Health Care Reform and the New Eugenics

September 25, 2009

Health Care Reform
And the New Eugenics

For immediate release (659 words)

by Dr. Eric Schansberg

I’ve written frequently on eugenics, the study of the hereditary improvement of the human race by controlled, selective breeding. The word derives from its Latin components (eu meaning well or good and genics meaning born or birth). In other words, eugenics seeks the products of “good birth” or being “well born” — “better” human beings or a “better” human race — through selective breeding.

Recently, I was struck by the following combination. First, the health care reforms proposed by Democrats would result in more rationing of health care services. Second, especially when listening to some of those who would implement the additional rationing, it seems likely to be concentrated among the elderly, newborns and those with “bad” lifestyle choices. Third, society in general (and the Left in particular) has a significant eugenics reflex.

Developing the first point, government proposals to increase health care coverage would almost certainly result in higher costs, more rationing, or both. (The unlikely exception: if the federal government can, somehow, provide an increase in efficiency.) At present, it looks like both costs and rationing would increase under the current Democratic proposals. Cost estimates range from $900 billion to $1.6 trillion. Meanwhile, the president pledges to decrease spending in Medicare, implying reduced services for the elderly. Beyond that, as the health care costs supported by taxpayers continue to increase, the subsequent budgetary pressures are likely to yield future cost-cutting measures and more rationing.

Developing the second point, consider Dr. Ezekiel Emanuel — the brother of Rahm Emanuel, the president’s chief of staff. Dr. Emanuel has already been appointed as a health-policy advisor at the Office of Management and Budget and is a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a significant role guiding the White House’s health initiative.

In January 2009, Dr. Emanuel had an article published in The Lancet, a prominent medical journal. In the article, he proposed rationing guidelines, including a relatively famous graph depicting an ideal “probability of receiving an intervention” at various ages. Babies, toddlers (up to age four), and those over 60 years old would be least likely to receive an intervention — less than one-third as likely as those who are 20-30 years old.

Of course, we don’t know whether Dr. Emanuel’s preferences would become the drive behind bureaucratic fiat. In any case, increased rationing will result in more difficult choices. Under dramatically increased government involvement, this translates to politicians and bureaucrats making more and more decisions about the care that would be available to people.

Over the past two decades, more and more attention has been paid to lifestyle choices — whether stricter prohibition efforts in the War on Drugs, the increasing squeeze on tobacco use, or the increasingly louder drumbeat against obesity, fat intake and unhealthy diets. A natural application of this paternalistic mindset would result in greater rationing efforts upon those who make the “wrong” decisions about diet, smoking and so on. 

Less treatment for the obese and those who smoke will result in earlier deaths for them. Maybe that’s one of the points. This certainly resembles a Darwinian emphasis on the survival of the fittest and healthiest. Meanwhile, those who are the least healthy and lowest on the utilitarian scale of usefulness will be culled from the population through natural selection.

I know this sounds harsh, and I don’t mean to imply that proponents of health care have connected these dots, but the results — intended or not — are likely to follow the path I have laid out here.

It’s also worth noting that the free market — if allowed to work — would achieve similar ends, even if by profoundly different means. The unhealthy would pay higher insurance premiums and be encouraged to change their lifestyles — or pay the proverbial piper.

Even so, the motives of the market-oriented options are more about individual freedom and responsibility than having a set of elites who would ration care to those who “deserve” it.

D. Eric Schansberg, Ph.D., is professor of economics at Indiana University Southeast, an adjunct scholar for the Indiana Policy Review, and the author of “Turn Neither to the Right nor to the Left: A Thinking Christian’s Guide to Politics and Public Policy.” Contact him at


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