RUTHFULLY YOURS

One of Joe Biden’s early actions after corporate media claimed he was president-elect was to name members of a task force to recommend actions about COVID-19. Most of the names were neither famous nor infamous, but for one: Ezekiel “Zeke” Emanuel, whose fame comes from family connections (he’s the brother of former Obama chief-of-staff and former Chicago mayor, Rahm Emanuel) and the infamy gained from a 2014 Atlantic article, “Why I Hope to Die at 75.”

Now, to be clear, Zeke did not argue for a “Giver”-style “release to elsewhere” of all 75-year-olds. He explicitly states opposition to legalizing euthanasia and physician-assisted suicide. And the initial paragraphs of his article emphasize that this is what he wants for himself: “I am talking about how long I want to live and the kind and amount of health care I will consent to after 75.”

But he should have stopped there. Instead, in that article, he expounds on the vastly-reduced ability of older people to “contribute” or to be “productive.”

What’s more, he writes that “Our living too long places real emotional weights on our progeny” — not merely in terms of caregiving needs, but because “there is much less pressure to conform to parental expectations and demands after they are gone” and because “living parents also occupy the role of head of the family [and] they make it hard for grown children to become the patriarch or matriarch.”

Finally, shockingly, even though he writes nominally in the context of his personal preferences for his life, he goes well beyond the rejection of intensive medical treatments such as heart bypass surgery. He writes:

What about simple stuff? Flu shots are out. Certainly, if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs. A big challenge is antibiotics for pneumonia or skin and urinary infections. Antibiotics are cheap and largely effective in curing infections. It is really hard for us to say no. Indeed, even people who are sure they don’t want life-extending treatments find it hard to refuse antibiotics. But, as Osler reminds us, unlike the decays associated with chronic conditions, death from these infections is quick and relatively painless. So, no to antibiotics.

Again, a strict reading of this conveys that he would personally decline a flu shot to increase availability for younger folk. This would be in keeping with the same manner as healthy young adults were discouraged from getting flu shots some years back to increase availability for those with health risks. It takes every available bit of goodwill to read this passage in that manner.

Since then, Emanuel has not recanted but has continued to discuss those ideas, and has made it even more clear that this is his opinion on what’s right for society rather than his personal decision. In a follow-up interview in 2019, he emphasized that he judges whether lives are meaningful by whether they are productive:

There are not that many people who continue to be active and engaged and actually creative past 75. It’s a very small number. … These people who live a vigorous life to 70, 80, 90 years of age — when I look at what those people ‘do,’ almost all of it is what I classify as play. It’s not meaningful work. They’re riding motorcycles; they’re hiking. Which can all have value — don’t get me wrong. But if it’s the main thing in your life? Ummm, that’s not probably a meaningful life.

What’s more, he has been holding himself out not as an expert in epidemiology in general (and his medical specialty is oncology), but has been actively writing about one very specific question concerning COVID: How should the vaccine be distributed? He concludes what matters is not preventing deaths, but preventing premature death.

In a Science article in September, in which Emanuel argued for distributing vaccine doses overseas out of “fairness” and argued against “vaccine nationalism” in which countries kept “too much” of the vaccine for themselves, he wrote, “we propose using Standard Expected Years of Life Lost (SEYLL) averted per dose of vaccine as the metric for premature death.”

This method renders the lives of people who have already lived beyond their country’s life expectancy as valueless. In the CDC’s definition, the cut-off is even sooner: only deaths occurring before age 75 are deemed “premature” and counted towards “years of potential life lost.” Yes, the very vaccine priority model Emanuel proposes would exclude those over age 75 from receiving a COVID vaccine, at least until availability is widespread and no shortages exist, globally.

Everyone’s talking about the coming depletion of the Social Security Trust Fund, and whether that will occur in 2035, as forecast before the pandemic, or much sooner. But the Medicare Part A Trust Fund (that’s the hospitalization benefits piece) is expected to be depleted in 2024, according to CBO calculations reflecting the impact of the COVID response.

If you’re doing the math, that’s within Biden’s term in office. And this is not something that can be waved away — it will be necessary for Congress to pass legislation authorizing new money to be spent or costs to be cut, or the federal government will need to run a bill backlog. This means that Emanuel’s status in the Biden administration, and his potential influence, matters more than just his voice in vaccine distribution.

What’s more, in one key element of understanding health care for the elderly, Emanuel gets it completely wrong. Emanuel wrote:

The American immortal desperately wants to believe in the ‘compression of morbidity.’ … This theory postulates that as we extend our life spans into the 80s and 90s, we will be living healthier lives — more time before we have disabilities, and fewer disabilities overall. The claim is that with longer life, an ever smaller proportion of our lives will be spent in a state of decline. … But researchers found not a compression of morbidity but in fact an expansion — an ‘increase in the absolute number of years lost to disability as life expectancy rises.’

Life insurance actuary Mary Pat Campbell dug into the expert literature, cites her sources, and says that’s wrong:

Here is the point: in many ways, we’ve actually gotten better health outcomes for the elderly than we’ve been able to extend life. Most of the ‘life extension’ we’ve seen is at older ages, and a lot of the extension is actually from keeping people well longer.

So what would health-care policy look like if Emanuel is not just one adviser among many but becomes a key adviser on policies for the elderly — someone who looks at his boss and sees, not evidence of the importance of valuing the lives of the old as well as the young, but as “proof” that the way to measure whether the value of a life is if that person is capable of being productive?

Frankly, Americans should be wary to find out.