In Sickness and in Health

If Ezekiel Emanuel (age 57)  had just stated his preference for dying at 75 or if he were a citizen uninvolved in public affairs, no attention need be paid. There is no use disagreeing with tastes, and the world is full of eccentrics. But Emanuel was one of the enthusiastic cheerleaders of the President’s health care plan, and he offers a lot of reasons to justify his preference. The considerations he adduces and those he fails to account for provide an unsettling perspective on the world view underlying some progressive support for Obamacare.

Insufficient interest in future innovation. Emanuel is concerned that, even if he lives longer than 75, he is likely to be a shadow of his former self. But Emanuel considers the world as it is today, not one that innovation could create when he is 75. Innovation can increase the quality of life as well as longevity. Indeed, if we reap the benefits of the age of genomics and personalized medicine, that medical progress could easily accelerate. Unfortunately, Obamacare may retard that innovation by discouraging investment. It is troubling that one of its architects does not consider the possibilities of transforming our future.

One Size Fits all in Advance.  Emanuel cannot possibly know his condition at 75. Natural aging is the most brutal of bell curves. While some die well before 75 others are possessed of full powers long into old age: Sophocles wrote Oedipus of Colonus at almost 90. At 84, Warren Buffett makes money for investors with the help of his 90 year old Vice-Chairman, Charlie Munger. Emanuel reflects here a common stance of enthusiasts for government impositions– an indifference to difference. In fact, one problem with Obamacare is that it forces standard insurance plans onto people, regardless of their different situations.

The Nature of our Humanity. Most troubling of all is Emanuel’s dismissal of the value of living even when frail or sick, not only for the individuals themselves but for those around them. By emphasizing the greater productivity of the young, he comes troublingly close to the old progressives who favored eugenics to cut down on people regarded as not socially valuable, or even to certain modern progressives, like Richard Dawkins, who argued that moral duty compels the abortion of babies with Down syndrome.

But youth and good health do not measure humanity. Millions in diminished health enjoy life, being with their relatives, laughing at old movies, even just sitting in the breeze and sunshine. And their relatives and friends enjoy being with them. Indeed, they may find in the elderly’s struggle with aging an inspiration and a reaffirmation of life. In caring for the frail, weak and sometimes woebegone, they may also expand their own sympathies and express some small measure of gratitude for the debt of a good upbringing that can never be fully repaid.

That is certainly my experience watching my parents age well past 75. I have never admired my father more than when at the cusp of ninety he faces down his own infirmities and cares for my mother who has Parkinson’s disease. And although much is taken from my mother, much abides—her concern for others, her delight in reading new novels and rereading old ones. Emanuel argues that in seeing the decline of those we love, we may forget our happy memories of them in their years of vigor and achievement. But those memories do not need to summoned at particular times, because they infuse my being. In any event, the most valuable memories of all are not defined by physical wellbeing but by spirit and character. For so many people beyond 75 the forging of character continues and the power of their spirit at their end will instruct us by example at our own.