Private Policy

Like Arnold Kling, I found some of the information in Ezekiel Emanuel’s article on aging troubling. But also, like health policy analyst Greg Scandlen, I found Ezekiel Emanuel troubling. I first saw reference to his article in a Tyler Cowen post and read the whole thing through. It shifted my prior. Shortly after I turned 40, I needed to get glasses for the first time and the experience made me so aware of my mortality that when I went back to Lenscrafters an hour later to pick them up, I had to work hard to restrain my tears in front of the woman putting them on me. In my men’s group that evening, I “went against” that feeling by saying that I wanted to live to age 100. That has been my line–and my belief–ever since.

Until Saturday, when I read Emanuel’s article.

For the first day after reading the Emanuel article, I did what I often do with a new idea that seems somewhat plausible but contradicts an old idea: I tried it on. I told my wife about the article and said that maybe I wouldn’t want to live past 80. (Notice that I had already adjusted the age in Emanuel’s article: with only 11 years and 2 months to go before I turn 75, the 75 number just seemed too low.) She asked me how old Emanuel is. “57,” I replied. “How can he know at age 57 how he’ll feel at age 75?” she asked. I had to grant her point.

So here’s how I’ve integrated his thinking into mine. There might be certain things that will happen to me that will make me want to end it early. But is that really new thinking? I’ve always said that if I get Alzheimer’s, I’ll try to figure out, before it’s too late, how to take my own life. So, now that I’ve had a few days to kick the tires of Emanuel’s idea, I don’t really think it has shifted my thinking much at all.

Now to one of Greg Scandlen’s points. Scandlen puts his finger accurately, based on what I’ve seen of Emanuel in the past, on Emanuel’s attitude. The way I would sum it up is “Sometimes wrong; never in doubt.” The man (Emanuel) really does seem to think he knows how everyone should live.

It seems clear, for example, that Emanuel would like his father to die:

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.

OMG! Can “no longer make rounds at the hospital or teach.” As Marisa Tomei says at the end of one of my favorite movies, My Cousin Vinny, “What a _______ nightmare!”

What might you expect the next paragraph to be? Maybe that, well, OK, different strokes (no pun intended) for different folks? No. Instead, Emanuel just goes back to his theme that when our physical faculties falter a lot, we should welcome death. I would like to know whether his 87-year-old (approximately) father, who is happy, would welcome death. Or whether he would have welcomed it age 77.

What I learned from Emanuel’s article is what a narrow view of the good life he has.

Health Care Policy

Now, this wouldn’t matter much if Emanuel were a random guy saying that he doesn’t want certain kinds of medical tests after age 75. But he’s not. Remember that he was one of the architects of ObamaCare. With his attitude about the importance of people over age 75, can we seriously think that he wouldn’t want to cut off certain health care services for people over age 75?

Emanuel says he’s not advocating any particular health policy based on his views:

Again, let me be clear: I am not saying that those who want to live as long as possible are unethical or wrong. I am certainly not scorning or dismissing people who want to live on despite their physical and mental limitations. I’m not even trying to convince anyone I’m right. Indeed, I often advise people in this age group on how to get the best medical care available in the United States for their ailments. That is their choice, and I want to support them.

And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy.

“Let me be clear.” Hmmm. Where have we heard that before? Basically, I just don’t believe him.

Now, if it’s just a matter of not having Medicare pay for health care services for people over age 75, but still allowing people to pay for them, then I’m on board, as I’ve written before. But Emanuel has never come across as someone who simply wants to persuade people; he has always come across as a life arranger. So don’t be surprised if he advocates that certain health care services not be available to people over age 75 even if they want to pay out of their own pockets or get Medigap insurance that would pay.