Dr. 'Zeke' Emanuel's Challenge; Proposes Medicare, Medicaid Phaseout into Health Care Voucher System for All

Article excerpt


Rahm Emanuel may be the most famous of the three Emanuel brothers, but he's probably not the most intense. Sitting next to his older brother, Rahm comes off as folksy, flashing Cheshire grins and cracking jokes as he did in a TV interview last year, while Dr. Ezekiel J. Emanuel radiates an almost nervous energy, leaning forward in his chair, earnestly waiting for the conversation to turn to health care reform.

It is that very issue that has brought Zeke Emanuel, as he is known, to the White House with his younger brother after two decades as an oncologist and nationally recognized bioethicist.

There is one complicating factor to all this: Dr. Emanuel, 51, has some very different ideas about health care reform than President Obama and some of his key advisers.

And he carries that same fire in the belly for which his younger brother is known. He has been known to challenge superiors during his time at the National Institutes of Health and elsewhere, colleagues say.

He's feisty. He's not a milquetoast or a pushover, says Victor R. Fuchs, a health policy and economics professor at Stanford University who worked with Dr. Emanuel over the past five years on a comprehensive health care reform proposal.

That infamous Emanuel feistiness - shared by the youngest brother, Ari, a Hollywood superagent - was on display recently when Dr. Emanuel helped moderate one of several small-group discussions between members of Congress and health care industry professionals.

Can I throw out a challenge? Dr. Emanuel asked nearly an hour into the session. Then he asked the group of about 20 to propose concrete ideas for how to make health care providers lower cost and increase the quality of care.

When a Pfizer Inc. executive praised an idea to collect and publicize infection rates among hospitals in an attempt to name and shame poor-performing institutions, Dr. Emanuel spun quickly to his left and placed his hand on the shoulder of Rep. Roy Blunt, Missouri Republican.

Do you agree? Dr. Emanuel asked pointedly.

Yes, said the startled Mr. Blunt, who is heading up a Republican health care working group.

Dr. Emanuel pounced quickly: And do you think the government ought to pay to collect that information?

Mr. Blunt hesitated, and before he could say anything, Dr. Emanuel raised his voice.

Who ought to get that information? he asked sharply. It's a public good. We know that we underinvest in the public good.

Sen. Debbie Stabenow, Michigan Democrat, also was in the session.

I was very impressed with him at that meeting, she says days later during an interview. He is intense.

Dr. Emanuel, who is divorced and a father of three daughters, just last year published a 240-page book on health care reform - the product of his collaboration with Mr. Fuchs - based on his two decades of practicing medicine, researching bioethics issues and studying the intersection of policy and politics.

The differences between the Obama approach to health care reform and Dr. Emanuel's plan is in the scope of change, not necessarily the direction.

Mr. Obama is pushing for universal and affordable coverage but does not want to take people off of their employer-based plans. His plan essentially offers a government-run alternative for those who do not have insurance, funded in part by increased taxes on those making $250,000 or more.

Dr. Emanuel thinks the best option would be to abolish the employer-based system and go to a voucher system providing all Americans with insurance paid for through a value-added tax.

Dr. Emanuel also proposes phasing out Medicare and Medicaid, arguing that the voucher system will cover the elderly and the poor sufficiently.

There's a part of Zeke's thinking which is somewhat more in tune with what some conservatives have argued, says Arthur L. …