Voyager Versus KennedyCare

Post by Gregory of Yardale

Post by Gregory of Yardale

Star Trek in general embraced an Obama-esque, hopey-changey vision of the future where socialism had eliminated all money, and hedonism had replaced all religion. All of which makes the willingness of the Enterprise crew to sacrifice themselves to save the Federation somewhat inexplicable. Europe has largely already achieved a god-free hedonistic socialist welfare state and its citizens seem to have no interest whatsoever in fighting for their culture, but anyway…

Star Trek Voyager, the weakest sister in the Trek Family (yes, that includes Star Trek V and the 1970’s Saturday Morning Cartoon), had an episode that was probably intended to argue in favor of a universal  health care system. It was one of those episodes where Voyager was trying to focus on something other than Jeri Ryan’s “borg implants” and make a social statement. And in their inept and ham-handed way, they succeeded… in making the case against it.

In the episode “Critical Care,” the bald doctor, Robert Picardo, is kidnapped and forced to work in an alien hospital. He is appalled to learn that some patients receive better care than others.

These patients, the administrator explains, have a higher treatment coefficient, and it determines the level of care they receive. It is derived through a complex formula based on the individual’s value to society, a prioritizing system for limited resources.

Now, where do we find anything like that on planet Earth in the 21st Century? How about, in the writings of President Dum-Dum’s chief medical advisor, Ezekial Emanual:

“In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations,” he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated.”

The youngest are also put at the back of the line: “Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . .  (thelancet.com, Jan. 31, 2009).

So, if “Death Panels” sounds like something from a bad episode of Star Trek… it is.

Under KennedyCare, everyone under 12 and over 70 will be issued a red shirt.

Under KennedyCare, everyone under 12 and over 70 will be issued a red shirt.

Obama’s Health Rationer-in-Chief

White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the ‘overuse’ of medical care.

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House’s health initiative.

[mccaughey] “Principles for Allocation of Scarce Medical Interventions” The Lancet, January 31, 2009

The Reaper Curve: Ezekiel Emanuel used the above chart in a Lancet article to illustrate the ages on which health spending should be focused.

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.”

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient’s needs. He describes it as an intractable problem: “Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.” (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained “to provide socially sustainable, cost-effective care.” One sign of progress he sees: “the progression in end-of-life care mentality from ‘do everything’ to more palliative care shows that change in physician norms and practices is possible.” (JAMA, June 18, 2008).

“In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations,” he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

“You can’t avoid these questions,” Dr. Emanuel said in an Aug. 16 Washington Post interview. “We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a ‘God committee’ to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions.”

Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: “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 citizens in public deliberations—are to be socially guaranteed as basic. Covering 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 dementia.” (Hastings Center Report, November-December, 1996)

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a “complete lives system” for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. “One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

“However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear.” In fact, Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated (see Dr. Emanuel’s chart nearby).

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: “Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not.”

The youngest are also put at the back of the line: “Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, ‘It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,’ this argument is supported by empirical surveys.” (thelancet.com, Jan. 31, 2009).

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12 Comments

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12 responses to “Voyager Versus KennedyCare

  1. The Doktor

    I’m sorry, but whenever I think of Jeri Ryan I think of implanting my own Borg.

    Yeah, yeah, yeah, I know – sexist. But, it’s Jeri Ryan!!! Not Pelosi. (Oooops! There went the ”Borg”.)

  2. Cylar

    Heh, yes Doktor. Seven of Nine…or as my friend used to call her, “Two of Thirty-Six.” (Get it?)

    I watched the series avidly in college. Yeah, I agree it was probably the weakest entry in the entire franchise, having gone out of its way to be PC – the racially diverse crew, the female captain, the promotion of left-leaning social values at every opportunity…not to mention the occasional episode that wasn’t about space exploration at all, but instead was an out-and-out soap opera between the Tom Parris and B’llanna Torrest characters.

    DS9 had a black captain, true, but he didn’t seem to be afraid to fight, to tell off the Cardassians, or call a situation like he saw it. I liked that series.

    I remember there was one episode in which the crew encountered a planet full of these reptilian humanoid creatures, which we were told had descended (somehow) directly from dinosaurs on Earth, even identifying a particular dinosaur species. Somehow or another, some of these prehistoric reptiles had “evolved” into a proto-humanoid lifeform and then figured out a way to travel to the Delta Quadrant and settle a planet there. On Voyager’s arrival, it found the planet filled with these creatures which were the functional equivalent of human beings, but separated from us by at least 65 million years’ worth of divergent evolution.

    The episode centered on one reptilian man in particular who’d come up with “the distant origin theory” which I described above and which clearly was a pseudonym for Darwin’s Theory of Evolution. Long story short, the ruler of the planet was persecuting this man and any other “scientist” which agreed with his theory. The ruler was clearly supposed to represent the Church or some other socially-conservative group which considered this Distant Origin bit to be heresy. The ruler was clearly the villain in the story, having announced that she was going to enslave Voyager’s crew on the reptile planet, and have the starship destroyed in order to strand them there. Captain Janeway winds up convincing the scientist to stop propagating this theory, which the viewers are supposed to see is the “real truth” of the origin of the reptile men). The scientist renounces his work, the ship and crew are released, and the viewer is supposed to be left mourning that one again, real science was crushed by the mighty but backward-and-reactionary social cons.

    All I could think about is how Captain Kirk would have avoided the entire debate and instead come up with a plan to fight the crew’s way out of captivity. Even Captain Picard’s diplomatic equivocating would have been refreshing at that point.

    Yeah, I’m a hardcore Trekkie. Sue me.

  3. The Doktor

    Cylar,

    Regarding your insightful and extremely well thought out review of the that one STV episode I can only say that I came away with, ”I wonder why 7of9 always wears heels?”

    And, I wonder if this is one of the scripts that Robert Beltran had hated?

    Doktor Von WarpDrive

  4. Cylar

    Thanks, Doktor. I like you better all the time.

    And, I wonder if this is one of the scripts that Robert Beltran had hated?

    The guy who played Chakotay? I didn’t know he hated any of the scripts. His character was a weenie in most of the episodes in which he appeared.

    The holographic doctor and Neelix were the only character on that show that I truly liked…and Neelix mostly when he was laying the smackdown on some Delta Quadrant villain he’d come across before. Everyone else I merely tolerated, or worse.

    Mostly I watched Voyager because it was the only Star Trek on at the time…and watching it had become a sort of weekly ritual with the girl I was dating at the time.

  5. The Doktor

    Well, since Gregory brought up the Voyager connection (at first glance I thought he was talking about V-Ger) I supposed we can dawdle around with Star Trek talk.

    Robert Beltran had wanted to leave the series because he thought that the scripts were hackneyed and had poor plots and dialog. The writing staff threw a few ”Chakotay centered” scripts to relieve some of his anguish but he was never happy.

    BTW – Did you know that Kate Mulgrew and John de Lancie were close friends in real life? That’s why there was an immediate ”chemistry” between them and Q was used often in the series.

    I am not a fanatic but a old Star Trek watcher. I can’t stand the latest one – Enterprise – and never warmed to the ”more cerebral” DSN. Ah, but there it is. First star to the left and straight on ’til morning.

  6. Teh Mole

    Chakotay and Neelix were my least favorite Voyager characters. Neelix was a stereotype they included to make children go “Mommy, the man with the funny hair!”; and everytime Chakotay did anything “Native American”, well, the less said, the better. I liked the Paris-Torres soap opera because it at least made them fully human, so to speak… plus Robert Duncan McNeill was kinda hot, for a straight guy. Kate Mulgrew may not have been the greatest ST lead ever – Patrick Stewart was that – but she was more 10 times more watchable than the Deep Sh*t 9 captain, , who had the persuasive charisma of a dead tree. “Different strokes.”

    Getting back to the Voyager episode… Medical care is always rationed by one means or another – always – and if I recall, “The Allocator” was meant as an allegory for the heartbreaking cruelty of rationing on the basis of how much people had contributed to society economically, in their lives. Heartbreaking, tsk tsk. But the allegory to allocation by bureaucratic / political formulas (Emanuel’s death boards) is, of course, far more apt. I have a feeling that if Obamacare passes, people will ‘read’ that episode quite differently 5-10 years.

    • I always thought there was sort of an inside joke with Janeway. She was a flat out bad captain. And I thought there was a secret backstory to her that she was a Starfleet bureaucrat who made her way up through the ranks on a combination of raw ambition and having a father who was an admiral. The main reason she got the command of Voyager was because all the really good officers had been wiped out at Wolf 359.

  7. Teh Mole

    She always seemed to relish her power a bit too much.

  8. The Doktor

    Greg & Mole,

    Ah, but she wasn’t as bad as Doctor Pulaski. I was always waiting for her to fall down a turbo shaft.

    Doktor Ironic

  9. Cylar

    The captain on DS9 didn’t have a lot of charisma, but the series was watchable, at least in my view.

    I never knew of any chemistry between DeLancie and Mulgrew. Funny because in front of the cameras, it always seemed a different story. Never knew the trivia about Beltran either.

    I just have one question about the “health care” episode on Voyager. Were they really arguing AGAINST rationed health care…or arguing FOR it (as would make more sense considering the series’ leanings) and just doing a really bad job of it?

    I remember watching the Voyager series when it was on TV and periodically thinking how much “times had changed.” The original series from the late 60’s actually had Lt Uhura once referring to “The Son of God,” meaning Jesus, in an episode about “sun worshippers.” I couldn’t possibly imagine that on the “evolved,” sanitized, PC Voyager or really, any of the other later series’s.

  10. The Doktor

    Cylar,

    I remember when it was patriotic to be for your country. I remember when actors and Hollywood actually loved their country.

    Now . . . .

  11. Teh Mole

    “The Allocator” considered an individual’s economic importance and contributions in deciding to let them have cosmetic surgery (say) while the little people heartbreakingly went without critical treatments. In context, and given ST social-fascist philosophy, I’m pretty sure they thought they were arguing *for* socialized medicine, i.e., *against* medicine based on how much money an individual has.

    But again: the episode really works better as an argument against socialized medicine, and after 10 years of ObamaCare even ST lefties will be reading it differently.

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