Susan Axelrod and Joe Biden Should Register as Heath Care Lobbyists

In a recent post noting Barack Obama's limitations as a comedian, I cited his well-known roast of Rahm Emanuel, which took place at a fund-raiser for Citizens United for Research in Epilepsy, organized by Susan Axelrod.

I spoke about Ms. Axelrod and her cause in my post, "Health Care Policy by HuffPo Celebs," to wit:

I watched on Morning Joe as the beautiful (both inside and outside) Susan Axelrod, wife of David (everyone's favorite political operative), proselytized for more money for the care of and research on epilepsy, from which her and David's daughter unfortunately suffers. How could your heart not go out for their family? NBC's medical editor, Nancy Snyderman, meanwhile intoned that not enough was being done in research on epilepsy and other "broad-spectrum" neurological disorders. Is this true? Or, to put it another way, should TV appearances by influential individuals be the way we make this decision?

Obviously, the Axelrods are deeply concerned about their daughter, and want to see great investments made in what ails her. But what if she had autism, or spina bifida, or childhood diabetes, or hydrocephalus? You see where I'm going - why should Obama (albeit before becoming President) be speaking to obtaining more funding for one of these diseases over another simply because he has friends and political allies with a child with that disease? Is that how American health care policy should be determined?

As we are fast becoming acutely aware, there is a limited health care and research pile of dough to be divided, and we have to have some rational, ethical, economic basis for making these decisions. Ironically, this is one of the principles President Obama has introduced into the health care debate in the United States. Doubly ironically, one of his key advisers in this area is Rahm Emanuel's brother Zeke. Writing in the British medical journal The Lancet earlier this year, Emanuel and his co-authors advocated as an ethical basis for allocating scarce medical resources:

the complete lives system [which] combines four morally relevant principles: youngest-first, prognosis, lottery, and saving the most lives. . . . Importantly, it is. . . a framework that expresses widely affirmed values: priority to the worst-off, maximising benefits, and treating people equally. To achieve a just allocation of scarce medical interventions, society must embrace the challenge of implementing a coherent multiprinciple framework rather than relying on simple principles or retreating to the status quo.

I think it's safe to say Emanuel et al. do not consider one relevant ethical principle for assigning health care and research resources to be, "Having the most influential boosters." (In a follow-up letter to their article Emanuel and his colleagues note: "equitable, non-corrupt health-care systems are an important part of ensuring fair access to scarce lifesaving resources.") Has no one ever questioned the President favoring his close friends' preferences for such allocations or their lobbying him for support?

There are many other examples of log-rolling in health care financing by powerful political figures. For example, Ted Kennedy has been the major source for seeking parity in insurance coverage for addiction, based on his son Patrick's frequent drug relapses. It is as hard to be critical of this funding thrust as to question research money for epilepsy. However, the 12-step treatment that Patrick Kennedy repeatedly receives for his addiction - the standard one administered around the country - has never been shown to be effective. (Disclosure: I am the creator of an alternative addiction treatment program which receives insurance reimbursement.)

Which brings us to everybody's favorite crazy uncle, Joe Biden. Did you notice that Joe was the only one drinking a non-alcoholic beer at the recent bash on the White House lawn? Uncle Joe clearly has issues around alcohol. This may explain his introduction - just prior to his nomination for the Vice Presidency - of the bill titled, "Recognizing Addiction as a Disease Act of 2007." The bill declares that "Addiction is a chronic, relapsing brain disease." (Disclosure: I would be arrested under this law, since I have repeatedly argued that viewing and treating addiction as a disease is harmful.) The primary provision in this bill - aside from dictating how we should think about addiction - is to change the name of the National Institute on Drug Abuse to the "National Institute on Diseases of Addiction."

I have five questions for "crazy" Joe:

1. Do you think gambling, sex, and shopping can be addictive?
2. If so, will this new institute deal equally with these matters along with drugs?
3. Do you believe people can use illicit drugs without being addicted to them (cf. Barack Obama)?
4. If yes, will the new institute thus ignore non-addicted drug use and users?
5. Will the new institute address people who are addicted to pharmaceuticals prescribed by their physicians?

Comments

[mythster]

Good on you, Mr. Peele
As an ex-alcoholic who woke up one morning two years ago and decided that "enough was enough" after more than fifty years of limping along on my alcoholic crutch, I decided why and how I needed to stop and did it for myself because I couldn't afford to waste any more nights or mornings under the influence or after-effects of alcohol. The last thing anybody who drinks to excess needs is an excuse to continue and a legal cop-out is just another excuse.
I think Biden is a perfect example of the kind of politician we don't really need and I can't understand why Obama ever took him on but perhaps "the great pragmatist" has some secret agenda that will de exposed in the future

[LizM]

I'm sorry but I found that to be about as clear as mud. Care to elaborate as to what your point is...parti­cularly with respect to your attempt to link the Vice President with your own situation?

[TravelDog]

"Did you notice that Joe was the only one drinking a non-alcoholic beer at the recent bash on the White House lawn? Uncle Joe clearly has issues around alcohol."

Yes, as a matter of fact, he does have 'issues' around alcohol. To quote the man himself: "There are too many alcoholic Irishmen and I decided not to risk becoming another one."

Senator, now Vice President, Biden has explained on several occasions that he decided early on in his life that he wasn't going to drink, and he simply doesn't. (I would guess that one or two of those drunken Irishmen may have been relatives and he was choosing to avoid something he'd perhaps seen too closely, but he has never said that). Trust me, if Biden himself had a "problem", you can be sure it would have been revealed sometime in the last 35 or so years. For a politician, esp an Irish politician, to announce that he doesn't drink is the same as daring the press and gossip mongers to prove him a liar.

This isn't secret, or hidden, information. Just for drill, you might want to check your facts before you start making -- and broadcasting -- smarmy assumptions about people.

[LizM]

That was very well said.

It continues to amaze me just how many people seem to think they know so much about Senator/Vice President Biden when their own words betray their complete ignorance on the subject.

[LizM]

Since you have not given us any information about the Senate bill in question, sponsored by Senator Biden and no longer pending, here it is...

http://www.govtrack.us/congress/billtext.xpd?bill=s110-1011

You assert that you would be arrested if this bill had been passed into law. Really? That's not a very good strategy for validating your credibility.

[SparkyDash]

Good information for others too...you should write the blog; actual information is a good thing, amen.

[PrincipiaChamp]

Yes, yes, intelligent information. Thank you.

"I'm sure he's not worth our time and effort..." agreed.

[SparkyDash]

Just as I was asking my spouse: "Who would be bumptious enough to attempt to find something negative about VP Biden consuming a non-alcoholic beverage," there you are.

Please note I said VP Biden, because Joe Biden is the Vice President of the United States, not as you blithly and disrespectfully state anyone's crazy uncle...fa­vorite or otherwise.

What's wrong with you?

[Stanton Peele - Huffpost Blogger]

Sounds like you and I both can't wait until Congress begins active consideration of Biden's "Recognizing Addiction as a Disease Act" declaring as a matter of U.S. law that "Addiction is a chronic, relapsing brain disease." I would give anything to see that debated on the floor of the U.S. Senate. But I fear his fellow Senators think this proposed legislation is - how can I put this daintily enough? - kooky. And, just remember, I'm a private citizen - Biden's our Vice President, amen.

[LizM]

It is clear that the gist of your post was lost on this blogger...­but, at least it passed through moderation! Perhaps he'll ponder it some but, I'm sure he's not worth our time and effort.

[SparkyDash]

Totally lost, but not surprising. Passing moderation was the objective ;-)

[PrincipiaChamp]

I'll bet the whole "just remember, I'm a private citizen" rhetoric goes one way only. Follows the blogger's schtick. No doubt SD has responded (as I know SD), but not allowed to post. Darned, those pesky one-sided rules.

Bless SD for his first response however.

[Mary2009]

It is stunning to learn the level of self-interest and blatant corruption in our government.

This self-interest, this use of our government for the benefit of the office holder, rather than the citizens, is about to cause an explosion - perhpas an implosion - and our average citizens will be hurt.

Is there no sense of conscience?

Are the highest offices filled with Baby Boomers who think only of themselves? ie, I want it,and I want it now!

Who can we trust?

[SuperJ]

"Why should President (at the time president-elect) Obama be speaking to obtaining more funding for one of these diseases over another simply because he has friends and political allies with a child with that disease? Is that how American health care policy should be determined?"

I'm not sure if I'm reading this right, but the Rahm Emanuel roast was in 2005. Obama was not president-elect.

[LizM]

There are a few other points that the blogger gets wrong, too...at least insofar as the implications he makes with respect (or not, as the case may be) to Vice President Biden. But, that's just par for the course around here...sad to say...

[wendy82551]

Good points. i've read your addiction work and I must say, it is more accurate than the disease model in describing the experiences of me, my friends, and family, all of whom have coped with alcohol or drug use that they considered to be problems by either quitting on their own or moderating their use. And my 20-something sons have confirmed for me what I always suspected--that the DARE program taught them nothing except how to identify drugs, where to get them, and how to use them. The medical model served a purpose in removing the moral stigma from addiction, and I do think that neuroscience research is suggesting that habitual behavior can actually change the brain, and there are consequences to be considered about that. But ultimately, we can make choices to change our behavior--we are in charge, not the substance.