critic of Ezekiel for balance. Instead he puts scare quotes while citing a few dramatic adjectives. He describes Mike Sola, the father of a son with cerebral palsy, who stood up at a Town Hall meeting as the product of hysteria.
Time: By Aug. 10, hysteria had begun to take over in places. Mike Sola, whose son has cerebral palsy, turned up at a Michigan town-hall meeting to shout out concerns about what he regarded as Obama and Emanuel's plans to deny treatment to their family. Later, in an interview on Fox News, Sola held up the Post article. "Every American needs to read this," he declared.
Scherer is cynically careful enough to avoid literally calling Sola hysterical, instead he formulates the phrasing in a way that gives that exact impression instead, piling cowardice on the already ugly act of smearing the parent of a disabled child whose one crime was to voice opposition to Obama's health care plan.
Then completely devoid of irony, Michael Scherer flashes back 8 years, completely ignoring everything Time Magazine had been writing during the Bush Administration to claim that;
Time: The attacks on Emanuel are a reminder that there is a narrow slice of Americans who not only don't trust government, but also have come to regard it as a dark conspirator in their lives.
Naturally Scherer is not referring to Code Pink or the ACLU or Paul Krugman, or the legion of liberal columnists and pundits who distrusted the Bush Administration and regarded it as a "dark conspirator".
For example there's the following bit of "paranoia" by a narrow slice of one American who viewed government as a dark conspirator.
The Next Worst Thing
Is the federal government's expansion of biodefense research paving the way for the bioweapons of the future?
The paranoid fellow who wrote that was Michael Scherer, of course that was back during the Bush Administration, when making up conspiracy theories about secret government conspiracies was cool. Now of course that the Dems are in power it means you're a dangerous extremist.
But maybe Michael Scherer could use the reminder that his "narrow slice" is not so narrow as he would like to pretend. It's something his former colleagues at Mother Jones magazine could tell him something about.
Finally though near the bottom of the article, Scherer gets around to addressing any of the specifics of the allegations against Ezekiel Emanuel.
Time: In her Post article, McCaughey paints the worst possible image of Emanuel, quoting him, for instance, endorsing age discrimination for health-care distribution, without mentioning that he was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources.
Emanuel does use organ donation and flu pandemics as examples, but he is not speaking only of extreme cases. He also lists beds in intensive care units in his article introduction as an example. He is speaking of how to address medical resource shortages, which would be a reality under a national health care plan.
Emanuel also mentions dialysis machines and penicillin as other examples. He is clearly not discussing only organ donations or absolute scarcities. In fact based on Emanuel's own introductory words, he is saying that any number of medical resources may be considered scarce, even if they are available, because their cost would be better utilized somewhere else.
For some interventions, demand exceeds supply. For others, an increased supply would necessitate redirection of important resources, and allocation decisions would still be necessary
So ironically it is Michael Scherer who deliberately misrepresents Ezekiel Emanuel's views, in order to pretend that Emanuel is speaking about organ donations and only the most extreme situations in which there is no alternative but to ration. In fact Emanuel views even some available treatments as not worthwhile if they do not meet his criteria.
Time: She quotes him discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy.
In fact the denial of care for dementia is mentioned in the conclusion of Ezekiel Emanuel's article. It is not treated as hypothetical in the sense that Emanuel mentions it without recommending it, instead he quite clearly treats it as one of those substantive practices that serve as an example of what we should be doing.
"This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia."
Ezekiel Emanuel is clearly not citing this example as something he disagrees with. It is an approach he is recommending. For Michael Scherer to claim otherwise is a blatant lie.
Time: She notes that he has criticized medical culture for trying to do everything for a patient, "regardless of the cost or effects on others," without making clear that he was not speaking of lifesaving care but of treatments with little demonstrated value.
In fact that is not clear at all. In the JAMA article, "The Perfect Storm of Overutilization", Ezekiel Emanuel cites a number of factors in the high cost of US medical care. These include,
"the abundance of amenities. Hospital rooms in the United States offer more privacy, comfort, and auxiliary services than do hospital rooms in most other countries. US physicians' offices are typically more conveniently located and have parking nearby and more attractive waiting rooms."
... as well as overutilization itself. Ezekiel Emanuel defines overutilization as;
higher volumes, such as more office visits, hospitalizations, tests, procedures, and prescriptions than are appropriate or more costly specialists, tests, procedures, and prescriptions than are appropriate.
One of the causes he blames for this is physician culture;
Medical school education and postgraduate training emphasize thoroughness. When evaluating a patient, students, interns, and residents are trained to identify and praised for and graded on enumerating all possible diagnoses and tests that would confirm or exclude them... This mentality carries over into practice. Peer recognition goes to the most thorough and aggressive physicians. The prudent physician is not deemed particularly competent, but rather inadequate. This culture is further reinforced by a unique understanding of professional obligations, specifically, the Hippocratic Oath's admonition to "use my power to help the sick to the best of my ability and judgment" as an imperative to do everything for the patient regardless of cost or effect on others.
This paragraph above is the source of the quote. The discussion is not about treatments of limited value as Michael Scherer wrongly contends, but what Ezekiel Emanuel feels is doctors being too thorough in excluding possibly more serious but less likely conditions, rather than simply treating the patient in the most "prudent" and efficient" way.
For example then a patient who comes to see a doctor with blood in her urine, would be treated with antibiotics for an infection, and given an ultrasound. Ezekiel Emanuel would consider this a waste of medical resources from a too aggressive physician who is trying to rule out more dangerous conditions that the patient might have.
In thes sole paragraph in Michael Scherer's article dedicated to actually listing specific criticisms of Emanuel based loosely on his words, Scherer gets all 3 statements wrong. Which suggests that he either did not read Emanuel's articles, did not understand them, or deliberately misrepresented them. Either way it's a level of incompetence or deceit that a major publication would not have tolerated once upon a time.
Scherer concludes by giving us the heroic image of Ezekiel Emanuel passing up on a return trip to the Italian Alps, surely an image right up there with a crowd of slaves rising to proclaim, "I Am Spartacus".
Emanuel, for his part, plans to continue his work, which is focused on finding the most equitable and ethical way for this reform to be carried out, even if he has opted against returning from the Italian Alps. "I am an Emanuel," he says. "We are pretty thick-skinned. I am not going to change my colors. I am not going to crawl under a rock."
Yes it's hard to crawl under a rock, when the rock has been lifted up and you've been exposed to the light. It'll take a lot more than articles like Scherer's to pull that rock back over him again.
You have only to look at Time's balance sheet to see how credible they are. Some people call it ''Slime Magazine'' & it's as good an example of a failed mainstream media as the NYT.ReplyDelete
What I find objectionable in Emanuel's views is that he would take away my right to make decisions on healthcare & give it to nameless, faceless, unaccountable bureaucrats.
I have many gripes about American healthcare, in my opinion, it's quite bad enough without deliberately making it worse.
Anyone who wants to see what the realities of a poorly run nationalised healthcare system look like, need only glance across the pond.
Here in the UK, there are numerous people who are denied medications because the ruling body - NICE - deems the cost 'too high'. Thus we've witnessed high profile and heartbreaking cases of women with breast cancer, who have had to spend their last months desperately campaigning to get the drugs that would aid them.
We've also had the scandalous situation whereby the government decided that if any National Health patients ALSO wanted to use their OWN funds to purchase drugs or more expensive treatments, then said patients would be DENIED any futher help on the NHS.
I attended a most interesting 'citizen jury' day dedicated to this precise issue. It was, frankly, terrifying, to hear the 'reasoning' employed by some politicians and administrators.
- And this was in a system *with* private healthcare as an option in addition to nationalised healthcare.
I've read with great interest about the American Town Hall meetings. I'm glad to see that Americans are making their objections known so passionately - that's something you guys do far better than Brits, and it may prevent you from experiencing some of the problems that we are currently facing.
When you put a bunch of bureaucrats in charge of anything, the results will be kafkaesque. The NHS has been playing a major unintentional role in America's health care debates for exactly that reason.ReplyDelete
Time is making Emanuel out to be the victim in all of this. Just curious--is he an MD or does he have a Ph.D. in public health? The reason I ask is because it's alarming to think he ever "cared" for patients in a clinical setting.ReplyDelete
Sheesh. Not only is he advocating eugenics but wants to deny his victims even palliative care by saying US hospital patients are treated too well. Good grief.
All of this sounds like something right out of a Robin Cook novel...or Nazi Germany.
To anonymous--you're right about Slime Magazine. Just the other day I went with a friend who had an appointment with a lawyer. In the waiting room I read an article about Ariel Sharon's stroke. It was a years old edition of the mag.
The article included a large picture of a Jew in obvious emotional anguish at the Western Wall and the caption: "Israelis praying for Sharon."
Maybe he was, maybe he wasn't. Had the photo been of Israelis praying at a prayer rally specifically for Sharon or something okay but this was just an Israeli praying at the Western Wall.
He had a blue and white knitted kippah on his head and an orange Gush Katif bracelet on. He could have been pouring his heart out over the expulsions. It could have been a personal family matter. It could have been over Sharon's stroke, the fate of the country, spiritual turmoil and conflict over whether to pray for his fellow Jew who was also victimizing his fellow Jews, anything.
No quotes or anything--just a photo inserted with no context whatsoever.
Yes, over here we're all discussing how the NHS is being talked about as part of the health service debate in America.ReplyDelete
In fairness, I should note that when the NHS works, which it does sometimes, it works superbly. But of course that is scant consolation to the numerous people who have died courtesy of hospital superbugs and also errors committed by overworked, overtired, underpaid doctors.
He seems to have both an M.D. and a PhD, but beyond the internship he seems to have gone on to academic medicine. I doubt he spent too much time around patients.
That's part of the concern here. I overheard a conversation with the manager of a dental office saying that with obamacare, dentists would be badly overworked, and would be unable to serve patients
That manager is right to be worried. Here there are goodness knows how many people who just can't get appointments with NHS dentists because the queues stretch round the block - literally.ReplyDelete
Private dentists are plentiful, of course, and many are excellent - but even with some form of dental insurance, the costs are extremely high.
Nationalised medical care eats up funds and often with little to show for it. Far too much money ends up in the hands of bureaucrats who have no idea how to run an effective hospital.
The dentist I go to was recently telling me that his brother - who is also a dentist, but NHS - literally gives each patient ten minutes or under and just does the absolute basics. And even then he can't see all those clamouring for appointments.
Yes it's essentially set to give us ten times the bureaucracy of private insurance with half the cost effectiveness. Not exactly a solution. And with the whole thing meant as a transition to a single payer system, the alternatives would begin to quickly disappear.ReplyDelete
Even now many doctors don't want to take medicare/medicaid and other government plans, because of compensation problems and difficulty dealing with the bureaucracy. And that's nothing compared to what they'd be dealing with in an all government system. Eventually we'd wind up with illegal health clinics like Canada.
And with individuals being taxed to fund ObamaCareReplyDelete
the system will devour all given time
Emanuel's complaint about physician over emphasis on thoroughness in training and practice is in fact an heuristic used by doctors to arrive at the correct diagnosis. Tellingly,there is no tort reform in any of the proposed bills. Doctors, therefore can't safely use Occam’s razor to reduce utilization costs. Our clinical judgment won't be enough to refute the so called expert witnesses. We are required to arrive at the correct diagnosis each and every time or the plaintiff's bar will be at our door trying to blow our houses down not to mention the benefit to the patient. This requirement mandates the use of modern technology to arrive at certainty. Look at it this way, when Lindbergh crossed the Atlantic in his single engine plane his chances for a safe landing on the other side was slim at best. Now look at the 747, what are the chances that it will have a successful trip? How much did the Spirit of St. Louis cost as compared to the 747?ReplyDelete
One last thing. It is obvious that Ezekiel has been a "chartologist" (a doctor that looks at patient records but never touches or speaks to actual patients) for most or all of his career. He has conflated the care of a population with the care of an individual patient. A physician has a moral obligation to the individual patient he or she is treating and only secondarily to a population. We have “end of life” discussions with patients and their families all the time. We don't need government mandates to tell us how to practice medicine.
That is indeed a danger with ObamaCare because so many patients would have that as their primary insurance; no health care professional would be able to refuse to care for public health insurance as they do with Medicaid patients.ReplyDelete
Believe me, a lot of people will drop their private insurance for cheaper or no cost ObamaCare. What health care professional would be able to afford denying patients with ObamaCare?
JWAV--I live on the border of Canada and know a lot of people in the US who go to Canada to get their prescriptions filled. It's a lot cheaper. Part of the reason is the US/Canadian exchange rate but apparently the Canadian version of the FDA is not quite as stringent as the FDA in the US.
The downsize of national health care in Canada is that patients have to wait months for an MRI in all but the most emergency situations.
A lot of Canadians come to Buffalo for MRIs, CAT scans, and elective surgeries.
Is there national health care in all of the EU or just select countries?
I don't know. The whole problem with this health care reform (at least my understanding of it) is that nobody is really talking in terms I can relate to:)
What I think needs to be done:
1. Allow people to enroll in private healthcare plans even if they aren't in a group, in other words, direct pay. I have a direct pay policy for my HMO. Not all insurance companies allow people to enroll if they are self-employed.
And the non-HMO direct policies are pretty crappy. When I had regular Blue Cross/Blue Shield direct pay none of my office visits were covered and I could only get $100 worth of blood tests a year. No prescription plan whatsoever, which was fine when I was healthy.
But I absolutely had to switch to a policy--HMO--that covered office visits, prescriptions, unlimited blood tests.
Really, there are a lot of health insurances that people could afford but are ineligible for simply because they're not in a group, they aren't getting it through an employer.
I don't understand why insurance policies--HMO and non-HMO--are denied to so many people who are self-employed.
HMOs, which are cost-effective, are typically closed to people who are self-employed.
I really lucked out in finding a really good HMO that offers a direct pay policy. I haven't had any prescriptions denied and can always get referrals to specialists and everything.
Minor pet peeve--the copays for the direct pay are slightly higher. I don't get it. It's the same exact coverage that people in a group get but because it's direct pay...higher.
For the working poor--the government should provide vouchers.
Ah, but don't worry. After all, when we're all living in the global Caliphate, as mere dhimmis, we won't qualify for medical help anyway...ReplyDelete
*cue hollow laugh
maybe one reason Emanuel went the chartologist route is because he didn't like dealing with patients
maybe we'll get some dental care if we put on our burkas and yellow stars...
the problem is that private insurance is itself the byproduct of regulation, and extra layers of bureaucracy mean either more cost or less coverage... and either way more complexity
It's the same here with MRIs. For example: it's been known for some years that the MRI is *far* more efficient in determining whether a woman has breast cancer, than Mammogram. Yet Mammogram is still used - purely because it is cheaper.
The only women in the UK who will get an MRI for any breast related problem are those with private health care, who will get it early. Women on the NHS will be lucky if they get offered an MRI at all.
As for other European countries:
France has an excellent national health care system, which is paid for by very high taxes.
Other countries seem to manage far better than the UK. We have Brits who actually go abroad for certain operations and treatments because firstly they'll get seen more swiftly and secondly, the hospitals are *so* much cleaner.