Newt's back.

Newton Leroy Gingrich, former history professor and conservative congressional icon, is trying hard to return to the public eye. You may recall Newt's departure from political prominence six years ago. After three years as the first Republican Speaker of the U.S. House since the Eisenhower administration, a majority of congressmen reprimanded the conservative Georgia politician for misusing donations to a nonprofit educational foundation for partisan political purposes. After he paid a stiff fine, fellow Republicans continued to attack him for engaging in a brazen extramarital affair--ironically, during the Clinton impeachment hearings on sexual misconduct--and alienating the affection of many swing voters.

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Since officially retiring from politics in 1999, Gingrich has coauthored several alternative history novels and tried his hand in business as CEO of The Gingrich Group, an Atlanta-based communications and management consulting firm. Now the key strategist behind the 1994 Republican electoral landslide is reinventing himself as an expert on healthcare by serving as cochair of the new National Commission for Quality Long-Term Care and venturing into the heart of long-term care with his ideas on Medicaid.

Gingrich's principal vehicle for his healthcare crusade is the Center for Health Transformation, an entrepreneurial project of The Gingrich Group. In September, the Center celebrated its first anniversary as an independent Washington-based health policy group. According to a Center spokesperson, Gingrich is one of its major assets because he is "one of the most compelling and sought-after speakers in America." In addition, the Center relies heavily on opinion polling to "define the right language" in addressing healthcare issues and on targeted media relations "to communicate the urgency and drive the demand for transformation beyond that of any other health transformation advocacy group."

The Center proposes "to create a responsive, 21st-century, intelligent Medicaid system that leverages the most cutting-edge technologies to provide better health outcomes at lower cost." Specifically, the Center claims to advocate for the elimination of racial and socioeconomic health disparities, 100% insurance coverage through leveraging Medicaid funding, greater gubernatorial responsibility for Medicaid programs, and the transformation of Medicaid into an entrepreneurial culture that seeks innovative solutions and embraces results over process.

Behind this progressive-sounding rhetoric is the core assumption that many of the problems of the American healthcare system derive directly from Medicaid and from private insurance programs that follow Medicaid's reimbursement model. According to the Center, such programs insulate consumers from the consequences of their health-related decisions and add unnecessarily to the costs and inefficiency of healthcare.

The Center's arguments were presented to the Missouri Commission on Medicaid Reform in September 2004 by James Frogue, formerly an expert on "socialized medicine" for the right-leaning Heritage Foundation. Frogue, a longtime opponent of Medicare Part D, now heads the Center's Medicaid Transformation Project. He told the commission members:

  There is only one way to truly transform Medicaid--to affect behavior
  change at the patient level. Everything else is window dressing. The
  solutions dujour--limited drug formularies, reimbursement rate cuts to
  providers, cutting eligibility, certificates of need, or begging the
  federal government for more dollars--will not solve your problems.
  They will, at best, merely postpone the problems until they are bigger
  and more difficult to solve. Individuals must think and act
  differently with regard to their health. New and creative incentives
  for individuals to meet various health metrics must be launched. This
  is particularly important for high-cost patients with multiple chronic
  conditions. Treating them quickly and effectively not only lowers
  overall cost, it improves their quality of life. If done correctly, it
  will reintegrate them back into the mainstream.

Frogue asserted that "people are immensely capable of learning about [healthcare] prices and quality, and making purchases based on that information." Perhaps in view of data indicating that consumers are spending at least $40 billion a year on quack medical treatments and devices and ineffective, unregulated dietary supplements, Frogue later qualified his comments by suggesting that consumers be provided with financial incentives to make the "right" choices.

The Center also testified to the commission that "an ideal emphasis would be on Health Savings Accounts, where dollars are owned by the person and can never be taken away. If a low-income worker is Medicaid-eligible, then Medicaid dollars should be available to help that worker buy into the employer's plan." No mention was made of the overwhelming majority of Medicaid recipients who are children.

As for the Center's proposals for long-term care, Center spokesmen state that "seniors strongly prefer independence and remaining in their own homes.... Enlightened public policy favors seniors staying in their homes and out of institutions in all but the most extreme circumstances, such as advanced Alzheimer's." Seemingly implied in the Center's critique is that CMS, the states, and SNFs apparently conspire to force unwilling elderly out of their homes and into institutional settings without valid clinical need. After the first public hearing of the National Commission for Quality Long-Term Care, Gingrich said, "This Commission is committed to transforming the long-term care industry into one of healthy, active aging." Frogue echoed this before his Missouri audience and praised a group exercise plan called "Silver Sneakers" that provides the twin benefits of physical activity and social interaction for older women who live alone. He did not clarify whether Medicaid should pay for this or explain how an exercise program for healthy elderly would substitute for skilled nursing care for individuals with ADL needs.

The Center's agenda includes such practical reforms as support for an individual electronic medical record that would follow a common format across all facilities and types of reimbursement. Indeed, bringing the "IT revolution" to healthcare settings has been a central tenet of the Center's program. The Center's proposals to reduce Medicaid costs by creating mechanisms to discourage healthcare "overuse" have received less prominent attention. It can be assumed that as forthcoming election seasons heat up, Gingrich--who has been identified as a presidential hopeful for 2008--will move beyond IT to more in-depth, substantive comments on "transforming" the American healthcare system.

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