U.S. Health Care at a Crossroads: A Conversation with Zeke Emanuel
The Solomon Center for Health Law and Policy hosted Dr. Ezekiel Emanuel for a conversation on March 27 about the U.S. health care and insurance systems, wellness, and the health policy initiatives under the Trump administration. Emanuel is vice provost of global initiatives, Diane v.S. Levy and Robert M. Levy University Professor, and co-director of the Health Transformation Institute at the University of Pennsylvania. The event was moderated by Abbe R. Gluck ’00, Alfred M. Rankin Professor of Law and founding Faculty Director of the Solomon Center.
Emanuel first pointed out that achieving substantive health care reform in the United States remains an uphill task. He noted that although reforms like the Affordable Care Act (ACA) have made progress – such as expanding insurance coverage to over 20 million people and generating cost savings – roughly 10% of the population remains uninsured. While racial disparities in access have narrowed, widespread inequities continue to persist in the system, he added. Moreover, according to Emanuel, there is little evidence that the ACA has improved the overall quality of care; in fact, patient satisfaction and quality metrics have declined in several areas. These shortcomings, he said, point to the influence of powerful interest groups that resist deeper change. Genuine reform, he emphasized, requires a willingness to confront entrenched power and to center decision-making at the service of core values we believe in.
Emanuel then discussed the importance of higher education institutions staying grounded in their values, especially when navigating unpredictable political climates.. He urged that it is at these moments that we must reflect deeply: What kind of society and institutions do we want to build?
Next, Gluck asked Emanuel for his thoughts on artificial intelligence (AI) and health care. Emanuel pointed out that as AI continues to improve, it is increasingly challenging to say that the risks of error and overreliance outweigh the benefits of employing AI in some capacity. Some chatbots, for example, have shown greater empathy and better therapeutic recommendations in text-based interactions with patients than clinicians, Emanuel said. The key challenge, he concluded, lies in thoughtfully integrating AI into health systems – leveraging its strengths while remaining attentive to broader impacts.
Before diving into the Q&A session, Emanuel shared his current perspective on his 2014 article “Why I Hope to Die at 75,” in which he expressed that he would refuse lifesaving treatments beyond the age of 75. Reflecting on that article, Emanuel said that while his perception has not changed much, he acknowledged the lifesaving potential of vaccines in elderly populations during the COVID-19 pandemic and views such safe and effective therapies as an exception to his arguments against treatment.
Emanuel and Gluck concluded the conversation with questions and answers, which included a discussion about strengthening primary care and the future of Medicaid.
