ATLANTA -- Like any good visionary, Newt Gingrich has a vision -- or two, or three. They come tumbling off his tongue in the self-assured tone of a man who does not hesitate to remind audiences he has a bit of experience making history. The ideas are, in Gingrich's words, "very big."
Take his vision for the health system of the future.
Each morning millions of Americans would awaken and log on to a secure, personal Web page featuring their individual medical record. It would track health status -- weight, height, blood pressure, maladies and medications -- and deliver reminders and advice where appropriate for managing their diseases and conditions.
When they needed care, patients would shop online, comparing prices and quality scores of the doctors and hospitals in the region. They could research the efficacy and risk of various treatments. At the doctor's office, the physician could look up the latest innovations with a tap on a wireless, palm-sized computer and use the same device to write prescriptions or order tests, all of which would automatically be recorded in the patient's electronic file. And if a small-town doctor didn't have the expertise for a certain diagnosis or procedure, she could link via satellite with experts halfway around the globe.
But as Gingrich knows all too well, all of this remains more vision than reality. His own doctor at Emory University in Atlanta cannot track down the results of a heart workup performed on Gingrich four years ago at a nearby cardiac imaging center. Chances are, Gingrich said, the Emory doctors will have to repeat the test, costing more time and money.
That is just one of the many "stunningly stupid" aspects of the U.S. health care system, Gingrich said. We are heading for a future in which we not only spend more money on health care, but the nation as a whole gets sicker, receives inferior care and loses its competitive edge.
Reforming the system will not do, according to Gingrich. It must be transformed.
"There is no middle ground," he declared. "Without transformation, we can't compete and we become western Europe: gracefully decaying, living pretty well, being pretty interesting, but in fact no longer in the game."
The quest to rescue America from that dismal fate is Gingrich's new mission, a project that began with a book and has grown into a new think tank focused on promoting technology, individualism and free market principles in the medical arena.
At a time when people buy gas without meeting an attendant, extract cash from an ATM in a foreign country and read headlines on cell phones, Gingrich is appalled that prescriptions are still written by hand, X-ray results are delivered via the postal service and patients have to pay money for photocopies of their own paper medical files.
He has little patience for the people who say his ideas will require years and large capital investments.
"Most public policy wonks talking about information technology and health are like theoreticians of aeronautics standing at an airport debating whether or not the Wright brothers' theory will ever work as the 747s take off," he said. They are "just crazily out of touch with reality.
"This is not science fiction; this is banking 30 years ago," he added. "All we're trying to do is catch up."
Six years after giving up the raw power of the House speakership, Newt Gingrich is, in the words of Rep. Patrick Kennedy (D-R.I), "the ultimate power broker," leveraging his name and contacts to influence the White House, shape legislation and collect lucrative consulting fees from his friends in the corporate world.
Gingrich is credited with helping sell President Bush's $534 billion Medicare drug bill to the AARP and few recalcitrant House Republicans. And he is teaming up with liberal Democrats such as Kennedy to promote high-tech improvements in medicine.
For Gingrich, life as a private citizen has been devoted largely to two seemingly unrelated issues: national security and health care. "Both of them," he explained, "are life and death."
The attacks of Sept. 11, 2001, elevated security, his life-long interest, to the top of the national agenda.He has been in high demand in the Bush administration's departments of State, Defense and Homeland Security. War and terrorism, however, are simple compared with his other obsession.
"Health is about 30 times more complicated than national security," Gingrich recently told a group of executives in his home state. The challenges confronting Bush's foreign policy warriors are "dramatically less complex than the health system. Health is the largest single sector of the economy."
It is natural that Gingrich would gravitate to the $1.6 trillion industry -- and take on the entire system, said aide Nancy Desmond. In her 12 years with Gingrich, Desmond has watched her boss find the areas in which he can have the greatest impact.
As she put it: "One of his philosophies is moving to the sound of the guns."
Armed with Information
Part of Gingrich's effectiveness derives from his ability to take complex ideas and relate them to everyday experiences. On health care, he says, think Wal-Mart prices at Travelocity speed.
Simply put, Gingrich believes that individual Americans armed with the latest gadgetry and information make the best health care consumers -- and when they take responsibility for their own care, prevention will improve, prices will plummet and quality will soar.
The approach is appealing, Gingrich argued, because it focuses on health first and financial savings second.
"If I can get somebody to never become a diabetic, they don't mind that we're not paying for insulin," he told the business crowd in Atlanta. "If they become diabetic but I get them to manage the diabetes so they don't need kidney dialysis, they don't mind that we don't pay for the dialysis.
"On the other hand, if they think I'm going to save money by having them die early by not paying for something, they get really angry."
Across the political and medical worlds, there is widespread agreement on the large themes articulated by Gingrich. For years, decision-makers have embraced in theory the need for modernizing medicine. And most agree that if and when the U.S. system does so, quality will improve and money will be saved.
But beyond that, academics, physicians, corporate leaders and politicians diverge sharply on how to get there, what government's role ought to be, how to sell radical change to physicians and whether patients will make the wisest medical decisions, particularly in a health crisis.
The largest gap in Gingrich's approach, said Robert H. Brook, vice president and director of the RAND Health think tank , is his failure to address the 44 million uninsured Americans and the ripple effect caused by that status.
"We are for 100 percent coverage," Gingrich replied, listing familiar approaches such as tax credits to help people buy insurance. But covering the uninsured, in Gingrich's view, is mere "mop-up" work compared with the technological investments he advocates.
Overall, Brook and University of Oregon health policy professor Judith Hibbard endorsed Gingrich's emphasis on information technology, prevention and empowering consumers and physicians with data. But they said Gingrich neglects fundamental problems associated with an insurance system that is priced out of reach for many small businesses and individual purchasers, and the fact that a fraction of patients consume the bulk of medical services.
Several years ago, one study traced the impact of giving consumers greater control over their health care dollars and treatment decisions, Hibbard said. "People did use less services, but they were not able to discern when they really needed care and when they didn't, so they just cut back indiscriminately."
A Tank of His Own
To quiet the naysayers and promote his ideas, Gingrich first wrote the book "Saving Lives & Saving Money" (published by the Alexis de Tocqueville Institution) and then created the Center for Health Transformation. The for-profit think tank provides a platform for disseminating ideas and enables Gingrich to play matchmaker, linking practical-minded businesspeople with policy-oriented lawmakers.
Both projects attempt "to create genuine public pressure for the right kind of changes," he said. "You are, in a sense, providing ammunition for elected officials to describe a better world."
The center's members include Eli Lilly, PricewaterhouseCoopers and the Hospital Corporation of America. Paying dues that range from $1,000 to $100,000 a year, executives participate in Washington seminars, receive white paper reports and CDs of Gingrich speeches, and, often, drum up business.
"Newt has been instrumental in getting us introduced to some clients," said Mark Bryson, CEO of Currahee Health Benefits Solutions Inc., based outside Atlanta. He said he enjoys networking with other center members because "these are people doing it, not talking about it."
It was through the center that Bryson met executives at Health Hero Network, makers of an electronic device that helps physicians remotely monitor patients with chronic illnesses. Patients use the "Health Buddy" to transmit vital signs or answer questions. A case manager reviews the data and intervenes if anything is abnormal.
Bryson liked the device so much that his firm now offers it as part of a disease management package for companies trying to control rising health costs through better health.
Gingrich's center is a "brilliantly packaged way of offering his services as former speaker and a man who can open doors to push along what he calls health transformation," said Joseph Antos, a health policy expert at the American Enterprise Institute. "In other words, lobbying."
Gingrich is not a registered lobbyist. The think tank is for-profit, he said, because "you get more drive and energy" from employees when money is at stake and "I believe in entrepreneurship."
Aide Rick Tyler, however, acknowledged there were political reasons for diverging from the standard nonprofit lobby group model.
Having been formally reprimanded by the House in 1997 for violations associated with the political use of tax-exempt organizations -- which were structured similarly to the new center -- Gingrich decided that a nonprofit would have invited enormous scrutiny. Organizing as a for-profit company, however, permits him to operate "under the radar," Tyler said.
"He's making more money than he ever thought possible and doesn't have to tell everybody where it's coming from," marveled former adviser Rich Galen. "He has the amount of influence he chooses to have. I suspect there is virtually no one in this town of either party who will not take a call from Newt Gingrich, if only to hear what he has to say."
Not that long ago, the very name Newt Gingrich made partisan blood boil. He was, after all, the renegade who shoved Democratic Rep. Jim Wright out of the speakership on ethics charges, devised the strategy for the 1994 Republican takeover of the House and memorably suggested Medicare ought to be left to "wither on the vine" (a reference he later said was aimed at the bureaucracy, not the actual program).
So it is both a testament to his political skill and the salience of the issue that Gingrich is playing policy footsie with the likes of Rep. Kennedy, Sen. Hillary Rodham Clinton (D-N.Y.) and William Novelli, executive director of AARP.
Gingrich recently traveled to Rhode Island to deliver the keynote address at Kennedy's "Frontiers of Healthcare" conference. The pair, worlds apart ideologically, have found common ground around information technology and the promise it holds for revolutionizing the delivery of medical care.
The association with Gingrich "gave me the cover so it would be kosher for Republicans to deal with a Kennedy," said the son of the senior senator from Massachusetts. "Newt Gingrich can bring a lot to the table. He knows a lot of people, he's very influential. This is a guy with entree."
When Republican congressional leaders began plotting strategy for the Medicare legislation, Gingrich introduced them to Novelli, who was already an admirer of the former speaker.
"Newt Gingrich has never been one to tinker," Novelli wrote in a glowing foreword to Gingrich's book. "He is a big-idea person and moreover, he has the ability to link big ideas into something even larger still."
When AARP threw its support behind the bill, many Democrats and seniors felt blindsided -- and said so, in no uncertain terms.
Once Democratic lawmakers learned that Novelli "wrote the foreword to Newt Gingrich's book on how to undermine Medicare -- he helped write that book -- then they placed the views of AARP in that perspective," House Minority Leader Nancy Pelosi (D-Calif.) fumed.
Novelli stood by the decision to support the Medicare bill, but still feels singed by the experience, aides said. Novelli refused several requests for interviews to discuss Gingrich.
Of all the curious alliances Gingrich has built since leaving office, none is more striking than the intellectual courtship taking place between him and Clinton.
It started with a magazine article in which she praised his book and ideas on information technology. The "personal health record" she described is nearly identical to the vision Gingrich sketches.
The man who helped lead the impeachment fight against Clinton's husband now cites their agreement as evidence of the rightness of his ideas.
On that, she agreed.
"I've learned through many years in Washington when an idea comes to maturity you will have people from different places on the political spectrum coming together to advocate for it," Clinton said in an interview. "The more we can use technology as quickly as possible, the better we can manage disease and lower costs."
Clinton just as quickly cites areas of disagreement with the former speaker. She strongly rejects Gingrich's promotion of health savings accounts or tax credits for consumers to buy their own health insurance. She also disagreed with the notion that patients are always best positioned to shop for care.
"I don't believe you can empower individuals lying on the side of the road from a motorcycle accident so they can make the best choice of what trauma center to go to," she said.
Still, aides to both see enormous political upside to any partnership. For Clinton, Gingrich could help erase the scars of the 1994 health care debacle, when as first lady she was vilified for promoting a massive overhaul of the entire health care system. For Gingrich, now out of office, Clinton represents an opportunity to translate his ideas into legislation.
But as Pelosi's comment revealed, Gingrich still may be radioactive in many parts of the Capitol.
As his longtime aide Galen put it: "The question for official Washington is: Has Newt been gone long enough so that people, especially Democrats, can put their dislike of the name Gingrich aside long enough to look at the ideas?"
For most of his adult life, Newt Gingrich has struggled to keep his weight under control.
"God wanted me to be a raccoon, not a gazelle," he said. Over the past year, he has shed 10 pounds, primarily by eating more fish and substituting wine for beer. But he remains overweight.
"My doctor was quite stern with me the other day. He told me, 'You are getting too old to be this self-indulgent,' " said Gingrich, 61. "I don't have the discipline."
These days, he blames his physical inactivity, which he knows is a health risk, on a grueling travel schedule.
It also appears that Gingrich is one of the millions of Americans who overuse medical services, particularly expensive specialists and sophisticated equipment. With his intellectual curiosity and the excellent health insurance provided to current and former members of Congress, he marked his recent birthday with a round of visit to four different physicians, including a few specialists. "You do all this abstract stuff about compliance and you deal with large populations and you realize it comes down to me," Gingrich said. "I learned a lot about compliance by watching me. It's sobering."
Gingrich and his staff are contemplating ways to weave healthier living into their work routine, perhaps with regular walks or diet contests. "We'd like to be enthusiasts without being fanatics," he said.
He hopes to begin putting one fundamental idea into action over the next few months. Part of the Medicare law he helped lobby for calls for seniors, beginning in January, to get "Welcome to Medicare" physicals. He's encouraging the Bush administration to make the results electronic -- a significant step toward making computerized records part of routine practice. The system would make this baseline patient information available from any hospital, doctor's office or nursing home.
"There is no possible way it is cost-effective to have scattered 2.2 million records around the country for a mobile population of retirees," he said. "With the amount you're going to spend on Xeroxing and Fedexing, you will have more than paid for electronic health records."
But like the man himself, even Gingrich's model companies have trouble complying with his vision.
The Mayo Clinic is one of the "transforming examples" detailed in Gingrich's book, for moving its Jacksonville, Fla., center to a "paperless" system a decade ago.
But the view from the ground today is less sparkling.
"It's a large investment, it's a very complicated process and until now" many of the computer systems on the market were not sophisticated enough to handle the plethora of detailed information physicians collect, said David Mohr, chairman of Mayo's Integrated Clinic Systems. A large health system such as Mayo, for instance, needs not only a standard form for orthopedic visits, but separate electronic forms for the orthopedists who specialize in knees or shoulders or elbows.
While the Jacksonville electronic records system is operational, it has taken Mayo nine years to unveil the system in its Rochester, Minn., headquarters, which it will do this summer.
With that accomplished, the Rochester system will still not be integrated with the computers in Jacksonville.
You can almost hear Gingrich's exasperated sigh.
Research assistance provided by Lucy Shackelford.