Around the same time President Obama was sworn into office in 2009, the book “Healthcare, Guaranteed” by Ezekiel J. Emanuel, M.D., Ph.D.  (Public Affairs Books) was published. Dr. Emanuel is related to Obama’s former chief of staff Rahm Emanuel. So, you might think that his book could have influenced the Patient Protection and Affordable Care Act. Indeed, the book supports several concepts that the Affordable Care Act did ultimately include, but we would have a very different reform law if Dr. Emanuel’s book had more strongly guided the debate.

Now that presidential candidates are pledging to repeal the law and the Supreme Court is determining the law’s future, we may be back in the market for reform ideas. 

Emanuel’s book calls for radical change and killing more than a few sacred cows. His most radical proposal is to eliminate employer-based health insurance entirely, along with the tax exemption. He argues persuasively that employers are in the business of business, not in the business of health care. Instead of getting health insurance from an employer, people would receive a voucher to purchase it. Insurers would have to accept all comers who have a voucher, and cover all pre-existing conditions. The voucher system would be funded by a national value-added tax (VAT) of 10% on goods and services. 

Like PPACA, Emanuel’s proposal calls for standard benefits. His standard benefits would be “more generous than Medicare and better than that which 85% of Americans currently receive through their employers.” This choice for standard benefits could in itself doom the entire proposal. With such rich standard benefits, the plans will not be affordable. 

Nevertheless, Emanuel’s proposal has some compelling arguments and support. For example, he argues that research comparing different treatments is poorly funded and supported because it is a public good. Emanuel’s proposal includes an entity to make this research a priority, and widely available. For example, we all benefit from knowing whether prostate cancer treatment by radiation seeds is superior to other options such as radiation therapy, intensity modulated radiation therapy or proton beams. One treatment might cost thousands of dollars less and be equally effective. 

The subtitle of the book is “A Simple, Secure Solution for America.” That is exactly what presidential candidates are seeking. As the election season begins, the market for health care reform concepts also will heat up. It will be interesting to see which ideas win favor, survive legal battles and move forward. 

Guest blogger Linda K. Riddell is a principal at Health Economy, LLC, where she works with clients on gaining practical tools to comply with health care reform, and to maximize the new opportunities that health reform offers. She can be contacted at

Register or login for access to this item and much more

All Employee Benefit News becomes archived within a week of it being published

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access