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The eldest Emanuel emerges

Success runs in the family of Obama's health-care adviser

By Judith Graham and Noam N. Levey | Tribune reporters

March 30, 2009

Dr. Zeke Emaunel, older brother of Rahm, now works in the Obama administration on health care reform. (Nancy Stone/ Chicago Tribune / March 16, 2009)

He's the eldest brother, a doctor and a scholar with a resume the size of a small book. Though brothers Ari and Rahm are both celebrities, he's the one they think could someday win the Nobel Prize.

Now, Ezekiel Emanuel has become something of a public figure, like his famous siblings, as he pursues a new challenge: trying to help the Obama administration reform the health-care system.

It's an enormously difficult task given the nation's economic woes, and one for which the former Chicagoan appears uniquely well suited but also surprisingly unprepared.

Zeke, as everyone calls him, is an accomplished academic with boundless energy and impressive medical and policy credentials who has written a well-received book on health-care reform. He has the ear of Rahm, the president's chief of staff: The brothers talk every day.

Yet Zeke has never been part of a political team or toed a party line. The reforms he has championed—giving all Americans insurance vouchers and getting rid of employer-based health-care coverage—bear little resemblance to those embraced by the president.

That doesn't bother the 51-year-old, who's serving as special adviser to Peter Orszag, the director of the Office of Management and Budget. The job puts Zeke Emanuel at the table with a small circle of trusted insiders crafting health-care policy.

As the top physician in the group, he gets to explain how policy proposals can affect providers working at the front lines of medicine—a perspective that was lacking during the debate over health-care reform in the Clinton presidency. Publicly, his role is to make the case for reform while reassuring medical professionals that it won't constitute an unwelcome upheaval.

"You are not going to flip a switch and change our system," he said in a recent interview, demonstrating a deliberate pragmatism. "It's got to be an evolution, not a revolution."

In his new role, "Zeke will absolutely speak his mind," predicted Thomas Murray, president of The Hastings Center, a bioethics think tank. "He will be able to ask the hard questions and be a powerful intellectual force for ensuring the integrity of proposals that are put forward."

As a child in the famously combative Emanuel family, Zeke was a self-described "goody two-shoes" who brought home top grades and was a hard-to-follow act for his less academically minded brothers. That hasn't hampered their success: Rahm is the president's right-hand man, while Ari, the youngest, is a high-powered Hollywood agent, who was the model for character Ari Gold on the TV show "Entourage."

From Zeke's perspective, the Emanuel boys inherited a "goal-directed, hyperkinetic quality" and "a lack of respect for authority" from their father, an Israeli immigrant and pediatrician. From their mother, the brothers acquired a feeling they could try anything they wanted, fail and still be supported.

"My parents had very high standards and no achievement got enormous, over-the-top celebration," Emanuel remembered. "It was like, 'That's great, what are you going to do next?' "

Often, on weekends the boys would follow their maternal grandfather, a union organizer, or their father, who would be going to see patients. In 1966, they marched with their mother and civil rights activists, an experience Zeke Emanuel describes as "searing."

"The ethos of the family was: Do something to make the world a better place," he said. Also, as in many immigrant families, there was a sense they had to stick together and look out for each other—which the Emanuel brothers do to this day.

Zeke Emanuel's professional path appeared scripted early on, shaped by his talents and his parents' aspirations. But he found medical school boring, even at Harvard, decided to pursue a PhD in political philosophy along with a medical degree, and became fascinated by bioethics.

"He has an unusual combination of interests, bringing together politics, medicine and health, and a remarkable capacity to do many demanding jobs at once," said Michael Sandel, a Harvard government professor and his dissertation adviser.

Those who know him well describe Emanuel as insatiably energetic and loyal, with a wide-ranging and razor-sharp intellect and a gift for friendship.

As founding chief of the bioethics division at the National Institutes of Health, he commuted for 12 years between his home in Evanston and Washington, balancing family and professional commitments. Zeke is divorced from Linda Emanuel, another prominent bioethicist, and he moved to D.C. when the youngest of his three daughters left home last year.

Although well-known in medical and academic circles, Zeke Emanuel was unfamiliar to many health-care reform advocates when he joined the White House team late last year.

Some were put off by proposals in his book, including a plan to scrap Medicare, Medicaid and employer-based health insurance in favor of vouchers that people could use to purchase coverage.