Paging Doctor Zeke
The Real Emanuel Brother to Watch
Moving from hospital to hospital, a young oncologist named Ezekiel Emanuel made a startling discovery. The doctors he worked with often didn't know if the treatment they were administering was the most sensible one available or merely, as was often the case, the most expensive. They would say, "That's how we do it here," he wrote in a book he published last year. All too regularly, the result was a poor patient outcome and wasted money and time.
That story is making the rounds in the White House now, not (sadly) because it's exceptional but because of the author: he's the older brother of the White House chief of staff. "Entourage" fans focus on Rahm Emanuel's younger sibling, Ari, the inspiration for superagent Ari Gold. But in Washington, the brother to watch is Zeke, a medical ethicist who has just taken a key role advising the budget director, Peter Orszag. "Zeke is a very innovative thinker," Orszag told me.
In the view of the health-care industry, Zeke is a fundamentalist. He favors guaranteed care for everyone through a system of government vouchers; national boards, he says, should help decide which treatments work most effectively. Costs should be funded by a dedicated national value-added tax. It's the rational way to do it, he said at the Aspen Institute last summer.
Rationality and political reality tend not to overlap, however. Orszag distances himself from Plan Zeke: "There are lots of ideas floating around." More important, Rahm says that, while Zeke's ideas are worthy, the politics are impossible. Administration officials don't dare repeat President Obama's campaign pledge to ensure health care is available to all by the end of his tenure. It may be too expensive, given current economic realities. "Universal coverage is a desirable goal," says Orszag, "but it does cost money upfront."
In the federal budget he'll unveil this week, Orszag plans to offer a fiscal "path to sustainability." But the only way to get there is to cut the growth of spending on health care for 83 million Americans via Medicare, Medicaid, SCHIP and veterans' programs. "This is the ballgame for our long-term fiscal future," he says.
Even if the government could still afford the system that exists, it's become clear the country cannot. Health care in America is an infuriating contradiction: a cutting-edge technological marvel, but one so bloated, wasteful and jerry-built that it consumes one sixth of the nation's wealth without making us comparatively healthy. Obama and his aides recognize this: a feature of the stimulus is a billion-dollar program to establish a clearinghouse for research on "best practices" and ways to measure which ones are the most cost-effective. (It will have only advisory power.)
The next step, to be unveiled in the budget, will be to find ways to apply some of this research in federal programs. As always, the tangled but powerful branches of the health-care industry—doctors, hospitals, insurance and pharmaceutical companies—are searching for ways to not just survive, but thrive, no matter what changes are made.
If Zeke had his way, they would become bidders in a government-funded and supervised marketplace—which is not about to happen any time soon. For now, Zeke is lying low (Orszag's aides declined to make him available). Don't expect to see him on the talk shows. But health-care lobbyists are aware of his prescriptions even as they meet privately on the Hill to hash out their own strategy. They know that he talks to his brother—and that his brother talks to the president.
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Howard Fineman is Newsweek's Senior Washington Correspondent and Columnist, senior editor and deputy Washington bureau chief. He is the author of "Living Politics," a column that began on MSNBC.COM and Newsweek.com and that now also appears in the print magazine. An award-winning reporter and writer, Fineman also is an analyst for NBC News and MSNBC, appearing regularly on "Countdown with Keith Olbermann," "Hardball with Chris Matthews" and "TODAY." The author of scores of Newsweek cover stories, Fineman's work has appeared as well in The New York Times, The Washington Post and The New Republic. His 2008 national best-selling book, "The Thirteen American Arguments," was released in paperback by Random House in the spring of 2009.
One of the nation's leading political reporters, Fineman has interviewed every major presidential candidate from (then-vice president) George H.W. Bush in 1985 to (then senator) Barack Obama early and often in the 2008 campaign cycle. His current work focuses on the Obama Administration and its top officials, as well as on Congress and politics throughout the country. Although based in Washington, Fineman travels widely in the U.S. and has covered politics and other events in 49 of the 50 states.
Fineman's work has produced many milestones and awards. A cover story in November 2001 featured President George W. Bush's first extensive interview after 9/11. Another cover, "Bush and God," was part of a series of articles that won the 2003 National Magazine Award for General Excellence. His reporting has helped Newsweek win many honors from the Magazine Publishers Association and the American Journalism Review. Other awards include a "Page One" from the Headliners Club of New York, a "Silver Gavel" from the American Bar Association and a "Deadline Club" from the Society of Professional Journalists (SPJ). In 2006 he received the Alumni Award from Columbia University's Graduate School of Journalism.
As a reporter and writer, Fineman ranges widely. Besides campaign-year covers, other projects have included: race and politics, the impact of digital technology on society, the influence of Hollywood on politics, the rise of the religious right and of conservative talk radio. He has interviewed business leaders such as George Soros, Bill Gates, Steve Case and Robert Rubin and entertainment figures such as Warren Beatty, Jane Fonda and Jay Leno.
Although now under exclusive television contract to NBC, Fineman over the years has appeared on major public affairs shows, such as Nightline, Face the Nation, Fox News Sunday, Larry King Live, Charlie Rose and the NewsHour. He was a regular panelist on Washington Week in Review on PBS (1983-95) and on CNN's Capital Gang Sunday (1995-98). He worked with Ted Koppel on Nightline specials, and has been a guest on Comedy Central's "The Daily Show with Jon Stewart" and "The Colbert Report."
A native of Pittsburgh, Fineman began his career at The Courier-Journal in Louisville, covering the environment, the coal industry and state politics before joining the newspaper's Washington bureau in 1978. He moved to Newsweek in 1980, was named chief political correspondent in 1984, deputy Washington bureau chief in 1993, senior editor in 1995 and senior Washington correspondent and columnist in 2008.
Fineman holds an A.B., Phi Beta Kappa, from Colgate, an M.S. in journalism from Columbia and a J.D. from the Brandeis School of Law at the University of Louisville. His legal education included a year as a visiting student at the Georgetown University Law Center. He received Watson and Pultizer Traveling Fellowships for study in Europe, Russia and the Middle East, and has traveled to more than 40 countries, among them China, Vietnam, Japan, Ukraine, Israel, Turkey and the West Bank Palestinian Territories.
Fineman is married to Amy L. Nathan, a senior counsel at the Federal Communications Commission. They live in Washington with their two children, Meredith and Nicholas.
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