Monday, April 7, 2014

Dr Ezekiel J.Emanuel: A Combative and Persuasive Champion of Healthcare Reform


By David Woods, PhD, FCPP
 
His simple office contrasts with the large and ornate College Hall in which it is situated on the University of Pennsylvania's campus. Similarly, Dr. Ezekiel Emanuel's affable and good-natured presence in an interview is equally at odds with his public persona as a combative and take no prisoners verbal swordsman.
 
Dr. Emanuel, or Zeke as he is known, is the Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at Penn. He's a Harvard- and Oxford- educated oncologist and the author of  six books and innumerable articles. He has received numerous awards, including election to the Institute of Medicine of the National Academy of Sciences, the Association of American Physicians and the Royal College of Medicine in the UK.
 
Despite being one of the principal architects of the Affordable Care Act and the author of ‘Reinventing American Healthcare,’ Emanuel describes himself as a reluctant doctor. He found the first year of med school “horrendous” and took off for Washington to work for the New Republic to explore a possible career in journalism. So the Fourth Estate’s loss is health policy’s gain; and anyway, the Emanuel byline often appears in the New York Times and the Wall Street Journal.
 
And he soon returned to the family business of medicine (his father was a pediatrician and his mother a radiology technician}, and with some training in philosophy and a PhD in ethics he began to see that oncology fused those with his medical studies and that ‘cancer fit in with all my interests; it's at the cutting edge of  science and raises such issues as coming to grips with mortality, and decisions about end-of-life care.’
 
Emanuel is not shy about these and other issues affecting medical practice. In fact, he seems to pop up in all kinds of places: on the speaking circuit; on television; and on the op-ed pages of national newspapers. Because of his fairly blunt and unequivocal style this can lead on occasion to misunderstanding, such as the description of him in some media as Dr Death when in fact he opposes legalizing euthanasia.
 
The combative style he shares with his equally high achieving and hard-driving brothers, Rahm the Mayor of Chicago, and Ari, a California-based super agent. They were always fighting and jockeying for position; moreover, when Zeke took ballet classes this further inured him to the taunts of colleagues, and gave him a bulwark against opposing forces. His propensity for non-equivocation is perhaps exemplified by the subtitle of his book: “How the Affordable Care Act will improve our terribly complex, blatantly unjust, outrageously expensive, grossly efficient, error-prone system.”
 
While fully acknowledging that at least in the short term the affordable care act has been a political disaster for president Obama and the Democrats, Emanuel believes that the ACA is stimulating a transformation of the entire American healthcare system. It's a work in progress though, and still has to deal with such fundamental issues as tort reform, and employer tax deductions.
 
It won't be easy, he says. Change always engenders fear and physicians are understandably apprehensive about the ACA.
There's going to be more accountability, more technologies such as electronic medical records; and tighter management; bundling of services is likely to supersede fee-for-service, and individual physician-patient relationships are going to be transformed into more team-based care. And there will likely be a focus on preventive medicine and dealing with ‘simple’ ailments such as high blood pressure and obesity.
 
Despite seemingly filling all 24 hours in the day, Zeke finds time, at 56, to run half marathons (“I like to go fast,” he says); to travel, and to cook, with a special interest in baking. He makes a mean apple pie, he contends, loves the theater and is
 an avid reader. Interestingly––and some would say commendably––he does not own a television. But he appears often on that medium, offering clearly articulated  and decisive points of view … and sometimes sparring with TV hosts and presenters.
 
A  man of strong religious conviction, Dr. Emanuel attends synagogue two or three times a month. A divorced father of three daughters -- Rebekah, Gabrielle, and Natalia – he says that, if anything, all are even higher achievers than their father and uncles. Some height indeed.

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