One of Pres. Barack Obama’s key advisers on medical policy, Dr. Ezekiel Emanuel — brother of super-agent Ari and of super-partisan Rahm — has penned an attack on the Hippocratic Oath, and the world is much obliged to Betsy McCaughey of the Hudson Institute for bringing that fact to public attention. In “The Perfect Storm of Overutilization,” published in The Journal of the American Medical Association, Dr. Emanuel describes Americans’ consumption of medical services as a “catastrophic force,” and assigns the blame to an eccentric collection of items that apparently are not to his taste: fancy waiting rooms, highly paid physicians, and the Hippocratic Oath.

Dr. Emanuel is stiff-arming Hippocrates because traditional Hippocratic ethics treat the patient as an individual. Dr. Emanuel prefers that the patient be treated as an input in an economic equation governing the allocation of medical resources under political discipline. (If you think that is an exaggeration, please do read the article.) With government in charge of health care, the objectification of human lives is inevitable. Governments must make resource-allocation decisions, which means that they must choose between eyesight-saving treatments for your grandmother and corrective orthopedic surgery for the kid next door. Word to the wise: Short your shares in Grandma, Inc. That’s because Dr. Emanuel has embraced a technique for simplifying some of the tough calls: age discrimination. He wrote in The Lancet in 2008: “Unlike allocation by sex or race, allocation by age is not invidious discrimination.” We all were young once, the argument goes, so denying the elderly and weak in order to care for the young and fit is just. It does not take the fine nose of a Robert Parker to detect a whiff of Social Darwinism in ideas of this vintage. It is morally shallow, but unsurprising: Age discrimination is not a side effect of politically managed health care; it is a critical and fundamental feature of Britain’s National Health Service and other government-run health systems admired by Obama and his advisers. Under their arithmetic, the rewards of a procedure must be divided by the remaining life expectancy of the patient, leaving the elderly with what McCaughey calls a “denominator problem.” As she points out, this has led to such perverse outcomes as elderly patients’ being denied eyesight-saving therapies to treat their macular degeneration until after they’ve lost the use of one eye. The benefits of saving a patient’s only remaining eye are weighted more heavily than the benefits of saving one of two functional eyes. The Obama administration prides itself on its pragmatism, but Dr. Emanuel’s view of health care is narrowly ideological, regarding it as a zero-sum game in which every act of consumption by one party is an act of denial to another. These views are commonly denounced as Marxist, but that does a disservice to the intellectual sophistication of the better Marxian critics. In Dr. Emanuel’s crude view, medicine is two kids fighting over a candy bar. In fairness, he does have two famously aggressive brothers, but let us forgo the Freudian analysis for now. Obama’s other key physician adviser, Dr. David Blumenthal, shares Dr. Emanuel’s rigidly ideological view of health care, and aims to apply that ideology universally by subsidizing and mandating the use of a national “decision support” computer network for doctors, through which physicians will be gently advised by the national health czar in Washington what treatments are advisable on what occasions, and at what cost. Physicians who do not participate in the decision-support apparatus will be fined, and possibly disbarred from the practice of medicine. It is important to understand this position as an ideology, one that posits that we spend too much money on health care. How this calculation was arrived at is obscure: When was the last time a Democrat argued that we spend too much money on education, or the arts, or services for the poor? But in practice, the fruit of this ideology is the Obama administration’s current mania for reducing per capita spending on health care. In other words, what is being contemplated is a regime of government-imposed scarcity, the inevitable consequence of which is rationing. Again, it is important to understand the ideology at work here: Rationing, in this view, is not an unfortunate necessity; it is the goal. Is there a constituency for market-based solutions? Properly understood, yes. That market is called “human beings.” The weakness of Obama’s vision is its implicit instrumentalization of human life. There are reasons medical decisions are made on a case-by-case, individual basis, and why medical procedures are not treated as statistical abstractions or commodities. Humaneness is one of those reasons: Human lives ought never to be treated as mere inputs in an economic equation. Under a centrally planned system, it is necessary that they be treated so. But the individualized approach is also more rational and produces better outcomes. By way of comparison: It is well established that agricultural price controls do much more harm than good, but a bushel of wheat is a bushel of wheat, whereas every cancer patient is unique. American government planners are no more likely to make good decisions about how many courses of chemotherapy should be administered each year than Soviet planners were to make good decisions about the five-year plan for wheat production. When one considers the number of people living in the United States, the variety of their health-care needs, and the diversity of factors shaping outcomes, one must appreciate that the volume of relevant data is, literally, incomprehensible. The information-management problem is insurmountable. This is hardly a new observation: The great economist Ludwig von Mises argued that socialist economies would collapse not because of misaligned incentives or the destructive effects of revoking property rights but because the information-management challenge makes central planning impossible. Not inefficient — impossible. No bureaucracy can possess or master the data necessary to make fully informed decisions for an entire nation, especially one as large and complex as ours. If they aren’t going to make decisions based on command of the data — and it is demonstrably true that they are not — what criteria might they substitute? Give a farm lobbyist truth serum and ask him how the farm bill gets written, and you’ll have a good idea. Given its inherently arbitrary character, centralized health-care planning will necessitate a certain amount of cruelty. If your mother and your child both were grievously sick, you might have to make a heart-wrenching resource-allocation decision between the two. Or you might not. Instead of deciding how to slice your medical-spending pie, you might decide to bake a bigger pie, forgoing other spending instead. But Drs. Emanuel and Blumenthal seek to foreclose that option and, in fact, to aggravate the problem: A political program of reduced health-care spending means more scarcity, and more hard decisions. And those decisions, in Obama’s vision, will be made by the government, not by consumers of health care. It is morally problematic under any circumstances for the government to force its health-care priorities upon individual citizens, but it is especially objectionable when the government is seeking to reduce, by all available means, the pool of resources available to be invested in health care. At present, in the worst-case scenario, in which you have to choose between two acute needs, having exhausted all other options and resources, you have the right to make the decision yourself as a matter of human dignity. This is why market-based approaches produce more humane results than do government-planning approaches: Decisions are made by the parties who have the most at stake and who, not coincidentally, have the most information. If the U.S. government is setting the price of a gallon of milk (and it does, to our national shame), and if it were attempting to do so honestly, rather than for self-serving ends, it would have to consider the entire dairy industry in all its complexities, the needs of all the producers and consumers and distributors and retailers. Even assuming that the planners were going to attempt to make decisions based on achieving the greatest public good (whatever that means) rather than on the campaign-donation patterns of dairy producers, Uncle Sam does not know how much milk you’re going to need next week. You may not know, either. Maybe you normally buy one gallon a week, but on Friday night your kids invite their friends for a sleepover, and you buy an extra gallon for the Saturday-morning Froot Loops. You don’t need comprehensive information about the state of the dairy industry to make that decision, and neither does the guy at the 7-Eleven who sells you the extra gallon of milk. You know how much milk you need, and you know whether you are willing to pay the price charged by 7-Eleven, or whether the grocery store down the street charges enough less to justify the time investment of running down there instead. It’s easy for you to make these decisions, but hard for a committee in Washington to do so on your behalf. And health care is much more complex than a relatively simple commodity such as milk. If you’re an 86-year-old with cancer, only you can say how much you would value a radical and expensive course of therapy. Maybe you’re an 86-year-old who also has heart disease and a general sense that you’re ready to check out; or maybe you’re an 86-year-old whose parents and grandparents all lived to be 100, and you are in otherwise good health. The equations that will govern politically managed health care will not be able to take those subtleties into account. Free-market thinkers generally emphasize incentives, and those do matter. But information matters, too. Neither you nor your doctor is infallible, but it is extraordinarily unlikely that a remote panel of politically minded men in the nation’s capital are going to make better decisions about your health care than those made by you and your family, with the advice of your doctor, his colleagues — and that great gold mine of information: his competitors. Politicians have neither the incentives nor the information to do so. What is most worrisome about Dr. Emanuel’s oddball attack on the Hippocratic Oath is his stated desire to replace one set of incentives — the Hippocratic mandate to do everything possible for an individual patient — with a different set of incentives: distributing medical resources in a manner consistent with the preferences of Dr. Ezekiel Emanuel. Physicians are not as a class known for their humility, but the arrogance implicit in his critique is remarkable, as is the naïveté. The government cannot even rationally or effectively price a gallon of milk (or a tranche of troubled mortgage-backed securities), but Dr. Emanuel and his trusted associates are going to manage every course of cancer therapy in the United States of America. Because they’re smart guys. Because they have computers. This is not an idea that deserves to be taken seriously, and to the considerable extent that Obama’s proposals are based on these assumptions, they do not deserve to be taken seriously, either. – Kevin Williamson is an NR deputy managing editor.