Monday, August 10, 2009

irreversibly prevented from being or becoming participating citizens

this article talks about the elderly and disabled and health care, and quotes Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.

the article quotes him directly as follows:

Hastings Center Report, Nov.-Dec. '96

Ezekiel J. Emanuel

"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 citi- zens 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 de-mentia."

The fundamental challenge to theories of distributive justice for health care is to develop a prin- cipled mechanism for defining what fragment of the vast universe of technically available, effective medi- cal care services is basic and will be guaranteed socially and what services are discretionary and will not be guaranteed socially. Such an approach accepts a two-tiered health system-some citizens will receive only basic services while others will receive both basic and some discretionary health services Within the discretionary tier, some citizens will re- ceive few discretionary services, other richer citizens will receive almost all available services, creating a multiple-tiered system

"The patient, or micro, level entails determining which individual patients will re- ceive specific medical services; that is, whether Mrs. White should receive this available liver for trans- plantation"

Obamacare scares the heck out of me, and it should ANY parent of a child with a disability, and especially those of us raising children with an extremely high rate of dementia as they age. This is not an email fwd, this is not someone elses words. This is me, fearing for our kids.

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