This small book does an excellent job of summarizing the political history of the Republican Party the past 60 years or so. It offers a critique of where it went, if not wrong, at least out of focus the past eight years. It is a companion to David Frum's book, "Comeback," and the authors refer to Frum's ideas frequently although he is not credited at the end. Some of their ideas I agree with, some I don't know enough about to criticize and I disagree with their health care chapter although I agree on its importance. The emphasis is on the appeal of the Republican Party to the "Sam's Club voter," a term they claim to have originated and which has been used by Governor Pawlenty of Minnesota. It is a very useful concept and the heart of this book. Their argument is that the family is a crucial institution for the lower income and less educated American. They discuss how the family, as an institution, has been badly damaged in the past 40 years and they offer suggestions on how to undo some of the damage.
The first three chapters are probably the best and summarize the history of attempted Republican reforms that would attract the working class voter to form a new coalition after the Roosevelt New Deal coalition broke up in the 1960s. They point out that, after 30 years of steady progress, wages for working class people stagnated beginning about 1973. They say little about the high inflation of the Carter years but I remember it well and think it deserves more emphasis because of its terrible effect on affordability of home ownership.
They point out, as does David Frum, that the high crime, high inflation and stagnant economy of the 70s were all mostly solved during the Reagan era and, following that, the working class had less affinity for the Republican party of George Bush. Their analysis of the attraction of Ross Perot for the working class voter was insightful and explains much. They point out that the Clinton years were actually quite conservative although I would give more credit to the Republican Congress after 1994 than they do. I agree that the impeachment frenzy was a terrible error and forced Clinton to the left as he sought allies.
They are quite complimentary to George W Bush's domestic agenda and the 9/11 attacks probably harmed the Republican Party by bringing a preoccupation with the war on radical Islam that diverted it from a realignment on domestic issues. They quote Bush as saying essentially that the war trumped all the domestic issues. That worked until the war began to go sour in 2005. From Chapter six on, the book is about suggested solutions, many of which are innovative and worth consideration.
I was disappointed with their chapter on health care because they use the French system as an example of how not to reform it. They misstate the principle of the French system which is that the patient pays the doctor in a fee-for-service transaction, then is reimbursed by the health plan, a non-profit corporation regulated by the government, at a 75% rate. For some service, the reimbursement is less and the patient has the option of purchasing coinsurance, like our "MediGap" policies, to cover the remaining 25%. There are a number of technological efficiencies that American doctors would love to see. The fee schedule is low for French doctors but medical education is free and doctors have the option to bill more than the government fee schedule. It is an interesting program to study and a possible alternative to the Canadian-style single payer system favored by the American left. They complain about the drain of the French health system on the economy but it uses about 10% of the GDP, whereas our own health care consumes over 16%. The French economy is harmed by the cost of the welfare state and the regulation of employment. If we could get to 10% of our economy for health care, it would save many billions. Health care is the single biggest issue for "Sam's Club voters" and should be a major focus for the Republican Party. I was disappointed to see this error. The French system is pluralistic, like ours, and a useful model to study. It is also the best health care system in Europe and probably the world. I should add that I am a physician with 40 years of private practice and a graduate degree in health care policy.
This book is a valuable addition to the debate on where the Republican Party goes over the next few years whether John McCain is elected or not. The best parts are its analysis of where we have been and how some opportunities were missed. I agree with the basic premise that the high income investor classes and education elites are no longer the base of the Republican Party. They are more concerned with life-style and cultural issues and are confident they can evade the additional taxes that President Obama has in mind. The natural base for the Republicans is now made up of traditional families, the people described in "The Millionaire Next Door," and potential middle class voters who need a fairer system to climb the ladder of success. These authors have many ideas on how to accomplish this that are worth the price of the book.
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