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Health Care Zeke: The other Emanuel

August 16th, 2009

Carrie Budoff Brown

There’s an Emanuel brother behind President Barack Obama's budget, but it’s not the one you think.

Ezekiel J. Emanuel, big brother to White House chief of staff Rahm Emanuel, is quickly emerging as a key player in Obama’s health-care overhaul, the biggest push to expand coverage in two decades.

Known as Zeke, Emanuel has labored behind the scenes on the issue for years, well-known to people who follow it closely. But he has significantly raised his political profile by signing on as a top adviser to White House budget chief Peter Orszag. And there he was Thursday, a fidgety presence at the back of the briefing room, nodding in approval as Orszag detailed the budget, and trading conversation with aides around him. “He has been detailed at Peter’s request to be the chief kibitzer on health care reform and health care issues at the OMB,” [Office of Management and Budget] said Robert Reischauer, president of The Urban Institute, who has worked health care.

“And then of course, besides his energy and knowledge base and smarts, Zeke has certain other attributes – genetic attributes – that make him a valuable member of the OMB,” Reischauer said. “His brother is the chief of the staff. Everybody is always trying to ascertain what the president is hearing and what the president is thinking, and I know Zeke has a lot of communication with his brother.”

Added Benjamin Sasse, former assistant U.S. health secretary in the Bush administration: "The health sector is the most lobbied space in Washington. Zeke's judgments about which industries should suffer what cuts and what new regulation are obviously going to matter quite a lot to his brother - and thus to the President."

But it’s hardly just his last name. Zeke Emanuel is a renowned oncologist and policy expert with degrees from Amherst, Harvard and Oxford who has written extensively about overhauling the nation’s health care system. He has been chair of the Department of Bioethics at the Clinical Center at the National Institutes of Health. He sat on the Clinton administration’s health care task force. And in June, he published a book advocating replacing the current health care structure with a voucher system.

Rahm Emanuel called his brother’s ideas a “game changer” during a June interview on the Charlie Rose Show, but declined to endorse it, citing the political realities of selling such a plan.

And now with brother Zeke in the budget office, and brother Ari emerging as a major Democratic fundraiser, it’s like the Emanuel brother act is finally complete.

But it took an unexpected development – the loss of Tom Daschle as health care czar and health secretary – to aid in the emergence of Zeke Emanuel by quickly realigning the balance of power on the health care debate. And in recent weeks, Orszag and his point man on health care, Emanuel, have filled a vacuum in leadership on the issue, according to people who follow health care closely.

Emanuel, for instance, is spending time this week one-on-one with key stakeholders on the issue, including Reischauer. Emanuel took the lead for the White House on a conference call Wednesday with health care insiders, explaining the president’s priorities.

Jeanne Lambrew, a close adviser to Daschle who was supposed to serve as deputy director of the White House Office of Health Reform, was on the call, but she didn’t speak. Lambrew is now working out the health and human services department rather than the White House, aides confirmed last week.

And on Monday, Zeke Emanuel sat at the head of the table at the health care breakout session at the White House fiscal summit – but he didn’t have a name tag. When the session ended, more than a few people rushed to his side, seeking introductions and reminding Emanuel of how they knew each other.

There was bound to be a power struggle between Daschle and the White House policy and budget experts over health care. This is why Daschle insisted on having a line into the White House as the health czar and the perch at health and human services. But with Daschle gone, and the search for an HHS secretary dragging into its fourth week, the budget experts have emerged as the key players – at least for the time being.

Zeke Emanuel referred questions to the White House press office. White House press secretary Robert Gibbs hinted at the shifting power balance Wednesday, saying not having an HHS secretary wouldn’t hamper the reform efforts.

Washington insiders now suspect the new secretary will take more of a communications role than a central policy one -- a dynamic that is the exact opposite of what Daschle imagined.


By Betsy McCaughey, founder of the Committee to Reduce Infection Deaths and a former New York lieutenant governor.

The health bills coming out of Congress would put the decisions about your
care in the hands of presidential appointees. They'd decide what plans
cover, how much leeway your doctor will have and what seniors get under

Yet at least two of President Obama's top health advisers should never be
trusted with that power.

Start with Dr. Ezekiel Emanuel, the brother of White House Chief of Staff
Rahm Emanuel. He has already been appointed to two key positions:
health-policy adviser at the Office of Management and Budget and a member of
Federal Council on Comparative Effectiveness Research.

Emanuel bluntly admits that the cuts will not be pain-free. "Vague promises
of savings from cutting waste, enhancing prevention and wellness, installing
electronic medical records and improving quality are merely 'lipstick' cost
control, more for show and public relations than for true change," he wrote
last year (Health Affairs Feb. 27, 2008).

Savings, he writes, will require changing how doctors think about their
patients: Doctors take the Hippocratic Oath too seriously, "as an imperative
to do everything for the patient regardless of the cost or effects on
others" (Journal of the American Medical Association, June 18, 2008).

Yes, that's what patients want their doctors to do. But Emanuel wants
doctors to look beyond the needs of their patients and consider social
justice, such as whether the money could be better spent on somebody else.

Many doctors are horrified by this notion; they'll tell you that a doctor's
job is to achieve social justice one patient at a time.

Emanuel, however, believes that "communitarianism" should guide decisions on
who gets care. He says medical care should be reserved for the non-disabled,
not given to those "who are irreversibly prevented from being or becoming
participating citizens . . . An obvious example is not guaranteeing health
services to patients with dementia" (Hastings Center Report, Nov.-Dec. '96).

Translation: Don't give much care to a grandmother with Parkinson's or a
child with cerebral palsy.

He explicitly defends discrimination against older patients: "Unlike
allocation by sex or race, allocation by age is not invidious
discrimination; every person lives through different life stages rather than
being a single age. Even if 25-year-olds receive priority over 65-year-olds,
everyone who is 65 years now was previously 25 years" (Lancet, Jan. 31).

The bills being rushed through Congress will be paid for largely by a $500
billion-plus cut in Medicare over 10 years. Knowing how unpopular the cuts
will be, the president's budget director, Peter Orszag, urged Congress this
week to delegate its own authority over Medicare to a new,
presidentially-appointed bureaucracy that wouldn't be accountable to the

Since Medicare was founded in 1965, seniors' lives have been transformed by
new medical treatments such as angioplasty, bypass surgery and hip and knee
replacements. These innovations allow the elderly to lead active lives. But
Emanuel criticizes Americans for being too "enamored with technology" and is
determined to reduce access to it.

Dr. David Blumenthal, another key Obama adviser, agrees. He recommends
slowing medical innovation to control health spending.

Blumenthal has long advocated government health-spending controls, though he
concedes they're "associated with longer waits" and "reduced availability of
new and expensive treatments and devices" (New England Journal of Medicine,
March 8, 2001). But he calls it "debatable" whether the timely care
Americans get is worth the cost. (Ask a cancer patient, and you'll get a
different answer. Delay lowers your chances of survival.)

Obama appointed Blumenthal as national coordinator of health-information
technology, a job that involves making sure doctors obey electronically
delivered guidelines about what care the government deems appropriate and
cost effective.

In the April 9 New England Journal of Medicine, Blumenthal predicted that
many doctors would resist "embedded clinical decision support" -- a
euphemism for computers telling doctors what to do.

Americans need to know what the president's health advisers have in mind for
them. Emanuel sees even basic amenities as luxuries and says Americans
expect too much: "Hospital rooms in the United States offer more privacy . .
. physicians' offices are typically more conveniently located and have
parking nearby and more attractive waiting rooms" (JAMA, June 18, 2008).

No one has leveled with the public about these dangerous views. Nor have
most people heard about the arm-twisting, Chicago-style tactics being used
to force support. In a Nov. 16, 2008, Health Care Watch column, Emanuel
explained how business should be done: "Every favor to a constituency should
be linked to support for the health-care reform agenda. If the automakers
want a bailout, then they and their suppliers have to agree to support and
lobby for the administration's health-reform effort."

Do we want a "reform" that empowers people like this to decide for us?


Sweet Jesus, as my sainted Irish grandmother would say, if that doesn't
scare you bedazzled bro-zos and ho-zo, then the lobotomies have truly done
their work.

We have to stop B.O., The Lyin' Prick from destroying our republic.

"If we're able to stop Obama on this, it will be his Waterloo. It will break
him." --Sen. Jim DeMint (S.C.)

"We are fast approaching the stage of the ultimate inversion: the stage
where the government is free to do anything it pleases, while the citizens
may act only by permission; which is the stage of the darkest periods of
human history, the stage of rule by brute force." --Ayn Rand

Where an excess of power prevails...No man is safe in his opinions, his
person, his faculties, or his possessions." --James Madison

I fight for my republic.


¤ ¤ ¤ ¤ ¤


"Angel of Death"; 2004 © Kristoffer Frisk, all rigts reserved

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