The ACA architect who calls for less

Published 10:07 pm Monday, January 12, 2015

1. About 1.2 million Texans signed up through health exchange
2. New woes for HealthCare.gov: Wrong tax info sent out
3. Annoyance arises from gov’t error on health care tax forms
4. Blue Cross Blue Shield reports ACA enrollees tend to be sicker

It’s becoming a disturbing pattern. One of the main architects of the Affordable Care Act, Ezekiel Emanuel, has come out again against actually using health care services. The upshot of all this is clear: for the ACA to work with more patients and limited resources, there must be rationing of some form.

Just as he wrote in The Atlantic last fall that he wouldn’t seek life-saving or life-extending medical treatments after the age of 75, Emanuel is now urging Americans to forego their annual physical exams.

The problem is that the ACA — also known as Obamacare — specifically urges and covers those physicals. No matter, Emanuel said. They’re not worth it.

“We all make resolutions and promises to live healthier and better lives, to make the world a better place,” Emanuel wrote in the New York Times. “Not having my annual physical is one small way I can help reduce health care costs — and save myself time, worry and a worthless exam.”

He cites a study from 2012 that finds the normal tests administered during an annual physical don’t do much to directly improve health and mortality rates.

The problem is that the study looked at annual physicals conducted from 1963 to 1999. Medical science has taken great leaps in the past 15 years, so even if the study’s findings were correct for 1999, they’re irrelevant today.

The bigger issue, of course, is demand on the American health care system. The math for the ACA has never worked. Increased demand on a stable (and even decreasing) supply of providers must mean higher costs and rationing.

That’s why Emanuel hopes to die at the age of 75.

“At 75 and beyond, I will need a good reason to even visit the doctor and take any medical test or treatment, no matter how routine and painless,” he wrote in The Atlantic. “And that good reason is not ‘It will prolong your life.’ I will stop getting any regular preventive tests, screenings, or interventions. I will accept only palliative not curative treatments if I am suffering pain or other disability.”

Now, it’s actually fine that Emanuel is making such a decision for himself. That should be the prerogative of every American and every Americans family. And it’s actually fine that Medicare is now paying for some end-of-life counseling sessions.

But the logic Emanuel employs can far too easily be applied by government bureaucrats and technocrats to everyone else.

For now, he’s using guilt to encourage people to self-ration.

“My medical routine won’t include an annual exam,” he wrote. “That will free up countless hours of doctors’ time for patients who really do have a medical problem, helping to ensure there is no doctor shortage as more Americans get health insurance.”

There are better ways to reform the American health care system than this. What’s more, individual medical decisions ought to be made in conjunction with our own doctors’ professional advice.

That doctor shortage is real, and there’s a way to fix it.

We can repeal and replace the ACA.