Dr. Ezekiel Emanuel is the brother of the current mayor of Chicago and, like MIT’s Johnathan Gruber, an architect of Obamacare, which proponents prefer to call “the Affordable Care Act.” It turns out one of the ways the good Dr. Emanuel wants to help make health care affordable is to dissuade patients from using it.
Emanuel has already made news by saying that he doesn’t see much use in living past age 75. That’s when, for many people, the body and the mind begin breaking down in ways that are essentially irreversible. Beside, says Dr. Zeke, most people past the age of 75 don’t accomplish much of anything worthwhile, and so are of little use to society. (To be brutal, most of us of any age don’t accomplish much that’s truly transformative.) And if life’s not worth living past 75, don’t expect the administrators of Obamacare to see that you get much health care after that age.
Exceptions abound, of course, from Supreme Court Justices to active centenarians. But they are exceptions, and Dr. Zeke does not bet on exceptions.
That’s why, for example, Dr. Zeke recently announced on The New York Times op-ed page that he’s given up his annual physical and that you should, too. (“Skip Your Annual Physical,” January 9, 2015.) For an estimated 45 million of us, according to Dr. Zeke, the annual physical has been a part of our well-being check: a reminder that we are another year older, to watch our weight, to get enough sleep and exercise, and to cut back on our bad health habits like excesssive drinking, smoking, or sniffing glue. (Sorry, you had to watch Lloyd Bridges in “Airplane.”)
An annual physical also serves as a way to stay in touch with medical care-givers; to monitor year-to-year changes in blood pressure, weight, cholesterol level, and blood sugar on a systematic basis; and to notice unusual changes like precancerous moles or emerging cataracts. A clean bill of health following an annual physical also puts most of us in a better psychological state, which indisputably enhances our happiness, productivity, and overall well-being.
But what are such well-known practical and intangible benefits in the face of hard scientific evidence, especially as wielded by experts like Dr. Zeke and Mr. Gruber?
For according to the impressively and alliteratively named “Cochrane Collaboration,” which sounds like the next Bourne Identity novel but which Dr. Zeke redundantly informs us is an “international group of medical researchers who systematically review the world’s biomedical research,” annual physicals are “unlikely to be beneficial.” And that must be true; after all, these are medical researchers who review medical research.
According to Dr. Zeke, the Cochrane Collaboration’s fourteen “randomized controlled trials with over 182,000 people followed for a median of nine years” –very scientific-sounding – showed that annual physicals from 1963 to 1999 “did not reduce mortality overall or for specific causes of death from cancer or heart disease.” Well, duh!
One reason, Dr. Zeke concedes, has nothing to do with annual physicals: unintentional injuries and suicides are the fourth and tenth leading causes of death among Americans. Physicals do nothing to detect or relieve the former, although they may actually help reduce chances of the latter; perhaps that’s partly why suicides come in tenth instead of fifth or sixth.
But a second, more obvious, reason that physicals may not reduce “overall mortality” is – get this – just like in most operas, everybody dies in the end. Or as Bob Dylan put it many years ago, “he not busy being born is busy dying.”
Of course an annual physical is not going to keep people from dying, nor can it prevent cancer or heart disease. But for all the reasons cited above, it can help people lead longer, healthier, more productive, more satisfying lives.
Dr. Emanuel’s real reason for discouraging annual physicals seems to be his expert-driven insistence on making Obamacare work despite the odds. In essence, the Affordable Care Act is yet another wealth transfer scheme, from the healthy to the sickly, from the middle class to the lower class. In systems of government-rationed care like Obamacare, Medicare, Medicaid, and the VA health system, some people must be denied care in order to provide it to others.
“Not having my annual physical,” admits Dr. Emanuel, “is one small way I can help reduce health care costs … ” If others will but follow his example, then “[t]hat will free up countless hours of doctors’ time for patients who really do have a medical problem, helping to ensure there is no doctor shortage as more Americans get health insurance.”
Or we could let Americans voluntarily pick their own health care plans and decide for themselves if an annual physical is worth their own time and money.
David Applegate is a Chicago-based trial lawyer and partner at the law firm of Williams Montgomery & John Ltd.
