By Terence Kane
The Hill
March 4, 2009
After one major false start, the health policy team
for the Obama administration is finally in place. Kansas Gov. Kathleen Sebelius
(D) will head the sprawling Department of Health and Human Services (HHS),
while former Centers for Medicare and Medicaid Services (CMS) director
Nancy-Ann DeParle will lead the newly created office of Health Reform.
The sheer size of HHS, with its plethora of
responsibilities, makes it ideally suited for a governor (the last three
secretaries were former governors). The secretary has administrative
responsibilities for not only two of the biggest entitlement programs (Medicare
and Medicaid), but also the National Institutes of Health, with its enormous
research budget.
Conversely, the Office of Health Reform is likely to
have a staff smaller than a college basketball roster. As this profile
indicates, DeParle is an undisputed healthcare policy expert and competent
manager. Daschle might have been one of the biggest political heavyweights in
politics, but even he didn't have DeParle's knowledge and background of the
healthcare system.
The relationship between Sebelius and DeParle might
not be unlike the Geithner-Summers dynamic profiled in yesterday's New York
Times, where the two form a close partnership that reaches across the Cabinet
and into the West Wing. Such a
relationship would likely be beneficial given that Sebelius and DeParle join an
administration already filled with staffers likely to have large influence over
health policy, including Jeanne Lambrew, Peter Orszag,and Ezekeil Emanuel.
Additionally, Sens. Edward Kennedy (D-Mass.) and Max Baucus (D-Mont.) are
likely to have large rolls in the drafting of health reform to say nothing of
Republicans and nearly every registered lobbyist in town.
By Edwin Chen and Aliza Marcus
Bloomberg News
March 4, 2009
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 U.S. 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.”
