Dr. ‘Zeke’ Emanuel’s challenge

“They’re very gun-shy,” said Jonathan Gruber, one of the nation’s top experts on health care economics and a professor at the Massachusetts Institute of Technology. “What we learned from the Clinton plan is that if you shake up the whole system, that dooms the whole thing to defeat.”

But Dr. Emanuel is no political novice. During his last two years of medical school at Harvard, he also obtained a doctorate in political philosophy.

In his book “Healthcare Guaranteed,” he says that “it is a big mistake to limit our thinking based on what we imagine is politically feasible.”

(Corrected paragraph:) Those who know Dr. Emanuel personally and professionally say he will subvert his personal preferences to serve the president’s agenda.

“He’s going to have to grit his teeth and probably make his point of view known, but I don’t think the Obama and Baucus plans are going to wind up looking like what Zeke favors,” Mr. Caplan says.

Yet he did add that the first step of creating a government alternative “will start to open the door for further change.”

Dr. Emanuel, Mr. Caplan says, is likely “hoping to start to get [his] ideas into place so they might be the object of further reform down the road.”

Henry Greely, a law professor at Stanford and a friend of Dr. Emanuel’s, says that while the eldest Emanuel is a “forceful, extroverted” personality, he’s “not so emotionally tied to his ideas that he views them as the only possible, sane alternative.”

“His role is to advance the administration’s position. He’ll advance the administration’s position,” Mr. Greely says. “He won’t go out and advance his own position. He’s a pro.”