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By Joel Mathis and Ben Boychuk

Ezekiel Emanuel, a physician and one of the architects of Obamacare, writes in the October issue of the Atlantic Monthly that Americans are too obsessed with living long lives.

"For many reasons," including diminished mobility, a "tsunami" of dementia, and sparing adult children from the pain of a long decline, Emanuel argues, "75 is a pretty good age to aim to stop."

Emanuel insists he isn't advocating death at 75 as a way to ration health care or save money. But with health care costs outpacing official estimates, conservative critics of the Affordable Care Act worry Emanuel's musings might eventually become law.

Are Americans living too long for their own good? Do we have a civic duty to die younger? Ben Boychuk and Joel Mathis, the RedBlueAmerica columnists, weigh in.

JOEL MATHIS

Here's some great news, America: Nobody's going to require you to die at age 75.

Not Ezekiel Emanuel. Not Barack Obama. Not the federal government.

The hysterics who spent the original Obamacare debate screaming about "death panels" have taken a (superficial) look at Emanuel's essay in The Atlantic and have brandished it as proof that they were right all along. In fact, they're wrong in almost precisely the same way they originally were.

Back then, the Obamacare provision that raised the spectacle of "death panels" was actually an effort to get older Americans to talk with their families and doctors about end-of-life care.

Lots of folks (even Republicans) would rather not spend the last weeks of their lives - and hundreds of thousands of dollars - in pain and hooked up to expensive machines that can only delay death without restoring real health.

But avoiding that fate sometimes means communicating your wishes early; all Obamacare was expected to do was to facilitate that conversation.

Emanuel's essay is basically a public version of that conversation. He thinks 75 is a good end date, but it's important to note that doesn't plan to kill himself at that age, and he doesn't want the government enforcing the decision either. He'll simply stop going to the doctor so often, and do more to let nature take its own course.

"Let me be clear about my wish. I'm neither asking for more time than is likely nor foreshortening my life," he writes. "Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide."

So why are Emanuel's critics so sure he's coming for granny with federal agents in tow? Obamacare isn't perfect, but it seems to be providing more people with insurance coverage and it's even credited with lowering medical costs. Conservatives need a bogeyman to distract you from the program's success.

BEN BOYCHUK

Just as Ezekiel Emanuel is careful to freight his 5,000-word Atlantic essay with caveats and qualifications, I would be careful not to make any guarantees or sweeping claims about what you may or may not be required to do in the autumn of your years.

But you needn't be a hysteric to distrust the easygoing claims of a man who elsewhere argues explicitly for rationing health care.

Emanuel coauthored a 2009 article for Lancet, a widely read and well-respected medical journal published weekly in the United Kingdom, which laid out "Principles for Allocation of Scarce Medical Interventions." Emanuel and his colleagues considered how best to allocate resources based on several different models before settling on a "complete lives system." Put simply: it prioritizes young people at the expense of old people.

Obamacare is no bargain. Fact is, health care is expensive and it's getting more so all the time. Contrary to popular belief in free markets, American health care is heavily regulated and subsidized. Nearly half of U.S. health care spending comes from the government.

Federal subsidies under the law will likely top .5 billion this year, according to federal figures. But precise estimates are hard to come by. The malfunctioning healthcare.gov website alone has cost taxpayers more than billion, a Bloomberg report found.

You needn't be an actuary to see where all this is headed. The government will be under tremendous pressure to curb costs as more Americans end up getting insured through subsidized exchanges. Older people often have chronic conditions that are more costly to treat. When resources are limited, you look to cut the big expenses.

Pretty soon, dying at 75 might look like a fiscal necessity.

But who knows? A recent Associated Press poll found that only 30 percent of U.S. adults approve of Obamacare. Another poll by McLaughlin and Associates found that 60 percent of likely voters now favor either repealing the law outright or replacing it with something else. Repeal, like growing old, may not be so bad when you consider the alternative.

Ben Boychuk is associate editor of the Manhattan Institute's City Journal. Joel Mathis is a contributing editor to Philadelphia Magazine. Reach them at bboychukcity-journal.org, joelmmathisgmail.com or www.facebook.com/benandjoel

Ben Boychuk (bboychukcity-journal.org) is associate editor of the Manhattan Institute's City Journal. Joel Mathis (joelmmathisgmail.com) is associate editor for Philadelphia Magazine. Visit them on Facebook: www.facebook.com/benandjoel.


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