Wednesday 04 March 2009
by: Edwin Chen and Aliza Marcus | Visit article original @ Bloomberg
President Barack Obama chose Dr. Zeke Emanuel to help push for universal insurance coverage while lowering costs. (Photo: Bloomberg)
White House Chief of Staff Rahm Emanuel once described his brother Zeke's plan for health-care overhaul in a single word: "wacko."
President Barack Obama is more sanguine. He chose Zeke Emanuel as counselor to the budget director to help push for universal insurance coverage while lowering costs.
To advocate the president's plan, Emanuel, a physician who treated patients at the Dana-Farber Cancer Institute and shaped policy at the National Institutes of Health, will have to keep some of his own ideas - notably a value-added tax to fund national health care - in check.
"I'm a very practical guy," Emanuel, 51, said in an interview. "There are lots of ways you can achieve the same goal."
Emanuel is the oldest of three brothers. The youngest is Ari, a Hollywood agent whose career was the inspiration for the HBO show "Entourage."
Tomorrow, it will be Zeke, the lower-profile, higher-educated Emanuel, at the forefront when Obama convenes a White House summit on health care.
Emanuel wants everyone in the US to be eligible for a voucher that could be exchanged for medical coverage, funded by the value-added tax. Insurers would be mandated to take all applicants, and people who wanted a more generous policy could pay extra.
Different Plan
There would be no need for Medicaid, the public plan for the poor, because everyone would get a voucher worth the same amount. Over time, Medicare, the federal health plan for the elderly and disabled, also would be phased out.
His plan differs significantly from Obama's. The president, in his budget last week, proposed setting aside $634 billion as a "down payment" toward universal coverage, building on the current system in part by expanding subsidies to make coverage more affordable.
Obama's is the more incremental approach, leaving one of Emanuel's former professional collaborators dubious.
"My hope is, having now embedded himself in the Washington milieu, he doesn't lose what he's learned," said health-care economist Victor Fuchs, a Stanford professor emeritus. "There, it's politics that determines everything."
Zeke Emanuel sidestepped the conflicts and said he would support the president fully.
"From a practical, politically feasible standpoint, let's be serious," he said. "I'm not wedded to the whole package. I'm not one of these people who says: 'You take my whole package or forget it.' That's not me at all."
Policy Heavyweights
That attitude may serve him well as the competition for the health-care spotlight will be great. Lawrence Summers, the chairman of the National Economic Council, will play an important role in the debate. Obama also has chosen Kansas Governor Kathleen Sebelius as secretary for Health and Human Services, and named Nancy-Ann DeParle on March 2 to lead a new White House Office of Health Reform.
Ezekiel Emanuel is accustomed to others having fame while building his own accomplishments largely out of public view.
As the first son of a Chicago pediatrician, Emanuel said, it was "inevitable" that he'd also become a doctor. "I was a first-born kid in a Jewish family. Isn't that good enough?" he said with a trademark laugh.
Emanuel's path to become a doctor was hardly linear.
After earning a bachelor's and a master's degree in chemistry, he enrolled in Harvard Medical School in Boston.
"Rote Memorization"
"I hated it - found it really boring, very hierarchical, a lot of rote memorization," Emanuel said.
So he also taught social studies and philosophy at Harvard College, and earned a Ph.D in political philosophy and bioethics before finishing medical school.
Emanuel arrived in the Washington area in 1996 to chair the newly created ethics department at the National Institutes of Health and quickly made the NIH a leader in the field, said Harold Varmus, a Nobel laureate who hired Emanuel.
Emanuel had been an oncologist at Dana-Farber in Boston and found his ability to help only one patient at a time "incredibly frustrating."
"I wanted to do something bigger - change policy that would be able to do something for lots of families," he said.
At the NIH in Bethesda, Maryland, Emanuel focused on the ethics of conducting research and clinical trials as well as allocating medical resources - de facto rationing, he said.
Over the years, Emanuel became more deeply involved in health-care policy, collaborating on papers and in meetings with economists such as former Congressional Budget Office director Peter Orszag, now director of the White House Office of Management and Budget.
It was that relationship, more than the one with his famous sibling, that led to his move into the administration. When Orszag called, Emanuel leapt at the job offer.
Intellectual Firepower
Orszag was looking for intellectual firepower to make the budget office a key policy-development center because, he said, "getting health-care reform right is perhaps the most important thing we can do to from a fiscal perspective."
Since joining the administration, Emanuel has proven to be a team player.
"He knows that you work for the political leadership," said Chris Jennings, a health policy analyst who worked in Bill Clinton's White House. "You can opine, you can talk about political visions, but at the end of the day, the elected political leaders are those who make the ultimate political decisions."
Orszag said that Emanuel has been "a very constructive participant in our internal policy discussions."
Points of View
"Any good policy process has lots of points of view represented," he added. "It becomes a problem only if someone has a particular perspective that, once having been raised and not accepted by other members, that person continues to push, to the detriment of the overall process. And that is not at all what's happening."
Emanuel accepts that reality. "I'm not doctrinaire," he said. Still, he doesn't hesitate to offer candid advice to brother Rahm, 49.
"He bounces ideas off me and he can ask me questions and can trust the answers that he gets from me," Zeke Emanuel said. "So far he has treated me like other experts."
On the politics of health-care reform, he defers to the kid brother.
"I'm related to an expert on it," Zeke Emanuel said before bursting into laughter again. ""And he's said something about the political feasibility of his brother's ideas - he thinks I'm wacko."
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