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The approach accentuated his differences with neoliberal doctrines—socialized medicine, tax hikes on the rich, deep cuts to the Pentagon budget—and more importantly, it convinced his voters that the only way to effect lasting change within the Democrats was not through reconciliation but by defeating them.

In his State of the State address last year, Mr. Reeves assailed what he described as a campaign led by Democrats for “the expansion of Obamacare, welfare and socialized medicine,” using language that many other Republicans around the country abandoned as the law gained popularity.

Most wealthy Western countries — bar the United States - have built their health systems on a form of socialized medicine.

Most wealthy Western countries – bar the United States – have built their health systems on a form of socialized medicine.

Bush for signing civil rights legislation and raising taxes and, in 2003, warned that a Medicare prescription drug benefit supported by the younger Bush would potentially “usher in the beginning of socialized medicine in America.”