To win the presidency in 2012, the Republican candidate will require certain strengths. Among them, a credible passion for ideas other than cost-cutting and small government. He or she will have to speak in the voice of Americans who know in their bones the extraordinary character of their democracy, and that voice will have to ring out steadily. That Republican candidate will need, no less, the ability to talk about matters like Medicare and Social Security without terrorizing the electorate.

Americans already have plenty of cause for fear. They have on one side the Obama health-care plan now nearly universally acknowledged as a disaster. A plan that entails huge cuts in health care—$500 billion cut from Medicare—that will nevertheless cause no pain, according to its architects. As the polls on ObamaCare show, this grand scheme appears mostly to have alarmed Americans.

From the Republican side comes an incessant barrage of doomsday messages and proclamations that the nation is imperiled by the greatest crisis in a generation—not, as we might have supposed, by our ongoing, desperate unemployment levels, but by spending on social programs. No sane person will deny the necessity of finding ways to cut the costs of these programs. But it's impossible not to hear in the clamor for boldness—for massive cuts in entitlements—a distinctly fevered tone, and one with an unmistakable ideological tinge. Not the sort of pragmatism that inspires voter confidence.

Thinking about all this, a physician friend recalls a lesson that experienced doctors learn: A patient comes in with symptoms—is it angina? Will it lead to a heart attack? Patients whose doctors show deliberation and care in the choice of their treatment, he observes, tend to have increased faith both in the treatment and the doctor. That is a point of some relevance to politicians.

The Republican who wants to win would avoid talk of the costs that our spendthrift ways, particularly benefits like Social Security, are supposedly heaping on future generations. He would especially avoid painting images of the pain Americans feel at burdening their children and grandchildren. This high-minded talk, rooted in fantasy, isn't going to warm the hearts of voters of mature age—and they are legion—who feel no such pain. None. And they don't like being told that they do, or that they should feel it, or that they're stealing from the young. They've spent their working lives paying in to Social Security, their investment. Adjustments have to be made to the system, as they now know. Which makes it even more unlikely they'll welcome handwringing about the plight of future generations.