A Hard-Charging Doctor on Obama’s Team
The New York Times
By ROBERT PEAR
April 17, 2009
Stephen Crowley/The New York Times
Dr. Ezekiel J. Emanuel looks at health care issues from a physician’s perspective.
His brother Rahm is President Obama’s White House chief of staff.
As a high school senior, he did a little experiment in chemistry class to test the explosive potential of hydrogen gas exposed to a match. A flask burst with a bang, sending shards of glass flying around the classroom.
Since then, Dr. Emanuel has been challenging conventional wisdom, first as a medical student, then as a doctor and an expert on medical ethics.
He is at it again as a White House official trying to remake the health care system.
By all accounts, Dr. Emanuel is a powerful force in his own right. In an interview in his cubbyhole of an office, he said he got his job on his own, with no help from his brother. Rahm was “very conscious of the nepotism thing,” he said. Still, he is widely perceived as having extra clout because of his brother.
For two decades, Dr. Emanuel has been writing about how to guarantee health care for all. In White House discussions on health policy, he emphasizes the need to slash co-payments for preventive care and insists that patients should be able to keep their doctors even if they change insurance plans.
But some of his proposals, calling for vouchers, a value-added tax and an end to the system of employer-provided insurance, have differed radically from President Obama’s.
Joseph R. Antos, an economist at the American Enterprise Institute, said, “These are mighty spicy ideas — the opposite of what any politician would say unless he was completely intoxicated.”
Dr. Emanuel brings to the White House a physician’s perspective, which was generally missing from the last big effort to overhaul health care in 1993-94.
Mr. Orszag, himself keenly committed to health care as an economic issue, “has given me the opportunity to stick my nose into anything that’s health-related,” Dr. Emanuel said.
Like his brother, Dr. Emanuel is hyperkinetic and speaks in
staccato bursts. The differences are also notable. Rahm, 49, is
a practitioner of bare-knuckle politics. Zeke, 51, earned a
Ph.D. in political philosophy while getting an M.D. at
“Zeke is the intellectual Emanuel,” said Amy Gutmann, a political theorist who is president of the University of Pennsylvania.
Rahm swears and swaggers. His belligerence has been an asset in crushing Republican hopes at the polls and in Congress, where he held a House seat for six years. Zeke’s mind, by contrast, is more subtle, and his vocabulary is more academic.
Zeke is the oldest of three hard-charging brothers. The
Ari, 48, is a top
“When we came out of college,” Zeke recalled, “we had to be in three quarters of the country. We couldn’t get anywhere close to each other because of the force fields of our personalities. Now fortunately we are all fairly well established and much more confident of who we are.”
The divorced father of three daughters age 18, 22 and 25, Dr. Emanuel has an unusual lifestyle.
“I don’t have a car, don’t have a TV, don’t have a house,” he said. “I do, however, have four cellphones, so go figure.”
A breast cancer specialist, Dr. Emanuel has built one of the
world’s leading centers for bioethics, at the
National Institutes of Health
In articles written over the last four years and in a book last May, Dr. Emanuel proposed giving every household a voucher to buy insurance. He would gradually phase out Medicare and Medicaid and “sever the link between employment and health insurance.” Employers would no longer pay for health care. The whole scheme would be financed with a value-added tax, similar to a sales tax.
While some of his ideas bear little resemblance to Mr. Obama’s, Dr. Emanuel said he fully supported the president’s agenda. “I’m all for my voucher plan,” he said, “but I don’t think it’s on the table now.”
In one chapter of his 2008 book, “Healthcare, Guaranteed,” Dr. Emanuel criticized proposals to require individuals or employers to buy insurance, with government subsidies for those who could not afford it.
Democrats in Congress support some variant or combination of such mandates, as does Mr. Obama. But Dr. Emanuel wrote that mandates “would do little or nothing to reduce high health care costs,” and he said the subsidies would be “an administrative monstrosity.”
A wiry man (5-foot-10, 142 pounds), he has expressed interest in the idea of taxing junk food or banning it from schools to combat obesity.
Dr. Emanuel does not apologize for his unorthodox views. “I’ve had various episodes where people have not liked what I said and tried to put the thumb screws to me to shut me up,” he said.
A decade ago, when many doctors wanted to legalize euthanasia or physician-assisted suicide, Dr. Emanuel opposed it. He challenged a common stereotype of patients expressing interest in euthanasia. In most cases, he found, the patients were not in excruciating pain. They were depressed and did not want to be a burden to their loved ones.
Many of Dr. Emanuel’s passions stem, by his own account, from his childhood. His father, Benjamin, a pediatrician on the North Side of Chicago, provided large amounts of free care and led the fight to get rid of lead paint because of its harmful effects on children.
Dr. Emanuel recalled that his father resigned from the American Medical Association because it opposed the creation of Medicare and Medicaid in 1965. The association, he says, is now “a very different organization, very engaged in health care reform in a positive manner.”
His mother, Marsha, a nurse and a social worker, was active in civil rights and took her children to marches and demonstrations.
“Worrying about ethical questions was very much part and parcel of our daily routine,” Dr. Emanuel said.
Like his brothers, Dr. Emanuel took ballet lessons as a boy. He endured his share of jokes. The experience, he says, “hardened us and taught us that if you do something unusual, people will take potshots at you.”
Dr. Emanuel recently got a black belt in tae kwon do, along with his youngest daughter.
“I like the flying kicks,” he said. But he insists he will use his new skills only as a means of self-discipline or self-defense.