Carol Felsenthal
On politics

Obama Should Have Listened to the Emanuel Brothers About Obamacare

Rahm pushed the president to delay health care reform; Ezekiel warned the White House couldn’t handle the implementation.

Ezekiel Emanuel Photo: Nancy Stone/Chicago Tribune

If only!  Back at the start of the Obama presidency, Rahm, then the rookie president’s chief of staff, warned his boss not to tackle health care reform out of the gate, but to focus first on jobs and the economy. Rahm was right about that and then some. The nightmarish rollout of the Affordable Care Act, with its attendant drop in the President’s approval rating, could, some say, tarnish the remainder of Obama’s presidency. Or not. 

That depends on the White House’s promise that the HealthCare.gov website will work well by November 30.  And on the public not reading too closely Obama’s promise that everyone could keep their health plan if they liked it and everyone could keep their doctors if they liked them, each promise punctuated by the no-wiggle-room, emphatic exclamation “period.” 

Rahm wasn’t the only Emanuel to issue warnings.  According to a story in Sunday’s  Washington Post, after Congress passed the law in March, 2010, big brother Ezekiel Emanuel, 56, credited or, to some, discredited,  as “an architect of Obamacare,” warned the president to put the implementation of the Affordable Care Act in the hands of crack entrepreneurs with hard experience in launching giant start-ups, and with “geeks” who have a track record of building complex websites that can handle millions of visitors. 

According to Post reporters Amy Goldstein and Juliet Eilperin, Zeke, who was a special adviser for health policy in the White House between 2009-2011—before that he was on President Clinton’s Task Force on National Health Care Reform—was among those lobbying for Obama to appoint “an outside health reform ‘czar’ with expertise in business, insurance and technology.” 

Zeke and others were opposed to the law being put in the hands of White House political/policy people who had done a masterful job of pushing a stupefyingly complicated 2000-plus piece of legislation that few members of Congress had read. (Remember Nancy Pelosi’s infamous line, “… we have to pass the [health care] bill so that you can find out what’s in it….”) Yes, these policy/political people, “knew [the law’s] every detail,”  Goldstein and Eilperin write, but what did they know about building websites and start-up businesses?

So Zeke issued his warning and the President rejected it, tapping instead Nancy-Ann DeParle, who then headed Obama’s health policy team, to take charge of the law’s implementation. She and her colleagues operated in an atmosphere of White House anxiety that Republicans would build every bump in the road into an insurmountable barrier for the ACA .  The President and his aides so feared Republican ridicule that they delayed tackling the thorniest aspects of implementation, including the website. “The president’s aides ordered that some work be slowed down or remain secret for fear of feeding the opposition,” Goldstein and Eilperin write. Calls to wait on drafting final rules until after the 2012 election—no ammunition for the opposition—show the drawback of Obama’s decision to deploy a political/policy team.

No one would blame Zeke, an impressively credential physician who holds both an MD and a PhD—oncologist, bioethicist, chairman of the department of medical ethics and health policy at the University of Pennsylvania, vice provost for global initiatives at Penn—if he walked around muttering to himself,  “Why did you, Mr. President, ever believe this would work?”

But  Zeke remains the loyal Obamacare soldier, appearing often, in the last couple of weeks, on the cable shout shows, including Fox News. Immediately after introducing her guest, Megyn Kelly asked Zeke,  “So my question is whether you believe the president was intentionally misleading or grossly mistaken?” Yesterday, MSNBC’s Joe Scarborough blasted Emanuel, who was arguing that Obama had not lied to the American people when he made those promises; that it’s the insurance companies’ fault:  “Oh, come on, that’s garbage!” Scarborough said. “This is so beneath you.” And then there was Sunday’s “blistering argument” between Zeke and Fox News’ Chris Wallace.

Last week, Zeke told the much friendlier Andrea Mitchell—Zeke is an MSNBC contributor—that the White House needs to hire a CEO who can “really manage the disparate parts and put them together; one person who would direct the current “competing experts.” (He discounts Obama’s hiring of Jeff Zients because he’s temporary and will soon return to directing the National Economic Council.) 

Zeke offered  specific advice: The tech experts working on  the site should give “wonky” daily press briefings complete with technical details. “Best practices” should be shared among the 14 state exchange websites and the people working on the federal site should appropriate “best practices” from the state sites. 

A senior fellow at the Center for American Progress, Zeke can almost match his brother in being short-tempered, partisan, bullying,  imperious, defensive, petulant, patronizing (see link to Megyn Kelly above). As the Sun-Times noted in an editorial complaining that when Zeke pronounced that everything about ACA with the exception of the website, which the paper described as “miserably dysfunctional,” was working “great,” he was “talking through his hat.” Kind of like any number of politicians these days including a certain mayor of Chicago.

Zeke, who splits his time between Washington and Philadelphia, will remain in the arena. If his little brother makes it to the White House, say in 2020 or 2024, he might appoint his eminently qualified, battle tested big brother to head HHS. (There would be the small matter of a law passed in the wake of JFK appointing his brother, RFK, Attorney General, that prohibits appointments to the cabinet of members of a president’s immediate family. But my money’s on Rahm figuring out how to maneuver around that.)

Remember the phrase “death panels,” popularized by Rep. Michele Bachmann and propagated by Sarah Palin?  Zeke was the man portrayed by right wingers at sitting at the head of the table decreeing who could get a kidney and how old is too old consume the precious resources required for open-heart surgery.  That could come back to haunt him, although it’s a phrase heard much less often today.  (In the Virginia governor’s race yesterday Ken Cuccinelli re-invoked it, without actually deploying the phrase, in a desperate ploy at the close of what seems to be a losing campaign.)

Once the website works reasonably well, anger from the five percent of the population (10-12 million people) who bought their policies on the individual market—huge numbers of them have been discontinued because they don’t meet ACA requirements—will ebb as they find replacement plans.

But as we head into the first full week of November with that November 30 deadline looming, a comment Zeke Emanuel made to MSNBC’s Chris Matthews last week has been lost in the fog of political battle: “In a year or two we’re going to get it right and then it’s going to be smooth….” If he’s right, we’ll be seeing a lot of Zeke on TV.

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