Monday, April 13, 2009

How the Republican Party Got its Mojo Back

By Dan Beauchamp

The other day a prominent Republican political operative called and asked to come and see me. He needed some advice about health care reform.

He said, "I'm desperate. My party is getting killed. We need to try something different. Stuff like making fun of Michele isn't working. We're dying because everyone knows what we are going to say next and only the nuts believe it."

I told him I line up with the other party all the time.

He said, "I don’t care. I'm told you know some things about health care. This recession stuff in turning everything upside down. We need to get in front of this somehow.”

He showed up the next day about noon, a rumpled, middle-aged man in a blue suit who looked like he didn't get much sleep. We went to lunch.

I said, "Look, what I have to say is not very complicated. The question is not whether we are going to change health care but who is going to change it and by how much. You have to decide if you want to be leading the parade or back behind the elephants picking up you know what."

"Your party is always going on about socialized medicine and the miracle of the free market but the public doesn't scare any more. They have heard it all for years. Nobody's afraid of France or England today."

"The recession has changed everything. You need to get out in front. And that's not going to be so hard because the Democrats are terrified they will screw things up. Your party is not so bothered about that. Start with something simple, like drugs and Medicare. Introduce a bill to get rid of all that private health insurance, all the forms and confusion, and just set up a simple program where people on Medicare get their drugs the regular way, by taking the script to the pharmacy or by having the doctor call it in."

The guy says, "Wait a minute. You're asking me to do what the other side want to do. That's crazy. The private insurance companies will go nuts."

I said, "No, the Democrats say they will negotiate with drug companies but actually they always chicken out. If your party gets behind change what are the insurance companies and the drug companies going to do? Someone needs to throw these guys under the bus and only you can do it. You tell the drug companies to take a deep breath and sit down with the federal government to negotiate drug prices.

"And don't stop there. Lower the age of eligibility for Medicare to 55 or even 50. That way business won't have to pay for all those patients who are having heart attacks and getting cancer. The employers will love it. They already all secretly think socialized medicine would be good for them anyway. And tell hospitals and doctors that government will negotiate fees on a per capita basis and will set up hospital budgets. Go whole hog."

The Republican operative was incredulous, "But why should we give the public all this stuff? Pretty soon they will want us to put it all in Medicare. All of it."

I said, "That's the point. The public will think that all this simplicity and ease of use and giving everyone a single Medicare card is a good thing and they will want more. People will start voting for the Republicans again because they like what you are doing. Let them."

"But that's capitulation, that's giving up on the free market," the Republican said.

I said, "No, it's not. You know the American people. They really do love the free enterprise system but they've just forgotten how much. You need to give them a dose of life under socialism. Sooner or later they will realize that they have lost their freedom and really have become like France or Germany.”

The guy looked at me for a long time and then he grinned. He said, "It may take a generation. Maybe two generations. All we have to do is wait until the public wakes up and then we will give them what they want again. Freedom. But until then we will be back."

"You get the picture," I said.

He left that evening and a few weeks later his boss had a big press conference with the top Senators in his party and the press went wild.

And the rest is history.

Dan Beauchamp, a health policy expert who now lives in Bisbee, Arizona, worked as a health official in the New York State Department of Health under the Cuomo administration. He led an effort to design a new health care reform proposal that attempted to create a de facto single payer system using clearinghouse technologies for checks much like the Federal Reserve system and using what we today call the Internet. This piece appeared first in Tales of Copper City, at

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