Ezekiel Emanuel is a former special adviser to the White House on health care, a world-renowned biothesist, and now a senior fellow at the Center for American Progress.
During the health care reform debate, conservatives manipulated his work on end-of-life care and health system modernization in order to support their narrative about government “rationing” and “death panels.” On Wednesday, I spoke with Emanuel about the GOP’s rhetoric about cost-control, where the health care debate stands today, and what kinds of policies progressives should be advancing.
Q: Are you concerned that the debt ceiling agreement will undermine the Affordable Care Act?
EMANUEL: What’s proposed in the agreement is sort of an across-the board 2 percent cut. Almost anyone who has run any kind of organization knows that across the board cuts are rarely prudent or wise — you don’t distinguish between good programs and bad programs, between things that are really essential and are really superfluous or are worse. So it may be necessary as a deal, but I think there are smarter ways to cut Medicare, and by the way, beyond the Super Committee, we are going to have to examine Medicare and modernize it and make it most efficient in what it does.
Q: It seems like the entire conversation about cost-control is focused on shifting costs to Medicare beneficiaries, whether it be through the Ryan voucher, or raising the Medicare eligibility age. As someone who has written about modernizing the system by getting rid of its inefficiencies — not paying for procedures and treatments that don’t work — what do you make of today’s public conversation about cost control?
EMANUEL: We don’t have to cut the bulb here in Medicare. There are smart ways of doing things and many alternative ways that get rid of what is classically waste or inefficiency in the system. So I think that beneficiaries — if we do the proper thing — don’t have to be stuck with unnecessary costs. They do not have to shoulder more of the burden. And or we have to raise taxes to pay for this. That’s a false choice and I think that one of the things that bothers me about the discussion is that we’re either rationing care or we’re cost-shifting. That’s a completely false dichotomy in my opinion. We have to actually modernize the Medicare health care system.
You got these Republicans who want to voucherize the system or do other things, and our response is don’t touch Medicare. No, we have to reform it. It’s not a perfectly running system and there are things that can be done. Let’s start with just a few, one is you could stop paying for care that is proven not to be beneficial or expensive. There are other changes we can also make. People floated an auction to bring down the prices of medial durable equipment. Unfortunately, the way the first auction was structured was not well, our job is to structure that well.
Q: Are you talking about ramping up some of the cost containment policies already in health care reform? Some of the demonstration protects in the law?
EMANUEL: Absolutely. This is the funny thing. Republicans want to undercut the bill, but some of the best cost containment measures, certainly over the next decade are right in the Affordable Care Act and they get everything everyone has been championing. Better coordinated care that’s cheaper, focusing on keeping people out of the hospital rather than on “sick care.” All that’s in the bill. Part of what we need to do is focus on its proper implementation rather than challenging its constitutionality or trying to prevent it from happening.
Q: How should we be talking about these things? It seems that in the beginning, people tried to have that conversation and then you started hearing a lot from people like Betsy McCaughey, who took your work and distorted it. On Wednesday, Michele Bachmann was in Iowa and explained that Obama would end Medicare and that all health care decisions will be made by the 15-member Independent Payment Advisory Board (IPAB). If you’re advising Obama, how should he frame this discussion?
EMANUEL: I think the first thing is, it’s important for people who are defending the Affordable Care Act not to leave the playing field to people like Michele Bachmann. We need responsible voices out there, I think. This is one of the areas I don’t think the administration has been particularly adapt at communicating — a) what’s in the Affordable Care Act and b) why it’s going to be helpful to people. Otherwise, you do get death panels, rationing, and all of that. The public, the medical profession are apprehensive, and a major reason they’re apprehensive is the Affordable Care Act and how it’s going to modernize the health care system has not been explained to them. That is a major challenge.