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“I was very impressed with him at that meeting,” she says days later during an interview. “He is intense.”

Dr. Emanuel, who is divorced and a father of three daughters, just last year published a 240-page book on health care reform — the product of his collaboration with Mr. Fuchs — based on his two decades of practicing medicine, researching bioethics issues and studying the intersection of policy and politics.

The differences between the Obama approach to health care reform and Dr. Emanuel’s plan is in the scope of change, not necessarily the direction.

Mr. Obama is pushing for universal and affordable coverage but does not want to take people off of their employer-based plans. His plan essentially offers a government-run alternative for those who do not have insurance, funded in part by increased taxes on those making $250,000 or more.

Dr. Emanuel thinks the best option would be to abolish the employer-based system and go to a voucher system providing all Americans with insurance paid for through a value-added tax.

Dr. Emanuel also proposes phasing out Medicare and Medicaid, arguing that the voucher system will cover the elderly and the poor sufficiently.

“There’s a part of Zeke’s thinking which is somewhat more in tune with what some conservatives have argued,” says Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania.

Mr. Caplan says he agrees with Dr. Emanuel that “the long-term reform should be to break health care insurance away from employment and make it more of a personal responsibility. You buy it, you get taxed for it, you have to have it, but it’s not something that has to go through your boss.”

Rahm Emanuel, for his part, has come down publicly on the side of the more politically cautious step of creating a government entity that is not mandated, an approach also advocated by key Democratic lawmakers such as Senate Finance Committee Chairman Max Baucus, Montana Democrat.

Dr. Emanuel is “an idea guy with strong principles about getting everybody affordable coverage,” says Judy Feder, a prominent health care reform expert at the Center for American Progress.

“He’s now part of a bigger political environment where other ideas are prominent,” she says.

Rahm Emanuel said last summer on “The Charlie Rose Show” that his older brother’s health care plan was “a game-changer” but that it is politically unfeasible because it would “scare a good portion of the American people.”

Dr. Emanuel is just one voice in an administration packed with health care reform devotees. In his official capacity, he is senior adviser to one of these other voices: Peter Orszag, director of the White House Office of Management and Budget.

Ken Baer, a spokesman for Mr. Orszag, did not want to make Dr. Emanuel available for an interview, saying he was “part of a much larger team of people who have expertise in different aspects of health policy.”

Rahm Emanuel’s cautious thinking reflects the general consensus of many in the Obama administration who still bear scars from trying unsuccessfully to help President Clinton pass health care reform in 1993.

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