Q&A With Ed Gillespie

One indicator of the changed atmosphere surrounding the health insurance debate is that Ed Gillespie, a former Republican National Committee chairman, is teaming with Big Business to push a larger role for government. Gillespie, a lobbyist, represents such clients as Safeway (SWY ), Tenet Healthcare (THC ), and Bristol-Myers Squibb (BMY ). Here are excerpts from his Apr. 3 discussion with BusinessWeek Senior Writer Richard S. Dunham:

What's changed that has prompted CEOs to push for universal health insurance coverage?

We're getting to the point where one in every five dollars in the economy is spent on health care. The health-care system we have is antiquated and unsustainable. American companies are at a disadvantage in an increasingly global economy. Businesses realize you're either going to be part of the problem or part of the solution.

While business largely agrees on the problem, isn't there a problem reaching consensus on the best solution?

Big business is split. Some businesses are trying to fix the system. There are some businesses trying to offload costs onto the federal government.

How do you see health-care reform playing out in the next election?

Health-care policy will be the defining domestic policy debate of the 2008 campaign.

Polls show that voters overwhelmingly favor Democrats when it comes to health issues. What should your party do?

Health care as an issue has not been good to Republicans in the past, and we have to be out in front on it. We have to push for access and affordability without destroying the market-based system.

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