Kentucky voices

Cameron S. Schaeffer: Affordable Care Act's undertone: 'the duty to die'

January 9, 2014 

Dr. Cameron S. Schaeffer of Lexington is a pediatric urologist.

The writer Jack London traveled extensively in the Klondike over 100 years ago, inspiring a great body of work. He wrote in the time of social Darwinism, and his work exudes "survival of the fittest." Personally, he embraced socialism, as he came up hard and exploited.

After all, it was an era when a man could be fired after getting his hand cut off in a machine for the mere reason that, without his hand, he could no longer work. But London was really a capitalist; he loved freedom and he created value and wealth from the ethers with his pen.

In his short story "The Law of Life," London creates Koskoosh, an old man who has been abandoned by his nomadic tribe because he has become a burden.

Sitting and reflecting in the snow, Koskoosh recalls, as a boy, watching an old moose succumb to a pack of wolves. As his small fire and his life fade, the old man perceives a howl and then, moments later, a ring of sidling, grey shapes and the thrust of a cold, wet muzzle.

The liberal press from Fairbanks to Yellowknife would have called members of a tribe that sheds its dead weight to survive "Republicans." Actually, leaving a burdensome old man in the snow affirms the socialist notion that resources belong to the tribe, ladled out and rationed by the tribal experts. That sounds like modern Democrats. The moose is a compelling parallel, but moose do not love one another.

In pre-war Germany, the phrase "lebensunwertes Leben" emerged — "life unworthy of life."

Prodded by party experts, doctors began a program of medical killing to rid society of those who, like old Koskoosh, had become a burden. Crippled children, the mentally ill, criminals and invalids were secretly put to death. This program of medical killing accelerated as war approached and resources dwindled, ensnaring more categories of "patients" and finally morphing into the Holocaust.

That word makes some eyes roll, but facts are facts.

Several years ago, Gov. Richard Lamm of Colorado, while reflecting on the entitlement state, made the comment that old people have a "duty to die." His political career died, but he still lives. He got his Medicare card 13 years ago.

Lamm's intellectual successor is Dr. Ezekiel Emanuel, the brain behind Obamacare. He once outlined a system for distributing medical resources based on patient age and societal value, an idea apparently plagiarized from the primitive tribes of the Yukon.

To summarize, because few societal resources have been invested in babies, they are not worth much. Since old people no longer work, they are not worth much either. Those in between deserve the best care. Only the experts determine human worth. Medical resources, in the discerning mind of Emanuel, should primarily be channeled to those who can hunt caribou.

President Barack Obama did not talk much about his namesake legislation before he was reelected. Other than calling for a repeal, Mitt Romney did not talk about it much either. After all, it was his idea first. Had he apologized for Romneycare and explained how the American Revolution ended in the state where it began, he would now be president.

The lesson is to pay attention to the unsaid. Under the planks, the unspeakable, beating, telltale heart of the Affordable Care Act is the Independent Payment Advisory Board. The IPAB, or "death panel" to some, is empowered to set Medicare reimbursements for medical services if costs become uncontrollable.

If the reimbursement for a medical service is set below costs, the service will disappear, unless you can find a doctor or a hospital that will work for free.

Under the law, the president is enjoined to appoint 15 bureaucrats to the IPAB, none of whom can be practicing physicians. Nominations for the IPAB, which now only require the assent of 51 senators, should now be completed. But nominations trigger public hearings, scrutiny and the attention of the rare journalist who is still awake.

Samuel Adams used the press to set brushfires for liberty. Today, the press is like the dying embers of old Koskoosh's fire — not enough to keep the wolves in suits at bay.

Dr. Cameron S. Schaeffer of Lexington is a pediatric urologist.

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