"It's not politically feasible," said Victor Fuchs, economist at Stanford University who wrote the foreword to Emanuel's book and has co-authored several papers with him. "There is a huge chasm between what is needed and what is possible."
Fuchs argued that the political system works against the kind of fundamental health care changes advocated by Emanuel. "There are too many individuals and organizations who don't want any significant change," Fuchs said.
But, sitting in the Old Executive Office Building at the White House, Emanuel insisted he is practical about achieving a politically viable plan.
"Not every good policy is achievable in practice and, you know, you have to make compromises and there are trade-offs," Emanuel said. "You can't be stuck to the ideal and let that torpedo making substantial improvements."
After the health care stakeholders meeting at the White House last month, Emanuel said he was convinced there is some common ground.
"Some of those groups were dead set against what Clinton did, ran advertisements against it and now they're at the table, wanting to be a part of it," Emanuel said, citing the TV commercial that aired in opposition to Clinton's proposals in the 1990s.
"Look, the guy who developed the 'Harry and Louise' ads, [Federation of American Hospitals President] Chip Kahn is now gung-ho, pro-reform. I mean, that says it all in some fundamental way."
Health Care Reform's High Strategy and Tactics
Working with his brother Rahm -- who once sent a dead fish to a pollster who displeased him -- has given him new insight into why Rahm has been successful in politics.
"He's incredibly perceptive, not just in articulating the strategic question but in identifying the tactical moves that need to be made to realize it," Emanuel said. "That combination, high strategy and tactics is not something everyone has."
Emanuel is also working with his youngest brother, Ari Emanuel, the inspiration for Hollywood superagent Ari Gold's character in the HBO series "Entourage." They are developing a new television show for HBO about medical ethical issues.
"I've worked with both brothers, the Hollywood brother and Rahm," Emanuel said, "and while you're growing up and you love your brothers and know they're both at the top of their field, sometimes you wonder what makes them good. I don't know Hollywood. I didn't know politics at all. But once you see them in action, I really understand what makes them so, so, so successful."
While not as well known as his brothers outside of medical and academic circles, Zeke Emanuel, who has degrees from Amherst, Oxford and Harvard Medical School, is every bit as intense and driven.
He said he puts in a minimum 12 hours a day at the White House, carries four cell phones, hasn't owned a television since college, and is at work by 7:45 a.m., in time for a daily senior staff meeting run by budget director Orszag, who Emanuel said is "one of the smartest people I've ever met."
Emanuel also has a black belt in Taekwondo, recently completed his first half marathon in 1:40:06 and runs long distances every weekend in Washington's Rock Creek Park.
"You can sort of forget the world, think about big issues," Emanuel said.
Something few people know about Emanuel: his love of dessert. He writes a regular column for The Atlantic Food blog and often brings in baked treats for his colleagues at the Office of Management and Budget.