RUTHFULLY YOURS

The Carnegie Council on the East Side’s posh E. 64th Street, off Third Avenue, boasts modestly to attendees that it is the “18th most important think tank”. In the city? Country? Universe? On ne sais pas.

The Carnegie handout describes themselves thus:

Founded by Andrew Carnegie in 1914, Carnegie Council for Ethics in International Affairs is an educational, nonprofit, nonpartisan organization that produces lectures, publications and multimedia materials on the ethical challenges of living in a globalized world.

Their programs include a roster of impressive events. This season, for instance, they have a lineup that includes:

•          The rise of the new far right in Europe and implications for EU parliament elections (panel discussion);
•          Attacks on the press: journalism on the front lines (Joel Simon; Jacob Weisberg);
•          Moral imagination (David Bromwich);
•          Age of ambition: Chasing fortune, truth and faith in the New China (Evan Osnos).

In the main, top shelf. Topics the knowledgeable and committed care about. We go into these details to demonstrate that the captures are worthy, and the scope of discussants as wide as one could hope in this astral work-in-progress called New York City.

We also come to the reason for this report. The latest presentation at Carnegie Council was titled “Ethics matter: A conversation with Ezekiel Emanuel”. He is the elder of the celebrated and occasionally reviled Rahm Emanuel, ex- of the White House under the current 44th president, and currently serving as mayor of the nation’s highest citadel of civilian crime, shootings, drive-by killings, and other mayhemia made fresh by the resuscitation of the tightest gun-control laws in the nation (excepting only Phoenix, perhaps; but that fair Arizona dry-heat destination is title-winner mainly for abductions and kidnappings).

For those on a yoga retreat for the past five years, Zeke, one of three Emanuel brothers, high-achieving sons (the third brother is the model for Ariel “Ari” Gold, the super-caffeinated agent made amazingly eclatant by Jeremy Piven in Entourage) of Israeli physician parents, Holocaust survivors, was a prime architect of the Affordable Care Act. For those partial to nicknames, the ACA is of course what we have come to lovably bristle at as ObamaCare.

A review of Dr. Emanuel’s high-profile vitae spans the medical, academic and governmental spheres. From universal healthcare, topic of the evening, through euthanasia and drug rationing, Dr. Z is a perfect paradigm of the “ethical and political issues surrounding American health care.”

But… While his conversation, moderated and propelled by the fluid and knowledgeable James Traub, was billed as his “foreign policy vision”, it was vintage apologetics: superficially breezy but embalming-banal, deceptive, self-serving, and reliably partisan to the follicle. Sort of a metaphor for the man himself. His unspoken assumption seemed to be that the 80-person capacity audience was automatically on his side. Because, apart from about four of us, it was. A polite and attentive audience that would not scruple to scathe his presentation of his mammoth bill, they may have sedately disagreed here or there, but not enough to cause a riffle in the tepid water of Council politesse.

Traub began with an easy introductory ask: What was your childhood like? Why did you choose medicine? Was it your first career choice? And all the rev-up questions that give legroom for a leisurely stretch as he reached topic A. Dr Zeke is currently Diane V.S. Levy and Robert M. Levy University Professor, U of Pennsylvania. The Levy addenda to his title tell you it’s a smartly endowed chair, with major dollars attached, as is fitting for the systemic infusion of regulatory obsessiveness contained in 2,700-plus pages that have yet, after a quartet of annual cycles, to be fully grokked by Congress, let alone the above-average public, save by perhaps the formidable Betsy McCaughey, a standout in a country of shoulder shruggers when it comes to the ObamaCare behemoth.

As a not-asked-for tidbit of presentational skills, he’s ‘way too physiologically demonstrative, moving his mobile face, nodding his close-cropped iron and steel hair, and swinging his arms around far too much for the small hall, which seats a maximum of 80; there were 75 people seated. He does not have the staring, icy, wall-eyed flat face of his brother Rahm, who has been called “dead-fish” not infrequently over the years.

Yet the evident rollout in the cozy and subdued robin’s-egg blue and white meeting hall was not notably ethical or, really, even accurate to the reality of issues involved.

Among the exciting yet hardly provable statements made by Dr. Zeke, interviewed by interlocutor Traub at this “18th most important think tank in the country,” as attested to by a projected slide on the wall to our far left, were these:

• We’re going to cut down substantially on the number of wrong limbs being amputated at the VA. (Did you know this is a prominent problem at the VA? It is.)
• About 10 million people have signed up already (No, make that 5.3 mm; the numbers are fudged and milked from blending demographics of people who have lost their insurance, switched insurances, or combined insurance with some motley blurred ambiguity of care and insurance.)
• We’re going to make our medical care both more efficient and cheaper. (Economics 1.1 underscores the iron law: You can be good, or fast, or cheap. You cannot be two of these at any one time.)
• We’re going to reduce costs by prescribing generics, which are, you know, much cheaper. (When you discourage investment in pharmaceuticals, which he and the ACA promise to do, there will be no generics, because pharma companies won’t put in the massive time and clinical and epidemiological dollar investment to produce excellent drugs.) Even Zeke acknowledged that the new Hep C drug, at about $1,000 each pill, works; he slammed the “purple pill” (unidentified to protect the guilty) for being a me-too, saying “It’s junk, just junk!” It is taken for granted that under this regimen, such a forbiddingly high-priced pill, no matter how effective, will simply never be available — except to anyone off-the-grid, going to private practice physicians and specialists.
• To our question about doctors already fleeing and hospitals rejecting such patients as will come under the new regime, he thoughtfully said “Doctors are good, we need doctors, but patients won’t be dealing in a doctor-patient relationship… they’ll be handled by a team.” (Where are they to come from? There are no more med schools, and no great upsurge in enrollees for degrees to handle the expected dozens of millions requiring care.)
• As our question also posited, Economics 1.1 is concrete: You can’t pay less for med-care and get superior treatment, which Zeke repeated; we brought up the UK as example — that country, and Canada and elsewhere where medical care is heavily subsidized and viewed as “free.”  He acknowledged my question was right, but gave some bafflegab to reinforce that bromide equal to Umm, never mind…
• We’ll do well in a decade, he kept repeating. (And in the meantime, as all the blocks are tumbling around our disbelieving ears?)
• He understated the costs, and said all the people he knew of are “happy” with their care. (Perfect. No charts. No graphs. No handouts dense with numbers and comparisons and figures and columns.)
• He said hospitals are being fined 1% for readmission, so lots of patients are not readmitted. And the penalty “really worked.” Yay. (Except that elderly or severely compromised patients often need to go back into hospital. So maybe they won’t go back in. And maybe, instead, they will languish and die. Like the dozens of VA hospitals’ recent infamous collateral damage.)
•  There are lots of other penalties, which are “only fair,” since the system works so well, so non-compliers must be penalized.
• We “don’t have a one-payer system,” and “never will” — though how he could know the pen and telephone of the honcho in chief is a puzzle. (Isn’t the one-payer system what he and the administration aiming at all along?)
• He dismissed the doctors and hospitals leaving in droves, the in-policy doctors refusing to accept ACA patients altogether, the good hospitals opting not to be in any of these platinum, gold, or silver [white-elephant] policies.

To his credit, Dr. Pol E. Yanna stayed smiley and upbeat all through, at least until the question portion arrived, never letting on that there are gross lacunae, primordial abuses with millions unhappy at the charges, premiums, fines, and gross intrusiveness of his brainvhild. Not to mention ineptitude awaiting us all in the waiting room.