Ezekiel Emanuel's class gives students firsthand glimpse into health care reform

Ezekiel Emanuel has a habit of doing the seemingly impossible. One example: he played a key role in helping the Obama administration pass unprecedented health care reform legislation in his two-year stint as special advisor for health policy to the director of the White House’s Office of Management and Budget. The successful passage of the Patient Protection and Affordable Care Act in March 2010 was a monumental achievement for Obama, who succeeded where a host of former presidents—including both Roosevelts, Truman, Nixon, and Clinton—had failed.

One of Emanuel’s most recent impressive feats came about this past January, when he was discussing his post-OMB plans with an NYU School of Law alumnus at the White House. The alumnus told Emanuel, who was just stepping down from his advisory post to return full-time to his position as chair of the Department of Bioethics at the National Institutes of Health’s Clinical Center, that he ought to speak with Dean Richard Revesz. That night the NYU Law grad emailed Revesz, who contacted Emanuel five minutes later and asked if they could speak the next day. A mere 10 days before classes would begin, the dean and the doctor tentatively agreed that Emanuel would teach the Health Law Policy Seminar that very semester, provided he could obtain government clearance.

Sure enough, two weeks after leaving the Obama administration, Emanuel was scribbling furiously on a chalkboard in front of a full class whose students had made room in their schedules on a week’s notice. “Ricky has the same metabolism that I do,” said Emanuel, “which is ‘Let’s just do something.’”

Ezekiel Emanuel and studentsBecoming an adjunct professor at the Law School was an opportunity Emanuel couldn’t pass up. “I like teaching,” he said. “I get energized by it rather than drained. And I don’t have a law degree, so I thought it would be interesting. I do have this view that none of the top 10 law schools have a very good health law program that encompasses intellectual property related to health, the FDA regulatory process, health care reform and health policy, bioethical issues. No one’s been able to crack that.”

The seminar offers a sweeping picture of U.S. health care. Emanuel places the current health care reform debate in context by analyzing the history and structure of health insurance, previous failed reform attempts (Emanuel was a member of Clinton’s Health Care Task Force in 1993), the current cost and quality of health care, alternative reform proposals, and the coverage and delivery system reforms of the recently passed Affordable Care Act. The class also examines legal issues, including constitutional challenges to the legislation and the regulation writing process.

Emanuel makes a compelling case for the necessity of teaching such topics as widely as possible. “The health care system now is almost 18 percent of GDP—one in six dollars,” he said. “We don’t have one out of every six kids coming out of law school or business school thinking about this problem. If we did, I think we’d have amazingly better solutions to many of the problems, because they’re really smart and creative people.”

Sara Cullinane ’12 not only signed up for the class, but also volunteered to work with several other students drafting a research survey that Emanuel initiated through the National Institutes of Health. The surveyors will canvass approximately 8,000 U.S. households to gauge how many have benefited from the already implemented provisions of the Affordable Care Act, as well as how many actually know about those provisions.

“It’s hard to quantify how much I’ve learned,” said Cullinane. “Professor Emanuel is able to distill everything in an extremely clear way. I think it comes from years of having to break down these issues for members of Congress, for people in the administration. My sense is that he was kind of their teacher on the Hill and in the White House about how health care works, and he’s bringing that knowledge back to us. He’s very well versed in explaining really complex ideas to people who have varying degrees of background and knowledge. He’s got incredible anecdotes about what it was like to be in the White House negotiating parts of the bill.... It makes you realize how amazing it is that Obama was able to pass this bill, because it’s been tried and failed many times before.”

Benjamin Furnas ’12 enjoyed one of the more hands-on experiences in the course. Emanuel asked the students to shop for health insurance on the Health Connector, an online marketplace where Massachusetts residents, who are required to have health insurance and receive free coverage if they cannot afford it, can compare plan features and prices. The Health Connector is the model for the insurance exchanges crucial to the Affordable Care Act’s private health insurance reforms.

The exercise demonstrated to Furnas that the success of a huge undertaking like a national health care overhaul can hinge on the smaller things. “It was really interesting to see the extent to which so much of this law will be based on people’s interactions with a website,” he said. “And if that website is good and people have a good user experience, that can shape their entire response to the law and to health care reform in general.”

So many factors, big and small, figure into the issue of health care reform that a class on it could easily get bogged down in the details. But the sheer enthusiasm of Emanuel, who commutes between Washington and New York every week to teach the Friday morning class, helps keep the unwieldy topic airborne.

“Even after taking a red-eye flight, he will be dancing around the classroom,” said Cullinane. “He’s an extraordinarily dynamic speaker and always fields questions. It’s a participatory lecture. He tells a lot of stories, and he has these two diagrams that he uses to explain the entire health care debate. He has a million facts in his head, and he brings all that factual information, but he’ll show how just using a couple different statistics can really help you get a grip on what’s happening in the health care debate.”

Students also appreciate the benefit of Emanuel’s personal experience with the Affordable Care Act. The class spent multiple sessions analyzing the bill.

“That’s one of the more fascinating parts of the class, seeing how the decisions are made, what different actors are pushing for and why they were or weren’t heard,” said Daniel Svirsky ’12. “It’s interesting to hear how maybe they wanted one policy but they knew it wasn’t politically feasible, or he wanted a policy but someone else disagreed. You see how the sausage gets made, a little bit.”

Emanuel is as struck by the law students’ willingness to tackle medical issues as the students are by the health care expertise he brings to the table. “I’m exceedingly impressed by not only how much they know, but how good they are on their feet,” he said. “You give them a few bits of information, and then you ask them what they think about it. Their thinking process is very good.”

Posted on April 25, 2011

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