Reforming Medicare, The Gingrich Way

Newt Gingrich is back. The fiery architect of the Republicans' Contract with America, who was forced to resign as House Speaker in 1999 after his attacks on Bill Clinton cost the G.O.P. big losses in the midterm elections, has been steadily increasing his backstage role in national politics. Nowhere was his presence more on display than in the Medicare-reform bill Congress passed last week. Beginning a year ago, Gingrich gave PowerPoint briefings to top Republican officials like Vice President Dick Cheney, House Speaker Dennis Hastert and Senate majority leader Bill Frist on market reforms for Medicare. Late in October, Gingrich worked with AARP to circulate a compromise proposal on Capitol Hill, much like the one eventually passed, for Medicare to compete with private insurance plans in a test program. Gingrich has his own health-care think tank and has advised AARP on technological innovations, such as websites for seniors to shop for the cheapest drugs as they can do for airline tickets.

G.O.P. congressional leaders, who still consider Newt politically radioactive, will say little publicly about his role in the Medicare bill. Gingrich too is circumspect, describing himself only as "a change agent. If they want my ideas, I'm happy to show up and give them." Several of the ideas he has pushed, it seems, wound up in the Medicare bill, such as grants for electronic prescription programs to cut down on medical errors and payments for heart-disease and diabetes screenings. Three days before the House vote, G.O.P. leaders brought in Gingrich for a private session to help win over conservative Congressmen opposed to the measure's high cost. Gingrich argued that the $400 billion prescription-drug benefit was balanced by a Medicare overhaul, long sought by conservatives. In at least enough cases, says a senior House Republican aide, Gingrich "gave them the rationale to vote for it."