Two More Pieces to the Healthcare Puzzle

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.

Emanuel the Doctor Helping Obama Deliver Health Care Overhaul

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.”