Former Tennessee Senator & Cardiothoracic Surgeon Bill Frist, MD enters healthcare dialogue
Posted by Warm Southern Breeze on Monday, September 17, 2012
Face it. Sooner or later, you’re going to die. Death is a part of life. Making a decision about whether or not you want to be connected to belts, tubes, hoses & pumps to circulate your blood, food & oxygen when your body would have naturally expired is essentially what the discussion is about.
The Bill Frist ℞
By: Brett Norman
September 16, 2012 11:06 PM EDT
Yes, the same Frist who as Senate majority leader led an army into the culture wars over Terri Schiavo and whose efforts in 2004 to unseat his then-rival, Minority Leader Tom Daschle, led to a nasty — and personal — Washington battle royal.
Now, Frist is pushing for a national conversation on end-of-life care and dismissing “caricatured”talk of death panels. He’s committing Republican heresy in endorsing elements of the loathed Affordable Care Act. He’s standing shoulder to shoulder with Daschle in search of a bipartisan way to tackle one of the thorniest problems around: how to get control of health care costs before they sink the economy.
The Frist-Daschle reconciliation, in particular, is a source of amazement to some longtime Washington observers.
“I didn’t think they would ever talk again,” said Bill Hoagland, a budget expert and former aide to Frist who has joined the duo on a health cost control initiative at the Bipartisan Policy Center. “I was surprised, pleasantly, that they would work together.”
Daschle told POLITICO, “He’s been a very important partner and I would say has become a friend in spite of the fact that we’ve had a difficult history.”
“That is past and we now find much more in common than not,” he added. “We both know that we need to find a consensus way forward.”
Frist, a heart and lung transplant surgeon who is now focused on research and policy, is working on a sweeping list of bipartisan health issues. A conservative who left Congress in 2007, before the tea party arrived, he is flexing his independence as a private citizen.
“I am supportive of exchanges and ‘Obamacare’ generally,” Frist told POLITICO. He noted that the law’s core ideas of an individual mandate and state-based health insurance exchanges have conservative roots.
And he isn’t particularly shy about it either, to the irritation of erstwhile colleagues and conservative activists who have been battling to repeal “Obamacare” since it became law.
In a recent essay in The Week, Frist urged states to get on board with the insurance exchanges and said he supports the government-subsidized expansion of insurance.
“As a doctor, I strongly believe that people without health insurance die sooner,” Frist wrote. People can go to the emergency room, but they delay treatment of health concerns, skip preventive care and when they finally seek treatment, their condition is worse and more costly, he continued. “State exchanges are the solution. They represent the federalist ideal of states as ‘laboratories for democracy.’”
Ears pricked up on Capitol Hill.
“It certainly got people’s attention,” one well-connected Republican policy analyst said. “Reaction ranged from, ‘OK, well maybe he’s a little more centrist than we are or can say it [because he’s not in office],’ to ‘Gee, this would be nice if the law actually contemplates the kind [of] state innovations that he is talking about.’”
And this month, right after news broke that he and his wife of 31 years are divorcing, the man who crusaded for Schiavo’s life penned another one of his semi-regular columns in The Week, this time calling for a national conversation on what we spend on end of life care and why. He also endorsed an expansion of palliative and hospice care.
Thirty percent of Medicare costs are spent on the last months of life, he wrote — more than $150 billion annually. And the system is chock full of incentives to use expensive technology on terminally ill patients who may actually prefer to die at home, not in an ICU.
“So how do we fix all this? We begin a national, high-profile, civil dialogue, which should begin in the living rooms of patients and their families and extend to nurses’ and doctors’ offices, hospitals, religious institutions, and policy chambers. ‘How do I want to die?’ That’s the framing question,” he wrote.
With Mitt Romney, Paul Ryan and congressional Republicans trash-talking the health care law at every turn on the campaign trail, Frist is off message, to say the least.
“Because it’s inconsistent with the current election environment, it is probably frowned upon,” Frist said. “Do they call me and tell me? No. Because they’ve come to expect it.”
Politicking is not Frist’s concern anymore. He skipped the Republican National Convention in Tampa, Fla., saying it “would not be the best use of my time.”
It’s a far cry from 2004, when the then-majority leader — seen as harboring presidential aspirations — broke from tradition and traveled to Daschle’s home state of South Dakota to personally campaign against him. After Daschle lost to John Thune, Frist arrived late to Daschle’s farewell address. Most Senate Republicans didn’t show up at all. All of that left a bitter taste in the Senate.
He also scored his share of partisan points before becoming Senate leader, when he chaired the Republican Senatorial Campaign Committee, one of the most political posts in the GOP.
That’s not to say that he didn’t ever work across the aisle in the Senate. He authored a health information technology bill with then-Sen. Hillary Clinton, pushed the U.S. fight on global AIDS and passed with some Democratic support the Medicare prescription drug act in 2003.
But he lives and breathes bipartisanship now, and finds it sorely lacking in Washington, where he said it “has come to mean sacrifice of principle, moving to the middle.”
When Frist and Daschle, along with the Bipartisan Policy Center’s budget gurus Pete Domenici and Alice Rivlin, release their report on bending the health cost curve early next year, it won’t recommend repealing the federal health law.
While work remains to be done, there’s consensus that the group will build on the ACA and retool rather than scrap it, said Hoagland, a former top aide to Domenici and Frist. Hoagland, a widely respected Republican budget expert, left his senior policy job at Cigna for BPC, in part to take on its new Health Care Cost Containment Initiative.
“I may be tilting at windmills, but I think we have to try,” Hoagland said. “I don’t think you can deal with this issue in a partisan mindset. It has to be bipartisan.”
There are sticking points — big ones. Frist is convinced that Medicare must move toward a premium support model, similar to the one proposed by Ryan. It would provide a fixed subsidy to seniors who can then shop for the best insurance plan. “It is inevitable,” Frist said, in the same way that traditional retirement plans gave way to 401(k) plans in most of the private sector.
Indeed, Frist backed a version of premium support way back in 1999, when he served on the National Bipartisan Commission on the Future of Medicare, also known as the Breaux-Thomas commission, named after co-chairmen Sen. John Breaux (D-La.) and Rep. Bill Thomas (R-Calif.). But that proposal wasn’t adopted.
And Frist is glad to see Ryan bringing premium support back in the spotlight. Before Ryan was tapped as Mitt Romney’s running mate, Frist didn’t think health care would be a campaign issue. Now, he thinks Ryan’s “clarity on health care will elevate the discussion beyond repeal and replace,” Frist said.
Hoagland said Medicare policy will be “the hardest nut to crack” for the bipartisan effort. “Now it’s very politicized.”
The Democrats’ object that premium support doesn’t contain costs, but merely shifts thousands of dollars of out of pocket costs to seniors.
“We really only have two choices — we can cut and shift the costs, or we can really redesign and improve, and in so doing, significantly reduce costs,” Daschle said, adding that he thinks he and Frist will be able to find agreement.
Whether the Frist-Daschle undertaking can gain any traction in a divided Congress is the bigger question. History is riddled with outside bipartisan reports left for dead by those in office.
“I don’t know how much stock folks are going to put in what Frist proposes,” said Tim Phillips, president of Americans for Prosperity, a tea party group. “His era of leadership is really when the Republican Party really went off the rails with the size of government and spending.”
Frist remains deeply engaged in global health and HIV and AIDS and is on numerous boards, many addressing health policy or public health: Save the Children, the Center for Strategic and International Studies, the Kaiser Family Foundation and the Robert Wood Johnson Foundation. He’s also worked with Michelle Obama on her Let’s Move! anti-obesity initiative.
“I didn’t go to Cato or [the American Enterprise Institute],” he remarked.
Frist is an heir to the family fortune from the Hospital Corporation of America, one of the country’s largest hospital management companies, but isn’t involved in it. He does have a partnership in the private equity firm Cressey & Co., which buys mid-market health care companies, including hospice and adolescent mental health interests. The work keeps him “in the health care currency of what’s really going on in the real world,” Frist said. He also writes and has taught health policy at Vanderbilt University and at his alma mater, Princeton, with one of his former mentors, health economist Uwe Reinhardt.
“Both he and I are sort of wandering souls in the middle who have a fair amount of concern for the uninsured and patients. … But we don’t think for-profit is evil, we think waste is evil,” Reinhardt said. “In my view, he’s always been at heart a pragmatist and centrist who wants to get stuff done and is willing to compromise.”