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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