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Ezekiel J. Emanuel, who was the special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, told us in a phone interview, “He was a consultant who, quote, ran the numbers,” meaning that “he did the estimates of how much, when you change things in a proposal, how that would affect the number of people covered and the cost of the program.”

Emanuel, who is now vice provost for global initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, says calling Gruber “the architect” of the law is “utter, total nonsense.”

In his book “Reinventing American Health Care,” which was published in March, Emanuel mentions Gruber just once, in the context of economic modeling. He writes that the White House was concerned about how the CBO would score the cost of legislation. Emanuel says his brother, then-White House Chief of Staff Rahm Emanuel, and the president “established a very firm maximum-cost limit” of $1 trillion over 10 years. They wanted half of the money to come from savings in existing programs and half to come from new revenue, Emanuel writes.

http://www.washingtonpost.com/wp-dyn/content/article/2007/07/09/AR2007070902029.html

For Democrats, Pragmatism On Universal Health Care

Washington Post Staff Writer
Tuesday, July 10, 2007

In a conference call in January, the health-care debate within the Democratic Party played out before former senator John Edwards of North Carolina, who was in search of policy advice for his presidential campaign, and his wife, Elizabeth.

On one side was Ezekiel Emanuel, a doctor and bioethics expert and the brother of Rep. Rahm Emanuel (D-Ill.), arguing that the American health-care system is so riddled with inefficiencies that it needs to be blown up and replaced by a plan in which people can buy coverage themselves with a voucher.

On the other side was an economist from the Massachusetts Institute of Technology who has become possibly the party's most influential health-care expert and a voice of realism in its internal debates.

“Far be it for me to lecture you on politics, Senator Edwards,” Jonathan Gruber recalled saying, and then he did just that. He told Edwards that whatever the merits of Emanuel's idea, it just would not be politically viable. Instead, Gruber argued for a more incremental approach, like the one in Massachusetts he helped write. Its central elements would be providing subsidies to people who are unable to pay for health care, increasing the number of those who are enrolled in public programs such as Medicaid and creating a public agency to help anyone ineligible for the programs buy health insurance.

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