Zeke Emanuel, 59, is Rahm’s older brother and the most brainy and credentialed of the Emanuel trio—with Amherst, Oxford, Harvard (MD and PhD) on his CV. The youngest is Hollywood super-agent Ari Emanuel whom Donald Trump once told me is “a very good friend of mine… and my agent.”
A physician, writer, teacher, and fast talker, Zeke heads the Department of Medical Ethics and Health Policy at the University of Pennsylvania and is known, to his annoyance—see below—as one of the “architects of the Obamacare.”
Last month, the Obama loyalist and staunch Democrat was hired as a contributor to Fox News, just at the time that the GOP’s “repeal and replace” of Obamacare (a.k.a. the Affordable Care Act) started to hog the headlines. Zeke has spent years since the ACA passed in March 2010 defending Obama’s signature law and arguing that its backers, including Obama, knew that the bill, as passed, wasn’t perfect; that it was a work in progress that would need fixes. He blames the Republican Congress for refusing to make those.
The divorced father of three daughters is making headlines himself for his willingness to answer President Donald Trump’s call for ideas on how to craft a replacement in a manner that will retain the best of the ACA, encompass GOP ideas, and, most importantly, protect those on Medicaid and those who could lose their ACA insurance under the GOP plan, dubbed the American Health Care Act.
I spoke to Zeke by telephone on Thursday afternoon, just as Speaker Paul Ryan and President Trump were struggling to bring the GOP bill to a vote on the House floor. By day’s end, the vote was postponed until today as Ryan and his whips admitted they were a dozen votes short of the number they need for passage.
Here’s a condensed and edited transcript of our conversation.
You’ve met with Trump three times since Election Day, once in mid-December at Trump Tower before his inauguration, and twice since he became president. Last Sunday on Chris Wallace’s Fox News show you were harshly critical of the GOP plan. Does Trump call you and tell you to just shut up?
I'm not going to talk about that. I think anyone who knows anything about Zeke Emanuel knows that I say what I think.
When you met with Trump in the Oval Office on Monday, who else was in the room?
A number of officials, including the Vice President, [Secretary of Health and Human Services Tom] Price, and [Speaker Paul] Ryan.
Before you have these meetings, do you consult with President Obama or members of his administration, say one or both of his HHS secretaries?
I know a lot of people on all sides, especially Democrats. I talk to a lot of Democrats, both people who have been in the administration as well as current politicians.
Have you spoken to the former president?
I'm not going to go into that.
Is President Trump up to speed on the fine points of health care policy?
Again, when the President calls you in, you go to talk to him, and it's for the President to decide what he wants to make public; that's the way it works. He asks for your advice and you deliver it in confidence. And if he cares to release it, it’s his choice.
“One of the architects of Obamacare” seems permanently attached to your name.
That's garbage, totally false. There were scores and hundreds of people who were involved in the ACA, both in the Congress and in the White House. The right wing likes to say I'm an architect so they can bash me.
As you were talking, I’m reminded that that “the architect” was a phrase of high praise bestowed by George W. Bush on Karl Rove.
As you tangled on Fox News Sunday with Rove, moderator/host Chris Wallace joked he felt like a lion tamer who needed a chair and a whip. I thought it was a really entertaining segment.
My goal is to be educational, not entertaining. I'm not an entertainer.
What happens between you and Rove during commercial breaks or in the green room?
I don't know Karl super well and we've only been in the green room [together] a couple of times, but he's a consummate gentleman. And when he gets out, he's as sharp as a knife. I try not to let my guard down too much with him, because he will be very gentlemanly and courtly and nice and then put the knives in you as fast and as hard as he can.
I got a kick out of Chris Wallace saying to you when you persisted in talking over another panelist, "Zeke, be fair!” It sounded like a mom scolding her five-year-old.
I win these debates on the facts and I'm not willing to stand for the distorted truths and half-truths that are frequently propagated. I'm an Emanuel. I grew up around a table where you had to engage in verbal argumentation and combat every night with my brothers and my parents. I’m used to it and I’m used to people having a different view and often the wrong view. And I'm not going to let Karl or anyone else distort the facts and the historical record. With all due respect to Karl, I think I know a little bit more about the health care system than he does.
You were previously a contributor to MSNBC. Do you get guff from Democratic friends for throwing your hat in the Fox News ring?
First of all, this polarization in American society is totally a mistake and I want to reject it. We need to talk to each other. I think the idea that on Fox you only get conservative commentators and people who are willing to shave and trim the news their way, and on MSNBC you only get liberals, I think that's terrible. I'm happy to participate and engage and I've made it clear to Fox that they cannot treat me differently than conservative commentators who get time to present their ideas. I get time to present mine. My deal was something my brother [Ari] negotiated and he was very clear about it. [He said,] I want you on Fox and I want the President to see you and hear you.
So was Fox your choice because Donald Trump watches it?
I have the best agent in the world. He made the decision.
So far so good on Fox?
So far so good. I have been on with Bret Baier and Chris Wallace, both of whom ask really good questions. Prior to our panel last Sunday, Chris had Paul Ryan on and he asked Ryan pretty tough questions; questions that I would have been proud to have asked him too.
What about Tucker Carlson? Have you been on his show?
I once went on with Tucker Carlson. He was abusive. I am not going back on with Tucker Carlson. I made that quite clear that until he apologizes to me, I will not go back on. He has yet to do that.
When I interviewed Donald Trump in 2011 he was full of praise for all three Emanuel brothers. He told me that you helped get the son of a friend of his into a cancer hospital in Washington and that you were “very, very nice about doing it.” What’s your history with Trump?
The first time I ever met him was on December 14 when he called me to meet with him in Trump Tower. It is the case that every time I go in, he does talk quite a bit about how much he admires our family. I can say that. [Ed. Note: Trump has donated to Rahm’s campaigns, and all three brothers met with Trump at his Manhattan tower during the transition.]
You wrote a controversial article in The Atlantic in 2014 that was headed, “Why I Hope to Die at 75: An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly.” A few years have passed since then. Are you still sticking to that opinion?
If you read what I said, I was very clear what I will do: I will stop taking any [medical] interventions where the justification for the intervention is it is going to make me live longer. I stick by that. As I say to people, don't stop by reading the title. I didn't have anything to do with that; that is chosen by the editor and doesn’t reflect what I wrote.
Michele Bachmann and Sarah Palin charged you with wanting to institute “death panels” because you argued that younger people should get more attention in the health care system than older people.
Yep, it was a typical distortion. I said in any paper I have ever written that, systematically, young people ought to get priority. When there are absolutely scarce resources, you cannot give every patient the medical service [they need]; so, for example, we don't have enough livers to go around in the country. We don't have enough hearts for all the people who need transplants. Under those circumstances, there is a justification to give priority to younger people over older people.
Would you ever be interested in serving as an HHS secretary in either a current or future administration?
I don't speculate on that. My job is to make the world a better place. I work hard at that.
Why is Obamacare suddenly so popular? It seems it was everybody's favorite punching bag, and suddenly people like it more. Do you think this just shows that once an entitlement is in place, it's very difficult to take it away from people?
No, I would not characterize it that way. I think you have the element of the right answer. Behavioral economics and human psychology shows that people value something much more if it's going to be taken away from them; it’s called loss aversion. Once you have something, you don't want to give it up. That's why most people find it impossible to take a pay cut. Even if you're making a whole lot of money, you're averse to taking pay cut. This is true of all human beings. A bird in the hand is worth more than two in the bush. That's the phenomenon.
In your 2014 book Reinventing American Health Care, you wrote that “beginning in 2020 or so, the ACA will increasingly be seen as a world historical achievement, even more important for the United States than Social Security and Medicare has been. And Barack Obama will be viewed more like Harry Truman—judged with increasing respect over time.” Do you still hold those views?
Yeah. I might have gotten the dates a little off, but, generally, I think we've had a lot of substantial change. I do believe it will increasingly be seen as a very positive development.
You said earlier in this conversation, revealing, I think, a gaping chasm between you and Republicans, that there are “still 18 million American citizens who haven't gotten insurance and I think it's important to get them into the market. The mandate is clearly not enough, so we might have to do other things, like auto-enrollment, or something like that.” That’s not going to happen while the GOP control the three branches of government. If you had a magic wand, would you want a universal system like the UK system? Or Medicare for all?
I am not a big proponent of having a single payer [system]. It has certain big advantages but certain difficulties too, especially if it's going to be for 320 million people. It's very hard to run a really good system for 320 million people from one administrator, and, by the way, Medicare is chronically underfunded.
Is there a system in a country other than the UK that you admire?
No, that’s the wrong question. At best, we can take the best practices from other countries. I think the much better question to ask is the one that I ask in my book that's coming out [on June 5] called Prescription for the Future, in which I identify 12 of these best practices.
Finally, the question Chicagoans care about most: Is Rahm going to run for a third term as mayor?
I have not been hired as his press secretary. I think it's best to ask him that question.