plenty capable of making decisions about their lives, and that the government ought to trust them to do so.
My effective secretary of health and human services, Mike Leavitt, worked with Medicare Administrator Mark McClellan and his team on a massive public outreach campaign. It paid off. More than 22 million seniors signed up for a prescription drug benefit during the initial five-month enrollment period. In a 2008 survey, 90 percent of Medicare prescription drug recipients—and 95 percent of low-income beneficiaries—said they were satisfied with the program.
Ultimately, Medicare modernization was a tradeoff. We created a needed new benefit but spent more money than I wanted. We introduced market-based competition among private drug plans, but we were unable to use the new benefit as leverage to move more seniors from government-run Medicare to private Medicare Advantage plans. We created health savings accounts, but we could not convince Congress to require government-run Medicare to compete on a level playing field with private plans.
By the time I left office, more than 90 percent of Medicare beneficiaries had coverage for prescription drugs. Ten million were enrolled in private-sector health-care plans through Medicare Advantage. Almost seven million Americans owned health savings accounts, more than a third of whom had not previously owned health insurance.
Thanks to competition between private-sector plans, the average monthly premium for prescription drug coverage dropped from an initial estimate of $35 to $23 the first year. By 2008, the initial estimate of $634 billion had dropped below $400 billion. The Medicare prescription drug benefit became one of the few government programs ever to come in well under budget. Market forces had worked. And we had moved America’s health care system in the right direction: away from government control and toward the choices and competition of a private market system, which is the best way to control costs in the long run.
“I’m optimistic,” I told Dad as we hunted quail in South Texas on New Year’s Day, 2004. “This election is going to come down to who knows how to lead, who will take on the big issues, and who can keep America safe.”
Dad was concerned. For months, he had watched the Democratic presidential candidates take swings at me every day. The poundings were having an impact. My approval ratings had topped 90 percent after 9/11 and 75 percent after the liberation of Iraq. By the end of 2003, I had dropped to the fifties in some polls. Dad had seen the pattern before. His approval rating had skyrocketed in 1991, then crashed before the 1992 election.
I assured him that our mutual friend Karl Rove had developed a solid campaign strategy. “If we do this right, it will come out just fine,” I said. “Especially if they nominate Howard Dean.”
I knew the Democratic front-runner, the former governor of Vermont, from events we had attended in the 1990s. Dean was loud, shrill, and undisciplined. I was pulling hard for him to get the nomination.
Unfortunately, Dean’s lead evaporated before he won a single delegate. Senator John Kerry of Massachusetts claimed an upset victory in Iowa, won the New Hampshire primary, and cruised to the nomination. A Vietnam veteran and four-term senator, Kerry was a hard worker, a polished debater, and a tough campaigner. I considered him a formidable opponent.
Kerry also had weaknesses. He had the process-oriented mindset of a longtime legislator and a voting record that qualified as the most liberal in the Senate. In the fall of 2003, he had voted against an $87 billion bill to fund troops in Iraq and Afghanistan. Shortly after he clinched the nomination, my campaign ran an ad highlighting his position. Kerry responded, “I actually did vote for the $87 billion before I voted against it.”
I spoke to Karl the moment I heard the sound bite. “There’s our opening,” I said. “The American people expect their president to take a clear stand and defend it, especially when it comes to supporting troops in combat.” We grabbed the “flip-flop” theme and ran with it for the rest of the campaign.
On March 10, 2004, I received a letter from Jenna, who was in her senior year at the University of Texas. In 2000, neither Jenna nor Barbara had attended a single campaign event. They had made it clear they wanted nothing to do with politics. So it was quite a surprise to read Jenna’s words:
I still choke up when I read her sweet words, which also reflected Barbara’s sentiments. I was thrilled they wanted to join the campaign. My last campaign would be their first.
The first event Barbara and I attended together was a rally in front of eleven thousand people in Marquette, Michigan, an Upper Peninsula town that hadn’t seen a visit from a sitting president since William Howard Taft. Just before I gave my speech, Barbara took her seat in the front row behind the podium.
The announcer introduced me, and the audience roared. As I stepped up to the microphone, I turned to look at Barbara. She had tears streaming down her face. After four years on a college campus, she was surprised and touched to see such enthusiastic support for her dad. It reminded me of the feeling I had when I first heard a crowd cheer for my father. The circle was complete.
Heading out on the campaign trail with Barbara.
In some ways, the 2004 campaign was easier than 2000. I benefited from the trappings of the presidency, especially Air Force One and Marine One. In another way, 2004 was tougher. I was both candidate and president. I had to strike a balance between the two.
I drew energy from the people around me, especially Laura and the girls. I loved our bus tours through the Midwest, where thousands of citizens lined the main streets of small towns. One day in Wisconsin we rolled through the hometown of Dick Tubb, the multitalented Air Force doctor who traveled everywhere with me. I saw a handpainted sign that read “Welcome Home, Dr. Tubb!” Underneath, in smaller print, the person had added, “You Too, George W.”
On the road, July 2004.
Nothing buoyed my spirits like our supporters on the campaign trail. I was energized by their intensity, and their dedication inspired me to work harder so that I would not let them down. In the 16,500-person town of Poplar Bluff, Missouri, 23,000 people turned out for a speech. In the township of West Chester, Ohio, 41,000 people packed Voice of America Park. As I outlined John Kerry’s shifting positions, a sea of arms swayed left and right amid a chant of “Flip-Flop, Flip-Flop.” Some people came dressed as human-size flip-flops. I encountered new groups, including Barristers for Bush, Buckeyes for Bush, and Barbara and Jenna’s favorite, Twins for Bush.
Speaking here in Troy, Ohio.
I was especially encouraged by signs that read “God Bless You.” As I shook hands and posed for photos on the rope line, I was amazed by the number who said the same four words: “I pray for you.” I told them their prayers were a wonderful gift. They gave me strength. Seeing those voters also gave me hope that some Bush supporters who stayed home after the DUI revelation in 2000 would come back to the polls in 2004.
John Kerry had intense supporters of his own. Hollywood filmmaker Michael Moore came out with a so-called
