By
Nina Easton, Fortune Washington bureau chief
To Gingrich, health care is rife with anachronisms, where nurses try to read the doctors' scrawls on paper medical records even as the industry experiences bursts of life-saving innovations, such as a cellphone that can test diabetics and transmit the results (one of Gingrich's favorite gadget references).
At root, Gingrich wants to subvert the system with a healthy dose of competition and information flow. States, he says, should borrow the idea of former Florida Governor Jeb Bush, who launched twin Web sites so that consumers could comparison-shop drugs and search listings of hospitals with the best-quality track records. At myfloridarx.com, consumers can see Lipitor selling at $114.78 at one local pharmacy vs. $138.55 at another. There's also floridacomparecare.gov, where consumers can compare both price and quality records of hospitals, surgery centers, and health plans.
"In one case there were two hospitals five miles apart," he says. "One hospital did a cardiovascular procedure at 20 times more quality for 20 percent of the cost. It's the beginning of a different world" - one that Gingrich wants to extend through Medicare and federal employee insurance systems. But Gingrich's cost-saving mission also takes him into wilder territory, where he envisions a future of "medical tourism." Medicare, he says, should foot air-travel costs for senior citizens to get procedures in states where they are far cheaper.
In Gingrich's vision, two other healthcare cultures need to change: Consumers need to regain a sense of ownership lost in the insurance system ("When was the last time you washed a rental car?" he likes to say), and providers need incentives to prevent disease rather than just treat it. He favors financial rewards to doctors for preventive treatment, and to patients - especially those in Medicaid and Medicare - for following their doctors' advice.
None of these ideas address the nation's biggest health-care crisis - those 46 million uninsured Americans. Here, Gingrich is willing to use the heavy hand of government to force consumers to take responsibility for their health, not just rely on coverage provided by employers. He favors national legislation similar to the law that Romney pushed through in Massachusetts, forcing individuals to buy health insurance just as they are required to purchase auto insurance - though providing some government assistance to those who can't afford it.
"Schwarzenegger has raised the right question," Gingrich says, "which is how we can get to 100 percent coverage of every individual. Like Romney, his biggest problem will be getting a liberal Democrat state legislature not to make it so bureaucratic and so expensive it cannot work."
There is a sweep and clarity to Gingrich-think that inevitably prompts the management experts in his audiences to take notes. He has the same effect on the political trail, a phenomenon that feeds his gnawing presidential ambitions. "He's dying for it," says a person who has known him for years.
By all accounts, Gingrich is astute enough to appreciate the risks of an official presidential run. Ethics issues during his congressional tenure "took care of themselves. He was cleared. But it's something that will need to be explained," says Michigan's Anuzis. The bigger problem, Anuzis says, are Gingrich's two divorces: "That's an issue with social conservatives." Still, for a man who believes he can change the course of history (and did it once), the White House is like honeysuckle.
"There are 3,300 counties, 17,000 elected school boards, 60,000 cities and towns, 14,000 state legislators, 50 governors, and 535 elected federal legislators," he says. "My hope is to create a wave that sweeps through that entire system and in a context that obviously includes the presidency."
It's a strategy that would be considered far-fetched if this were any other politician. But Gingrich's impact on the 2008 race - whether he runs himself or uses the season as a forum to promote himself and his ideas - has to be taken seriously.
Aside from his high standing in polls, there is the fact that Gingrich has routinely defied the odds and reinvented himself with convincing results. Says his friend Dick Armey: "He's never been a parochial member of Congress. He has big ideas and has had them for a long time. He's not going to appear to have just discovered them for the purposes of an election. And that's a good place to be for an '08 candidate." 
