‘You Have to Understand the World in Which You Live’

Ezekiel J. Emanuel has had something like nine lives, careerwise.

A Harvard-trained oncologist who also holds a doctorate in political philosophy, he is an expert in medical ethics, euthanasia, and end-of-life care. One of his sidelines is as a top-selling author; his Brothers Emanuel (Random House) is a memoir of growing up in a trio of high-powered brothers, including Rahm, mayor of Chicago and a former White House chief of staff, and Ari, a Hollywood agent who inspired the television show Entourage. Dr. Emanuel is probably best known, though, as a special adviser to President Obama and a chief architect of the Affordable Care Act, or Obamacare.

In his latest act, he is vice provost for global initiatives at the University of Pennsylvania, where he also serves as chair of the department of medical ethics and health policy.

Dr. Emanuel, known as Zeke, sat down with The Chronicle to talk about the role of the university as an academic think tank, why Penn won’t build a campus overseas, and the future of Obamacare under the next president, Donald J. Trump.

We’ve just come through an election that has been inward-looking, even hostile to global engagement. How should colleges respond?

At this moment, when there seems to be this wave of retrenchment — maybe nativism, maybe nationalism, maybe even a touch of xenophobia — we stand against that. We think the future is one where there is going to be increasing interaction among everyone around the globe. As universities, we still believe that.

“Global” is kind of a buzzword in higher education these days. But it’s mushy. How do you define “global,” and why does it matter for universities and for students?

It really cuts across everything that we at Penn are doing. It’s heavily focused on students: bringing in students from outside the United States with different cultures, religions, backgrounds, social experiences, and taking our students on campus and sending them out into the world as part of their education, to gain experience by living and working in other countries. We think that is integral to educating students in the 21st century. You have to understand the world in which you live.

At the faculty level, we’ve always had people who have done global things. The executive director of Penn Global likes to say that the Penn Museum was the first global part of Penn, in that we had major expeditions going to Latin America, to China.

We don’t view this as simply comparative, which many places do. They just take comparative studies and put the “global” label on it. It encompasses everything in our view, from climate change to global health and global finance. What do you do in a world where states seem to have less and less power? Those are global questions.

You talk about faculty as key to global engagement, but you don’t talk about building overseas campuses, as many of Penn’s peers have done.

The idea of no bricks and mortar was very clear at Penn. Faculty end up being, in every place that’s tried it, quite upset about it. They think it dilutes credibility. They might go to Shanghai or Singapore or Abu Dhabi once, your best faculty, but getting them to go over and over is not happening. So sustaining high-quality teaching at these distant outposts is very, very difficult.

A lot of places take a laissez-faire attitude. It’s not a core focus of what they’re doing, they’re not thinking strategically and investing. That’s what Penn had been doing. You don’t get the biggest bang for the buck, you don’t have a strategic vision, you don’t have an impact. We decided we were going to go a third way.

We have reconceptualized for students what their global experience should be. We want every student to have a global opportunity. When I was going to school, a global experience meant one very narrow thing: junior year abroad. Now we’re making available a variety of experiences. And we’re trying to be more of a global agenda setter, sort of a think tank looking at particular issues and putting together a group of academics, policy makers, public officials to think through them.

How do you pick where to place your bets?

We are not USAID. We are not here to help the whole world. We can’t, we don’t have the resources. We have selected areas. It’s really easy, in the following way: You can’t run a program unless you have faculty who are interested in a particular program and willing to drive it. We have a lot faculty doing stuff in China, a lot of faculty doing stuff in South Asia. We actually have a big group, mostly in health sciences, interested in Latin America. One thing I’m very committed to is, Let’s get action done.

Do you ever shy away from being of-the-moment and taking up potentially controversial topics?

You’re asking me? I’m probably as controversial a faculty member as you can get.

No, we don’t. But in general, I don’t think that academics’ best insights are in of-the-moment issues, trying to resolve what to do about the United States, for example, negotiating with Iran on the nuclear deal. Academics are best trying to look over the horizon. Politicians don’t have the time. Washington-based think tanks are in the moment. Academics are better trying to anticipate the future.

How did your experience in both the academic and policy arenas shape your thinking?

When I began doing academic research in the mid-’80s, when I was still a student, I was looking at end-of-life care. The dean of students at Harvard Medical School basically told me, Medicine is not interested in end-of-life care; it’s going to be a career ender for you. My response was, We have patients dying all the time in the hospital, and I think we’re doing a crummy job. Since that time, we’ve made tremendous changes.

Similarly, in the early 2000s, I teamed up with a health economist at Stanford, and we began thinking through health policy. At that time, no one was working in this area. We were ahead of where the political system was, and we developed many ideas that became very standard.

So when Barack Obama picked up the phone, you were ready.

Well, he didn’t pick up the phone, but when the opportunity came, we already had been thinking for many years. That’s where I think academics are best. At Penn, that’s certainly what we’re trying to encourage. What are the themes or the issues on the global stage where academics’ work will be the defining work in the next five, seven, 10 years?

Yet the fruit of much of your work, the Affordable Care Act, is in danger of being repealed by President-elect Trump.

It would be a terrible mistake. The things he says — We’ll repeal it now, and sometime in the next two years we’ll replace it — wreak havoc on the insurance markets. I don’t think Republicans appreciate that insurance is one of those businesses that requires stability. Health care is complicated, and they will learn that very quickly.

How difficult is it for academics to pivot to the policy world?

As an academic, you are trained to be skeptical. That’s how you get ahead as a graduate student: Question the assumptions, question the data, question the methodology, the robustness of the conclusions. One of the things you have to do in policy is be less subtle. All the questions, all the caveats, all the limitations, you can’t go into that when you’re talking to a policy maker. You don’t want to distort, and I think it’s very important to maintain academic credibility and academic rigor. But you do need to make it digestible to someone who isn’t an expert in the field.

One thing I hear, particularly from younger academics, is, I’d really like to be engaged in real-world problems, but I’m not rewarded for it in the tenure process. Is there something that’s got to happen in higher education to help encourage that?

The tenure process rewards two things: publications and teaching. That’s not going to change radically. How we measure tenure, you don’t want to tinker with something that seems to work great for the American university system.

So you’re conceding tenure’s not going to change?

No, I do think it’s changing. Just very slowly, on a time scale that may not be my time scale.

You have an unusual background. How did you end up getting a medical degree and a Ph.D. in political philosophy at the same time? Were you bored?

No, I was frustrated with medical school. My advice for any young academic who wants to do interdisciplinary work is, Stop worrying about tenure, OK? Become world-famous. That will guarantee you tenure. It will be the biggest benefit for the world. And it will be the best thing you can do for your career, because in the end, that’s how people get evaluated.

Choosing the right question is huge, huge. It’s the most important thing you do as an academic, and it’s really hard. What is something that everyone says is important, or is thinking about, but no one’s actually doing the research? I’ve had a wonderful and very lucky career in that I’ve been able to do that a number of times.

I will admit, I’m not systematic about it. I tend to rely on my intuition. I have 20 irons in the fire, and at any one time, two or three of them are catching fire, and I go with them. Sometimes I’ve gotten it right, and sometimes I’ve gotten it wrong.

So everyone should have a gut as golden as yours.

Some people are much more methodical about it, actually. And I respect them. I’m not that guy.

This interview, drawn from two conversations, has been edited for length and clarity.