After attending a Sunday evening wedding in New York earlier this month, I woke up at some uncivilized pre-dawn hour to return to DC for work and to attend an interdisciplinary (and ideologically eclectic) lunch here at New America. We had some foreign policy types, and some domestic policy types, and even one Hollywood type, and the conversation floated from one theme to another (universal pre-K? the war in Afghanistan?) in a rather interesting way until a conservative participant posed the question that dominated much of the rest of our luncheon.  Doesn't Zeke Emanuel, he asked, want to ration care to save money and stop access to expensive cancer drugs? Doesn't he want to remake the Unites States health system over to look like Britain's? (I'm paraphrasing, but only slightly).

I replied (perhaps not as well as I could have had I more than 3 hours sleep) that the health reform debate is not about rationing. It's about covering the uninsured -- whose lack of access to timely and ongoing care and whose higher risk of death because they are uninsured can be viewed as de facto rationing. It's about the long-run economic health of our country; we're on a trajectory that can't be sustained. And it's about changing incentives and systems so we can provide better and more coordinated care for everyone, including the elderly and the chronically ill.

Obama has numerous health policy advisers in the White House and at HHS and I left that lunch wondering why Emanuel, an oncologist by training with a special interest in breast cancer, an ethicist with a long record of opposing euthanasia and physician-assisted suicide, had become the bogeyman. Reading some right-wing blogs, I soon found out. This weekend the Washington Post editorial page (which has not been an unqualified booster of all things health reform) addressed the distorted view of Zeke Emanuel's record.

Some excerpts:

EZEKIEL EMANUEL, one of President Obama's top health advisers, is a respected bioethicist who opposes euthanasia and physician-assisted suicide. When the Supreme Court was considering the constitutionality of state laws that prohibit physician-assisted suicide, Dr. Emanuel was an outspoken opponent of the practice. He warned it could be abused "to justify using euthanasia for children, the incompetent, the mentally ill, and others who are suffering or who we imagine are suffering in some fashion." So it is grotesque that Dr. Emanuel has become the latest bogeyman -- the "Dr. Death" behind the "death panels" -- for opponents of the Obama administration's push for health-care reform. The case against Dr. Emanuel, brother of White House chief of staff Rahm Emanuel, stems from his writings on how to allocate medical resources in cases of scarcity -- for example, who should get preferences for heart transplants or scarce flu vaccine. The furor was touched off when former New York lieutenant governor Betsey McCaughey, reprising her 1994 role as health-care misleader-in-chief, wrote an op-ed for the New York Post asserting that Dr. Emanuel advocates rationing care and believes "medical care should be reserved for the non-disabled." Dr. Emanuel's view, in Ms. McCaughey's caricature, boils down to: "Don't give much care to a grandmother with Parkinson's or a child with cerebral palsy." These statements distort Dr. Emanuel's thoughtful and nuanced positions. And they have even less to do with the pending health-care proposal.

In a 1996 essay for the Hastings Center Report, Dr. Emanuel struggled with the question of how to determine, in a system where everyone is guaranteed health coverage, what services patients are entitled to. Ms. McCaughey and other critics, including former Alaska governor Sarah Palin, cherry-picked from the piece to quote Dr. Emanuel writing that "services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." This would be troubling if it were Dr. Emanuel's view; it isn't. "I never say this is the way we ought to go," Dr. Emanuel told us. "I never say this is the solution to the problem." In any event, Dr. Emanuel said he has since become convinced that there is enough waste in the health-care system that universal coverage can be achieved without rationing. ...

Dr. Emanuel's writings reveal him to be a thoughtful person grappling with difficult ethical issues. The same cannot be said of his critics, who seem less intent on discussing what is in the health reform proposal than in deploying scare tactics to defeat it.