The Treatment

An Emanuel Who Doesn't Curse But Knows Health Care

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Ezekiel Emanuel has drawn lot of attention in the past few days. And it's not just because he's the older brother of Rahm Emanuel.

Emanuel is the prominent oncologist and policy expert who's now working on health care reform for the Obama administration. In his writings, which include an article in this magazine and (more famously) a book called Healthcare, Guaranteed: A Simple, Secure Solution for America, Emanuel has called for replacing existing insurance arrangements with a voucher system. Everybody would choose from among a set of affordable private plans. Reformers would then introduce incentives designed to achieve better quality at lower prices, ultimately making the whole system more sustainable. (You can read the book if you want more details on how he'd do this.) Healthcare, Guaranteed got some very favorable reviews--and rightly so. (It's a great book!) It's also one reason that Peter Orszag, Obama’s new budget director, appointed Emanuel to be his chief advisor on health care policy. Orszag, a bona fide health policy expert in his own right, has been a key player inside the administration when it comes to shaping the health care agenda--more than, say, your typical budget director. That means Emanuel has influence, as well.

To be sure, Obama’s health care reform principles may not track Emanuel’s that closely. Obama will likely trot out something closer to what he proposed in the campaign--a scheme that would leave in place most existing employer-based insurance, thereby disrupting current arrangements far less than Emanuel’s would. (This probably makes Obama’s plan better as politics and worse as policy.) Nor is Obama likely to call for a value-added tax to finance universal health insurance, as Emanuel does in the book, although the idea has a lot to recommend it.

Still, there is plenty of overlap between what what Emanuel has proposed and what Obama has said he wants to do. It's not too far-fetched to imagine Obama and the Democratic Congress proposing, or at least implementing, a plan that might someday look a lot like the one Emanuel sketches out in his book. 

One point worth clarifying: Over at The Spine, my colleague and editor Marty Peretz--who also holds Emanuel in very high regard--writes that Emanuel was brought over to the Office of Management and Budget in the wake of Tom Daschle’s recent departure. While Emanuel is one of several people helping to fill in some of the holes that Daschle’s departure left, his tenure at at OMB actually traces back to December.

Oh, and while Zeke Emanuel is said to share many things in common with his brothers Rahm and Ari, the model for "Ari" on HBO's "Entourage," my legions of super-secret administration sources assure me that he doens't have the same potty mouth.--Jonathan Cohn

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