Health care for non-disabled, participating citizens; rationed for those who are disabled or otherwise “non-participating”?

I wonder how much actual authority to affect policy these two have.

Advisors want to ration care:

… Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel. He has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of Federal Council on Comparative Effectiveness Research.

Emanuel bluntly admits that the cuts will not be pain-free. “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely ‘lipstick’ cost control, more for show and public relations than for true change,” he wrote last year (Health Affairs Feb. 27, 2008).

Savings, he writes, will require changing how doctors think about their patients: Doctors take the Hippocratic Oath too seriously, “as an imperative to do everything for the patient regardless of the cost or effects on others” (Journal of the American Medical Association, June 18, 2008).

Yes, that’s what patients want their doctors to do. But Emanuel wants doctors to look beyond the needs of their patients and consider social justice, such as whether the money could be better spent on somebody else.

Many doctors are horrified by this notion; they’ll tell you that a doctor’s job is to achieve social justice one patient at a time.

Emanuel, however, believes that “communitarianism” should guide decisions on who gets care. He says medical care should be reserved for the non-disabled, not given to those “who are irreversibly prevented from being or becoming participating citizens … An obvious example is not guaranteeing health services to patients with dementia” (Hastings Center Report, Nov.-Dec. ‘96).

Translation: Don’t give much care to a grandmother with Parkinson’s or a child with cerebral palsy.

…

Dr. David Blumenthal, another key Obama adviser, agrees. He recommends slowing medical innovation to control health spending.

Blumenthal has long advocated government health-spending controls, though he concedes they’re “associated with longer waits” and “reduced availability of new and expensive treatments and devices” (New England Journal of Medicine, March 8, 2001). But he calls it “debatable” whether the timely care Americans get is worth the cost. (Ask a cancer patient, and you’ll get a different answer. Delay lowers your chances of survival.)