One of the most interesting aspects of the 1990s was the manner in which the Clinton-led Democratic Party was able to co-opt, albeit for a short time, the issues of taxes and fiscal responsibility from Republicans. Democrats did so by triangulating on the tax issue and moving away from a position of higher taxes, which the party had advocated for most of the 1980s, and towards a position of targeted tax relief. Prior to Bill Clinton, middle class Independents, who wanted their own taxes to remain low, but who feared that massive tax cuts would lead to a budgetary fallout, were forced to choose between the Republicans, who advocated sweeping, across-the-board tax cuts, and Democrats, who proposed tax relief for no one, and who often suggested raising taxes on those same middle class Americans. Given this choice, voters favored the GOP on the tax issue, because some sort of relief was better than no relief.

But Bill Clinton changed all of that in the late ’90s, when his post-Gingrich Revolution position on taxes became one that favored “targeted tax cuts” that would focus on spurring economic growth and making it easier for Americans to live their lives without increasing the deficit or threatening popular domestic programs. That triangulation changed the calculus for middle class Independents: now they had a choice between a party that wanted, in their view, massive, budget-busting, entitlement-threatening tax cuts for everyone, and a party that advocated tax cuts for those very middle class Independents when they bought a home or sent their kids to college or tried to start their own business. To swing voters, Democrats then became the party whose position on taxes was more prudent, more cautious, and more small-c conservative given its reliance on actual revenue to maintain a balanced budget and not on theoretical revenue created by future growth. Or to put it another way, the Clinton position divided those Americans who favor low taxes for utilitarian reasons, i.e., to keep the economy strong and/or to maintain their own standard of living, and those who favor low taxes for ideological reasons, i.e., to starve the beast and force government to shrink and/or because it is morally or constitutionally inappropriate for government to levy taxes on individuals.

With President Obama and a Democratic Congress prepared to enact a massive overhaul of the American health care industry that will almost certainly raise the cost of health care for the middle class through higher health insurance premiums as well as through the inevitable tax increases that will eventually have to be enacted to pay for the governmental role being proposed, Republicans now have an opportunity to pull a Clinton on the health care issue and co-opt health care reform in much the same way Democrats co-opted tax cuts during the Clinton years. In other words, Republicans should become the party of “targeted health care reform,” in contrast to the Democrats’ massive, sweeping, budget-busting health care overhaul. In so doing, Republicans will drive a wedge between voters who want health care reform for practical reasons, such as the cost of or accessibility to health care, and those who want action on health care for ideological reasons, i.e., those on the Left who want government and not individuals, medical providers, or the market to be in charge of health care decision-making.

Republicans already have all the ideas they need to put forth a comprehensive package of targeted health care reform. They just need a strong national leader or cohesive Contract with America type document in order to get their message out to the American people. The sum of the ideas that have been put forth by congressional Republicans, as well as those GOPers running for president in 2008 and 2012, would present voters with health care reforms that would solve most of our nation’s health care problems — which exist largely due to cost and to outdated regulations — without busting the budget or taking away too much freedom. A combination of tax credits to help Americans purchase health insurance, allowing Americans to shop for health plans across state lines, making health insurance more portable, creating new ways to pool risk (such as high-risk pools and association health plans), incentivizing preventative care, and caps on non-compensatory damages in lawsuits against medical professionals would lower the cost of health care for everyone, make it easier for folks to buy insurance, and would help the uninsurable get insured. And all without a new middle class entitlement, mandates, guaranteed issue, or the fear of rationing.

When middle class Independents were forced in the past to choose between Democrats’ intrusive, messy, bossy health care overhaul, and Republicans’ insistence that we presently have the Finest Health Care System in the World, they quite predictably chose the party that offered them a solution over the one that did not. This is comparable to the way voters chose big tax cuts over no tax cuts. But when swing voters are presented with cheap, effective reforms targeted to them, they will choose those reforms over expensive, massive overhauls filled with empty promises and unintended consequences.

By making targeted health care reform the official Republican position, Republicans both end the notion that the Democrats are the party of health care, and leave Democrats with just those voters who want government to be in charge of health care decision-making in this country. The Left has long wanted a state takeover of health care because leftists believe that since there’s only so much health care to go around, it should be distributed as equitably as possible, by a central authority, hence the constant stream of rationing ideas we’ve seen come out of the political and media establishment over the past few months, from delaying mammograms to finding natural ways to alleviate pain. As such, Democratic solutions on health care generally involve reducing demand for health care from the top-down by essentially telling people that they can’t have it. Republicans, then, need to become the party of choice on health care. Through tax credits and new ways to pool risk, Republicans should say, you can more easily choose your health plan. Through preventative care, demand will be reduced for the most expensive types of care, not because Americans are told they can’t have it, but because they won’t need it. And so on. All of the sudden, Republicans become the party that want people to go do the doctor, and Democrats become the party standing between Americans and medical care.