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 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.


9 months ago
Posted by pol&pers

The White House staff has increased significantly over the past decades to the detriment of public policy development and administration. Too much propaganda, too little wisdom.

Nancy DeParle is one of those smart DC professionals who shifts between public and private sectors, without cutting ties to either. It's personally beneficial, but not good for the rest of us.

9 months ago
Posted by parkerpal

I am stunned by the Obama administration's hands off approach to this law. The failure to spend time explaining it to the public, especially in the midst of the Supreme Court case, was stunning. The Republicans totally defined it in the absence of any effort by the White House. there should have been pamphlets in every doctor's office, clinic and ER-- "The ACA and YOU", highlighting key provisions and dispelling Republican claims such as "death panels". There should have been an outreach to local community organizations who could help their members understand what was coming. All the 'talking heads' you heard were Republicans. You can see how confused people are by the polls that ask people if they approve of the ACA and of Obamacare, and people like the first but hate the second.

The fact that they failed to listen to Zeke Emanuel's warnings about the complexity of the implementation and the need for experienced hands to oversee it reveals a hubris in his inner circle. This is his lasting legacy and the issue that will define his presidency (it certainly won't be the Nobel Peace Prize--think they'd like that back??). Every effort should have been expended to ensure that it was ready to go and working efficiently. It defines him as an executive--not that he needed to be involved, but his staff needed to be on top of the progress and actively ensuring that this would meet expectations. They knew the Republicans would be gunning for this. They may not have expected the overwhelming rejection of the Medicaid expansion by Republican governors, but this is his law. I had lunch with two Obama staffers from the 2012 campaign, and they were amazed that the Spanish language site would not be ready, noting how important this issue is to such a vital constituency of the President's. Their comment was that, from experience, was that putting a few dozen people on it for a week could address the problem.....and that it was important to do so.

Thank you for this's helpful to hear what was going on in their heads.

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