Emanuel Bets on Favorable Supreme Court Ruling

Knowing the serious side of Dr. Ezekiel Emanuel, the University of Pennsylvania's Vice Provost for Global Initiatives, I was surprised when he disclosed at the Jewish Social Policy Action Network (JSPAN) annual meeting that he had placed 5 bets speculating that the insurance mandate in the recently passed Patient Protection and Affordable Care Act (Obamacare) would survive the Supreme Court. Despite making dinner for him, he does not expect that his good friend Supreme Court Justice Antonin Scalia will vote yes. 

Emanuel, who served as a Special Advisor on Health Policy to the administration when the bill was being drafted, said, "I believe that the mandate will survive. I think the vote will be 6:3 in favor with Kennedy and Roberts voting for. Otherwise, it will be 5:4 against. If that happens, the country will have bigger problems because then it will be a partisan ruling along party lines."

He argues that the commerce clause of the constitution makes the healthcare mandate constitutional. 

"The constitutionality of this clause has been upheld many times," said the doctor. "One example is Heart of Atlanta Motel vs United States. The owner of the hotel, which was on an interstate highway, was forced to integrate."

He continues, "There are already plenty of healthcare mandates. "Vaccinations. No Smoking Laws."

He has a ready answer for those that fear mandating health insurance will mean more mandates, such as requiring funeral coverage. 

"What is so wrong about that? Funerals are expensive," said Emanuel. "I had a poor patient who could not afford to bury her husband. She wanted to donate his body to science. To avoid the costs of a funeral home, she just wanted to drive the body to MIT herself. I had to tell her that it was illegal to transport a dead body in Massachusetts without a special license."


Emanuel is emphatic that if the Supreme Court rules that the Affordable Care Act is unconstitutional that this country will never again see comprehensive health reform. 


"We have been trying to trying to reform healthcare since Teddy Roosevelt's administration and never succeeded until now," he noted. "If it is over turned again, no one will have the political will to attempt it again."

Emanuel, who is the Diane v.S. Levy and Robert M. Levy Professor, blames the Republicans for the lack of medical malpractice reform included in the bill. 

"There was no Republican support for the bill so there was no incentive for malpractice reform," explained the doctor. "We talked to Olympia Snowe. We made the changes that she wanted, but she still did not vote for the bill."

According to Emanuel, there is still hope for malpractice reform. A trial program in Michigan, which allows doctors to apologize to patients but not allow the apology be admitted into court, has shown encouraging results. 

Dr. Emanuel turned serious when the discussion turned to end of life counseling aka death panels. 

"My critics named me Dr. Death," said Emanuel. "I am an oncologist. I love to talk, but even I avoid having this talk with my patients. Patients want to have that talk with their doctor."

Emanuel is always ahead of the curve in his thinking about medicine. He is now suggesting that both medical school and residency be cut by one year.  

My one question for Emanuel- Is it ethical for the renowned bioethicist to bet on the outcome of a Supreme Court ruling?